1. Dr. Heleen Riper hriper@trimbos.nl Innovation Centre of Mental Health & Technology Sustainable prevention with e-mental health INPES April 2010

2. What woulddo?

3. What woulddo?

4. 1 out of 4 mental health problem in lifetime

5. 1 per 15 YP

6. 1 million suicides per year

7. Disease burden in 2030 Worldwide % of total DALY Source: Mathers & Loncar, 2006 High-income countries Cataracts HIV/AIDS Depression Is. heart disease Road traffic Perinatal Cerebrovasculair COPD chest infections Hearing loss Alzheimer / dementias Depression Is. heart disease Alcohol Diabetes Cerebrovasculair Hearing loss Lung cancers / infections Ostearthritis COPD % of total DALY

8. more people less money transition chonic diseases self-management life style

9. health decisions are made by..

10. EMH 2000 - 2010 costs treatment duration and intensity effect sizes small medium large mental fitness prevention treatment relapse prevention care population health gain large medium small © Riper 2008

11. Is it scalable from research into the Real World?

12. 33% 73% 5% 60% Developing Developed World % mobile subs. 90% 25% 17% 5% Internet Penetration

13. StudyNTarget groupComp CYL/WL/ 12 wks* significant Spek 200830150+d= 0.55 Warmerdam 200826818+d= 0.69 De Graaf 200930318+d= 0.20 Voordouw 20096568/ 1111 18 +d= 1.09 (Pre-post within) Color Your Life

14. Drinking Less

15. *P<0.001 Drinking Less Real World N= 378 ITT N/ RCT Target GroupSuccessful drinking at 6 months Successful drinking at 12 months 26114/21 SU Alcohol weekly and/or 6/4 per occasion 17,2% DL 5,4 % Control (p=.008) 13,6% DL 5,5% Control (p<.05) 18,8 %* 17,5 %* 2.750 monthly visitors 1 out of 16 starts with DL Mean 40.9 (25.2 SD) SU Weekly AUDIT: M 20.27 (sd 6.30) 6 months study period: N= 972 Response rate 39% Drop out 59% & 56%

16. Theory: 4 possible outcomes Modelling cost-effectiveness of eHealth interventions16 More costs Less effect Fewer costs Less effect More costs More effect Fewer costs More effect

17. Example 1: Self-help in depression Modelling cost-effectiveness of eHealth interventions17 Smit F, Willemse G, Koopmanschap M, Onrust S, Cuijpers P, Beekman A. (2006) Cost-effectiveness of preventing depression in primary care patients: randomised trial. British Journal of Psychiatry 188: 330-336

18. Example 2: eHealth v waitlist Modelling cost-effectiveness of eHealth interventions18

19. Example 3: eHealth v Group CBT Modelling cost-effectiveness of eHealth interventions19

20. Key messages Modelling cost-effectiveness of eHealth interventions20

22. low ses etnic cultural minorities recruitment acceptable interventions visual screener

23. Visual Screener

24. Visual Screener Depression, Anxiety &Alcohol Dutch N=86 Turkish N= 82 1. How do you feel?depression0.39 r0.21 r 2. How did you feel in the past two weeks?depression0.47 r0.29 r 3. Do you worry a lot?GAD0.46 r0.30 r 4. Do you sometimes suddenly panic?Panic15.14 χ 2 21.94 χ 2 5. Are you afraid of busy places that are difficult to leave? AGO0.53 χ 2 n.s.7.28 χ 2 6. Is there something that you are very afraid of? Specific Phobia 21.30 χ 2 6.53 χ 2 7. Are you afraid of being watched by people?Social Fobia 14.22 χ 2 1.33 χ 2 n.s. 8. Have you ever experienced something horrible? PTSD24.39 χ 2 12.32 χ 2 9. Do you sometimes have unpleasant thoughts that wont go away? OCD5.58 χ 2 0.92 χ 2 n.s. 10. Do you ever think about your own death?Alcohol0.70 r0.22 r 11. Do you ever think of killing yourself?Suicide23.47 χ 2 4.29 χ 2 Validadion Visual Screener

25. effective scalable acceptable planned efforts knowledge turning point sustainable filling the gap health gain

26. thank you for your attention Heleen Riper hriper@trimbos.nl