A smartphone app that can help psychiatrists diagnose mental illness

A smartphone app that can help psychiatrists diagnose mental illness

“A smartphone app that can help psychiatrists diagnose mental illness” –  Peter Hagelund, a Monsenso user, speaks about his experience using the Monsenso mobile health solution to support his treatment, and how it has helped  him improve the communication with his psychiatrist.

Prior to using the Monsenso smartphone app, Peter and his psychiatrist followed the typical therapeutic setting, they would schedule an appointment every two-three weeks, and they would have a conversation to discuss Peter’s previous weeks.  Peter would usually say that he had been doing fine for each appointment, but sometimes he forgot important details that he wanted to discuss.

“It can be pretty tricky to remember, two weeks later [between appointments] how you actually felt that day. With the app it’s really easy to go back and see if your mood has been pretty stable over the last two months, or if you had had some ups and downs over a period,” says Peter Hagelund.

Now, instead of relying on Peter’s memory during the appointment, his psychiatrist can access his data and see how he has been doing, as it happened. He can view how much he has been sleeping, how much he exercises, how much he drinks, how much anxiety he has, and other relevant aspects to his treatment and his disorder.

“My psychiatrist now says things like You say you’ve been doing fine, but I can actually see that you’ve had a few ups and downs. I think the app helps him get a real view of how I have been doing,” says Peter Hagelund.

In his Danish documentary series “Jeg savner min sygdom” (which translates to “I miss my illness”), Peter Hagelund talks about his experience of getting the wrong diagnosis and how finally after six years he got the right diagnosis and treatment. 

In 2014, he was diagnosed with Bipolar Disorder Type 2.

During his whole life, he knew there was something different about him. He always struggled with depression and anxiety, and what eventually turned out to be hypomania. When he was 22, he had his first big episode of depression and began taking antidepressants. However, it took six more years before he was officially diagnosed with Bipolar Disorder Type 2.

He says that one of the trickiest things about having this diagnosis is that he does not experience the typical manic episode where a person feels over-energetic and nearly psychotic. Instead, he feels hypomanic, which means that he is socially well functioning. He is not psychotic. He just feels really well; the problem with this, was that he didn’t feel the need to inform his psychiatrist the fact that he was feeling too well

His psychiatrist found out that he had Bipolar Disorder was because he couldn’t come out of his depression. At first, he was diagnosed with depression and ADD. But these diagnoses didn’t seem to fit because he still had strong mood swings and a lot of anxiety. When he was diagnosed with Bipolar Disorder Type 2, it actually made sense to him. Suddenly, he could see why he had felt the way he had most of his life.

“I really believe that the Monsenso smartphone app could have helped my psychiatrist give me the right diagnosis at an earlier stage because the app helps me to keep track of my mood and to become more aware of how I feel. With the app, I have to pause and take a moment to think about how I’ve actually been doing before entering my answers. Keeping track of all this information has helped my treatment. My psychiatrist and I can plan better on how to avoid my future depressive or hypomanic episodes because we can clearly identify when I am having mood swings”. says Peter Hagelund.  

In August 2018, his documentary about living with Bipolar Disorder aired on national Danish television and the response was overwhelming. Many people contacted him, to thank him for talking about his illness. He made the documentary so other people who have this illness, do not feel ashamed of it.

“My hope is that in the future people are diagnosed at an earlier stage than I was and I truly believe the Monsenso app is one of the things that can help. I really hope that other psychiatrists and their patients will start using the app,” he added.

Click here to read this story in Danish.

