NEWSLETTER ISSUE #9 - SUMMER/FALL 2019


Overview  

The Depression Grand Challenge (DGC) team is working to cut the burden of depression in half by 2050 and eliminate it by the end of the century. New approaches are needed to prevent, diagnose, and treat depression. Developing and applying these approaches drives the DGC, which is organized into four components:

  • Component 1: Discovering the causes and characterizing the trajectories of depression through large-scale longitudinal studies
  • Component 2: Implementing new treatments for depression and anxiety and concurrently increasing the scalability and accessibility of existing evidenced based treatments through the Innovative Treatment Network (ITN)
  • Component 3: Finding the mechanisms underlying depression through discovery neuroscience to inform the development of new treatments
  • Component 4: Understanding and ending the stigma and prejudice surrounding depression

This newsletter focuses on the planned advancements for the Screening and Treatment for Anxiety and Depression (STAND) program a key strategy under the ITN.
About STAND
The DGC piloted the first generation of the STAND program ( STAND 1.0 ) in 2017, making it available to the UCLA student population as part of a research study. College students are an ideal population of focus because rates of depression are increasing in all age groups but they are rising fastest among teens and young adults. 

STAND program participants take a five-minute computerized adaptive test, which provides a self-reported measurement of depression, suicidality, mania, and anxiety symptoms in a manner personalized to the individual and tailored to their specific responses. The test calculates scoring with immediate onscreen feedback regarding symptom level (e.g., mild, moderate, or severe depression or anxiety), which guides treatment selection and adaptation. Participants are routed for treatment into one of four tiers, with an automatic alert system immediately triggered for participants reporting suicidality. 

The treatment system includes online modules, certified coaches, graduate trainees, and expert clinicians equipped with specific protocols that influence the type and frequency of care provided. Once participants are enrolled in the program, they are monitored with ongoing symptom assessment and behavioral tracking to escalate or decrease treatment as appropriate.

Key features of this system differentiate it from other treatment platforms: 

  • System of care that screens, track and treats from prevention through severe symptoms including suicide risk
  • Instant assessment of symptoms and seamless routing to appropriate level of treatment
  • Proactive outreach to individuals who exhibit signs of suicide risk
  • Continuous tracking of symptoms and behavioral features to adapt treatment just-in-time
  • Evidence-based i-Therapy modules that incorporate principles learning and memory
  • Commitment to ongoing evaluation and updating of system of care
  • Workforce development embedded as a core principle
  • Unique model for training, supervising and using i-Therapy coaches
Successes of STAND
To date over 6,000 students have registered for online screening; more than 1,900 have received treatment, ranging from online psychological therapy (with support from certified coaches) to in-person treatment under direct supervision of faculty psychiatrists and psychologists, and 600 have triggered real-time risk alerts for suicidality or severe depression. The pilot study has enabled the DGC team to demonstrate the promise and possible scalability of a comprehensive, digitally-enabled depression care system for students; it also has revealed a number of areas where improvements are necessary to realize that potential.
Upgrades for STAND 2.0
Through an accelerated fundraising campaign in Spring and Summer 2019 we successfully raised funds to upgrade STAND 1.0. STAND 2.0 will address the gaps identified during the first two years of implementation at UCLA. 

Planned upgrades include the following:

  • Suite of evidence-based digital treatment tools that are personalized
  • An engaging online interface for the assessment and treatment modules 
  • Functionality to track symptoms and behaviors in real-time
  • Ability to create interpretable assessment of passive behavioral data (e.g., sleep disruption)
  • Use of predictive algorithms to provide personalized and adapted treatment 
  • Enhanced operational tools (dashboards, data management) for better scalability

Given the success of the campaign exceeding its fundraising goal we now anticipate adding the following capabilities and features: 

  • Evidence-based digital treatment modules for sleep disorders and substance use disorders
  • Specific modules and coaching training designed for the issues unique to veterans at community colleges
  • Supplemental materials to connect STAND participants with other services that are known gaps with the community college population including housing, food security, veteran resources, etc.
  • Translation of recruitment, consent, assessment and treatment materials into Spanish and Mandarin, the second and third most common first-languages spoken by students at the targeted community college
  • Development of curriculum for coach training that might be portable
Rollout of STAND 2.0 Targets Community Colleges
The 2 million students who enroll annually at California’s 114 community colleges face a risk for severe depression at least twice that of students at four-year colleges. A high proportion of these students are members of ethnic minorities, experience financial hardship, and have few available resources for depression treatment. Implementation of STAND 2.0 in the community college system could therefore realize a huge impact. We anticipate piloting STAND 2.0 in at least one community college in the coming year.
Next Phase of Expansion
While STAND 2.0 is under development, the DGC is now turning its attention to the next phase of expansion for STAND — adaptation and pilot testing of STAND within the UCLA Health System. This development is particularly timely, as the DGC has recently launched Component 1 in UCLA's OBGYN Clinic, recruiting participants from UCLA Health for a cohort study to elucidate the genetic and environmental causes of depression. The detection of untreated depression in members of this cohort presents an opportunity to extend STAND and demonstrate its utility in a new setting. 
 
Therefore, we aim to implement a customized version of STAND in this clinic to predict, prevent and treat perinatal depression (PND) symptoms (STAND-PND). PND is the term used to refer to depression that occurs during the time period encompassing pregnancy through the first twelve months after giving birth (post-partum). Approximately one in seven women experiences PND. The impact of PND as a health and social threat is greater than its numbers would suggest because having this condition:

  • Amplifies the natural stress and fatigue of pregnancy and new motherhood
  • Impairs the mother’s ability to care for her infant
  • Increases the risk of disrupted cognitive, emotional, and social development of the baby

The majority of women who exhibit PND symptoms do not currently have access to effective interventions for preventing or treating depression. Prevention and early intervention programs for PND are essential to decrease these negative outcomes.
The Plan for STAND-PND
In collaboration with the OBGYN care providers, researchers will recruit pregnant women when they initiate prenatal care. For those who choose to enroll in this pilot study, the DGC will continue to track them throughout pregnancy and the postpartum period.

To realize the vision of building STAND-PND and conducting a one-year pilot trial to test the feasibility and efficacy of the program with depressed or anxious women during the perinatal period, the DGC anticipates requiring $720K .

Funds will be allocated to:

  • Develop and integrate separate therapy modules for moms, dads, and parents into the treatment platform
  • Develop algorithms for predicting treatment response
  • Embed a psychology/psychiatry team into the OBGYN clinic for purposes of the study
  • Integrate STAND-PND with existing services within the OBGYN clinic

If you are interested in supporting STAND-PND, please contact Dorin Esfahani at  desfahani@support.ucla.edu , or visit the give to site .
Recent News
To stay informed about the Depression Grand Challenge visit our  happenings page  for the latest news: