Researchers Working to Implement Enhanced Measurement-Based Care for Depression in Shanghai

A team of UBC researchers is working with colleagues in Shanghai to implement the use of technology when it comes to treating and managing depression.

The study is looking at measurement-based care, which involves using validated outcome measures to inform decision-making about treatment for depression. Measurement-based care can be enhanced by using mobile technology to engage patients and their doctors to track changes in depression symptoms. Standardized scales are available through an app, so that a person with depression can easily track how they’re feeling week to week. The UBC team is working with partners in Shanghai to implement enhanced measurement-based care through WeChat, an extremely popular app in China.

In follow up appointments after a depression diagnosis, doctors will often rely on a patient’s described symptoms to gauge how they’re doing. But questions like “how have you been feeling?” can be difficult to answer, especially if there is a long stretch between appointments. These types of questions can also result in a vague reflection of how a patient is doing, whereas scales identify progress on specific symptoms. This is a challenge in China, where people with depression are primarily treated by psychiatrists who will see upwards of 100 patients per day, which means time with each person is limited. Documenting mood changes on an app will allow doctors to gain a better sense of how someone has been feeling and will also make it easier for patients to see signs of progress.

“Enhanced measurement-based care helps patients be more engaged in their care and allows them to take a more collaborative approach with their doctor in making changes to treatment or medication,” says Dr. Jill Murphy, Research Associate in DMCBH researcher Dr. Raymond Lam’s lab. “It’s a way for the patient to actually see small improvements and to easily flag any concerns with their doctor.”

A second aspect of the study is adapting a Canadian program called Bounce Back to be suitable for use in China. Bounce Back, delivered by the BC Chapter of the Canadian Mental Health Association, is well established in Canada and is intended to help people self-manage mild to moderate depression and anxiety. It’s delivered online through a series of workbooks and videos, and participants also have access to a coach. Dr. Murphy and her team are working to create similar workbooks and videos in Mandarin. 

“This study is an implementation science study, which means that we’re mainly assessing uptake from patients and clinicians, fidelity, acceptability and long-term potential for scale up,” says Dr. Murphy. “We will look at clinical outcomes too but that’s more of a secondary analysis.”

The team is operating on a five-year grant funded jointly by CIHR and the National Natural Sciences Foundation of China. The study is being led by Dr. Raymond Lam and also includes DMCBH researcher Dr. Erin Michalak. The first part of the project—doing a situational analysis to better understand what adaptations need to be made for a Chinese audience—is complete. The team is now working towards completing these adaptations and training people on how to deliver the Chinese version of Bounce Back and how to use the new technology. The goal is to start implementation in Shanghai and if successful, branch out to other cities in China.

“Even though we know measurement-based care works, it’s not often used by doctors and this study will help us understand how to successfully integrate this into their regular practice,” says Dr. Murphy. “By implementing enhanced measurement-based care using digital technology and supported self-management programs, we can help empower patients to be actively involved in management and treatment decision-making for their depression.”

*Photos in this story are handouts from the team, and capture their process of shooting videos for the study.