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Maria Wolters (University of Edinburgh), Aura Szentagotai, Silviu Matu, Ramona Moldovan, Daniel David (Babes-Bolyai University),Brian McKinstry (University of Edinburgh)Chris Burton (University of Aberdeen)
eHealth Support for People With Depression in the Community: A Case Study Series
Maria WoltersUniversity of Edinburghfor the Help4Mood Consortium
maria.wolters@ed.ac.uk@mariawolters
Overview
❖ What is Depression?
❖ The Development of Help4Mood
❖ 4 Case Studies
❖ What Have We Learned?
What is Depression?
Mental Illness is common.
http://www.cdc.gov/features/dsdepression/; Cho and Lee (2005) Psychiatr Invest 2005; 2 (1): 22-27
In Korea, rates vary between2% - 7% depending on genderand age.
Focus on Major Depressive Disorder
❖ persistent low mood
❖ loss of interest in things that give pleasure
❖ over two weeks or more
❖ plus other symptoms (DSM 4)
http://www.optipess.com/2012/09/28/dressing-up/
Treatment Options
❖ Watchful waiting
❖ Lifestyle changes / exercise
❖ Medication: does not always work, needs adjustment, trial and error
❖ Psychotherapy (also Internet-Based Self Help) most forms are equivalent
Davidson, J. R. T. (2010). Major depressive disorder treatment guidelines in America and Europe. The Journal of Clinical Psychiatry, 71 Suppl E, e04. doi:10.4088/JCP.9058se1c.04gry
Baardseth, T. P., Goldberg, S. B., Pace, B. T., Minami, T., Wislocki, A. P., Frost, N. D., … Wampold, B. E. (2013). Cognitive-Behavioral Therapy versus Other Therapies: Redux. Clinical Psychology Review, doi:10.1016/j.cpr.2013.01.004
Blended Practice: Human Support Matters
Fig. 1, Johansson and Andersson (2012), systematic review of Internet-Based cognitive Behaviour Therapy
0 - no support1 - contact before treatment2 - contact during treatment3 - contact before and during treatment
http://informahealthcare.com/doi/full/10.1586/ern.12.63#_i11
Help4Mood
The Team
http://www.help4mood.info
Funding: 2011-2014, European Union Framework 7 Programme
Group of projects were funded, including • ICT4Depression• Monarca• Interstress• OPTIMI
Help4Mood: Supporting People with Depression
• daily monitoring • of activity using
actigraph • of mood, thought
patterns & psycho-motor symptoms using talking head GUI
• weekly one-page reports to clinicians
Maria K. Wolters, Juan Martínez-Miranda, Soraya Estevez, Helen F. Hastie, Colin Matheson (2013). Managing Data in Help4Mood AMSYS ICST DOI: 10.4108/trans.amsys.01-06.2013.e2
One Help4Mood per Day❖ Users interact with Help4Mood once a day
❖ Sessions can be short, medium, or long
❖ Planning algorithm ensures
❖ different kinds of data are collected regularly, e.g.
❖ mood: every day
❖ speech: 1-3 times per week
❖ sessions are varied
The Development of Help4Mood
0. Stakeholder Consultations
• across countries• across key stakeholder groups• across health care systems• across care pathways
Focus Groups
TechnologyProbe
(Powerpoint)
shared, agreedscript
People with depression (All)
General Practitioners(UK / Spain)
Clinical Psychologists(Romania)
Psychiatrists(All)
Community Psychiatric Nurses
(UK)
Burton, C., Wolters, M. K., Blanco, A. S., Szentagotai, A., Ure, J., Pagliari, C., & McKinstry, B. (2012, June 5). Help4Mood: avatar-based support for treating people with major depression in the community. International Journal of Integrated Care. (Conference Abstract, full paper to follow)
Patient Focused Development1. Actigraphy
Case Studies
People with history of depression
Patient Focused Development1. Actigraphy
2. Mood Tracker +Actigraphy
Case Studies
People with history of depression
Patient Focused Development1. Actigraphy
2. Mood Tracker +Actigraphy
3. Mood Tracker,Thought Patterns,Speech + Actigraphy
Case Studies
People with history of depression
People with current depression
Patient Focused Development1. Actigraphy
2. Mood Tracker +Actigraphy
3. Mood Tracker,Thought Patterns,Speech + Actigraphy
4. Mood Tracker,Thought Patterns,Behavioural Activation,Relaxation,Speech + Actigraphy
Case Studies
Pilot RCT
People with history of depression
People with current depression
Patient Focused Development1. Actigraphy
2. Mood Tracker +Actigraphy
3. Mood Tracker,Thought Patterns,Speech + Actigraphy
4. Mood Tracker,Thought Patterns,Behavioural Activation,Relaxation,Speech + Actigraphy
Case Studies
Pilot RCT
People with history of depression
People with current depression
4 Case Studies
Design
❖ Participants with Major Depressive Disorder (SCID)
❖ Use Help4Mood for 2 weeks
❖ Background measures include demographics and attitudes to computers
❖ Pre/Post measures to establish change
❖ Qualitative interviews at intake and debriefing
Pre/Post Measures of Change
BDI II Depression Screening Beck Depression Inventory II
DAS-SF 2Attitudes Characteristic of Depression
Dysfunctional Attitudes Scale Short Form
QIDS-SR 16 Symptoms of Depression
Quick Inventory of Depressive Symptoms Self Report
EQ-5D-5F Quality of Life Brief Quality of Life Assessment (European Norm)
Participants
❖ 4 female professionals between 23-30, computer literacy medium to good, positive attitudes to computers
❖ None formally tracked or measured their mood before, but some used introspection
❖ Used Help4Mood 8-15 times over two weeks
Help4Mood as Coping
“I noticed that when I was upset or when I was dealing with negative events I always chose the long session, not the short one.” (P04)
Self-Reflection is Hard Work
“This wasn’t very pleasant. Because you don’t go to therapy every day. You wouldn’t go every day; you would go maybe once a week or two or three times maybe, but not every day. It’s a bit too much to use it every day.” (P01)
Limits of Technology“I think there was a day when it was really really bad. And poor Roger he was really emphatic and said ‘sorry to hear that’ and at some point he offered an alternative way of thinking which gave me like. . . an insight and it did it at the time. But I felt like I needed more. But I didn’t get it and I had to be satisfied with what I had” (P01)
What Have We Learned?
It Doesn’t (Quite) Work This Way
http://imgarcade.com/1/depressed-stick-figure/
Well-DesignedMonitoring
Self-Help Internet-Based
Therapy
+
http://www.acog.org/About-ACOG/ACOG-Departments/Long-Acting-Reversible-Contraception
https://www.osneybuyside.com/forget-big-data-just-collect-smart-data/
Protected Peer Support
http://www.clipartsfree.net/small/3977-game-piece-group-clipart.html
It’s a complex adaptive system
http://www.thebolditalic.com/articles/3609-the-stick-figure-guide-to-kicking-depression
Individualised monitoring based on what person has & does
Coping and getting better:• Twitter, exercise, kindness• Friends • Medications• GP
Productive (!) self insightand reflection
Conclusions
❖ Design for self-reflection
❖ Design for support and coping
❖ Design for personalisation
maria.wolters@ed.ac.uk @mariawolters
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