1. Les « E-Therapies » en prévention du suicide : de
quoi ont-elles l’air, fonctionnent-elles et quelles sont
les avenues pour la recherche?
Professor Simon Hatcher
The University of Ottawa
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3. What do they look like?
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4. E-therapies
1. 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 mobile
phones/email/smart devices
4. Fourth generation – smart environments and
“mobile therapist”
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11. Benefits of e-therapies
• Convenient for users (access from home, no
waiting lists)
• Can be tailored for specific groups
• Addresses work force problems
• Cost effective (?)
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12. Problems with new technologies
• Reinforce inequalities – access and language
• Limited evidence of effectiveness
• Ethics of monitoring
• Rapidly outdated
• Privacy and risk issues
• Seductive (!)
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13. Do they work?
• Recommended by NICE for mild to moderate
depression and anxiety
• But evidence not strong and in non-clinical
populations.
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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 line
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19. #1
#2
#3
#6
Journal Lesson Activity
13,020
2,350 1,700 1,2001,100
3,700
650
June 2010 to July 2011
700,000 visitors
20, 000 registered with The Journal
13,020 active users
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20. PHQ-9 SCORES GIVEN AT START, MIDWAY
AND END
PHQ-9 SCORE
Sample completing end PHQ-9 score
INITIAL SCORE MIDWAY SCORE END SCORE
(392)
%
Under 10: Not depressed 17.1 56.6 75.3
10 to 14: Mild depression 22.7 24.0 15.3
15 to 19: Moderate depression 29.1 10.5 4.1
20 or more: Severe depression 31.1 8.9 5.4
Mean score: 15.84 9.84 6.92
56% decrease
overall
30%
decrease
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21. CHANGE IN PHQ-9 FROM START TO END
CHANGE IN PHQ-9
FROM START TO END
Sample
completing end
PHQ-9 score
(392)
%
Improvement 15+ 21.2
75.3
90.1
Improvement 10 to 14 24.0
Improvement 5 to 9 30.1
Improvement 1 to 4 14.8
No change 3.3
Worsening 1 to 4 5.1
6.6
Worsening 5 or more 1.5
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22. Reasons for not continuing
REASONS FOR NOT CONTINUING
Those who did
not complete
all six
Those who
registered but
did not begin
(101) (68)
% %
Not had time 45 34
Needed more support to keep going 38 24
Satisfied with what had got 32 NM
Wanted to be able to skip some sessions 28 10
Felt too unwell 26 28
Didn't feel able to do what was being asked of me 26 9
Because of Journal no longer feeling depressed 24 NM
Couldn't be bothered 23 18
For reasons nothing to do with Journal am no longer feeling depressed 18 NM
No longer depressed NM 31
Journal not working properly – technical problems 15 15
Sessions take too long 14 12
Did not know or forgot how to get back into Journal to continue 14 32
Videos were downloading too slowly 12 NM
Had other computer problems 11 21
Did not receive email NM 16
Did not know how to continue once received email NM 13
Improvements did not last long enough to be worth continuing 11 NM
Doing Journal made me feel more depressed 11 NM
Did not think what done so far was useful 10 NM
Did not think it would be useful 8 10
Too many sessions required to complete Journal 7 6
Content didn't interest me 5 4
None of these/ not answered 1 4
NM = Not measured; Circled items are most mentioned main reason
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24. Appeal of option for integrating The
Journal
APPEAL OF DATA
BEING AVAILABLE
TO PRACTICE
Total* GPs
Practice
nurses
Primary
mental
health
(135) (69) (30) (36)
% % % %
Appeals a lot (4) 36 25 47 47
Appeals somewhat (3) 29 30 27 28
Appeals a little (2) 20 28 13 11
Does not appeal (1) 14 17 13 8
Don't know 1 0 0 6
Mean 2.9 2.6 3.1 3.2
* Excludes receptionists
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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 intense
computer supported care, home monitoring
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26. Effectiveness studies needed
• RCT’s (must include ITT analysis, report adverse
effects, economic analysis)
• Do RCT’s at primary care level as that is where most
people present
• Where do e-therapies fit within stepped care
• Comparisons with self-help, placebo and therapist
delivered therapy
• Head to head comparisons of different e-therapies
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27. How do they work (or not work)
• Acceptability
• Feasibility (access, low tech alternatives)
• Minority preferences
• How to interact with humans to produce change in
behaviour
• Reasons for drop outs
• What training is needed for clinicians to use
computerised therapies
• Privacy, risk and ethical issues
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