Mental health app could help prevent depression in young people at high risk

Mental health app could help prevent depression in young people at high risk

A cognitive behavioural therapy (CBT) app, based on Monsenso’s digital health platform, has been found to significantly prevent increases in depression in young people who are at high risk – and could be implemented as a cost- effective, large-scale public mental health measure.

Globally, concern is growing about the high and steadily increasing rates of anxiety and depression in young people. Effective and scalable ways of preventing poor mental health in this group are needed, and digital tools such as mobile apps have been proposed as part of the solution.

Whilst there is emerging evidence for mental health apps being effective in treating anxiety and depression, the EcoWeB project led by the University of Exeter is the first to rigorously test a mental health app on such a large scale across four countries. Two linked papers published on Oct 4 in Lancet Digital Health report the results of the ECoWeB-PREVENT and ECoWeB-PROMOTE trials, which ran concurrently in the four-year study funded by Horizon 2020. Critically, these studies found that a CBT self-help app based on Monsenso’s digital health platform can protect vulnerable young people against depression.

Professor Ed Watkins from the University of Exeter led the project and said: “For young people with elevated risk, our findings suggest the CBT app does have a preventative effect on depression and could have a public health benefit. Participants’ quality-of-life measures were better, and their reported work and social functioning was better.

“However, we also found that it’s hard to make improvements in young people who are basically doing okay. Our findings add to the evidence that prevention for depression works best when we identify and select individuals who are more at risk, rather than take a more universal approach. This identification could be done by an online self-screening process or through professional referral.”

CEO Thomas Lethenborg at Monsenso said: “We are happy with the outcomes of this study and see great potential for our platform based on this. It shows that our platform can be used to deliver cost-effective guidance and interventions at scale and that it can be used to enable large-scale, international decentralised trials collecting continuous real-world data from participants.”

The aim of the EUR 4-million project was to test the effects of mobile apps in preventing depression and promoting mental well-being for young people aged 16 to 22. In one of the largest studies of its kind, 3,700 young people took part across the UK, Germany, Belgium, and Spain and were allocated into two trials based on their emotional competence abilities at the start of the study. That resulted in 1,200 young people with reduced emotional competency scores that confer increased risk for depression such as increased worry and overthinking going into one trial focused on prevention, whilst 2,500 without such risk went into the other trial focused on wellbeing promotion.

Those two groups were then randomised in equal numbers to three different apps developed by the project based on Monsenso’s platform. There was a self-monitoring app where people can report their emotions every day, a self-help app that provided personalised training in emotional competence skills, and a self-help app based on CBT principles. Participants were then followed up at three months and 12 months to see how their wellbeing and depression symptoms changed.

The trials found the CBT app prevented an increase in depression, relative to self-monitoring in the higher risk sample, but that there was no difference between any of the interventions in their effects for the lower risk sample.

Professor Ed Watkins at University of Exeter said: “Our results suggest that even when young people used the self-help app just a few times, there was a small but meaningful benefit. Because the app is scalable to large numbers of people in a cost-effective way, these effects have potential value as a public health intervention, within a broader portfolio of digital and in-person services and interventions. Next steps are to identify the active ingredients of the app that were beneficial and to improve engagement and ongoing use of these elements.”

The project involved 13 different partners, including two commercial companies – digital health platform provider Monsenso and German voice analysis company audEERING. The University of Exeter (UK), LMU Munich (Germany), Ghent University (Belgium), and Universitat Jaume I (Spain), were the main treatment development and trial sites. Meanwhile, the University of Oxford led on the qualitative analysis.

The studies are titled ‘Emotional competence self-help app versus cognitive-behavioural self-help app versus self-monitoring app to prevent depression in young adults with elevated risk (ECoWeB PREVENT): an international, multicentre, parallel, open-label, randomised controlled trial‘ and ‘Emotional competence self-help mobile phone app versus cognitive behavioural self-help app versus self-monitoring app to promote mental wellbeing in healthy young adults (ECoWeB PROMOTE): an international, multicentre, parallel, open-label, randomised controlled trial’, and both are published in Lancet Digital Health. This work was supported by European Union Horizon 2020 Personalised Medicine SC1-PM-07–2017 grant agreement 754657.


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Healthcare as a business case: Which importance is placed on societal impact vs economic impact?

Healthcare as a business case: Which importance is placed on societal impact vs economic impact?

