Raymond W. Lam, MD, FRCPC

Report
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).
[email protected]
Disclosure Statement 2012-2014
Dr. Raymond Lam, MD, FRCPC
Ad hoc Consulting/Advisory
AstraZeneca, Bristol Myers Squibb, CANMAT, Eli Lilly, Lundbeck,
Mochida, Pfizer, Takeda
Ad hoc Speaking honoraria
AstraZeneca, 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
Stocks
None.
Patents/Copyrights
Lam Employment Absence and Productivity Scale (LEAPS)
Book Royalties
American Psychiatric Press, Cambridge University Press, Informa Press,
Oxford University Press.
Objectives
At the end of this presentation, participants will be able to
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.
www.WorkingWithDepression.ca
Comparing the burden of mental and physical
illness
Years of Reduced Function
Years of Life Lost
 Depression ALONE
Depression
carries a burden
that is more than the
COMBINED burden
of lung, colorectal,
breast, and prostate
cancers.
Bipolar Disorder
Alcohol
Schizophrenia
Lung, Colorectal,
BreastAll
& Prostate
Cancers
Cancers Combined
0
50
100
150
200
250
Health Adjusted Life Years* Lost (in
thousands)
Ratnasingham S, et al. Ontario Burden of Mental Illness and Addictions Report
Institute for Clinical Evaluative Science, 2012.
* Health-adjusted life years (HALYs)
A combination of years lived with less than
full function and years lost to early death.
Impact of depression on employment
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.
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.
Depression is associated with huge
economic costs
Work-related economic losses are estimated to cost,
per year:
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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.
Love and work
are the
cornerstones
of our
Humanness.
~ Sigmund Freud ~
Why is work important to patients?
Source of income
Sense of accomplishment
Intellectual stimulation
Regular activity schedule
Social interactions
Clinical consequences of cognitive deficits
Cognitive dysfunction in depression is common, broad-based and
often debilitating, leading to difficulties including
Impaired ability to concentrate
Difficulties with memory
Problems with planning
Slowness in responding
Hammar Å, Årdal G. Front Hum Neurosci 2009;3:26
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?
Patient Health Questionnaire-9
(PHQ-9)
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.
☐
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2. Feeling down, depressed, or hopeless.
☐
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3. Trouble falling/staying asleep, sleeping too much.
☐
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4. Feeling tired or having little energy.
☐
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5. Poor appetite or overeating.
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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.
☐
☐
☐
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9. Thoughts that you would be better off dead or of hurting yourself
in some way.
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Over the last 2 weeks, how often have you been
bothered by any of the following problems?
A score of 10 or higher indicates significant depression.
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.
Doctors understand the importance
of scales – but many don’t use them
Type of scale
Symptom questionnaire
Currently
Would
Use
like to use
50%
40%
Quality of life
23%
54%
Overall functioning
37%
54%
Work functioning
23%
59%
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.
Act Local
Think Global
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
Desktop computer
Laptop computer
Wireless handheld device
Games console
Canadian Internet Use Survey 2012.
Depression apps in iTunes store
Name
Depression – screening, diagnostic
• STAT Depression Screening PHQ-9
• Doctor Depression
• Depression Screening/ Pro
• Geriatric Depression Screening
• Depression check
Target audience
Main purpose/ description
Clinicians; patients possible Guides physicians in selecting and monitoring depression treatment.
Clinicians
Assessment scales to measure depressive symptoms in patients.
Patients
Screens depression with PHQ-9, with additional questions on suicide,
psychosis, and mania.
Patients
Screens for geriatric depression with a 15-item geriatric depression scale.
Patients
Screens, assesses risk for depression, bipolar, anxiety disorders
• iCrazy - Psychology Tests
Gen. pop.
Mood Tracking – depression, bipolar, etc.
• Depression Monitor
Patients
• T2 Mood Tracker
Patients
General interest, education; screening for various mental disorders
• MoodyMe – Mood Diary
• MoodPanda
Gen. pop., patients
Patients, Gen. pop
Monitor moods and emotions (including depression, mania), medications, etc.
Monitor moods: “interactive mood diary”
• iMind & Mood
• Moodtrack.com
Treatment/Programs
• Depression Cure – 12 week course
Patients
Gen. pop.
Assessment & recommendations
Mood tracking
Patients
Treatment
• iBiomed
Synchronize with caregivers; social network; health records
• Anti-Depression
Patients, caregivers,
clinicians
Patients
• HappyApp
Patients/Gen. pop.
“brainwave” synchronization, audio frequencies
Patients *teenagers
Patients
Connection/community/ discussion/social networking
Social networking, community
Gen. pop.
Gen. pop.
Gen. pop.
Inspire, motivate
Inspire: quotes; Social: chat
Social/Community Support
• Depression Connect
• Bipolar Disorder Connect
Happiness, General Well-Being
• Happiness Tips
• happiness+
• Optimism
Screens depression with PHQ-9 and tracks (graphs) scores over time.
Mood tracking
info and strategies
MoodFx mobile web app
Partners in Measurement-based mHealth
eHealth
Strategy
Office
www.MoodFx.ca
MoodFx mobile web app
www.MoodFx.ca

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
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
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
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
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?
0
1
2
3
4
Have trouble concentrating on what you
were reading?
0
1
2
3
4
Forget the date unless you looked it up?
0
1
2
3
4
Forget what you talked about after a telephone
conversation?
0
1
2
3
4
Feel like your mind went totally blank?
0
1
2
3
4
During the past 7 days, how often did you…
Add up score in each column:
TOTAL SCORE:
_________
Copyright: Professor Sullivan, McGill University
MoodFx mobile web app
www.MoodFx.ca
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 measurementbased care
www.MoodFx.ca
Thanks to our collaborators and funders
Collaborators in workplace mental health:


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

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






CV Manjunath
Trish Nolan
David Bond
Lakshmi Yatham
Auby Axler
Kendall Ho






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





www.WorkingWithDepression.ca
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”
70
Patients (%)
60
52%
50
40
30
20
10
0
Anergia
Low
mood
Tension Cognitive
Cognitive Insomnia
Difficulty
difficulty
Guilt
Pain
Appetite
Suicidal
52% of depressed patients report that cognitive difficulty
severely interferes with their occupational functioning
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
Adapted from
Lam RW et al. Depress Res Treat 2012;2012:630206
Evaluation of MoodFx in an
Employee Assistance Program (EAP)
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
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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