1. Background
This ongoing usability study investigates whether electronic monitoring of mood, sleep and activity in patients with depression is possible in the period when patients are
discharged from inpatient wards. At the ward patients are encouraged to keep a stable rhythm though the sheltered environment with regular zeitgebers (time signals):
regular sleep-wake cycle, regular meals, regular physical activities and regular medication compliance. The inpatient wards refer patients with depression in need of
intensive follow-up to Intensive Outpatient Unit for Affective Disorders (IAA). Patients are received at the IAA approx. 2 weeks after discharge. From clinical observations
on patients referred to IAA we hypothesized that some patients would deteriorate when discharged from the inpatient wards before starting treatment in the IAA.
Methods
In order to closely observe patients in the phase from hospitalization to outpatient status we used the Daybuilder PC application. Patients registered, on a daily basis, their
mood, sleep-onset, sleep-offset, sleep naps, sleep quality, activity and medication adherence for a four week period. This included some days in the wards, some days
between inpatient and outpatient assistance and a period at the IAA. All patients referred to the IAA from the inpatient wards were asked to participate in the study. Patients
were evaluated at baseline, when still at the ward, and after four weeks when in treatment at IAA. Each week patients were phoned and the registered data were discussed
and advice was given as needed. Exclusion criteria for the study was bipolar disorder, alcohol abuse that could affect the ability to perform study procedures, psychotic
symptoms, serious suicidal ideation, age under 18, dementia and severe cognitive deficits.
Results
Preliminary results from 29 patients are presented. Usability was high with few system related problems, high satisfaction with monitoring and good adherence. Mean sleep
onset was 23:29 (1:30) hour:minutes at baseline (mean of day one till day three) and 23:47 (1:44) hour:minutes at endpoint (mean of day 26 to day 28) (p=0.67). Mean
sleep offset was 7:31 (1:10) hour:minutes at baseline and 7:51 (1:20) at endpoint (p=0.0003). Hamilton 17 items scores were 19.1 (6.6) at baseline and 14.9 (6.8) at
endpoint (p=0.004). Mood and sleep registration showed large day-to-day variations. Mood improved in 55 % and deteriorated in 41 % of patients in the days after
discharge (mean of three days before and after discharge). Delay of sleep offset was associated with lesser improvement of mood (p=0.01).
Conclusion
The Daybuilder application was useful in monitoring patients after discharge. A minor improvement of depression severity was seen during the four week phase. Sleep
phase was delayed after discharge and as a sleep delay is known to be depressiogenic this might account for the less than expected depression improvement. Day-to-day
mood and sleep was highly variable. Based on these preliminary data we suggest that, in future studies, electronic monitoring with the Daybuilder application coupled with
weekly feedback focusing on sleep might help patient avoid a sleep phase delay and thus improve outcome. This study is ongoing and will include a total number of 45
patients.
The SAFE Study
Electronic monitoring of patients with depression
when discharged from inpatient wards
Lise Lauritsen1 Louise Andersen1, Emilia Olsson1, Lasse Benn Nørregaard2, Philip Løventoft2, Klaus Martiny1
1 Intensive Outpatient Unit for Affective Disorders (IAA) Mental Health Centre Copenhagen, Department O, Copenhagen Denmark, 2 Daybuilder Solutions,
Copenhagen, Denmark.
FA C U LT Y O F H E A LT H A N D M E D I C A L S C I E N C E S
U N I V E R S I T Y O F C O P E N H A G E N A N D
M E N TA L H E A LT H S E RV I C E S C A P I TA L R E G I O N O F D E N M A R K
Sociodemographics Depression severitySleep parameters
This study is supported by a grant from TrygFonden (E-monitoring ved depression or The SAFE study)
Mean (SD) / per cent
N=29
Range
Age, years 37.4 (10.5) 24-62
Duration of depression, month 9.3 (11.9) 1-52
Number of previous depressions 1.9 (2.4) 0-10
Gender 62.1 % -
Electroconvulsive treatment (ECT) 24.1 % -
Electronic
monitoring with
Daybuilder
Interview Selv-assessment
(paper)
Mood (10 best)
N=29
HAMD-17
N=24
MDI
N=23
WHO-5
N=23
Day 1 4.6 (1.6) 19.1 (6.6) 29.6 (12.3) 26.1 (20.9)
Day 7 4.6 (1.4) - - -
Day 14 4.6 (1.3) - - -
Day 21 5.0 (1.8) - - -
Day 28 5.3 (1.5) 14.9 (6.8) 25.1 (11.4) 39.3 (21.1)
p-value 0.08 0.004 0.05 0.0005
Day Sleep Onset
Hour:minutes
Sleep Offset
Hour:minutes
Sleep Dur
Hour:minutes
Day 1 23:29 (1:30) 7:31 (1:10) 8:02 (1:27)
Day 7 23:24 (1:05) 7:45 (1:16) 8:21 (1:17)
Day 14 23:48 (1:36) 8:19 (1:49) 8:31 (1:17)
Day 21 00:23 (2:25) 8:19 (2:19) 7:56 (1:58)
Day 28 23:47 (1:44) 7:51 (1:20) 8:03 (1:42)
p-value 0.67 0.0003 0.51
Graphic representation of one patient’s recordings of mood (red line,10=best), sleep-onset and sleep-offset (blue ribbon, lower and upper limits),
and activity (orange dots, minutes). This graph is updated automatically when the user enters data and is accessible to the mental health worker