The top cause of insurance claims is mental illness

The top cause of insurance claims is mental illness

The top cause of insurance claims is mental illness. According to a new study conducted in the UK, two-thirds of British adults said they have experienced mental ill-health at some point in their lives. The survey revealed that on average 70% of people between the ages of 18 and 54 have experienced a mental health problem. In all, 65% of all the people surveyed, said they had experienced some form of mental health problem. [1]

Britain’s high stress, long-hours work culture has led to a higher level of people out of work with mental health problems than any other country in the developed world. [2]

Furthermore, a different study has shown that approximately 53% of NHS patients displayed clinical symptoms of depression and anxiety within a year after completing psychological treatments. Over half of these were found to have suffered a relapse event, with up to 79% of events occurring within the first six months after treatment.[3]


The economic cost

According to an OECD report, people unable to work because of mental health issues cost the UK economy £70 billion each year with 40% of all people claiming disability benefits is due to psychological issues.[2]

Top cause of insurance claims

The top cause of insurance claims are mental health issues, which have remained at the top of the list since 1999, far above other claims such as back injury or stroke.[4]

According to an analysis by the Institute for Fiscal Studies, nearly half of all people claiming disability benefit are doing so because they have a mental illness rather than a physical condition. [5]

The analysis reveals that the proportion of disability claims which are related to mental illness has risen from 27 per cent to 41 per cent since 1999. [5]

In fact, six in ten claims by those aged between 25 and 34 are now related to mental illness, up from half in 1999. [5]

In a recent interview, Vanessa Sallows, Benefits and Governance Director at Legal & General’s Group Protection, said: “Mental health continues to be the main reason for absences on our group income protection. [4]

mHealth technology is here to help

Smartphones and wearables
In the UK alone, there are over 40 million smartphone users over 3 million people utilise some type of wearable device.

Mobile health technology
mHealth technology uses connected devices to help prevent illness, improve compliance and get people back to health.

Customer centricity
mHealth technology puts customers at the centre, where they want to be, and helps them to live the lives they want.

The Monsenso mHealth solution for mental health can be used by insurance companies to offer a preventive, mental wellness programme.

Policyholders can use the Monsenso smartphone app to enter their daily levels of stress, anxiety, irritability, physical activity and number of hours they slept. This information is gathered and stored electronically so it can be accessed by a coach or telehealth consultant, anytime, anywhere.

In this way, the coach or telehealth consultant can remotely monitor policyholders and follow up with those users who present any triggers or warning signs. For example, the the coach or telehealth consultant will be notified when a policyholder indicates a high level of stress, anxiety and irritability for more than five consecutive days or when someone sleeps less than six hours for more than three consecutive days. These two actions would be considered indicators that the individual needs to be contacted for a “wellness check” and implement the necessary measures to prevent the person from going on long-term leave, or become affected by other physical conditions such as heart disease.

References:

[1] Two-thirds of Britons have had mental health problems. The Guardian. Haroon Siddiqi. (2017, May 8)
https://www.theguardian.com/society/2017/may/08/two-thirds-of-britons-have-had-mental-health-problems-survey?CMP=share_btn_tw

[2] British workers among the most stressed in the world. The Telegraph. Georgia Graham. (2014, Feb 14)
http://www.telegraph.co.uk/news/health/10629374/Over-a-million-people-with-mental-health-issues-are-out-of-work-and-claiming-benefits.html

[3] More than half of NHS patients display symptoms of relapse after depression treatments, study finds. News Medical Life Science. (2017 May 3)
http://www.news-medical.net/news/20170503/More-than-half-of-NHS-patients-display-symptoms-of-relapse-after-depression-treatments-study-finds.aspx?showform=printpdf

[4] Legal & General group protection payouts rise. FT Adviser. Simoney Kyriakou. (2017, May 2).
https://www.ftadviser.com/protection/2017/05/02/legal-general-group-claim-payouts-rise/

[5] Nearly half disability benefit claimants have a mental illness. The Telegraph. (2015, May 21)
http://www.telegraph.co.uk/news/health/11622166/Nearly-half-disability-benefit-claimants-have-a-mental-illness.html

Clinicians to monitor cardiovascular disease markers for teens suffering from mental illness

Clinicians to monitor cardiovascular disease markers for teens suffering from mental illness

According to a recent statement by the new American Heart Association (AHA),  major depressive disorder and bipolar disorder should be recognized as moderate risk factors for atherosclerosis and early cardiovascular disease.  [1]

In 2011, the National Heart, Lung and Blood Institute identified four conditions (chronic inflammatory disease, human immunodeficiency virus, Kawasaki disease, and nephritic syndrome) that lead youths to a mild risk of developing cardiovascular disease before they reach 30. [2]

The statement released a few days ago, reveals that depression and bipolar disorder meet the same criteria as these conditions. Moreover, these two behavioural disorders are more widespread than the previous mentioned conditions combined.