Over the past decade, public spending on health in Denmark has been above the EU average. Due to the COVID-19 pandemic, government spending on healthcare has grown by more than 5% in 2020 alone [1], reaching total healthcare expenditures of DKK 270.794m in 2021 [2]. But how does Denmark decide which new treatment approaches to spend money on, and does the societal impact of healthcare measures play an equally important role as their economic impact?

Though member states of the European Union are not precluded from “releasing marketing authorisations valid at national level” for new medicines/treatments, EU-wide marketing authorisations require new treatments to go through a centralised authorisation procedure managed by the European Medicines Agency (EMA), which evaluates the pharmaceutical quality, safety, and efficacy of new treatments [3]. However, whereas obtaining marketing authorisation on an EU level allows providers to offer their new medicines/treatments, it is mainly the national health authorities’ decisions on reimbursement and pricing measures that affect if patients will have access to them [3]. 

In Denmark, the Danish Medicines Council (Medicinrådet) is an important body that assesses new treatment approaches and makes recommendations related to which medicines/treatments should be used in the Danish healthcare system [4]. Typically, cost-effectiveness and the impact on the healthcare budget are two important economic factors that national health authorities consider during such evaluations [3]. But what about the societal impact of new treatments? Does it receive sufficient consideration during the assessment procedures? 

Let’s take innovative digital health solutions as an example. If we purely consider the direct economic costs digital health solutions for mental health can help to reduce, such as the costs for (re)hospitalisation (e.g., DKK 6.000 per day), do we really get a full picture of the value of these innovations in healthcare? Potentially not, as the societal impact would not have been considered.

For instance, we would have not taken into account that digital health solutions for mental health can significantly improve the quality of life of individuals suffering from mental disorders [5], or that these innovations can enable mentally ill individuals to better recover and return to work faster. Neither would we have considered that digital solutions can facilitate making better use of resources available in the future, for instance by helping clinicians to handle growing patient data volumes they often feel overwhelmed with [6]. 

The societal impact of new treatments may be more difficult to quantify than the pure health economic impact, but we believe it is an important factor to consider when evaluating innovative approaches. At Monsenso, we have made it our mission to enable better mental health for more people at lower costs, and the positive societal impacts and increased quality of life that we help generate are as important to us as the pure health economic impact.
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About Monsenso
Monsenso is an innovative technology company offering a digital health solution used for decentralised trials, remote patient monitoring and treatment support. Our mission is to contribute to improved health for more people at lower costs by supporting treatment digitally and leveraging patient-reported outcomes data. Our solution helps optimise the treatment and gives a detailed overview of an individual’s health through the collection of outcome, adherence, and behavioural data. It connects individuals, carers, and healthcare providers to enable personalised treatment, remote care, and early intervention. We collaborate with health and social care, pharmaceuticals, and leading researcher worldwide in our endeavors to deliver solutions that fit into the life of patients and healthcare professionals. To learn more visit  www.monsenso.com

References: 

[1] European Commission (2021). State of Health in the EU · Denmark · Country Health Profile 2021.
https://eurohealthobservatory.who.int/docs/librariesprovider3/country-health-profiles/chp2021pdf/denmark-countryhealthprofile2021.pdf?sfvrsn=e79f1c55_7&download=true

[2] Statistics Denmark (n.d.). Health care expenditure.
https://www.dst.dk/en/Statistik/emner/oekonomi/offentlig-oekonomi/udgifter-til-sundhed

[3] European Parliament (2015). Towards a Harmonised EU Assessment of the Added Therapeutic Value of Medicines.
https://www.europarl.europa.eu/RegData/etudes/STUD/2015/542219/IPOL_STU(2015)542219_EN.pdf

[4] Medicinrådet (n.d.). Danish Medicines Council.
https://medicinraadet.dk/om-os/in-english

[5] Monsenso (2022). Key research findings.
https://www.monsenso.com/wp-content/uploads/2022/06/Monsenso-Key-Research-Findings.pdf

[6] Elsevier Health (2022). Clinician of the Future Report 2022.
https://www.elsevier.com/connect/clinician-of-the-future

PhaseV: Input from users and clinicians is essential in the development of new digital health solutions

PhaseV: Input from users and clinicians is essential in the development of new digital health solutions

User involvement is an important phase in the development of new solutions in healthcare. A digital health solution should fit into the patient’s life, should provide value for the patient, and should be easy to use. This is why the input from both end-users and clinicians is a crucial part of the design phase in the PhaseV decentralised trials innovation project, where Monsenso and partners will develop a range of new digital health solutions for future clinical trials.

