Mobile Health Apps for - PowerPoint Presentation

Slide1

Mobile Health Apps for

Depression

Focus

on

MoodFx

Raymond W. Lam, MD, FRCPC

Professor and Associate Head for Research,

Department of Psychiatry, University of British Columbia; Director, Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, BC;Executive Chair, Canadian Network for Mood and Anxiety Treatments (CANMAT).r.lam@ubc.caSlide2

Disclosure Statement 2012-2014

Dr. Raymond Lam, MD, FRCPC

Ad hoc Consulting/Advisory

AstraZeneca, Bristol Myers Squibb, CANMAT, Eli Lilly, Lundbeck,

Mochida, Pfizer, Takeda

Ad hoc Speaking honoraria

AstraZeneca, Bristol Myers Squibb, CANMAT, Canadian Psychiatric Association, Lundbeck, Lundbeck Institute, Medscape, Mochida, Otsuka,

Servier

.

Clinical trials/research

(through UBC)

Bristol Myers Squibb, Canadian Institutes of Health Research, Canadian Psychiatric Association Foundation, CANMAT, Lundbeck,

Merck, Ontario Brain Institute,

Pfizer, St. Jude Medical, UBC Institute of Mental Health/Coast Capital Savings,

University Health Network, VGH Foundation

Stocks

None.

Patents/Copyrights

Lam Employment Absence and Productivity

Scale (LEAPS)

Book Royalties

American

Psychiatric Press, Cambridge University Press,

Informa

Press, Oxford University Press.Slide3

Objectives

www.WorkingWithDepression.ca

Describe the nature of occupational impairment in MDD.

Discuss challenges in application of measurement-based care.

Describe the clinical use of a free mobile web app for tracking symptoms and work functioning.

At the end of this presentation, participants will be able toSlide4

Comparing the burden of mental and physical illness

* Health-adjusted life years (HALYs)

A combination of years lived with less than full function and years lost to early death.

Ratnasingham

S, et al.

Ontario Burden of Mental Illness and Addictions Report

Institute for Clinical Evaluative Science, 2012.Lung, Colorectal, Breast & Prostate Cancers Combined

Health Adjusted Life Years* Lost (in thousands)Depression ALONE carries a burden that is more than the COMBINED burden of lung, colorectal, breast, and prostate cancers.

Years of Reduced Function

Years of Life LostSlide5

Impact of depression on employment

Health Report. Statistics Canada Health Statistics Division. 2006; 17:1-88.

Alonso et al. Acta Psychiatr Scand 2004; Suppl (420):38-46. Kessler et al, Health Aff

1999; 18:163-71.

Depressed workers have:

32 days unable to work in the past year

(Statistics Canada report)

3-4 times more work loss days per month, compared to non-depressed workers (ESEMed study)2-3 times more short-term disability, compared to non-depressed workers

(United States survey of corporations)

Presenteeism

is a greater

problem than

absenteeism.

Presenteeism

= reduced productivity when people are still at work.Slide6

Depression is associated with huge economic costs

Work-related economic losses are estimated to cost, per year:

In Canada: C$6 billion.

In the UK: £8.6 billion.

In Europe: €118 billion.

In the US: US$83 billion.

Health Report. Statistics Canada 2006; Stephens &

Joubert, Chron Dis Canada 2001.UK House of Commons Library report, 2009; Sobocki et al, J Ment Health Policy Econ 2006;Greenberg et al, J Clin

Psychiatry 2003.Slide7

Love and work

are the

cornerstones

of our

Humanness.

~ Sigmund Freud ~Slide8

Why is work important to patients?

Source of income

Sense of accomplishmentIntellectual stimulation

Regular activity scheduleSocial interactionsSlide9

Clinical consequences of cognitive deficits

Problems with planning

Difficulties with memory

Impaired

ability to

concentrate

Slowness in responding

Hammar Å, Årdal G.

Front Hum Neurosci 2009;3:26

Cognitive dysfunction in depression is common, broad-based and often debilitating, leading to difficulties includingSlide10
Slide11

Measurement-based care for depression?

Can you treat hypertension without measuring blood pressure?Can you treat diabetes without measuring HbA1c?What makes us think we can treat depression without measuring it?Slide12

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Not at all (0)

Several days (1)

More than half the days (2)Nearly every day (3)

1.

Little interest or pleasure in doing things.

☐☐☐

☐2. Feeling down, depressed, or hopeless.☐☐

☐

☐3. Trouble

falling/staying asleep, sleeping too much.

