The Lowdown - Using Interactive Computer Technology to target depression

This article is also available as a PDF file.

1. Introduction
2. The National Depression Initiative
3. Using ICT to empower the National Depression and Suicide Prevention Strategies
4. Indicators of success
5. Conclusion
6. References    

1.  Introduction

Depression and suicide are major health issues for New Zealand. Approximately 500 people, of whom 100 are young people, die by suicide, every year, which is higher than the road toll. In 2006 there were 2,868 intentional self-harm hospitalisations.  Females were most commonly hospitalised in the age range 15 – 19 years. [1]  Although suicide is a complex multifactorial entity with at times no clear causative factors, there is often a high correlation with unrecognised or non-optimally treated depression or other major mental illness. As well as suicide, depression can also be associated with significant negative functional and developmental impact, with deterioration in family and social relationships, poor school or work performance, and comorbid anxiety and substance abuse.

New Zealand has particularly high rates of depression and suicide among its youth. Approximately 1 in 8 young people aged 16 – 24 years will experience a mood disorder over a 12 month period [2], and suicide is the second most common cause of death for this age group. Indeed approximately 1 in 4 of all deaths among 15-24 yr olds is attributable to suicide [3,4].

In recognition of these sobering facts the Ministry of Health in New Zealand has funded a website (www.thelowdown.co.nz) that aims to encourage young people to seek help for depression, and to improve access to treatment. The site was launched on 5 December 2007 and forms part of the National Depression Initiative which is a key component of the Ministry’s Suicide Prevention Strategy. This work has been featured in IIMHL before in the ‘Brag & Steal”.

The Lowdown site development was managed by DraftFCB, a creative marketing and communications agency that specialises in social change. The site is interactive and enables visitors to become part of an online supportive community.

Lifeline Aotearoa is a significant provider in New Zealand of integrated telephony and ICT based helpline services in the mental health and addictions sector.  As part of the Lowdown project Lifeline is contracted to provide online and text based support services for young people backed by skilled personalised support. The site utilises a range of contemporary technologies, to engage and facilitate communication. Users can contact skilled support team members via email or text or share experiences via a message board with peers. Lifeline has identified these modes of communication as an effective way to connect with the 13-24yr old age group which is the targeted demographic of the site [3-10]. The website was created by Oktobor (a multimedia media agency) using Flash built on Actionscript 3, LowRa and the Sandy 3D engine. [6]

2.  The National Depression Initiative

The objectives of the NDI are twofold; to strengthen individual, family & social factors that protect people from depression, and to enhance community and professional responsiveness to depression. The NDI campaign has developed five main strategies to achieve its aims.  These are:

1. Identify and build on opportunities to create a social and physical environment that protects people from depression.
    
2. Encourage people to recognise and become more responsive to depression, including:
   (a) The importance of early identification and intervention;
   (b) Assisting people to recognise symptoms of depression in themselves and others;
   (c) Encouraging people to seek appropriate help;
   (d) Increasing awareness of effective interventions for depression, including self help strategies.
    
3. Improve the capability of health professionals to respond appropriately to people seeking help with depression.
    
4. Support co-ordination mechanisms between public health, primary health care and mental health care services, consistent with the objectives of the National Depression Initiative.
    
5. Support the above with research, monitoring and evaluation.

The public health campaign focuses mainly on strategy two through prevention and promotion activities, with linkages with and support for new primary mental health care initiatives being delivered through Primary Health Organisations (PHOs) in New Zealand. The campaign seeks to help people to make informed decisions about treatment through educational resources, interactive websites, and advisory services.   Young people are also encouraged to connect with some of the help lines that are available and work to build self-esteem, self- belief and self help strategies. The wider initiative aims to support the implementation of all five strategies with a strong focus on prevention, promotion and primary care with more limited focus on secondary care. 

Young people are recognised as a priority for the campaign.  It is known that young people are less likely to seek professional help if they are depressed.  There is good evidence for internet-based strategies as young people interact and communicate extensively via the internet. The Lowdown aims to: 

• To communicate effectively with young people aged 13 to 24 years, including:
• Encourage early help-seeking
• Improve knowledge about depression, including how to recognise it, appropriate treatments (including self-help strategies) and where to go for help
• Improve knowledge and skills about supporting other people who might have depression

3.  Using ICT to empower the National Depression and Suicide Prevention Strategies

Like a road fatality, a completed suicide typically results from a complex mixture of interacting factors. Suicide needs to be considered in the context of so called wider determinants of (mental) health.  The interaction and complexity of apparent simple causative factors can have detrimental consequences to one’s mental health.  Similarly depression can be a complex multifactorial disorder. The Lowdown website seeks to leverage the power of ICT and associated human networks to increase knowledge and effective action with regard to known risk and protective factors associated with depression and suicide.   Although depression and suicide may be complex multifactorial disorders, perceived damage to one’s concept of self, sense of competency or control over one’s life and, and sense of connectedness to others may increase the risk of depression and suicide and the associated morbidity.

