Personal Health Technologies for Management of Mental Health – Prevention, Early Intervention and Treatment Experiences. Korhonen I. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. Personal health systems for
mental health management,
early intervention and
treatment
Ilkka Korhonen
Technology Manager
VTT Technical Research Centre of Finland

2. Mental health - costs
• Mental health problems costs 3-4% GDP in
OECD countries (ILO 2000)
• Finland: 49% of all disability pensions, 30% of
absenteism, 13% direct healthcare costs (2007)
• Germany: 74% increase from 1995 to 2002 in long-
term sick-leaves due to mental health problems
(Knapp et al 2007)
• Depression 6% of all DALYs (WHO 2005) –
most common mental disorder
• Prevalence ~6-7%, ~20% of all people at some point
of ther life

3. Depression - challenges
• Depression is under-diagnosed or diagnosed with a delay
• Treatmens more effective when applied in time
 Tools to improve early diagnosis needed
• Efficient treatments of depression exist (medication + therapy) but:
• In Europe, 90% of people with mental health problems said they had
received no care in the previous 12 months, and only 2.5% of them
had seen a therapist (Knapp et al 2007)
• Only 1/3 of people with anxiety and depressive disorders have mental
health treatment, of which half occurs in primary care and lacks expert
consultation (Katon 2003)
• Main reason: access block = lack of resources for treatment (esp.
scarcity of therapists/experts)
• Also, fear of stigma, lack of expertise and tools in primary care
 Tools for efficient treatment needed

4. Computerised Cognitive Behavioral
Therapy (CCBT)
• Treatment of affective disorders:
medication + therapy (esp. CBT)
• CCBT = “generic term for
delivering CBT via an interactive
computer interface delivered by a
personal computer, internet or
interactive voice response system"
• CCBT has been shown to be
effective
• Outcomes comparable to
traditional care
• Up to 75% less therapist time
needed
 Opportunity to ease the access
block!
• Current CCBT tools
• Based on simple technologies
• Not widely deployed

5. Personal Health Systems
New wearable devices Advanced analysis tools
- easy, affordable, accurate and psychophysiological models
- from data to information and feedbac
Computing and connectivity + New service models
- pervasive + New delivery and business models
+ New peer and social networks
Easy, available, affordable, efficient,
personalised, trusted, standard-based,
interoperable, citizen-driven

6. Personal Health Toolbox
www.nuadu.org

7. 7
Mobile Wellness Diary

8. Matching of intervention and PHS
Theme Structure Technology
NUADU I NUADU II
•Goal of Interventions •Healt binder •Scale
1. Analysis of good
•Analysis of Good life •Self observation •Pedometer
life and actions to •Self awereness exercise form •Wellness Diary
promote it •Home assignments •Scale •Nuadu-portal
ACT
•Self Observations
•Nuadu-portal
2. Analysis of •Analysis of health- and wellbeing
•Self observation -Wellness Diary
health- and •Self awereness and observer
form -Nutritioncode
wellbeing exercise
(food diary)
•Home assignments
•Self Observations
3. Own work ability •Rapatti-learning game •Self observation
•Mobile Coach
and lifestyle •Problem solving method form
•Home assigments
4. Solutions to •Speed relaxation
RaPatti
•Feedback from Rapatti-learning
problematic •Self observation
game •SelfRelax
situations •Finding solutions to problematic
form
situations
•Stages of change •Firstbeat
5. Plans for the •Experiences from problem solving •Self observation HEALTH +
future •Plans for the future form borrowing HR-
•Feedback from interventions belt

