This PhD is nested in the RADMIS project which seeks to design smartphone-based monitoring and treatment technology for bipolar and depressive patients. (LINK) The aim of this PhD is to establish the efficacy of this technology by measuring re-admission and clinical outcome for patients discharged from a psychiatric ward with a depressive episode and a diagnose of depression using af RCT design.
Find the PhD here
Background
Unipolar disorder (Depression) is a severe and common disease with a lifetime prevalence of 15–20%1. Patients with affective disorders are more frequently hospitalized than any other patient group, counting 20% of all psychiatric hospitalizations in Denmark2. The period following discharge from hospitalization is a high risk period with increased risk of suicide and readmission.3
Unipolar disorder is associated with changes in several behavioral components (e.g. reduction in activity level, change in speech) and motivational states (e.g. anhedonia), that may be detectable using readily available smartphone sensors. Smartphones are capable of collecting automatically generated behavioral data on measures of illness activity on a daily basis and comprise an innovative and unique platform for the monitoring and treatment of depression and hold significant promise as a platform to monitor behavioral and environmental indicators of depression and mania (see also the MONARCA II project).
Objectives
The aim of my PhD is to investigate whether using a smartphone-based monitoring and treatment system, including an integrated clinical feedback loop, reduces the rate and duration of readmissions more than standard treatment in patients with unipolar disorder. No prior trial has done that.
The trial uses a randomized controlled, single-blinded design. Patients with unipolar disorder are invited to participate when discharged from psychiatric hospitals in The Capital Region of Denmark following an affective episode and randomized to either
- Standard treatment + a smartphone based monitoring & treatment system (intervention group)
- Standard treatment (control group)
Study period is 6 months with assessments at baseline, 3 month and 6 month.
The smartphone system used in the trial was designed in an interactive process between patients with unipolar and bipolar disorder, IT researchers, clinicians, and clinical researchers and consists of 3 main functionalities:
- Data collection: The app collects information either automatically (i.e. social- and physical parameters) or by daily patient ratings (i.e. mood, sleep, stress and medicine intake).
- Integrated double feedback loop: The collected data is made available by various graphic presentations to the patient and a study nurse. Based on data observations the patient and the study nurse can interact to help the patient in a number of ways.
- Tools for cognitive behavioral therapy (CBT): The app contains a number of tools including movies and graphics about CBT, CBT assignments, action plans, list of triggers and warning signs and other tools and functions to help the patient in the daily life. All functionalities can be personalized and used by the patient alone or with help and guidance from the study nurse.
References
- Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the national comorbidity survey replication (ncs-r). JAMA. 2003;289(23):3095–105
- The Psychiatric Central Register. [Internet]. 2016. Available here. Accessed 11 June 2017
- Mortensen PB, Agerbo E, Erikson T, Qin P, Westergaard-Nielsen N. Psychiatric illness and risk factors for suicide in Denmark. Lancet Lond Engl. 2000;355(9197):9–12.