Depression Help4Mood

The Help4Mood programme for people with major depression.

Background

Depression is one of the most common causes of short and long term disability in Europe. It accounts for substantial costs both directly to health services and indirectly through lost productivity and the burden of caring.

Most patients with Major Depression (MD) recover with treatment, which may be with antidepressant drugs, psychological therapy or, in severe cases, hospitalisation. However for many, that recovery is either slow or incomplete.

Research shows that psychological therapies can be delivered effectively without face to face contact: computerised cognitive behavioural therapy (CCBT) is suitable for self-guided treatment in the individual's own home. However, its value for patients is limited by the difficulty of staying engaged, and there are professional concerns that important changes in mood may be missed.

Help4Mood is a computerised support programme for people with MD that monitors mood, thoughts, physical activity and voice characteristics, prompting adherence to CCBT, and promoting behaviours in response to monitored outputs. 

The programme is delivered through a Virtual Agent (VA) which can interact with the patient through a combination of enriched prompts, dialogue, body movements and facial expressions. 

Monitoring combines movement sensor, psychological ratings and voice analysis as inputs to a pattern recognition based decision support system for treatment management. 

Outputs include:

• a validated personal monitoring system
• a personal interaction system embodied in a virtual agent
• a clinical decision support module

The aim of Help4Mood is to target added support for patients most in need and facilitate their earlier return to normal health and social and economic activity.

For more information see the Help4Mood website.

Aim

The purpose of the research study was to establish: 

• the acceptability of the programme among patients with major depression
• the clinical effectiveness
• the feasibility of recruitment to future trials

Method

A mixed method randomised controlled study. 

Quantitative data from validated measures of:

• depression
• negative thoughts
• quality of life

Qualitative interviews with patients to establish: 

• themes relating to experience of technology
• their treatment for depression
• their expectations and impression of Help4Mood

Setting

The study had three centres: Scotland, Romania and Spain. 

In Scotland, recruitment was in a primary care setting and GPs provided study information packs to potential participants. Seven participants were recruited in Scotland, three to the intervention (Help4Mood) and four to usual care.

Results

We conducted a pilot randomised controlled trial of Help4Mood in three centres, in Romania, Spain and Scotland, UK. Patients with diagnosed depression (major depressive disorder) and current mild/moderate depressive symptoms were randomised to use the system for four weeks in addition to treatment as usual (TAU) or to TAU alone.

Twenty-seven individuals were randomised and follow-up data were obtained from 21 participants (12/13 Help4Mood, 9/14 TAU). Half of participants randomised to Help4Mood used it regularly (more than 10 times); none used it every day.

Acceptability varied between users. Some valued the emotional responsiveness of the system, while others found it too repetitive.

Intention to treat analysis showed a small difference in change of Beck Depression Inventory II (BDI-2) scores (Help4Mood -5.7 points, TAU -4.2). Post-hoc on-treatment analysis suggested that participants who used Help4Mood regularly experienced a median change in BDI-2 of -8 points.

We concluded that Help4Mood is acceptable to some patients receiving treatment for depression although none used it as regularly as intended. Changes in depression symptoms in individuals who used the system regularly reached potentially meaningful levels.

Papers

Pilot randomised controlled trial of Help4Mood, an embodied virtual agent-based system to support treatment of depression (Journal of Telemedicine and Telecare, 2015)

Activity monitoring in patients with depression: A systematic review (Journal of Affective Disorders, 2013)