These studies showed evidence of a link between paediatric depression and bipolar disorder with premature cardiovascular mortality. Cardiovascular risk factors for these teens include obesity, insulin resistance and diabetes, dyslipidemia, and hypertension.[1]   According to the statement, depression and bipolar disorder are the first- and fourth-most disabling conditions, among adolescents worldwide.

After the report had been unveiled, researchers from schools around the U.S. and Canada looked at existing studies on mood disorders in people under the age of 30. Researchers looked specifically into youths suffering from depression or bipolar disorder with cardiovascular markers such as high pressure and cholesterol. They found a significant connection between having depression or bipolar disorder and increased odds of high blood pressure, high cholesterol, obesity (especially belly fat), type 2 diabetes, and hardening of the arteries. [3]

This discovery denotes that healthcare providers should track physical activity levels and food intake as well as metabolic monitoring is crucial for these young patients as a preventive measure.

However, to monitor cardiovascular markers, physical activity and food intake, of thousands of young patients who also suffer from mental illness is not an easy task. Although, there are hundreds of smartphone applications tracking physical activity and counting calories, these apps are personal, and clinicians do not have access to an individual’s data. Nevertheless, with the Monsenso mobile health (mHealth) solution, this cumbersome task becomes easy and achievable.

The Monsenso mHealth solution enables clinicians to access a patient’s data on a daily basis. Every day, youths would be reminded to fill in a self-assessment with important information that could include the number of hours they slept, the amount of unhealthy food they have eaten, and if they realized any physical activity throughout their day. Additionally, the smartphone can also collect physical activity and mobility data, based on the smartphone’s inbuilt accelerometer and GPS locator.

The Monsenso mHealth solution, especially designed to monitor behavioural data of patients suffering from mental illness, can in this way help clinicians monitor any unhealthy habits of patients with risk of developing cardiovascular disease.

Further, with the customisable action plans, each youth could follow “contingency plans” if they experience some symptoms related to their mental illness or if they have engaged in unhealthy activities. For example, a special trigger could set up if a youth has indulged in unhealthy food for several days in a row, or has had a low level of physical activity. The action plan listed for this trigger could then encourage individuals to engage in physical activities and and to try to avoid sugar and fat during the upcoming week.

References:

[1] Browser,D Medscape. Depression, Bipolar Disorder in Teens are CVD Risk Factors: AHA (2015, August 10)  http://www.medscape.com/viewarticle/849312

[2] American Heart Association. Young people with mood disorders have increased risk of developing early cardiovascular disease (2015, August 11)

http://blog.heart.org/young-people-with-mood-disorders-have-increased-risk-of-developing-early-cardiovascular-disease/

[3] Walton, A Forbes. Teens with depression, bipolar disorder, should be screened for heart disease, experts say. (2015, August 11) http://www.forbes.com/sites/alicegwalton/2015/08/11/depressed-teens-may-be-at-higher-risk-for-heart-disease/

Goldstein BI, Carnethon MR, Matthews KA, et al. Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease. Circulation 2015.

Mental health a global priority- The WHO action plan

Mental health a global priority- The WHO action plan

Making Mental Health a Global Priority”  is a two-day high-level meeting hosted  by the World Bank Group and World Health Organization (WHO) with the objective to include mental health as a global priority. This blog post is based on the report published after the meeting.

