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Mobile Health Apps for Depression Focus on MoodFx Raymond W. Lam, MD, FRCPC Professor and Associate Head for Research, Department of Psychiatry, University.

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Presentation on theme: "Mobile Health Apps for Depression Focus on MoodFx Raymond W. Lam, MD, FRCPC Professor and Associate Head for Research, Department of Psychiatry, University."— Presentation transcript:

1 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).

2 Disclosure Statement 2012-2014 Dr. Raymond Lam, MD, FRCPC Ad hoc Consulting/AdvisoryAstraZeneca, Bristol Myers Squibb, CANMAT, Eli Lilly, Lundbeck, Mochida, Pfizer, Takeda Ad hoc Speaking honorariaAstraZeneca, 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 StocksNone. Patents/CopyrightsLam Employment Absence and Productivity Scale (LEAPS) Book RoyaltiesAmerican Psychiatric Press, Cambridge University Press, Informa Press, Oxford University Press.

3 Objectives 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 to

4 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 FunctionYears of Life Lost

5 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.

6 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.

7 Love and work are the cornerstones of our Humanness. ~ Sigmund Freud ~

8 Why is work important to patients? Source of income Sense of accomplishment Intellectual stimulation Regular activity schedule Social interactions

9 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 including


11 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?

12 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.

13 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 counselling Timely 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.

14 Doctors understand the importance of scales – but many don’t use them 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.

15 Think Global Act Local

16 Enlist the power of the internet! 83% of adult Canadians have internet access (2012 data) 90% have high speed connection; >70% use the internet daily 59% 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 console

17 NameTarget audienceMain purpose/ description Depression – screening, diagnostic STAT Depression Screening PHQ-9 Clinicians; patients possibleGuides physicians in selecting and monitoring depression treatment. Doctor DepressionCliniciansAssessment scales to measure depressive symptoms in patients. Depression Screening/ Pro Patients Screens 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 PatientsScreens, 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 PatientsScreens depression with PHQ-9 and tracks (graphs) scores over time. T2 Mood Tracker PatientsMood tracking MoodyMe – Mood Diary Gen. pop., patientsMonitor moods and emotions (including depression, mania), medications, etc. MoodPanda Patients, Gen. popMonitor moods: “interactive mood diary” iMind & Mood PatientsAssessment & recommendations Gen. pop.Mood tracking Treatment/Programs Depression Cure – 12 week course PatientsTreatment iBiomed Patients, caregivers, clinicians Synchronize with caregivers; social network; health records Anti-DepressionPatients info and strategies HappyApp Patients/Gen. pop.“brainwave” synchronization, audio frequencies Social/Community Support Depression Connect Patients *teenagersConnection/community/ discussion/social networking Bipolar Disorder Connect PatientsSocial networking, community Happiness, General Well-Being Happiness Tips Gen. pop.Inspire, motivate happiness+ Gen. pop.Inspire: quotes; Social: chat OptimismGen. pop. Depression apps in iTunes store

18 MoodFx mobile web app Partners in Measurement-based mHealth eHealth Strategy Office

19 MoodFx mobile web app Optimized for computers, tablets, smartphones Patient-centred focus on work functioning and depression Assess and track outcomes using validated scales Interactive text and email appointment reminders Subscribe to text/email tips Simple and easy to use

20 Validated scales used in MoodFx For work functioning = LEAPS Lam Employment Absence and Productivity Scale For depression = PHQ-9 Sensitivity and specificity for diagnosis of Major Depressive Disorder (MDD) = 83% and 83% For anxiety = GAD-7 Sensitivity and specificity for diagnosis of anxiety disorder =  For GAD: 89% and 82%  For Others: 66-74% and 80-81% For cognition = PDQ-D-5 Perceived Deficits Questionnaire for Depression

21 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, 2009

22 Perceived Deficits Questionnaire – Depression 5-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?01234 Have trouble concentrating on what you were reading? 01234 Forget the date unless you looked it up?01234 Forget what you talked about after a telephone conversation? 01234 Feel like your mind went totally blank?01234 Add up score in each column: TOTAL SCORE:_________ Copyright: Professor Sullivan, McGill University

23 MoodFx mobile web app

24 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

25 Thanks to our collaborators and funders Collaborators in workplace mental health :  Melady Preece  Paula Cayley  Anne Walker  Debra Wolinsky  Erin Michalak  Ellen Anderson Funding partners :  Canadian Institutes of Health Research  Michael Smith Foundation for Health Research  Mathematics of Information Technology and Advanced Computing  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



28 Depressive symptoms and impairment in work functioning Percentage 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 Difficulty

29 Employee and Family Assistance Programs (EAPs) are the “first line of defence” for workers with depression Ongoing collaboration with Optum (previously PPC Canada), an accredited EAP provider to over 350 organizations across Canada Randomized controlled trial of MoodFx vs. standard care in clients attending EAP services N=50 Optum clinicians and 750 clients Outcomes to include symptoms and work functioning Evaluation of MoodFx in an Employee Assistance Program (EAP)

30 Knowledge translation and dissemination for MoodFx Continuing Professional Development activities Webinars for clinicians Lunch and learn sessions CME conferences and events Aids for users – fridge magnets, online videos, whiteboards, social media Evaluation using RE-AIM principles, including users and clinicians

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