The site seeks to identify with youth and various youth cultures and create a sense of community and connectedness for participants. The opening page provides a range of youth celebratory role-models (‘navigators’), from which users can pick one to guide them through the site. There is a range of multimedia resources including depression fact sheets, a self assessment tool, and songs on related themes by Kiwi bands, to videos where various contributors recognised by youth as role models in the entertainment and sporting world discuss their experiences of dealing with their own depression or that of friends and family. The resources on the site aim to engage, educate, empower and encourage, developing the participants’ sense of competency and skill base to cope with their situation, and sense of control that there is a way through it. The central message is one of hope and encouragement to seek appropriate help [3-9].  The key to the success of the site is the combination of interactive and multimedia resources backed up and supported by a personalised approach by skilled support team members (The Lowdown Team).

The site recognises that although facts are important in bringing about change, they can be greatly enhanced by the power of related music, stories or personal narrative by those with whom we identify or respect. Similarly although we can make positive changes by ourselves, effective change can be enhanced by sharing our experiences with others and participating as an online community.

In addition to the current email, text, and message board facilities, a Web videoconferencing e-coaching and support service is also about to be launched on the site. This will allow selected participants to engage in one to one support, and be provided with and taught how to use tools such as structured problem solving. The user will be able to see the trained facilitator but can choose whether the facilitator can see them.

4.  Indicators of success

The following indicators give some examples of effectiveness of the website and the personalized brief early intervention services which support this highly effective national youth depression initiative in New Zealand.

Service Uptake – (December 2007 – April 2008)

• 174 009 total website visits.
• 130 732 unique website visitors.
• 144,345 text messages received and sent.
• 6285 emails received and sent.

Evaluation Findings

• 80% of Website Users rated the website highly for finding out generally about Depression.
• 63% of people invited to look at the website felt helped to some extent by their visit.
• 80% of Service Users indicated that the text service met their needs extremely to quite well
• 70-75% of Service Users indicated that the email support services met their needs extremely to quite well.

Service User Feedback

• “I love this site because it is genuinely good, the fact sheets, the self test, just everything....I have severe depression and finding this place is like gold....I’m serious....”
• “That what I was experiencing wasn’t weird or strange and that I wasn’t alone in the way I was feeling....also that there were so many different ways for me to get help, i.e. I have trouble using the telephone, so the message board was great....”
• “They gave me advice and didn't make things awkward and they genuinely cared for you”
• “Helped me see that I needed to get myself help”
• “I feel a bit better knowing that I was able to talk to someone – just having someone listen made me feel a whole lot better”

5.  Conclusion

The reduction in the road toll in New Zealand can be attributed to a massive multi-pronged global investment in a risk identification and management system that extends from vehicle and road safety research and development to driver education and legal enforcement.  The hope is that a similar risk identification and management, and building of individual and community empowerment and resilience can lead to a similar reduction in the youth depression and suicide toll through developing and leveraging ICT developments aims to play a part in reducing these tolls.

Through research based iterative development we are developing the likes of seatbelts, airbags, ABS, road design and driver education of depression.  We aim to do this by empowering users and communities to assess and identify risks and seek help where appropriate, and to improve the journey to positive self development and well being.

Acknowledgements

We would like to acknowledge individuals in the Ministry of Health, Lifeline, DraftFCB and Phoenix Research who have made the Lowdown possible.

6.  References
 

[1]  MoH 2008, Suicide Facts 2006. Wellington: Ministry of Health

[2]  MoH 2006. Te Rau Hinengaro: The New Zealand Mental Health Survey.  Wellington: Ministry of Health

[3]  Associate Minister of Health. 2006. The New Zealand Suicide Prevention Strategy 2006-2016. Wellington: Ministry of Health

[4] http://www.moh.govt.nz/moh.nsf/indexmh/national-depression-initiative      

[5]  http://www.thelowdown.co.nz/ndi/html/aboutus/aboutus.html

[6] http://dev.webbymx.net/2007/12/20/the-lowdown-website-sandy-3-and-lowra/

[7]  http://www.progressive.org.nz/modules.php?name=News&file=article&sid=3027

[8]  http://en.wikipedia.org/wiki/The_Lowdown

[9]  http://en.wikinews.org/wiki/Getting_the_exclusive_lowdown_on_The_Lowdown

[10]  CSR,“Understanding Youth Development: Promoting Positive Pathways of Growth”, Incorporated for Family and Youth Services Bureau, Administration for Children and Families, U.S. Department of Health and Human Services