Depression is one of the most prevailing health conditions of the 21st century, affecting over 300 million people worldwide. The illness does not discriminate. It is a leading cause of workplace disability and represents a large financial burden for many families. Consequently, the Canadian Institutes of Health Research and the National Natural Science Foundation of China, under the Global Alliance for Chronic Diseases’ mental illness funding initiative have co-funded a five-year implementation project to optimize clinical care. The pilot project is taking place in Shanghai, China and tests the use of technology to improve uptake of measurement-base care for depression. To do so, it uses tools like Bounce Back, an online supported self-management program from Canada, and smartphone apps for patients to track their outcomes.
Dr. Raymond Lam, Professor and BC Leadership Chair in Depression Research at the University of British Columbia, and his team are working toward implementing EMBED (Enhanced Measurement-Based Care Effectiveness for Depression) in Shanghai to support patients with depression and provide them the necessary tools to monitor their condition and treatment.
The learning opportunities and outcomes that will transpire through EMBED will greatly benefit Canada’s ever-evolving demography and health policies. This research includes elements such as cultural adaptation and cultural integration. Overarching themes that directly impact policies around immigration, diversity, and cultural inclusion.
“Measuring symptoms and side effects is still not routinely done in mental health care,” says Dr. Lam, “and often it is unclear how much benefit that patients are getting from treatment. We aim to use technology to make it easier for both doctors and patients to track their outcomes and to collaborate in clinical decisions.”
The EMBED project includes over 15 mental health researchers from 4 countries (Canada, China, United States, Australia). Dr. Murphy, funded by a postdoctoral grant from Mitacs, is leading the cultural adaptation to ensure that the interventions will be appropriate for a Chinese patient population.
The Canadian Mental Health Association, a partner in EMBED, introduced the online Bounce Back program to Canadians some years ago and EMBED will soon launch a similar initiative in China. Starting fall 2019, Dr. Murphy will begin the cultural adaptation of the Bounce Back supported self-management program. In collaboration with 3 community mental-health centres in Shanghai, Dr. Murphy will begin translating core knowledge for the program and adapting it for appropriateness within the Chinese context. EMBED will set the stage for widespread dissemination of tech-based services for mood disorders and open channels for future collaborations and research, including a network of researchers, providers and policy makers in the Asia-Pacific region, through the APEC Digital Hub for Mental Health, which is led by Canada.
“The EMBED research initiative leverages online and mobile applications to empower patients to track their own treatment outcomes,” says Dr. Murphy. “This will help to identify when things are not improving and when treatment changes are needed.”
She has been involved in the project since its inception in 2018 and is currently wrapping up the first phase of the investigation, a thorough situational analysis of Shanghai clinical care for depression. According to Dr. Murphy, current local treatment plans for depression may not effectively measure patient progress. They may not include standardized questionnaires that pin-point how the patient is feeling on a given day, nor do they provide patients with the ability to record their own progress via interactive mobile software.
Phase 2, the implementation of the EMBED project, is about to change that. The Bounce Back online program and self-assessment software empowers patients to actively participate in their treatment plan, and consequently, has had a high success rate in British Columbia. EMBED also integrates tech tools, such as mobile apps and standardized assessment scales, as well as provides direct access to qualified mental health coaches via telephone and online chat.
“Patients can then bring all this relevant information to their next appointment with their healthcare practitioner,” says Dr. Murphy. “This program is a highly effective and adaptable tool for the self-management of depression. It can be adapted to any context.”
“In many ways, China has integrated smartphones into everyday life more rapidly than Canada. Lessons from our study in China may actually help us in Canada to overcome some of the barriers to using technology and measurement in mental health care,” says Lam. “In addition, the cultural adaptations to Bounce Back developed by EMBED can be used in Canada for Chinese-speaking residents, a significant segment of the Canadian population where there is still limited access to mental health services.”
Mitacs’s research fellowship program helps fund this project. Dr. Murphy explains that Mitacs plays a fundamental role in her work. Through Mitacs, she has access to funding, project management courses, technology software. She also benefits from key networking opportunities.
The 5-year EMBED implementation project is set to run till 2022.
Mitacs thanks the Government of Canada and the Government of British Columbia for their support of the Elevate research fellowship in this story. Across Canada, the Elevate program also receives support from the Government of British Columbia, the Government of Manitoba, the Government of New Brunswick, the Government of Newfoundland and Labrador, the Government of Nova Scotia, the Government of Ontario, the Government of Prince Edward Island, the Government of Quebec, and the Government of Saskatchewan.
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