Mental health a global priority

  • Studies estimate that at least 10% of the world’s population is affected by mental illness
  • 20% of children and adolescents suffer from some type of mental disorder
  • Mental disorders account for 30% of the non-fatal disease burden worldwide and 10% of the overall burden of disease, including death and disability

It is a known fact that two of the most common mental disorders, anxiety and depression, respond well to treatment. However, due to a lack of funding, these disorders are not treated in most cases. For governments and healthcare authorities, investing in the treatment of mental illness may seem questionable; nevertheless, mental disorders have many ripple effects, including a strong economic impact on society.  In fact, mental disorders account for almost one in three years lived with disability globally. Additionally, there is a strong link between mental disorders and potentially fatal conditions including cancer, cardiovascular disease, diabetes, HIV and obesity.

A recent analysis shows that treating anxiety and depression is a cost-effective way to promote well-being and prosperity in a community – and that failure to be treated can contribute to impoverishment at a household level and to reduced economic growth and social well-being at a national level.

To tackle today’s mental health challenges, governments and international development partners should work together to fund cost-effective alternatives to treat mental health. This funding will provide a strong return on investment, with scale-up leading to good returns in restored productivity as well as improved health.

Action plans proposed by the World Bank and WHO

1. A new mental health system

The effective care of depression and anxiety requires a comprehensive mental health system including governance, healthcare institutions and community settings to endorse holistic mental health plans. Mental health planners and policy makers need to develop, through public awareness and community engagement, care delivery systems that are sensitive to local social, economic, and cultural contexts; this will ensure that services are appropriately sought out and utilized.

2. Integrated care for depression in primary, maternal, and paediatric care

In addition to its impact on physical health, depression can affect the management of chronic co-occurring diseases, such as diabetes, hypertension, cardiovascular disease and cancer.

Collaborative care—an evidence-based approach to care for chronic illness applied in primary care settings—guides the effective use of resources for delivery of quality mental health care. It emerges as an effective way to address co-morbid conditions and commonly co-occurring risk factors while improving overall health outcomes. Collaborative care emphasizes systematic identification of patients, self-care, and active care management by clinical providers, blended with other medical, mental health, and community supports.

Anxiety and depression also play large roles in the health of expectant and new mothers and their children. A study conducted in 2007 revealed that more than 50% of pregnant women suffer from anxiety and more than 37% suffer from depression. Antenatal depression can increase the likelihood of preterm birth, low birth weight, and cognitive disturbances. In addition, 10-15% of new mothers suffer from post-partum depression. Studies have shown that antenatal and postnatal interventions are effective in reducing depression and anxiety, which improves infant outcomes.

Children and young adults are also affected by depression and anxiety, which causes a negative effect on their ability to learn and study. Besides, since 75% of all mental disorders have a first onset by the age of 18-24, integrating mental health treatment into standard paediatric health care would not only improve students’ learning outcomes, it would also allow children and young adults to obtain treatment at an early stage.

3. Information and communications technology (ICT)-based platforms

ICT-based platforms, such as the one offered by Monsenso, provide an alternative method of mental health care delivery when resources are scarce, while also addressing long-standing obstacles in mental health delivery, such as transportation barriers, stigma associated with visiting mental health clinics, clinician shortages and high costs.

These platforms, especially mobile mental health interventions, can offer remote screening, diagnosis, monitoring and treatment; remote training for non-specialist healthcare workers; and can be used to develop and deliver highly specific, contextualized interventions.

Cognitive Behavioural Therapy (CBT) has been successfully implemented through information technology platforms, demonstrating improvement in depressive symptoms, reduced costs, patient acceptance and enhanced primary care workflow. In addition, patient participation is rapidly expanding in peer-to-peer social networks where patients can access around the clock support with demonstrable improvements in depression symptoms.

4. Platforms outside the health sector

Anti-stigma campaigns

Stigma associated with mental disorders can result in social isolation, low self-esteem, and limited chances in education, employment, and housing. Therefore, anti-stigma campaigns are powerful tools to confront mental disorders.

School-based interventions

The key strength of school-based health screening and care is that it maximises outreach in school age children and adolescents. The potential benefits include the healthy development of students, improved academic performance, and opportunities to integrate school and clinic-based services.

