Health Information Technology in the Service of Depression Treatment

							                                            Editorial



Health Information Technology in the Service of Depression
Treatment
Neal Kaufman, MD, MPH




Patient self-management of depres-        not limited to their clinicians’ office       affords the opportunity to make
sion and other chronic conditions         hours.                                        psychosocial interventions avail-
supported by information tech-                Web-based learning and support            able to large segments of the public.
nology is becoming an important           technology benefits both clinicians           Interventions can be delivered pro-
factor in the way providers deliver       and patients; patients learn to over-         grammatically and reliably, greatly
health care. This new modality            come barriers and to self-document            extending the numbers and types
offers a remarkable opportunity for       activities and interactions, permitting       of people who can be reached with
clinicians. As the From Research          clinicians to review their progress           services.”1
to Practice section in this issue of      and feedback at any time. In addition             Since that 2002 report, the Inter-
Diabetes Spectrum (p. 7–37) shows,        to automating much of the educa-              net and cell phones have been used
patients with depression often need a     tional content, this time-shifting            more frequently to provide patient
complex set of services including psy-    element afforded by online tools is           self-management education and sup-
chotherapy, medication management,        one of the keys to making the sup-            port to help patients with depression
social support, physical activity         port process efficient and affordable.        and other chronic conditions meet
promotion, nutrition counseling,          The ability to perform automated              their complex and ever-changing
and more. Implementing such sup-          reviews of patients’ activities also          needs. Several reviews have sum-
port for individuals who are already      provides clinicians with a valuable           marized the depression-related
overwhelmed can be a challenge that       boon to effectiveness and efficiency.         experiences with a variety of these
requires a variety of strategies. Using       Linked with an online interven-           approaches.2–8
new online tools, clinicians can now      tion, “virtual coaches” can provide               In recent years, Web- and cell
have a major impact on depression         individualized guidance and support           phone–based approaches have been
outcomes by providing robust and          based on readily available analyses of        shown to be effective and inex-
affordable support to large numbers       patients’ characteristics and perfor-         pensive alternatives to traditional
of patients who want to make emo-         mance. Clinicians can communicate             depression treatments.9–17 These
tional and behavioral changes.            frequently, offering personalized             and other programs use a variety of
                                          email support to patients with-               psychological approaches typically
    Online tools can extend mental
                                          out requiring in-person meetings.             based on effective in-person interven-
health practices and provide support
                                          Clinicians can also monitor “virtual          tions that have been transformed
through cost-effective programs that
                                          support groups,” through which                for delivery via the Internet or cell
help clinicians guide their patients
                                          patients interact with others online          phones. Even with these successful
to better manage their depression.
                                          via informational chat rooms and              programs as examples, the limited
The best Internet self-management         blogs. By incorporating Web-based             available evidence makes it difficult
education and support programs are        patient self-management and support           to definitively state what impact
rich in pertinent content, provide        into traditional treatment methods,           these types of interventions will have
engaging interactive elements, and        one clinician can effectively support         on patients with depression. Still,
offer users a tailored, personalized      many patients, one patient at a time.         many of these innovative programs
learning experience. They contain                                                       are quite promising.
self-assessment tools and ways for        Depression Interventions
individuals to monitor their perfor-      As early as 2002, a work group                Summary
mance and changes in biological           commissioned by the U.S. National             Online self-management educa-
measurements such as weight, blood        Institute of Mental Health1 rec-              tion and support for patients with
pressure, mood, and blood glucose.        ommended the development of                   depression have the potential to
Patients can access their informa-        innovative mental health treatments           make not just an incremental dif-
tion, input their data, and receive       that could be delivered at low cost           ference in patient outcomes, but
support 24 hours a day, at times and      to large populations. Specifically,           rather a profound change in the way
places most convenient for them and       the work group noted, “the Internet           providers engage with patients. To
                                          Diabetes Spectrum Volume 23, Number 1, 2010                                            5
                                                        Editorial



    date, their use in clinical settings has       depression: cross sectional survey. BMJ           program. J Med Internet Res 4:e14, 2002
    been limited primarily because of              321:1511–1515, 2000                               (doi:10.2196/jmir.4.3.e14)
    the lack of reimbursement for online           6
                                                    Spek V, Cuijpers P, Nyklícek I, Riper H,         13
                                                                                                       Christensen H, Griffiths KM, Jorm AF:
    interventions. In the near future,             Keyzer J, Pop V: Internet-based cognitive         Delivering interventions for depression by
                                                   behaviour therapy for symptoms of depres-         using the Internet: randomised controlled
    clinicians may be able to use infor-           sion and anxiety: a meta-analysis. Psychol        trial. BMJ 328:265, 2004 (doi:10.1136/
    mation technology, coupled with                Med 37:319–328, 2007                              bmj.37945.566632.EE)
    traditional treatment approaches, to           7
                                                    Andersson G, Cuijpers P, Carlbring P,             Christensen H, Griffiths KM, Korten AE,
                                                                                                     14

