Prescripción accesible de psicoterapia en pacientes con depresión en Atención Primaria: iFightDepression.

Prescripción accesible de psicoterapia en pacientes con depresión en AP: Ifightdepression

The development of the iFightDepression website and self-management tool
Annabel Cebria1,2,4 Eva Aguilar1,2,4; ;Azucena Justicia1,2,3; Matilde Elices 1,3; Jesús
Gorosabel5;Dolors Puigdemont1,6;Javier de Diego16;Andrea Gabilondo7Alvaro Iruin7; E.
Arensman, U. Hegerl, Víctor Pérez1,2,3;,Diego J Palao1,2,4
1

Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain

2 Departament

de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain
Institut de Neuropsiquiatria i Addiccions, Hospital del Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
4 Parc Taulí Hospital Universitari. Sabadell, Spain
3

5 Lagasca
6

Health Center. Madrid, Spain

Department of Psychiatry, Hospital de la Santa Creu i Sant Pau. Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.

7 Outpatient

Mental Health Care Network, Osakidetza- Basque Health System. Biodonosti Health Research Institute, San Sebastian, Spain

University Hospital, Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
German Depression Foundation, Depression Research Centre, Leipzig, Germany

What are the benefits of implementing the iFightDepression
tool in clinical practice?
· A tool to offer to (mild and moderately) depressed patients
· Which might help to bridge waiting times to specialised care
· Early intervention with this patient group to prevent the development of
severe depression
· Improving your knowledge about Cognitive Behavioural Therapy (CBT) and
basic psychotherapeutic skills
· The opportunity to develop local networks of professionals
· Additional material for your work with depressed patients

Depression:
Public Health Significance
Size of the Problem in developed countries:
Developed countries

10

14.6

6.2

5.7

5.4

4.1

4.0

3.5

3.4

2.6

2.4

% of total YLD

8
6
4
2
0

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YLD

12

*COPD:
chronic obstructive
pulmonary disease

WHO: The global burden of disease (2004; update 2008).

Depression:
Diagnostic and therapeutic deficits
Patients in
primary care
treatment

100

60-70

Correctly
diagnosed

Adequate
treatment

Compliant
after 3 months

RANGE OF OPTIMISATION

Patients with
depression in
need for
treatment

35-50

15-20

< 10

Kohn et al. (2004), Boenisch et al. (2012), Pence et al. (2012)

The iFD tool - a self-management tool

What is self-management?

· "Interventions, trainings, and skills by which patients
with a chronic condition, disability, or disease can
effectively learn how to take care of themselves and
effectively deal with difficult situations"
(Sterling et al, 2010)
· Successfully applied to chronic somatic diseases
· Increasingly being applied to mental health

GPs and Mental Health Practitioners role in
supporting self-help with the iFD tool

· To identify patients who might benefit from the iFD
tool
· Encourage patients to use the iFD tool
· To help tackle obstacles in using the materials

· NB ­ Patients can and should continue to use
medication or any other treatments they have been
undertaking while using the iFD tool.

The development of the iFD tool

· iFightDepression is based on
· Elements of Cognitive Behavioural Therapy (CBT)
· Other elements, such as sleep regulation

· It was developed based on
· The existing evidence of online self-management of
depression
· Additional input to the material by international experts
from the field
· Personal experiences of the researchers involved in PREDINU
· Phase 1 of the PREDI-NU project which provided user and
professional feedback

computerised CBT (cCBT):
An evidence based approach?

Findings from a meta-review conducted by the PREDINU researchers (including 1 meta-review and 21 systematic reviews)
· cCBT is ...
· equally effective to therapist-led CBT
· more effective than treatment as usual and bibliotherapy
· effective in reducing depressive symptoms and improving
diagnostic status
· more effective in guided interventions than non-guided or
purely self-guided cCBT interventions
· more effective for people with mild to moderate
depression than for those with major/severe depression

iFightDepression: overall outline

iFightDepression

iFightDepression

Adult version

Version for young
people (15 ­ 24)

(25 and older)

6 core modules

6 core modules

1 optional module

3 optional modules

Healthy Lifestyle

Healthy Lifestyle

Social anxiety
Relationships

iFightDepression: overall outline

The 6 core modules:
Module 1: Thinking, Feeling and Doing
Module 2: Sleep and Depression
Module 3: Planning and Doing Things That You Enjoy
Module 4: Getting Things Done
Module 5: Identifying Negative Thoughts
Module 6: Changing Negative Thoughts
1 Optional module
Module 7: Feel Better All Round: Healthy Lifestyle

What does iFightDepression
involve for the patients?
· Completion of six core modules

· Suggestion: one module per week (approx. 30 ­ 45 min each)
· Patients themselves decide about the pace of their work

· Optional modules

· 1 for adults, 3 for young people
· Patient can choose depending on their personal circumstances

· Worksheets and exercises
· Mood scoring (PHQ-9)

· 3 automated obligatory time points
· Can be completed as often as they like meanwhile
· Might be printed and shared with you, but patient can choose to maintain
confidentiality.
·

(Note for professionals: 3 x consecutive scores indicating `severe' depressive symptoms and/or positive response to
item 9 (suicidal/self-harm tendencies) automatic feedback window appears advising patient to contact healthcare
professional or emergency services)

What does iFightDepression
look like?
· www.ifightdepression.eu

and FAQs

Introduction

Activity monitoring worksheet

Selection of patients

· Who can use the iFightDepression tool?
· Patients with mild to moderate depression
Selection can be made
· Based on your clinical judgment
· Screening for depression (WHO 5 and / or PHQ-9)

· Age 15 years
· Access to telephone, computer, internet connection and
email account

Selection of patients

· The Patient Health Questionnaire-9 (PHQ-9)
· Nine item depression scale of the Patient Health Questionnaire
· Assessing symptoms and functional impairment
· Measuring severity score

· As well as screening, PHQ-9 will be used for evaluation,
automatically administered to patients
· At first log-in, after 6 weeks, and after three months

· Benefits
· Good validity in primary care (Kroenke, Spitzer & Williams, 2002)
· Will be used over the course of the intervention
· Sensitive to change (Löwe et al, 2004)
· Can be self-rated
· Suitable for adolescents from the age of 13 as well as adults (Richardson et al., 2010)

Score between 5 and 14 indicates mild to moderate depression

Expected Outcomes
Increased uptake of support options by young people and
adults with mild to moderate depression

Increased uptake of support options by men who otherwise
may not receive support

Increased awareness of depression among health
professionals which will contribute to early identification of
depression and the prevention of suicidal behavior

Diffusion of effects throughout Europe through awareness
website, which will be made available in nine languages

Thank you!