Dr. Heleen Riperhriper@trimbos.nl

Innovation Centre of Mental Health & Technology

Sustainable prevention with e-mental health

INPES April 2010

What would do?

What would do?

1 out of 4 mental health problem in lifetime

1 per 15 YP

1 million suicides per year

0

2

4

6

8

10

12

Disease burden in 2030

Worldwide

% o

f tot

al D

ALY

Source: Mathers & Loncar, 2006

0

2

4

6

8

10

12

High-income countries

Cataracts

HIV/AID

S

Depression

Is. h

eart dise

ase

Road traffi

c

Perinata

l

Cerebrovascu

lair

COPD

chest

infections

Hearing l

oss

Alzheim

er / dementias

Depression

Is. h

eart dise

ase

Alcohol

Diabetes

Cerebrovascu

lair

Hearing l

oss

Lung c

ance

rs / in

fections

Osteart

hritis

COPD

% o

f tot

al D

ALY

more people less money transition chonic diseases

self-managementlife style

health decisions are made by ..

EMH 2000 - 2010co

sts

treatment duration and intensity

effect sizessmall medium

large

mental fitness

prevention

treatment

relapse preventioncare

population health gainlarge medium

small

© Riper 2008

Is it scalable from research into the

Real World?

33%

73%

5%

60%

Developing

Developed

World

% m

obile

sub

s.

90% 25% 17%

5%

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

020406080

100120

Internet Penetration

Study N Target group Comp CYL/WL/ 12 wks* significant

Spek 2008 301 50+ d= 0.55

Warmerdam 2008 268 18+ d= 0.69

De Graaf 2009 303 18+ d= 0.20

Voordouw 2009 6568/1111

18 + d= 1.09 (Pre-post within)

Color Your Life

Drinking Less

*P<0.001

Drinking Less Real World N= 378 ITT

N/ RCT

Target Group Successful drinking at 6 months

Successful drinking at 12 months

261 14/21 SU Alcohol weekly and/or 6/4 per occasion

17,2% DL5,4 % Control(p= .008)

13,6% DL5,5% Control(p<.05)

6 months 12 months

Percentage successful

18,8 %* 17,5 %*2.750 monthly visitors1 out of 16 starts with DLMean 40.9 (25.2 SD) SU WeeklyAUDIT: M 20.27 (sd 6.30)6 months study period: N= 972Response rate 39%Drop out 59% & 56%

Theory: 4 possible outcomes

Modelling cost-effectiveness of eHealth interventions 16

More costsLess effect

Fewer costsLess effect

More costsMore effect

Fewer costsMore effect

Example 1: Self-help in depression

Modelling cost-effectiveness of eHealth interventions 17

-7.500

-5.000

-2.500

0

2.500

5.000

7.500

10.000

-0,40 -0,20 - 0,20 0,40 0,60 0,80

Additional effects

Ad

dit

ion

al c

ost

s

Smit F, Willemse G, Koopmanschap M, Onrust S, Cuijpers P, Beekman A. (2006) Cost-effectiveness of preventing depression in primary care patients: randomised trial. British Journal of Psychiatry 188: 330-336

Example 2: eHealth v waitlist

Modelling cost-effectiveness of eHealth interventions 18

-500

-0.20 - 0.20 0.40

Additional effects

Additio

nal

cost

s

Example 3: eHealth v Group CBT

Modelling cost-effectiveness of eHealth interventions 19

-2,000

500

-0.20 - 0.20 0.40

Additional effects

Additio

nal costs

Key messages

Modelling cost-effectiveness of eHealth interventions 20

low sesetnic cultural minoritiesrecruitment

acceptable interventions

visual screener

Visual Screener

Visual Screener Depression, Anxiety &Alcohol DutchN=86

TurkishN= 82

1. How do you feel? depression 0.39 r 0.21 r2. How did you feel in the past two weeks? depression 0.47 r 0.29 r3. Do you worry a lot? GAD 0.46 r 0.30 r4. Do you sometimes suddenly panic? Panic 15.14 χ2 21.94 χ2

5. Are you afraid of busy places that are difficult to leave?

AGO 0.53 χ2 n.s. 7.28 χ2

6. Is there something that you are very afraid of? Specific Phobia 21.30 χ2 6.53 χ2

7. Are you afraid of being watched by people? Social Fobia 14.22 χ2 1.33 χ2 n.s.

8. Have you ever experienced something horrible?

PTSD 24.39 χ2 12.32 χ2

9. Do you sometimes have unpleasant thoughts that won’t go away?

OCD 5.58 χ2 0.92 χ2 n.s.

10. Do you ever think about your own death? Alcohol 0.70 r 0.22 r11. Do you ever think of killing yourself? Suicide 23.47 χ2 4.29 χ2

Validadion Visual Screener

effective scalable acceptable

planned effortsknowledge

turning point sustainablefilling the gap

health gain

thank you for your attention

Heleen Riperhriper@trimbos.nl