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Digital Mental HealthDavid C. Mohr, Ph.D.Northwestern UniversityFeinberg School of Medicine
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www.cbits.northwestern.edu
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DisclosuresHonoraria/Consulting fees
Otsuka PharmaceuticalsOptum Behavioral Health
Ownership InterestActualize Health
FundingNational Institute of Mental Health
P20 MH090318
R01 MH100482
R01 MH095753
R01 MH109496
R34 MH095907
Verizon Foundation
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Mental Health12 Month Prevalence:
• >61 million (20-25%) American adults will meet criteria for a mental health disorder in any given year.• 24 million (9.5%) Mood Disorders
• 44 million (18%) Anxiety Disorders
Workforce is Inadequate:
• 21% receive “minimally adequate” care in any given year.
• 350,000+ mental health professionals needed (>twice what we have).
Geography:
• 90 million Americans live in federally-designated Mental Health Professional Shortage Areas (55 million for primary care, 45 million for dentistry)
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What is Digital Mental Health:CBT delivered via different platforms
Didactic Content Homework Exercises
Human Support
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Research and Practice
~100 RCTs show that
• Self-directed digital treatment are at best minimally helpful.
• Coach-supported web-based interventions
• Appear to be as effective as standard treatments (ds=.56 – 1.08)
• Coaches do not have to be mental health professionals
Lots of Validation
Richards D, et al. Clin Psychol Rev 2012;32:329-342.
Alvarez-Jimenez M, et al. Schizophr Res. 2014;156:96-106. Mohr, et al., Psychiatric Services, in press.
Real World
Implementation
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Research-to-Practice GapDigital mental health technologies are poorly designed
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IntelliCare Platformwww.intellicare.northwestern.edu
Apps in
www.cbits.northwestern.eduR01 MH100482
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Diagnostic Status at End of Treatment
14.00%
22.00%
45.00%
40.00%
42.00%
37.00%
0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00% 50.00%
ANXIETY
DEPRESSION
Full Remission Recovery Symptomatic
Mohr, et al. J Med Internet Res. 2017;19(1):e10.
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Average App Launches over 8 weeks: 195Average time: 1.1 min (Median = 17 seconds)
2123
2527 28 29
26 26
0
5
10
15
20
25
30
35
1 2 3 4 5 6 7 8
Average # of App Launches Per Week
Week www.cbits.northwestern.eduAve
rage
Ap
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aun
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pe
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eek
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New Directions in Digital Mental HealthValue-Burden Ratio
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Personal SensingReview: Mohr, et al.. Annu Rev Clin Psychol. 2017;13:23-47.
www.cbits.northwestern.edu
Challenges• Lack of reproducability
• Variability
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Thanks to our funders and team!Some of our Team
Stephen Schueller, PhDKonrad Kording, PhDKen Weingardt, PhDMadhu Reddy, PhDEvan Goulding, MD
Bernice Ruo, MDKate Tomasino, PhD
Emily Lattie, PhDColleen Stiles-Shields, MS
Chris Karr, MASusan Kaiser, MPHSohrob Saeb, PhD
Darren Gergle, PhDEric Carty-Fickes, MS
Chris Brenner, MSand many more…
Funding:National Institute of
Mental HealthP20 MH090318 R01 MH100482 R01 MH095753R01 MH109496R34 MH095907
Verizon Foundation