Telemedicine for Mental health

31 Pages·2016·2.47 MB·English

Telemedicine for Mental health:
innovations in digital e-interventions for
depression and anxiety

Professor Ed Watkins
University of Exeter
eHealth Week, Amsterdam, 8-10TH June
2016
The Global Challenge of Depression1
• 1 in 5 people during lifetime; 151 Million per year
• Recurrent, disabling, major personal cost
• WHO2 estimates No.1 disease burden by 2020
• Economic cost: €92 billion per year in Europe
1Collins et al., 2011 Nature 475: 27-30
2Lopez et al., 2006 Lancet 36: 1747-1757
A Major Treatment Gap
ILL
WELL
1. Effectiveness
- 1/3 full recovery
- 50% further depression
2. Availability
- Majority not receive
evidenced treatment
- Traditional approaches
have limited scalability
3. Acceptability
- Patient preference
A Major Prevention Gap
Treatment alone insufficient as depression highly recurrent
Assuming 100% coverage and adherence to evidence-based
treatments, c. 1/3 of depression’s disease burden could be
averted1
1. Andrews et al. Br J Psychiatry.
2004;184:526-533.

1. More available therapy via e-health
• As effective & feasible as face-to-face treatment1
• Increases access, coverage, convenience of therapy
(anytime/anyplace) & mitigates stigma
• Potential to reach v. large numbers of people & reduce
therapist time per patient
1. Andrews et al.. PLoS One, 2010; 5(10): e13196. doi:10.1371/journal.pone.0013196.
2. e-Health Prevention for Depression
• Despite potential to be widely available, almost no trials of
e-Health to prevent depression
• Two v. recent innovative trials in Netherlands & Germany
Buntrock et al., JAMA 2016
406 adults in Germany with subthreshold depression
Randomised at chance
Internet guided cognitive- Web-based
behavioural & problem- psychoeducation
solving therapy
12 month follow-up
Depression:
27% intervention
vs 41% control
Topper, Emmelkamp, Watkins & Ehring (in revision);
ZonMW funded

251 x Dutch 15-19 year olds with elevated worry/rumination
Randomised at chance
Internet guided cognitive-
Group CBT for Usual care
behavioural therapy
rumination
targeting rumination
12 month follow-up