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

What woulddo?

What woulddo?

1 out of 4 mental health problem in lifetime

1 per 15 YP

1 million suicides per year

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

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

health decisions are made by..

EMH 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

Is it scalable from research into the Real World?

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

StudyNTarget groupComp CYL/WL/ 12 wks* significant Spek d= 0.55 Warmerdam d= 0.69 De Graaf d= 0.20 Voordouw / d= 1.09 (Pre-post within) Color Your Life

Drinking Less

*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 %* monthly visitors 1 out of 16 starts with DL Mean 40.9 (25.2 SD) SU Weekly AUDIT: M (sd 6.30) 6 months study period: N= 972 Response rate 39% Drop out 59% & 56%

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

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:

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

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

Key messages Modelling cost-effectiveness of eHealth interventions20

low ses etnic cultural minorities recruitment acceptable interventions visual screener

Visual Screener

Visual Screener Depression, Anxiety &Alcohol Dutch N=86 Turkish N= 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 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 χ χ 2 7. Are you afraid of being watched by people?Social Fobia χ χ 2 n.s. 8. Have you ever experienced something horrible? PTSD24.39 χ χ 2 9. Do you sometimes have unpleasant thoughts that wont go away? OCD5.58 χ 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 χ 2 Validadion Visual Screener

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

thank you for your attention Heleen Riper