    support large numbers of patients              Lindefors N: Effects of Internet-delivered        Brittliffe K, Groves C: A comparison of
    with depression in an economical               cognitive behaviour therapy for anxiety           changes in anxiety and depression symptoms
    and feasible manner.                           and mood disorders. Helix Review Series           of spontaneous users and trial participants
                                                   Psychiatry 9:9–14, 2007. Available online         of a cognitive behavior therapy website. J
                                                   from http://carlbring.se/review_series.pdf        Med Internet Res 6:e46, 2004 (doi:10.2196/
    References                                     8
                                                    Barak A, Hen L, Boniel-Nissim M, Shapira
                                                                                                     jmir.6.4.e46)
                                                   N: A comprehensive review and a meta-             15
                                                                                                       Evolution Health: Welcome to Depression
    1
     Hollon SD, Muñoz RF, Barlow DH,
                                                   analysis of the effectiveness of Internet-based   Center Beta 3.0 [article online]. Available
    Beardslee WR, Bell CC, Bernal G, Clarke
                                                   psychotherapeutic interventions. J Technol        from http://www.depressioncenter.net/
    GN, Franciosi LP, Kazdin AE, Kohn L,
                                                   Human Serv 26:109–160, 2008                       Default.aspx. Accessed 30 December 2009
    Linehan MM, Markowitz JC, Miklowitz
    DJ, Persons JB, Niederehe G, Sommers D:        9
                                                    van Straten A, Cuijpers P, Smits N:               Andersson G, Bergström J, Holländare F,
                                                                                                     16

    Psychosocial intervention development for      Effectiveness of a Web-based self-help inter-     Carlbring P, Kaldo V, Ekselius L: Internet-
    the prevention and treatment of depression:    vention for symptoms of depression, anxiety,      based self-help for depression: randomised
    promoting innovation and increasing access.    and stress: randomized controlled trial. J        controlled trial. Br J Psychiatry 187:456–461,
    Biol Psychiatry 52:610–630, 2002               Med Internet Res 10:e7, 2008 (doi:10.2196/        2005
                                                   jmir.954)
    2
     Griffiths KM, Calear AL, Banfield M, Tam                                                         MoodGYM: Interactive Web program
                                                                                                     17

    A: Systematic review on Internet support
                                                   10
                                                     Meyer B, Berger T, Caspar F, Beevers CG,        designed to prevent depression. Available
    groups (ISGs) and depression (2): what         Andersson G, Weiss M: Effectiveness of a          online from http://moodgym.anu.edu.au/
    is known about depression ISGs? J Med          novel integrative online treatment for depres-    welcome
    Internet Res 11:e41, 2009 (doi:10.2196/        sion (Deprexis): randomized controlled trial. J
    jmir.1303)                                     Med Internet Res 11:e15, 2009 (doi:10.2196/
                                                   jmir.1151)                                        Neal Kaufman, MD, MPH, is the
    3
     Christensen H, Griffiths KM, Farrer L:
    Adherence in Internet interventions for         Warmerdam L, van Straten A, Twisk J,
                                                   11                                                founder and chief executive officer
    anxiety and depression: systematic review. J   Riper H, Cuijpers P: Internet-based treat-        of DPS Health in Los Angeles, Calif.
    Med Internet Res 11:e13, 2009 (doi:10.2196/    ment for adults with depressive symptoms:
    jmir.1194)                                     randomized controlled trial. J Med Internet       Note of disclosure: Dr. Kaufman
                                                   Res 10:e44, 2008 (doi:10.2196/jmir.1094)
    4
     Lissman TL, Boehnlein JK: A critical review                                                     is the founder, owner, and chief
    of Internet information about depression.
                                                   12
                                                     Clarke G, Reid E, Eubanks D, O’Connor           executive officer of DPS Health,
                                                   E, DeBar LL, Kelleher C, Lynch F, Nunley
    Psychiatr Serv 52:1046–1050, 2001
                                                   S: Overcoming Depression on the Internet
                                                                                                     which develops and commercializes
    Griffiths KM, Christensen H: Quality of
    5
                                                   (ODIN): a randomized controlled trial of          health-promoting Internet and cell
    Web-based information on treatment of          an Internet depression skills intervention        phone–based interventions.




6                                                      Diabetes Spectrum Volume 23, Number 1, 2010