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, accurateAdvanced 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
TR
aP
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 QuestionnaireCity 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 IResults from measurementsPersonal health goalHealth binderSelf-observation equipment Group meetings (5 x 1.5h)
Drop-out: other reasons (n=1)Non-compliance (n=1)
Intervention IIResults from measurementsPersonal health goalHealth binderGroup 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
participaten= 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
programmeHome 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