Personal health systems for

mental health management,

early intervention and

treatment

Ilkka Korhonen

Technology Manager

VTT Technical Research Centre of Finland

Mental health - costs

• Mental health problems costs 3-4% GDP in

OECD countries (ILO 2000)

• Finland: 49% of all disability pensions, 30% of

absenteism, 13% direct healthcare costs (2007)

• Germany: 74% increase from 1995 to 2002 in long-

term sick-leaves due to mental health problems

(Knapp et al 2007)

• Depression 6% of all DALYs (WHO 2005) –

most common mental disorder

• Prevalence ~6-7%, ~20% of all people at some point

of ther life

Depression - challenges

• Depression is under-diagnosed or diagnosed with a delay • Treatmens more effective when applied in time

Tools to improve early diagnosis needed

• Efficient treatments of depression exist (medication + therapy) but: • In Europe, 90% of people with mental health problems said they had

received no care in the previous 12 months, and only 2.5% of them had seen a therapist (Knapp et al 2007)

• Only 1/3 of people with anxiety and depressive disorders have mental health treatment, of which half occurs in primary care and lacks expert consultation (Katon 2003)

• Main reason: access block = lack of resources for treatment (esp. scarcity of therapists/experts) • Also, fear of stigma, lack of expertise and tools in primary care

Tools for efficient treatment needed

Computerised Cognitive Behavioral

Therapy (CCBT) • Treatment of affective disorders:

medication + therapy (esp. CBT)

• CCBT = “generic term for delivering CBT via an interactive computer interface delivered by a personal computer, internet or interactive voice response system"

• CCBT has been shown to be effective • Outcomes comparable to

traditional care

• Up to 75% less therapist time needed

Opportunity to ease the access block!

• Current CCBT tools • Based on simple technologies

• Not widely deployed

Personal Health Systems

New wearable devices

- easy, affordable, accurate Advanced analysis tools

and psychophysiological models

- from data to information and feedback

Computing and connectivity

- pervasive + New service models

+ New delivery and business models

+ New peer and social networks

Easy, available, affordable, efficient,

personalised, trusted, standard-based,

interoperable, citizen-driven

Personal Health Toolbox

www.nuadu.org

7

Mobile Wellness Diary

Matching of intervention and PHS

1. Analysis of good life and actions to

promote it

•Goal of Interventions •Analysis of Good life •Self awereness exercise •Home assignments

•Scale •Pedometer •Wellness Diary •Nuadu-portal

2. Analysis of health- and wellbeing

3. Own work ability and lifestyle

4. Solutions to problematic situations

5. Plans for the future

•Self Observations •Analysis of health- and wellbeing •Self awereness and observer exercise •Home assignments

•Self Observations •Rapatti-learning game •Problem solving method •Home assigments

•Speed relaxation •Feedback from Rapatti-learning game •Finding solutions to problematic situations

•Stages of change •Experiences from problem solving •Plans for the future •Feedback from interventions

•Nuadu-portal -Wellness Diary -Nutritioncode (food diary)

•Mobile Coach

•SelfRelax

•Firstbeat HEALTH + borrowing HR-belt

AC

T

RaP

att

i

Theme Structure

NUADU II

•Healt binder •Self observation form •Scale

NUADU I

Technology

•Self observation form

•Self observation form

•Self observation form

•Self observation form

RCT – impact of PHS? Health Questionnaire City of Espoo Employees

(n ~10 900)

Fulfilled Inclusion criteria (n=782)

Subjects (n=352)

Intervention Group 1 (n= 118)

Intervention Group 2 + technology (n= 118)

Control Group (n= 116)

Randomization

BASELINE: Measurements, NUADU-Questionnaire and personal feedback (n=352)

Intervention I Results from measurements Personal health goal Health binder Self-observation equipment Group meetings (5 x 1.5h) Drop-out: other reasons (n=1) Non-compliance (n=1)

Intervention II Results from measurements Personal health goal Health binder Group meetings (5 x 1.5h + 30min) ICT-tools Non-compliance (n=4)

6 MONTHS: NUADU-Questionnaire (n=347, 99%)

12 MONTHS: NUADU-Questionnaire (n=318, 90%), Measurements (n=317, 90%) and personal feedback (n=333, 95%)

Replied n=4134 (38%), willing to

participate n= 3401 (31%)