“It is important that we get the users’ perspective already while we design the solution. We need to know what their everyday life is like as patients, and when and how it creates value for the individuals to use our solution. Therefore, the phase of user involvement is important, and it is equally important that we get help from research to qualify and nuance users’ input”, says Thomas Lethenborg, CEO of Monsenso.

PhaseV is an interdisciplinary project based on citizen-generated data. The project will develop three apps for patients suffering from cost-intensive chronic diseases. The three apps are developed on top of an existing solution from Monsenso and address:

  •   obesity
  •   diabetic foot ulcers, and
  •   chronic urticaria.

The three apps will collect data in real time and show the effect of a given treatment – also between consultations.

Researchers are an important intermediary between users and the company
Monsenso is assisted by researchers from Aarhus University and the Research Unit for General Practice (FEAP) in collecting and analyzing user feedback. For the digital health solution for diabetic foot ulcers, a group of interviewers visited both the Wound Healing Center at Bispebjerg Hospital and Steno Diabetes Center Aarhus. Here, they have been in dialogue with almost 30 patients and a number of clinicians and home care employees.

The research team has also visited the section for chronic urticaria at Bispebjerg Hospital, where they have been in dialogue with several patients and clinicians, explains Christa Thomsen, Professor at the Department of Business Administration, Aarhus University.

“We need a lot of data from both patients and caregivers to get an idea of ​​what solution is needed and how it should work. Patients’ and employees’ experiences should form the basis for the information we pass on to the company so they can develop the most valuable solution“, explains Christa Thomsen.

Later this spring, the team will delve into user involvement for Monsenso’s third app aimed at citizens with obesity.

Interviews, observations, and workshops
Researchers have, among other things, developed question guides, which are used as a guideline for interviews with patients and staff. In addition, the interview team has witnessed a number of consultations, which have given them insight into patients’ daily lives with their condition (in this case, with diabetic foot ulcers) and clinicians’ daily routines.

“The solution to be developed must help ensure the best personal treatment for each patient. Therefore, it is important for us to know what information the caregivers need and how this data should be collected to provide value for both caregivers and citizens“, explains Ida Hestbjerg, research assistant at the Research Unit for General Practice.

Researchers’ data provides valuable knowledge
Emil Meyland Kortsen is responsible for developing the three apps for patients with diabetic foot ulcers, obesity, and chronic urticaria, respectively, and he describes user input as indispensable.

“We have received extremely valuable knowledge from the research team about users’ and clinicians’ needs and desires for the new solution. As a developer, I can present the possibilities that exist in the technology, but I need qualified sparring from users, healthcare professionals, and research to be able to refine the drafts. The task now is to become even more specific about the different functions and to continue to optimize the solution,” says Emil Meyland Kortsen, Product Owner at Monsenso.

This article is a translation of an original Danish version written by Lotte Overbjerg, 01st March 2023.
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About Monsenso
Monsenso is an innovative technology company offering a digital health solution used for decentralised trials, remote patient monitoring and treatment support. Our mission is to contribute to improved health for more people at lower costs by supporting treatment digitally and leveraging patient-reported outcomes data. Our solution helps optimise the treatment and gives a detailed overview of an individual’s health through the collection of outcome, adherence, and behavioural data. It connects individuals, carers, and health care providers to enable personalised treatment, remote care, and early intervention. We collaborate with health and social care, pharmaceuticals, and leading researcher worldwide in our endeavours to deliver solutions that fit into the life of patients and health care professionals. To learn more visit  www.monsenso.com.

Monsenso participates in new project to investigate what works best for patients with depression after discharge from psychiatric treatment

Monsenso participates in new project to investigate what works best for patients with depression after discharge from psychiatric treatment

Depression is more common than one might think. In Denmark, it is estimated that between 7-12% of men and 15-25% of women suffer from depression at least once in their lifetime [1], which means that approximately 150.000 Danes live with moderate to severe depression at any given time [2]. But how do patients who have received psychiatric treatment for depression experience the sector-transition into the primary sector? And what are their needs for treatment and care from different healthcare sectors? The DEPRIC research project is now trying to find answers and thereby develop a new treatment model for depression across healthcare sectors in Denmark.

The transitional phase from inpatient wards into the primary sector can represent a vulnerable period for patients suffering from depression [3,4], with “high risks of relapse and readmission” [5] . The research project DEPRIC thus aims to establish a new treatment model for depression across the healthcare sectors in Denmark. The project is led by PhD student Anne Sofie Mosborg Aggestrup from the Mental Health Services in the Capital Region of Denmark. The DEPRIC project began in October 2021, and the project now offers patients who have completed a treatment course for severe depression at an affective disorders outpatient unit at the Mental Health Centre Copenhagen to participate in this cross-sectoral study by self-reporting data in an application (app) [6].