Workplace interventions

There is a huge amount of evidence that investing in workplace wellness programs is good for employees and companies.

Workplace mental health interventions can be centred on treatment or mental health promotion such as cognitive-behavioural approaches targeting stress reduction. Organizational-level workplace interventions can include policies that address prevention and early intervention.

Interventions related to conflicts and natural disasters

Conflict exposes civilian populations and refugees to violence and high levels of stress, resulting in dramatic rises in mental illness that can continue for decades after armed conflict has ceased. Therefore, part of the rebuilding efforts in post-conflict and post-disaster societies should include building mental health services that are well integrated into primary care and public health efforts.

Reference:

Out of the Shadows: Making Mental Health a Global Development Priority. World Bank and World Health Organization. 2016

The MONARCA system for Bipolar disorder – The foundation of Monsenso

The MONARCA system for Bipolar disorder – The foundation of Monsenso

The MONARCA system for Bipolar Disorder is the foundation of the Monsenso mHealth solution for mental health. MHealth solutions are now broadly used to manage a wide range of health-related conditions. These monitoring systems help users monitor and visualise their behaviour. For example, it states users’ physical state, it reminds them to perform specific tasks, it provides feedback on their behaviours, and it recommends healthier actions.

Until very recently, mHealth solutions have primarily targeted somatic diseases, even though, they have the potential to assist the management of mental illnesses such as depression, bipolar disorder, and schizophrenia. It is possible that this has been the case due to the complexity of mental illness, since symptoms vary from patient to patient, it may be unclear what data should be monitored. Besides, there isn’t a set treatment and standard medications that will work for all patients; therefore, treatment should be as individualised as the illness itself. Additionally, it could also be difficult for patients to reflect on their own mood and behaviour, and they may only recognise their symptoms if they understand the illness and know what to look for.

This article portrays the origins of the Monsenso mHealth solution, founded in October 2013 by Jakob E. Bardram, Ph.D. and Mads Frost, Ph.D. as a spin-off from the IT University of Copenhagen. The company was based MONARCA research prototype, funded by the European Commission under the 7th Framework Program.

The MONARCA Project (2009 to 2013) aimed to develop and validate solutions for multi-parametric, long-term monitoring of behavioural and physiological information relevant to bipolar disorder. It included the development of an appropriate platform and a set of services into an innovative system for management, treatment, and self-treatment of the illness.

The MONARCA system was designed to comply with relevant security, privacy and medical regulations. It also paid close attention to interoperability with existing medical information systems. The system was integrated into appropriate medical workflows, and evaluated in clinical trials. The project involved 13 European academic, clinical, and commercial partners.

As part of the MONARCA project, a close collaboration was established between the researchers in the PIT Lab and the Department of Psychiatry at the University Hospital of Copenhagen (Rigshospitalet) represented by Professor Lars Vedel Kessing, MD & Ph.D. This Copenhagen-based alliance formed the basis for developing a unique sensing and treatment platform utilizing semi-automatic data collection from smartphones used by patients.

During the project, the MONARCA system was designed and developed in close collaboration between the researchers, psychiatrists, and patients suffering from bipolar disorder. The system was subject to intensive clinical trials and ultimately went into a randomised clinical trial (RCT). The aim was to establish clinical evidence for the efficacy of using the MONARCA system in the treatment of bipolar disorder. More than 100 patients were enrolled in the clinical trials and used the system.

The MONARCA system

The Monsenso platform and the MONARCA research prototype consist of two parts:

  • A smartphone app for patients that allows them to enter self-assessment data, collects sensor-based data from the phone, helps the patients track their medicine and provides feedback on the data collected.
  • A web portal that provides detailed historical overviews of a patient’s data, and it can be accessed by patients and clinicians.

The patient web portal can be fully customisable to accommodate the needs of each individual, such as their own Early Warning Signs and Triggers.

The clinician web portal provides them with a quick overview of all their patients enabling them to focus on the patients in need of immediate attention.

