My Patients On Mobile: Leveraging text messaging for better health

outcomes

Patricia Roy, MDDirector, Continuity Clinic for Women’s

Mood DisordersJohns Hopkins School of Medicine

• Major Depression has a lifetime prevalence of up to 25% for women, twice the prevalence for men. Major Depressive Disorder is the #1 cause of disability in the US for ages 15-44.

• Bipolar Disorder has a lifetime prevalence of approximately 2% and is also a significant cause of disability.

• In women of reproductive age, 13-18% have premenstrual mood symptoms that are significant enough to induce impairment and distress (Halbreich et al, 2003), 3-8% of women meet criteria for premenstrual dysphoric disorder (PMDD) (Steiner et al, 2006).

• 60% of women with Bipolar Disorder and Major Depression report premenstrual worsening of their symptoms (Payne et al 2006).

Mood Disorders are highly prevalent and cause significant disability

• Mood Symptoms such as depression, irritability, and anxiety occur in the luteal phase, which is generally the week before menstruation.

• Accompanying physical symptoms include sleep disruption, appetite changes, bloating and breast tenderness.

• Improves with the onset of menstruation.

• Diagnosis requires two months of prospective daily mood ratings.

Diagnosing Premenstrual Mood Symptoms

• Patients are not able to comply with mood rating charts, which is an obstacle in diagnosis and ongoing care.

• Studies are limited by resources and time. Subjects also not able to comply with mood rating charts.

Diagnosis is a barrier for treatment and for research in the development

of treatments

VAS and Likert Scale Assessment of Mood

• Visual Analog Scales (VAS) in Mood– Standard VAS is a self-rated ordinal scale consisting of a horizontal 100 mm

line with word anchors at each end, such as “worst mood” at one end and “best mood” at the other.

– Likert scales are a method of measuring attitudes (e.g. mood) usually on a 3, 5, or 10 point scale.

– Both methods were developed in 1920’s and have been studied extensively. – VAS and Likert scales have been shown to be equally efficacious, though more

research on VAS in mood disorders has been published.

(Ahearn, 1997)

• 254 million US mobile phone subscribers.– 95% of mobile phones are text capable.– 100 million+ subscribers (43%) use SMS.– 1.5 billion Global active messaging users.

Mobile Phone Use in US

On the Move, University of Michigan, May 2006

Technology is designed to be simple

On the Move, University of Michigan, May 2006

What does this mean for patients?

A New World of Access & Transparency