Throughout the research project so far, interviews, focus groups, and a group interview have been conducted with participating patients, healthcare professionals, and job consultants across sectors. In addition, the project will conduct workshops during the autumn of 2023. Currently, patients will be provided with the Monsenso digital health solution, an app that will allow them to register relevant data throughout the research project. This self-reported patient data will entail, for instance, data on the patients’ mood, sleep patterns, mental well-being, use of medication, connections to the labour market, and on why and how often they have approached specialist groups after their treatment course in the psychiatry [6]. 

It is anticipated that patients will begin their app registrations at the end of February 2023, and will then register every second week for a period of six months. The researchers behind the DEPRIC project aim to establish a more coherent patient course by involving patients, healthcare professionals, and job consultants in developing a new treatment model across healthcare sectors in Denmark. The researchers hypothesize that this will promote patients’ recovery process from depression, and reduce relapses of depression and psychiatric hospitalizations after the patients’ discharge from outpatient psychiatric treatment.

“Our aim is to help provide better health with better data. We are looking forward to contributing to this project and helping patients with mental illness transition across sectors more seamlessly for a better patient experience and higher quality of life”, says Thomas Lethenborg, CEO at Monsenso.

 “The self-registrations in the app will help us to identify factors and parameters to support patients on their pathway into the primary healthcare sector. Together with interviews, focus groups, group interviews, and workshops, the data in the app will help to develop a new treatment model that aims to prevent relapse of depression”, says Anne Sofie Mosborg Aggestrup, PhD student at the University of Copenhagen.
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About Monsenso
Monsenso is an innovative technology company offering a digital health solution used for decentralised trials, remote patient monitoring and treatment support. Our mission is to contribute to improved health for more people at lower costs by supporting treatment digitally and leveraging patient-reported outcomes data. Our solution helps optimise the treatment and gives a detailed overview of an individual’s health through the collection of outcome, adherence, and behavioural data. It connects individuals, carers, and health care providers to enable personalised treatment, remote care, and early intervention. We collaborate with health and social care, pharmaceuticals, and leading researcher worldwide in our endeavours to deliver solutions that fit into the life of patients and health care professionals. To learn more visit  www.monsenso.com.

References:
[1] Kessing, L.V. (2021). Depression, forekomst. Sundhed.dk.
https://www.sundhed.dk/borger/patienthaandbogen/psyke/sygdomme/depression/depression-forekomst/#:~:text=Depression%20er%20hyppig.,de%20lettere%20og%20moderate%20depressioner.

[2] Videbech, P., & Deleuran, A. (). The Danish Depression Database. Clinical Epidemiology, 8, 475–478.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5098510/

[3] Dunker Svendsen, S., Aggestrup, A.S., Nørregaard, L.B., Løventoft, P., Præstegaard, A., Danilenko, K.V., Frost, M., Knorr, U., Hageman, I., Vedel Kessing, L. & Martiny, K. (2019). Circadian reinforcement therapy in combination with electronic self-monitoring to facilitate a safe post-discharge period of patients with depression by stabilizing sleep: protocol of a randomized controlled trial. BMC Psychiatry, 19, 124. https://doi.org/10.1186/s12888-019-2101-z

[4] Tønning, M.L., Faurholt-Jepsen, M., Frost, M., Martiny, K., Tuxen, N., Rosenberg, N., Busk, J., Winther, O., Melbye, S.A., Thaysen-Petersen, D., Aamund, K.A., Tolderlund, L., Bardram, J.E. & Kessing, L.V. (2021). The effect of smartphone-based monitoring and treatment on the rate and duration of psychiatric readmission in patients with unipolar depressive disorder: The RADMIS randomized controlled trial. Journal of Affective Disorders, 282, 354-363. https://pubmed.ncbi.nlm.nih.gov/33421863/

[5] Lauritsen, L., Andersen, L., Olsson, E., Søndergaard, S.R., Nørregaard, L.B., Løventoft, P.K., Svendsen, S.D., Frøkjær, E., Jensen, H.M., Hageman, I., Kessing, L.V. & Martiny, K. (2017). Usability, Acceptability, and Adherence to an Electronic Self-Monitoring System in Patients With Major Depression Discharged From Inpatient Wards. Journal of Medical Internet Research,19(4), e123. https://pubmed.ncbi.nlm.nih.gov/28432040/

[6] Madsen, M.B. (2023). Forskere vil forbedre overgange i behandling til mennesker med depression gennem en brugerinddragende indsats. Region Hovestandens Psykiatri.
https://www.psykiatri-regionh.dk/presse-og-nyt/Nyheder-og-pressemeddelelser/Sider/forskningsprojektet-depric.aspx

European community-based intervention project will use Monsenso’s platform to prevent mental illness

European community-based intervention project will use Monsenso’s platform to prevent mental illness

Together with a European consortium of partners, Monsenso has received a grant letter on a new community-based intervention project that includes development and trial of a digital health intervention delivered on Monsenso’s platform to prevent mental illness among vulnerable groups.

