RADMIS: Reducing the rate and duration of readmission among patients with unipolar and bipolar disorder using smartphone-based monitoring and treatment

According to WHO, depression is becoming a leading cause of disability. The RADMIS project seeks to design smartphone-based monitoring and treatment technology for depressive patients. The goal is to establish the efficacy of this technology by measuring re-admission and clinical outcome.

Background

Depression and bipolar disorder (affective disorders) impose a very high societal burden in terms of cost, lost productivity, morbidity, suffering, and mortality, and is according to WHO a leading cause of disability and disease burden worldwide. According to the European Commission, depression is among the most pressing public health concern today, and account for more than 12% of all estimated ill health and premature mortality in Europe, only exceeded by heart disease and cancer.

Although psychiatric treatment internationally and in Denmark has shifted more from inpatient treatment to outpatient treatment during recent decades, costs to psychiatric hospitalization are still significant. In Denmark, two third of all direct costs within psychiatry is related to hospitalization. Patients with affective disorders are more frequently hospitalized than any other patient group, counting more than 10.800 patients in 2013 and 20% of all psychiatric hospitalizations.

Objectives

Smartphones provide a unique platform for monitoring and treatment of depression and mania. Equipped with powerful sensing, computation and communication capabilities, smartphones can continuously monitor an individual’s context including physical activity, location and environment. Depression and mania are associated with several behavioral components (e.g., reduction in activity, change in speech, changes in sleep) and motivational states (e.g., anhedonia), some of which may be detectable using smartphone sensors. Thus, smartphones hold significant promise as a platform to monitor behavioral and environmental indicators of depression and mania (see also the MONARCA II project).

Moreover, a smartphone also provides a rich multi-media and communication platform for Ecological Momentary Intervention (EMI), i.e. the delivery of context-aware and real-time treatment, including medication reminders and cognitive behavioral therapy (CBT). This intervention utilize the data monitored. The objective of the RADMIS project is to design, implement, and evaluate a platform for delivery of such just-in-time, context-aware treatment for patients with depression. This objective is divided into three goals:

Research, design, and develop a smartphone-based monitoring and treatment platform for affective disorders.
Provide clinical evidence for reduction of the number and duration of hospital re-admissions of patients with unipolar and bipolar disorder using smartphone-based treatment;
Provide clinical evidence for improving depression and other outcomes for patients with unipolar and bipolar depression receiving smartphone-based CBT.

The RADMIS study protocol is published and available in TRIALS [1].