Les « E-Therapies » en prévention du suicide : dequoi ont-elles l’air, fonctionnent-elles et quelles sontles avenues pour ...
CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
What do they look like?CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
E-therapies1. First generation – “books on-line”2. Second generation – some on-line interaction– fill in questionnaires, a...
CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
Benefits of e-therapies• Convenient for users (access from home, nowaiting lists)• Can be tailored for specific groups• Ad...
Problems with new technologies• Reinforce inequalities – access and language• Limited evidence of effectiveness• Ethics of...
Do they work?• Recommended by NICE for mild to moderatedepression and anxiety• But evidence not strong and in non-clinical...
CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
National depression initiative• Reduce stigma• Educate GP’s – guidelines, training• John Kirwan – Depression.org.nz– Socia...
CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
#1#2#3#6Journal Lesson Activity13,0202,350 1,700 1,2001,1003,700650June 2010 to July 2011700,000 visitors20, 000 registere...
PHQ-9 SCORES GIVEN AT START, MIDWAYAND ENDPHQ-9 SCORESample completing end PHQ-9 scoreINITIAL SCORE MIDWAY SCORE END SCORE...
CHANGE IN PHQ-9 FROM START TO ENDCHANGE IN PHQ-9FROM START TO ENDSamplecompleting endPHQ-9 score(392)%Improvement 15+ 21.2...
Reasons for not continuingREASONS FOR NOT CONTINUINGThose who didnot completeall sixThose whoregistered butdid not begin(1...
CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
Appeal of option for integrating TheJournalAPPEAL OF DATABEING AVAILABLETO PRACTICETotal* GPsPracticenursesPrimarymentalhe...
What is the research agenda?• Address different levels of suicide prevention –patients, family, clinicians• Community e-th...
Effectiveness studies needed• RCT’s (must include ITT analysis, report adverseeffects, economic analysis)• Do RCT’s at pri...
How do they work (or not work)• Acceptability• Feasibility (access, low tech alternatives)• Minority preferences• How to i...
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CRISE - INSTITUT 2012 - Simon Hatcher - E-therapies in suicide prevention : what do they look like, do they work and what is the research agenda?

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CRISE - INSTITUT 2012 - Simon Hatcher - E-therapies in suicide prevention : what do they look like, do they work and what is the research agenda?

  1. 1. Les « E-Therapies » en prévention du suicide : dequoi ont-elles l’air, fonctionnent-elles et quelles sontles avenues pour la recherche?Professor Simon HatcherThe University of OttawaCRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
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  3. 3. What do they look like?CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
  4. 4. E-therapies1. First generation – “books on-line”2. Second generation – some on-line interaction– fill in questionnaires, answer quizzes,learning by gaming (SPARX)3. Third generation – integration with mobilephones/email/smart devices4. Fourth generation – smart environments and“mobile therapist”CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
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  11. 11. Benefits of e-therapies• Convenient for users (access from home, nowaiting lists)• Can be tailored for specific groups• Addresses work force problems• Cost effective (?)CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
  12. 12. Problems with new technologies• Reinforce inequalities – access and language• Limited evidence of effectiveness• Ethics of monitoring• Rapidly outdated• Privacy and risk issues• Seductive (!)CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
  13. 13. Do they work?• Recommended by NICE for mild to moderatedepression and anxiety• But evidence not strong and in non-clinicalpopulations.CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
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  15. 15. National depression initiative• Reduce stigma• Educate GP’s – guidelines, training• John Kirwan – Depression.org.nz– Social marketing– E-therapy for mild to moderate depression– Telephone help lineCRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
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  19. 19. #1#2#3#6Journal Lesson Activity13,0202,350 1,700 1,2001,1003,700650June 2010 to July 2011700,000 visitors20, 000 registered with The Journal13,020 active usersCRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
  20. 20. PHQ-9 SCORES GIVEN AT START, MIDWAYAND ENDPHQ-9 SCORESample completing end PHQ-9 scoreINITIAL SCORE MIDWAY SCORE END SCORE(392)%Under 10: Not depressed 17.1 56.6 75.310 to 14: Mild depression 22.7 24.0 15.315 to 19: Moderate depression 29.1 10.5 4.120 or more: Severe depression 31.1 8.9 5.4Mean score: 15.84 9.84 6.9256% decreaseoverall30%decreaseCRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
  21. 21. CHANGE IN PHQ-9 FROM START TO ENDCHANGE IN PHQ-9FROM START TO ENDSamplecompleting endPHQ-9 score(392)%Improvement 15+ 21.275.390.1Improvement 10 to 14 24.0Improvement 5 to 9 30.1Improvement 1 to 4 14.8No change 3.3Worsening 1 to 4 5.16.6Worsening 5 or more 1.5CRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
  22. 22. Reasons for not continuingREASONS FOR NOT CONTINUINGThose who didnot completeall sixThose whoregistered butdid not begin(101) (68)% %Not had time 45 34Needed more support to keep going 38 24Satisfied with what had got 32 NMWanted to be able to skip some sessions 28 10Felt too unwell 26 28Didnt feel able to do what was being asked of me 26 9Because of Journal no longer feeling depressed 24 NMCouldnt be bothered 23 18For reasons nothing to do with Journal am no longer feeling depressed 18 NMNo longer depressed NM 31Journal not working properly – technical problems 15 15Sessions take too long 14 12Did not know or forgot how to get back into Journal to continue 14 32Videos were downloading too slowly 12 NMHad other computer problems 11 21Did not receive email NM 16Did not know how to continue once received email NM 13Improvements did not last long enough to be worth continuing 11 NMDoing Journal made me feel more depressed 11 NMDid not think what done so far was useful 10 NMDid not think it would be useful 8 10Too many sessions required to complete Journal 7 6Content didnt interest me 5 4None of these/ not answered 1 4NM = Not measured; Circled items are most mentioned main reasonCRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
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  24. 24. Appeal of option for integrating TheJournalAPPEAL OF DATABEING AVAILABLETO PRACTICETotal* GPsPracticenursesPrimarymentalhealth(135) (69) (30) (36)% % % %Appeals a lot (4) 36 25 47 47Appeals somewhat (3) 29 30 27 28Appeals a little (2) 20 28 13 11Does not appeal (1) 14 17 13 8Dont know 1 0 0 6Mean 2.9 2.6 3.1 3.2* Excludes receptionistsCRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
  25. 25. What is the research agenda?• Address different levels of suicide prevention –patients, family, clinicians• Community e-therapies• Education for gatekeepers• Decision support for primary care• Clinican supported computer care in primary care• Secondary care – decision support, more intensecomputer supported care, home monitoringCRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
  26. 26. Effectiveness studies needed• RCT’s (must include ITT analysis, report adverseeffects, economic analysis)• Do RCT’s at primary care level as that is where mostpeople present• Where do e-therapies fit within stepped care• Comparisons with self-help, placebo and therapistdelivered therapy• Head to head comparisons of different e-therapiesCRISE - SUMMER INSTITUTE 2012 - MONTRÉAL
  27. 27. How do they work (or not work)• Acceptability• Feasibility (access, low tech alternatives)• Minority preferences• How to interact with humans to produce change inbehaviour• Reasons for drop outs• What training is needed for clinicians to usecomputerised therapies• Privacy, risk and ethical issuesCRISE - SUMMER INSTITUTE 2012 - MONTRÉAL

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