Global trends such as war, economic crisis, climate changes, migration, pandemics and ageing population place increasing stress and pressure on European societies. To be able to adapt to fast-changing situations, scalable intervention programmes targeted at building resilience and enhancing self-help competency to prevent mental illness are needed.

Upon receiving this grant letter, Monsenso is now entering into grant agreement negotiations with a consortium of leading researchers in clinical psychology, internet-based therapy, AI and community mental health providers across Europe. The aim of the project is to develop and trial an AI-enabled personalised self-care program based on Monsenso’s platform to help prevent mental illness for high-risk groups. The five-year project is anticipated to start in Q2-2023 and is expected to contribute with DKK 5.7 mio to Monsenso.

“This is the second AI-enabled personalised therapy project that we plan to start in the coming year, and it comes after finalising another European research project this year, where results showed significant effect of delivering digital cognitive behavioral therapy for prevention of mental illness. We will build on the evidence and experience of previous projects and further develop our platform to provide personalised, AI-driven digital programs for people at risk of developing mental illness, so that they can get easy and timely access to evidence-based support”, says Thomas Lethenborg, CEO of Monsenso.

Further information on the project including consortium members, funding program and population groups targeted will be communicated upon signature of a grant agreement, which is expected in Q1 of 2023.
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About Monsenso
Monsenso is an innovative technology company offering a digital health solution used for decentralised trials, remote patient monitoring and treatment support. Our mission is to contribute to improved health for more people at lower costs by supporting treatment digitally and leveraging patient-reported outcomes data. Our solution helps optimise the treatment and gives a detailed overview of an individual’s health through the collection of outcome, adherence, and behavioural data. It connects individuals, carers, and health care providers to enable personalised treatment, remote care, and early intervention. We collaborate with health and social care, pharmaceuticals, and leading researcher worldwide in our endeavours to deliver solutions that fit into the life of patients and health care professionals. To learn more visit  www.monsenso.com.

Monsenso to participate in AI-enabled personalised mental health therapy project

Monsenso to participate in AI-enabled personalised mental health therapy project

Monsenso and a consortium of partners have received a grant letter from a funding entity to develop and trial a new, AI-enabled personalised therapy concept for people with mental disorders.

Currently, digital mental health interventions are largely developed as a one-size-fits-all approach, where patients get a fixed 6-12 week intervention and where drop-out rates are relatively high.

With the grant letter received, Monsenso is entering grant agreement negotiations with a consortium of leading researchers in clinical psychology, internet-based therapy, health economics and AI to develop and trial a new AI-enabled personalised care concept based on Monsenso’s platform. The four-year project is anticipated to start in Q2-2023 and is expected to contribute with DKK 3.9 mio to Monsenso.

“With this project, we will further develop our platform’s ability to deliver personalised digital treatment programs and to ensure optimal adherence to treatment. By leveraging patients’ own data and artificial intelligence, the aim is to be able to give more engaging and personalised care based on patients’ actual state, so that patients are offered the right treatment at the right time in a scalable way”, says Thomas Lethenborg, CEO of Monsenso.

Full disclosure of the project details including consortium members, funding program, and disorder area will be possible upon signature of the grant agreement, which is expected in Q1 of 2023.
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About Monsenso
Monsenso is an innovative technology company offering a digital health solution used for decentralised trials, remote patient monitoring and treatment support. Our mission is to contribute to improved health for more people at lower costs by supporting treatment digitally and leveraging patient-reported outcomes data. Our solution helps optimise the treatment and gives a detailed overview of an individual’s health through the collection of outcome, adherence, and behavioural data. It connects individuals, carers, and health care providers to enable personalised treatment, remote care, and early intervention. We collaborate with health and social care, pharmaceuticals, and leading researcher worldwide in our endeavours to deliver solutions that fit into the life of patients and health care professionals. To learn more visit  www.monsenso.com.