The STEADY project: Managing depression with wearables

These days, smartphones and wearables of all kinds more or less "incidentally" collect lots of personal data about our lives. Many people have privacy and security concerns – and rightfully so – especially if mountains of data fall into the wrong hands. But what if patients collect their own data and get help to use it for their own purposes? The STEADY project for people with depression takes this approach.

In this MEDICA-tradefair.com interview, Prof. Ulrich Hegerl and Dr. Christian Sander talk about the STEADY project of the German Foundation for Depression Relief, which helps people with depression to better understand and manage their disease by determining biological parameters.

Prof. Hegerl, Dr. Sander, what problem does the STEADY project address, which is a collaboration between the German Foundation for Depression Relief and its partners?

Prof. Ulrich Hegerl: Today there is a great need to improve the quality of care for people with depression. More and more people are diagnosed with "depression" – and rightfully so since depression frequently went unrecognized in the past. Instead, patients were often diagnosed with acute back pain or tinnitus, which are physical ailments that can be a part of this disease. Meanwhile, there are not more specialists or psychotherapists available to help these patients, which results in a shortage of care. We have a huge deficit in diagnostic and therapeutic services in this area. Depression is probably the one disease that offers the biggest room for improvement because it is very common, strongly impacts the quality of life and life expectancy of the affected persons, and where great treatment options are used far too rarely.

The STEADY project aims to encourage affected patients to self-manage their disease. The goal is to set up a system that enables people with depression to manage and better utilize the existing data about their bodily functions, behavior, and environment.

What parameters do you plan to capture with STEADY?

Hegerl: By using smartphones and wearables, we produce an ever-increasing amount of data about our bodies, environment, smartphone use per se and our state of health thanks to self-rating tools. This data can provide valuable information that can be used to better cope with the disease. For example, before and during a depressive episode, a patient’s behavior changes significantly. Affected persons communicate, talk and move differently – and although this varies for each person, almost everyone exhibits distinct changes.

Our basic concept is to systematically self-collect data about sleep patterns, exercise and movement patterns, speech tempo and volume, heart rate, skin conductance and cell phone use and then edit the data to make it available to STEADY users. Thanks to algorithms, the goal is to search for correlations between the data and changes in mood and overall drive over several months, which is self-assessed daily by STEADY system users. The focus is on longitudinal assessments. This is not intended as a group comparison of people with depression versus healthy people. The idea is for individuals to learn how to use this data and learn how to better cope with their depression.

What do we already know about physical parameters that change in connection with a depressive episode?

Hegerl: As I indicated earlier, this varies by patient. Some patients might exhibit a slightly increased heart rate in the days leading up to and during an episode. However, you will only be able to determine this if you measure and know the average heart rate over an extended period of time. Meanwhile, other sufferers might take longer to fall asleep or their voice becomes hoarser and softer. If patients systematically and consistently collect data over months and years, many changes will become apparent that signal an impending depressive episode, which in turns allows sufferers to take countermeasures.

The longer you collect these data patterns, the more valuable they become. Viewed over time, we discover whether or not there is a correlation between the course of the disease and changes in voice, movement, mood, sleep patterns and other parameters. That’s what makes our approach so great: the STEADY system is designed to give each person the chance to personally process information and use it to better manage his/her disease. If patients are so inclined, they can share and discuss this information with their physician. Together they can then determine whether there might be a connection between moods on the one hand, and movement or sleep on the other and decide on behavioral approaches.

The STEADY project is still in its early stages. What are your next steps?

Dr. Christian Sander: We plan to first assess the possibilities of the platform. As part of a feasibility study, we have also recruited our first test subjects who have collected data for several months by using a pre-version of the STEADY system.

At the moment, along with our partners in the STEADY Consortium, we are primarily focused on the integration of the individual sensors into the platform. We truly emphasize sensors that are commonly available as part of smartphones or wearables. Admittedly, these types of sensors will never be as great as the technology that’s being used in research laboratories. However, the real challenge of this project is to apply the type of technology people with depression can use in everyday life.

How can people with depression benefit from today’s mHealth and eHealth approaches?

Hegerl: This field is very broad and dynamic. In our work with the German Foundation for Depression Relief, we already make information on depression and a discussion board available for patients and family members on our website – services that are used by nearly 3,000 people each day. In addition, our free "iFight Depression" tool is available to patients who can utilize it for self-management to complement any psychological and drug treatment.

I am sure that it will become increasingly important in the future to take advantage of all the data we constantly produce and the possibilities of digital technologies to improve our health. The medical field is also tasked with integrating these possibilities into routine health care. Even though the digital choices might not be suitable for every patient, there will be more and more sufferers who want to utilize this option to better manage their disease.