9. RCT – impact of PHS?
Health Questionnaire
City of Espoo Employees
Replied n=4134
(n ~10 900)
(38%), willing to
participate
Fulfilled Inclusion criteria (n=782) n= 3401 (31%)
Randomization
Subjects (n=352)
Intervention Group 1 Intervention Group 2 + technology
Control Group (n= 116)
(n= 118) (n= 118)
BASELINE: Measurements, NUADU-Questionnaire and personal feedback (n=352)
Drop-out: other reasons
Intervention I Intervention II (n=3)
Results from measurements Results from measurements
Personal health goal Personal health goal
Health binder Health binder
Self-observation equipment Group meetings
Group meetings (5 x 1.5h) (5 x 1.5h + 30min)
ICT-tools
Drop-out: other reasons (n=1)
Non-compliance (n=1) Non-compliance (n=4)
Drop-out: other reasons
(n=1)
Personal support (n=117, Personal support, ICT, borrowing
99%) HR-belt (n=114, 97%)
6 MONTHS: NUADU-Questionnaire (n=347, 99%)
Drop-out: other reasons Drop-out: other reasons Drop-out: other reasons
(n=3), health (n=3) (n=3), health (n=1) (n=4)
Intervention Group 1 Intervention Group 2
Control Group (n= 112, 97%)
(n=111, 94%) (n=110, 93%)
12 MONTHS: NUADU-Questionnaire (n=318, 90%), Measurements (n=317, 90%) and personal
feedback (n=333, 95%)

10. Preliminary results
• PHS usage
• At the beginning, >80% at least tried some PHS
• Usage dropped during study – after 12mths, ~30% active users
• Different PHS had different users and each PHS gained an active and
committed group of users
• Benefits (own assessment)
• Increased exercising
• Better understanding of own health
• Better understanding of own fitness
• Improved motivation towards better lifestyle
• Improved stress management
• Feedback more positive after the end of the study (experiences) than
prior to study (expectations)
• Note: analysis of true health benefits not completed

11. Cardiac rehabilitation, QLD,
Australia
Personal devices at home Service Provider
Web-portal access Web portal Other Health
PC via internet Information
Measurement Health Systems
Diary data
data Reports
Data display for
self management Educational Discussion,
material messaging
Diary, data & photo Server Health
Database Health
Database
Motivational
synchronisation Records Records
SMS & Video
Server
Relaxation audio via 3G
Internet
Measurement Bluetooth and
manual entry Treatment & Community Care Team
Devices Health
mentoring
feedback via Information
Mobile
Phone phone
3G
Data to server:
• Diary entries
• Measurement data
• Photos
Movement activity Feedback Tools:
Heart Rate • Videoconference
Blood Pressure • Teleconference
Weight Web portal GUI
• Multimedia & SMS
In collaboration with AEHRC, CSIRO

12. Home-based rehabilitation
programme
Home Program Overview
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7->
Getting Activity Anxiety Smoking Medications Sleep
Themes started Relaxation Panic Overweight Cholesterol Family
Motivation Worries Phobias Diet High blood Sex
Heart Attack Emotions Low mood pressure
Angina Stress Depression Diabetes
Tele & Video-
conference (Mentor)
Goals & Plan
WellnessDiary Entries twice/day
StepCounter Continuous use
SMS (text messages) 2/day
Video clips 2/week
Relaxation Audio Every day

13. P4Well: Technology Toolkit for
Supported Self-Management of Stress
and Mild Depression
• PHS toolkit +
psychological intervention
programme
• 3 group intervention
meetings
 cost-efficiency of a
group intervention
• PHS to empower self-
management
 personalisation through
use of PHS and
eConsultation

14. Depresssion
9
8
7
6
5 Test
4 Control
3
2
1
0
Pre Post

15. PHS and mental health
• Main challenge in mental health problems is to provide treatments to all in
need – especially depression
• Early access – empowerment – efficient use of expert’s time
• PHS may significantly improve CCBT
• Better access
• Continuous monitoring
• Contextuality – treatment opportunity
• Our experiences
• PHS are accepted and used (~30-90% active users in long-term) when applied
in combination with a proper intervention model (support / service)
• Mobility is the ”killer application”
• Toolkit approach seems to work
• PHS and intervention programme need to be designed in parallel
• PHS alone will not work
• PHS glued on top of existing treatment models will not work
• Stepped care models

16. Thank you!
ilkka.korhonen@vtt.fi