Personal support (n=117, 99%)

Personal support, ICT, borrowing HR-belt (n=114, 97%)

Intervention Group 2 (n=110, 93%)

Drop-out: other reasons (n=3)

Drop-out: other reasons (n=1)

Intervention Group 1 (n=111, 94%)

Drop-out: other reasons (n=3), health (n=3)

Drop-out: other reasons (n=3), health (n=1)

Drop-out: other reasons (n=4)

Control Group (n= 112, 97%)

Preliminary results

• PHS usage • At the beginning, >80% at least tried some PHS

• Usage dropped during study – after 12mths, ~30% active users

• Different PHS had different users and each PHS gained an active and committed group of users

• Benefits (own assessment) • Increased exercising

• Better understanding of own health

• Better understanding of own fitness

• Improved motivation towards better lifestyle

• Improved stress management

• Feedback more positive after the end of the study (experiences) than prior to study (expectations)

• Note: analysis of true health benefits not completed

Cardiac rehabilitation, QLD,

Australia

Web portal

Diary dataMeasurement

data

Health

Reports

Personal devices at home

Health

Information

Data display for

self management

Treatment &

mentoring

feedback via

phone

Movement activity

Heart Rate

Blood Pressure

Weight

Data to server:

• Diary entries

• Measurement data

• Photos

Feedback Tools:

• Videoconference

• Teleconference

• Multimedia & SMS

Measurement

Devices

Bluetooth and

manual entry Community Care Team

Server

Diary, data & photo

synchronisation

via 3G

Service Provider

Motivational

SMS & Video

Relaxation audio

Server

Web portal GUI

Web-portal access

via internet

Discussion,

messaging

Educational

material

Mobile

Phone

Internet

3G

PCOther Health

Information

Systems

DatabaseHealth

Records

DatabaseHealth

Records

Web portal

Diary dataMeasurement

data

Health

Reports

Personal devices at home

Health

Information

Data display for

self management

Treatment &

mentoring

feedback via

phone

Movement activity

Heart Rate

Blood Pressure

Weight

Data to server:

• Diary entries

• Measurement data

• Photos

Feedback Tools:

• Videoconference

• Teleconference

• Multimedia & SMS

Measurement

Devices

Bluetooth and

manual entry Community Care Team

Server

Diary, data & photo

synchronisation

via 3G

Service Provider

Motivational

SMS & Video

Relaxation audio

Server

Web portal GUI

Web-portal access

via internet

Discussion,

messaging

Educational

material

Mobile

Phone

Internet

3G

PCOther Health

Information

Systems

DatabaseHealth

Records

DatabaseHealth

Records

DatabaseHealth

Records

DatabaseHealth

Records

In collaboration with AEHRC, CSIRO

Home-based rehabilitation

programme Home Program Overview

WellnessDiary

StepCounter

SMS (text messages)

Video clips

Relaxation Audio

Goals & Plan

Tele & Video-

conference (Mentor)

Themes

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7->

Entries twice/day

Activity

Relaxation

Worries

Emotions

Stress

Getting

started

Motivation

Heart Attack

Angina

Sleep

Family

Sex

Anxiety

Panic

Phobias

Low mood

Depression

Smoking

Overweight

Diet

Medications

Cholesterol

High blood

pressure

Diabetes

Continuous use

2/day

Every day

2/week

P4Well: Technology Toolkit for

Supported Self-Management of Stress

and Mild Depression

• PHS toolkit + psychological intervention programme • 3 group intervention

meetings cost-efficiency of a group intervention

• PHS to empower self-management personalisation through use of PHS and eConsultation

Depresssion

0

1

2

3

4

5

6

7

8

9

Pre Post

Test

Control

PHS and mental health

• Main challenge in mental health problems is to provide treatments to all in need – especially depression • Early access – empowerment – efficient use of expert’s time

• PHS may significantly improve CCBT • Better access

• Continuous monitoring

• Contextuality – treatment opportunity

• Our experiences • PHS are accepted and used (~30-90% active users in long-term) when applied

in combination with a proper intervention model (support / service)

• Mobility is the ”killer application”

• Toolkit approach seems to work

• PHS and intervention programme need to be designed in parallel • PHS alone will not work

• PHS glued on top of existing treatment models will not work

• Stepped care models

Thank you!

ilkka.korhonen@vtt.fi