As the world grows older, richer and more informed, the number of people being diagnosed with depression is expected to increase even further.
Besides the impact on health and lifestyle, at its worst, depression can lead to suicide.
In India, where one in 10 people suffer from depression, there is 1 mental health worker for a 100,000 population. Contrast this with a global average of 9 and a much higher number in many western countries. Clearly, there is a need to use digital innovations to find non-linear ways to help educate, diagnose and provide care to many patients with depression. A number of digital interventions launched over the last few years are helping manage patients of depression.
Types of digital health solutions
Intellicare is a suite of 12 interactive mini-apps that combat depression and was launched by Northwestern Medicine. The intervention is funded by the National Institute of Mental Health and functions like a shopping site by recommending a simple mobile app to help in mental distress based on past preferences and feedback from a larger crowd of users.
The MoodHacker app takes a self-management approach to depression management. Users can track their mood on the app along with other factors like food and activity, to educate themselves about what things correlate to different moods. The app responds to the data with analysis and videos about depression. A randomized control trial of the app in 300 adults showed users performed better on behavioural activation, depression knowledge and management of negative thoughts.
A number of other digital health interventions like Lantern, TalkSpace and InnerHour that use web and mobile app-based platforms offer cognitive behaviour therapy for depression and other mental health conditions.
In rural India, where suicide rates may be higher that the rest of the country, a scarcity of healthcare workers is leading to innovative digital solutions. The SMART program deployed in villages of Andhra Pradesh, empowers healthcare workers with mobile phones and tablets to conduct standardised tests in target populations. The test results are reviewed by remotely placed experts who then can direct the health workers to specific interventions. Challenges abound in scaling such solutions, but they do provide a template to use digital technologies for increasing diagnosis and intervention options beyond those currently available.
Challenges with digital interventions
The availability of digital technologies offers a great opportunity to address the issue of access, affordability and outcomes for patients of depression. This is evident from the profusion of mental health apps in the last few years. However, the promise of these interventions must be tempered with results they have produced thus far.
A UK based study found that over 85% of the National Health Services accredited mental health apps do not show any evidence of outcomes. The same study found that that while there were more than 1,500 apps available in 2013 that claimed to help deal with depression, only 32 academic articles had been published on the subject.
Dr John Torous, the Editor-in-chief of the JMIR Mental Health has cautioned that a lot of mental health apps are based on “flimsy science”. “If you type in ‘depression’, its hard to know if the apps that you get back are high quality, if they work, if they’re even safe to use.” Dr Torous, who chairs the American Psychiatric Association’s Smartphone App Evaluation Task Force says “Right now it almost feels like the Wild West of health care.”
Depression remains widely under-diagnosed and plagued with a severe shortage of trained health experts. This situation is not getting better and from available trends, the demand-supply gap will continue to widen. It’s easy to see how digital technologies can and must play a bigger role in improving diagnosis, treatment and ongoing care for patients of depression.
A recent review recognised the opportunity that smartphones provide in expanding treatment options, especially due to their ubiquity and the privacy they offer to users. The paper also urged the need for randomised clinical trials to validate many of these apps as well as the principles on which they are established. Digital technology proponents have been urged to follow the sixteen recommendations laid in this paper to demonstrate the impact of these interventions on patient outcomes. This paper and the scrutiny around depression apps are great for driving impactful interventions. They provide a map for digital innovators to demonstrate that their solutions indeed accomplish what they set to do.
Despite the limited evidence of impact thus far, it remains clear that digital interventions will play a key role in enhancing our ability to identify, manage and treat the millions of depressed patients that don’t get the care they should be entitled to. That is the future – we just need to chart out the path to get there.
Dr Aakash Ganju is a healthcare consultant and entrepreneur, focused on increasing transparency, access and convenience to health providers and consumers. He is the CEO of Mirai Health and lives in Mumbai, India.