☐

☐

☐

☐

4.

Feeling

tired or having little energy.

☐

☐

☐

☐

5.

Poor

appetite or overeating.

☐

☐

☐

☐

6.

Feeling

bad about yourself, or that you are a failure, or have let yourself or your family down.

☐

☐

☐

☐

7.

Trouble

concentrating on things, such as reading the newspaper or watching TV.

☐

☐

☐

☐

8.

Moving

or speaking so slowly that other people could have

noticed.

Or

the opposite; being

so

fidgety

or restless that you have been moving around more than usual.

☐

☐

☐

☐

9.

Thoughts

that you would be better off dead or of hurting yourself in some way.

☐

☐

☐

☐

Patient Health Questionnaire-9 (PHQ-9)

A score of 10 or higher indicates significant depression.Slide13

Measurement-based care for depression

Routine assessment with scales integrated into clinical care.Symptoms

, side effects, functioning, quality of life.

Timely adjustments of medication and counsellingTimely changes in treatments depending on outcomes.

Measurement-based care improves outcomes

in people treated for depression

Trivedi

MH, et al. Am J Psychiatry. 2006;163:28-40.Slide14

Doctors understand

the importance of scales – but many don’t use them

Type of scaleCurrently Use

Would like to use

Symptom

questionnaire

50%40%Quality of life

23%54%Overall functioning37%54%

Work functioning

23%

59%

Survey of 115 family physicians

2/3 of psychiatrists don’t use a scale. Reasons why?

Do not believe it would be clinically helpful.

28%

Do not

know what scale to use.

21%

Takes too much time.

34%

Too disruptive to practice.

19%

Wasn’t trained to use them.

34%

Survey of

314

psychiatrists

CANMAT Needs Assessment, September

2010;

Zimmerman &

McGlinchey

, J

Clin

Psychiatry 2006.Slide15

Think Global

Act LocalSlide16

Enlist the power of the internet!

83% of adult Canadians have internet access (2012 data)90% have high speed connection; >70% use the internet daily59% of households used wireless handheld devices to connect to the web at home

Canadian Internet Use Survey 2012.

Desktop computer

Laptop computer

Wireless handheld device

Games consoleSlide17

Name

Target audienceMain purpose/ description

Depression – screening, diagnostic

STAT Depression Screening PHQ-9

Clinicians;

patients possible

Guides physicians in selecting and monitoring depression treatment.Doctor Depression

CliniciansAssessment scales to measure depressive symptoms in patients.Depression Screening/ ProPatientsScreens depression with PHQ-9, with additional questions on suicide, psychosis, and mania.

Geriatric Depression Screening

PatientsScreens for geriatric depression with a 15-item geriatric depression scale.

Depression check

Patients

Screens, assesses risk for depression, bipolar, anxiety disorders

iCrazy

- Psychology Tests

Gen. pop.

General interest, education; screening for various mental disorders

Mood Tracking – depression, bipolar, etc.

Depression Monitor

Patients

Screens depression with PHQ-9 and tracks (graphs) scores over time.

T2 Mood Tracker

Patients

Mood tracking

MoodyMe

– Mood Diary

Gen.

pop., patients

Monitor moods and emotions (including depression, mania),

medications,

etc.

MoodPanda

Patients, Gen. pop

Monitor moods: “interactive mood diary”

iMind

& Mood

Patients

Assessment & recommendations

Moodtrack.com

Gen.

pop.

Mood tracking

Treatment/Programs

Depression

Cure – 12 week course

Patients

Treatment

iBiomed

Patients, caregivers, clinicians

Synchronize with caregivers; social network; health records

Anti-Depression

Patients

info and strategies

HappyApp

Patients/Gen.

pop.

“brainwave” synchronization, audio frequencies

Social/Community Support

Depression Connect

Patients *teenagers

Connection/community/ discussion/social networking

Bipolar Disorder Connect

Patients

Social networking, community

Happiness, General Well-Being

Happiness Tips

Gen. pop.

Inspire, motivate

happiness+

Gen.

pop.

Inspire: quotes; Social: chat

Optimism

Gen.

pop.