An mHealth solution for Bipolar disorder

The bipolar disorder is characterised by recurring episodes of depression and mania, and its treatment aims to reduce symptoms and prevent episodes through a combination of:

  • Pharmacotherapy – Symptoms are controlled and mood is stabilised with a customised combination of antidepressants, anti-psychotics, mood stabilisers, and other drugs such as sleeping pills.
  • Psycho-education – Patients are taught about the complexities of their disorder, the causes of recurrence of episodes, and how to manage their illness.
  • Psychotherapy – Patients are coached to deal with their symptoms and find practical ways to prevent episodes through actionable behavioural and life-style choices, such as routine, sleep, and social activity.

A good approach to treatment is predicting and preventing episodes by training patients to recognise their Early Warning Signs (EWS), which symptoms that indicate of an oncoming episode [2]. This type of training is resource-intensive and its success varies highly from patient to patient.

In particular, it was discovered that these three parameters are crucial in keeping a bipolar patient stable:

  • Adherence to prescribed medication: Taking all medications on a daily basis, exactly as prescribed.
  • Stable sleep patterns: Sleeping eight hours every night and maintaining a consistent routine of going to bed, waking up.
  • Staying active both physically and socially: Getting out of the house every day, going to work, and engaging in social interaction.

Although at first glance this list seems simple, numerous studies have shown that each of these items are very difficult to achieve for many patients, and achieving all three at the same time every day is inherently challenging in combination with a mental illness. Hence, the core challenge is to create technology that would help – or persuade – the patient to do these three things daily. [1]

Therefore, the MONARCA system was developed to include five core features that support a patient’s self-management:

  • Self-assessments – Reminded by an alarm, patients enter subjective data directly into the system through their smartphones. This data includes mood, sleep, level of activity, and medication. Some items can be customized to accommodate a patient’s specific needs, while others are consistent to provide statistical analysis.
  • Activity monitoring – Through a GPS and accelerometer, objective data is collected to monitor a patient’s level of engagement in daily activities. The system can also measure the amount of social activity based on phone calls and text messages.
  • Historical overview of data – On the web portal, patients and clinicians can obtain a two-week snapshot of a patient’s basic data for immediate feedback. The portal also gives them access to a detailed historical overview of the data, enabling them to explore it in depth by going back in time, and focusing on specific variables.
  • Coaching and self-treatment – The MONARCA systems supported psychotherapy in two ways. Firstly, through customisable triggers that notify the patient and clinician when the data potentially indicates a warning sign. Second, since the patients have access to their own Early Warning Signs, it empowers them to learn more about them.
  • Data sharing – To strengthen the relationship between patients and clinicians, important information and treatment decisions are shared.

In general, patients and clinicians found the system quite useful and easy to use. The preliminary user feedback revealed all research participants agreed it was easier to use the smartphone-based self-assessments than the paper-based ones.All participants believed that entering data on the self-assessment is easy and that the system provides them allows them to adjust to their personal needs.

A user explained that “It is much easier to use the phone that the piece of paper. I have the phone with me at all times, and I don’t have to worry about the paper getting lost in the piles. I is very convenient that you can just enter data when you remember or experience instead of having to recall it all when you have the paper in your hands.” [1]

References:

[1] The MONARCA Self-assessment System: A Persuasive Personal Monitoring System for Bipolar Patients. Bardram, Jakob E., Frost, Mads, Szanto, Karoly and Marcu, Gabriela. In Proceedings of the 2nd ACM SIGHIT International Health Informatics Symposium, pages 21-30, New York, NY, USA, 2012.

[2] Long-term mental health resource utilization and cost of care following group psychoeducation or unstructured group support for bipolar disorders: a cost-benefit analysis. J. Scott, F. Colom, E. Popova, A. Benabarre, N. Cruz, M. Valenti, J. M. Goikolea, J. Snchez-Moreno, M. A. Asenjo, and E. Vieta. J. Clin. Psychiatry, 10, Mar 2009.