PosterPDF Available

The SAFE Study�Electronic monitoring of patients with depression when discharged from inpatient wards

Authors:

Abstract

The SAFE study Louise Andersen1, Emilia Olsson1, Lasse Benn Nørregaard2, Philip Løventoft2, Klaus Martiny1 1 Intensive care outpatient unit for affective disorders (IAA) Mental Health Centre Copenhagen, department O, 2Daybuilder Fogedmarken 8, 7 th, 2200 København N. Presenting author: Louise.andersen.04@regionh.dk Background and aim: We know very little of what happens when patients with depression are discharged from inpatient wards. In the wards patients are kept in a sheltered environment with a stable sleep wake cycle, regular meals and regular physical activities. At the Intensive care outpatient unit for affective disorders (IAA) we receive patients discharged from hospital. From case records and through Hamiltons interview we speculated whether these patient deteriorate when discharged. Materials and methods: Patient referred to the IAA from affective disorders wards, were included in the study. All patients was instructed to use the Daybuilder PC application and registered daily mood, sleep onset, sleep offset, sleep naps, sleep quality, exercise and medication adherence for a four week period including: some days on the ward, some days without psychiatric assistance, and a period at the IAA. Results: Preliminary results from 16 patients are presented. Mean sleep onset was 22:56 (3:36) hour:minutes at baseline (mean of days one till three) and 23:46 ( 1:23) hour:minutes at endpoint (mean of days 26 to 28). Mean sleep offset was 6:33 (1:33) hour:minutes at baseline and 8:14 at endpoint (1:41). Linear regression showed sleep onset to be delayed by 1.5 minutes per day (p=0.07) and sleep offset delayed by 1.6 minutes per day (p=0.03). Hamilton 17 items score was 19.7 (6.1) at baseline and 17.5 (6.5) at endpoint. Mood registration showed large day-to-day variation and a tendency for worsening of mood in the days after discharge but with improvement after inclusion at the IAA. Conclusion: Sleep was delayed after discharge. Sleep delay is known to be depressiogenic. Day-to-day mood and sleep was highly variable. Electronic monitoring with the Daybuilder application coupled with weekly feedback might help patient avoid a sleep delay and keep a more regular sleep pattern and thus prevent relapse. Study is ongoing and will include a total number of 45 patients.
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.
FACULTY OF HEALTH AND MEDICAL SCIENCES
UNIVERSITY OF COPENHAGEN AND
MENTAL HEALTH SERVICES CAPITAL REGION OF DENMARK
Sociodemographics Depression severity
Sleep 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
ResearchGate has not been able to resolve any citations for this publication.
ResearchGate has not been able to resolve any references for this publication.