Depression apps in iTunes storeSlide18

MoodFx

mobile web app

www.MoodFx.ca

Partners in Measurement-based mHealth

eHealth

Strategy OfficeSlide19

MoodFx

mobile web appOptimized for computers, tablets, smartphonesPatient-centred focus on work functioning and depression

Assess and track outcomes using validated scalesInteractive text and email appointment reminders

Subscribe to text/email tipsSimple and easy to use

www.MoodFx.caSlide20

Validated scales used in MoodFxFor work functioning =

LEAPSLam Employment Absence and Productivity ScaleFor depression = PHQ-9Sensitivity and specificity for diagnosis of Major Depressive Disorder (MDD) = 83% and 83%For anxiety = GAD-7Sensitivity and specificity for diagnosis of anxiety disorder =For GAD: 89% and 82%

For Others: 66-74% and 80-81%For cognition = PDQ-D-5Perceived Deficits Questionnaire for DepressionSlide21

The Lam Employment Absence and

Productivity Scale (LEAPS) 10-item, self-rated scale assessing symptoms and function at work.Designed specifically for depressed patients in primary care and specialty clinic settings.Takes only 3–5 minutes to complete.

Used to track progress and to help in work/off work decisions.

©

Lam RW, University of British Columbia, 2009Slide22

Perceived Deficits Questionnaire – Depression5-item version

The following questions describe problems people may have with their memory, attention or concentration. Please select the best response based on your experiences during the past 7 days

During the

past 7 days, how often did you…

Never in the

past 7 days

Rarely (once or twice) Sometimes (3 to 5 times)

Often

(about once a day)

Very often

(more than

once a day)

Have trouble getting things organised?

0

1

2

3

4

Have trouble concentrating on what you

were reading?

0

1

2

3

4

Forget the date unless you looked it up?

0

1

2

3

4

Forget what you talked about after a telephone conversation?

0

1

2

3

4

Feel like your mind went totally blank?

0

1

2

3

4

Add up score in each column:

TOTAL SCORE:

_________

Copyright: Professor Sullivan, McGill UniversitySlide23

MoodFx mobile web app

www.MoodFx.caSlide24

Summary

Depressive symptoms cause significant interference in work functioning.Measurement-based care can involve patients in tracking outcomes to improve collaboration with their clinicians

New mobile web apps like MoodFx can utilize technology to support measurement-based care

www.MoodFx.caSlide25

Thanks to our collaborators and funders

Collaborators in workplace mental health

:

Melady

Preece

Paula CayleyAnne WalkerDebra

WolinskyErin MichalakEllen AndersonFunding partners:Canadian Institutes of Health ResearchMichael Smith Foundation for Health Research

Mathematics of InformationTechnology and AdvancedComputing

Canadian Psychiatric Association Foundation

Sagar

Parikh

Andrew Clarke

Dorothy

Shaw

Erica Frank

Cindy

Woo

Marie-

Josee

Filteau

Canadian

Network for Mood and Anxiety Treatments

UBC Institute of Mental

Health /

Coast Capital Savings

Lundbeck

Canada

AstraZeneca Canada

Pfizer Canada

Optum

CV

Manjunath

Trish Nolan

David Bond

Lakshmi

Yatham

Auby

Axler

Kendall Ho

www.WorkingWithDepression.caSlide26
Slide27
Slide28

Depressive symptoms and impairment in

work functioningPercentage of depressed patients (n=164) reporting that depressive symptom interfered with work functioning “Very much” or “So much that I had to stop working”

Adapted from

Lam RW et al. Depress Res Treat 2012;2012:630206

Patients (%)

Anergia

= lack of motivation, low energy, physically slowed down, sleepy during day;

Tension = anxious / tense / nervous, irritability / anger;

Cognitive difficulty = trouble concentrating, trouble with memory

52%

52% of depressed patients report that cognitive difficulty

severely interferes with their occupational functioning

Cognitive DifficultySlide29

Employee and Family Assistance Programs (EAPs) are the “first line of defence” for workers with depression

Ongoing collaboration with

Optum

(previously PPC Canada), an a

ccredited

EAP provider to over 350 organizations across CanadaRandomized controlled trial of MoodFx vs. standard care in clients attending EAP services

N=50 Optum clinicians and 750 clientsOutcomes to include symptoms and work functioning

Evaluation of MoodFx in anEmployee Assistance Program (EAP)Slide30

Knowledge translation and dissemination for MoodFxContinuing Professional Development activities

Webinars for cliniciansLunch and learn sessionsCME conferences and eventsAids for users – fridge magnets, online videos, whiteboards, social mediaEvaluation using RE-AIM principles, including users and clinicians