Enhanced Measurement-Based care Effectiveness for Depression (EMBED) A Canada-China implementation project

 

 

We are excited to announce the Canadian Institutes of Health Research (CIHR) and National Natural Science Foundation of China (NSFC) through the Global Alliance for Chronic Diseases (GACD) have awarded a team of Mood Disorders Centre and other researchers approximately $2.1 million over 5 years to conduct a research and implementation program to improve depression treatment and outcomes in China.

The project, called “Enhanced Measurement-Based care Effectiveness for Depression” (EMBED), will adapt and develop technologies such as mobile apps, online training programs, electronic medical records, and internet, telephone and WeChat interventions to promote measurement-based care (MBC) for depression in community mental health centres across Shanghai. MBC is an evidence-based practice that can improve depression diagnosis and treatment, and technology-enabled MBC (called “enhanced” or eMBC) tools developed through the program may serve as models for future development and scale up in the region.

Principal Investigators are Dr. Raymond Lam, Professor of Psychiatry at the University of British Columbia (UBC) and Director of the Mood Disorders Centre (Canada) and Dr. Chen Jun, Professor of Psychiatry at the Shanghai Jiao Tong University (China) and Director of the Clinical Research Center at the Shanghai Mental Health Centre.

Dr. Erin Michalak, Professor in the UBC Department of Psychiatry, and Dr. Jill Murphy, Research Associate, are also co-investigators. Dr. Murphy was formerly a Postdoctoral Fellow for EMBED, funded by a MITACS Elevate Award.

The program is also one of the first initiatives affiliated with the Asia-Pacific Economic Cooperation’s (APEC) Digital Hub for Mental Health, which supports APEC’s vision to strengthen mental health and reduce the economic impact of mental illness in the Asia-Pacific region.

WHAT’S NEW?

Read the press release (2017)

Read the CBC news article. (Nov, 2017)

See the EMBED summary of progress video, presented at the 2018 GACD Annual Scientific Meeting in Sao Paulo, Brazil, November 2018.

View the EMBED summary of progress slides, presented at the 2019 GACD Annual Scientific Meeting in Bangkok, Thailand; and at the GACD 2020 Virtual Annual Scientific Meeting.

Congratulations to Dr. Jill K. Murphy, who was appointed as a Research Associate in the UBC Department of Psychiatry (2020)!

Check out our EMBED site (2021) at the Open Science Framework for more information and resources.

The MBC Training Program that we developed for EMBED is now online (2022)! See information below.

Our EMBED papers and chapters are now published!

• Yang XR, Chen J, Fang YR. Enhanced assessment-based treatment (MBC) in depression. Journal of Psychiatry/Jingshen Jixue, 2019; 31(3).
• Wang Z, Ma X, Xiao C. Standardized treatment strategy for depressive disorder. In Fang Y (ed). Depressive Disorders: Mechanisms, Measurement and Management. Adv Exp Med Biol 2019; 1180:193-199.
• Chen J, Hu S. Individualized treatment strategy for depressive disorder. In Fang Y (ed). Depressive Disorders: Mechanisms, Measurement and Management. Adv Exp Med Biol 2019; 1180, 219-232.
• Wang Z, Niu Z, Yang L, Cui L. Internet-based management for depressive disorder. In Fang Y (ed). Depressive Disorders: Mechanisms, Measurement and Management. Adv Exp Med Biol 2019; 1180:267-276.
• Murphy JK, Michalak EE, Colquhoun H, Woo C, Ng CH, Parikh SV, Culpepper L, Dewa CS, Greenshaw AJ, He Y, Kennedy SH, Li XM, Liu T, Soares CN, Wang Z, Xu Y, Chen J, Lam RW. Methodological approaches to situational analysis in global mental health: a scoping review. Glob Ment Health (Camb). 2019 Jun 13;6:e11.
• Yang XR, Murphy JK, Michalak EE, Yang T, Wang X, Liu J, Lu Y, Lin X, Su YS, Huang J, Wang ZW, Zhang P, Liu TL, Chen J, Lam RW, Fang Y. A survey of acceptability of e-mental health in outpatients with depression. Journal of Psychiatry/Jingshen Jixue 2019;31(6)
• Hong RH, Murphy JK, Michalak EE, Chakrabarty T, Wang Z, Parikh SV, Culpepper L, Yatham LN, Chen J*, Lam RW* (*co-senior authors). Implementing measurement-based care for depression: Practical solutions for psychiatrists and primary care physicians. Neuropsychiatric Disease and Treatment 17:79-90, 2021.
• Yang T, Chen J, Lam RW, Fang Y, Xu Y. Mental health service challenges during the early stage of the COVID-19 pandemic: Experience and best practices from China. Canadian Journal of Psychiatry 66:621-623, 2021.
• Murphy JK, Khan A, Michalak EE, Greenshaw AJ, Ng CH, Ravindran AV, Chakraborty PA, Hatcher S, Hwang TY, Irarrazaval MD, Mahajan S, Minas H, Nurashikin I, O’Neil J, Sharmini K, Sun Q, Tien M, Vu N, Withers M, Lam RW. Needs, gaps and opportunities for standard and e-mental health care among at-risk populations in the Asia Pacific in the context of COVID-19: A rapid scoping review. International Journal for Equity in Health 20:161, 2021.
• Murphy JK, Michalak EE, Liu J, Colquhoun H, Burton H, Yang X, Yang T, Wang XR, Fei Y, He Y, Wang ZW, Xu Y, Zhang P, Su Y, Huang J, Huang L, Yang L, Lin X, Fang Y, Liu T, Lam RW*, Chen J* (*co-senior authors). Barriers and facilitators to implementing measurement-based care for depression in Shanghai, China: A situational analysis. BMC Psychiatry 21:430, 2021.
• Zhu M, Hong RH, Yang T, Yang X, Liu J, Murphy JK, Michalak EE, Wang Z, Yatham LN, Chen J, Lam RW. The efficacy of measurement-based care for depressive disorders: A systematic review and meta-analysis of randomized controlled trials. Journal of Clinical Psychiatry 82:21r14034, 2021.   Watch Dr. Lam’s video abstract.
• Lam RW, Chen J, Michalak EE, Murphy JK, Colquhoun H, Ng CH, Culpepper L, Dewa C, Greenshaw AJ, He Y, Kennedy SH, Li X-M, Liu T, Parikh SV, Soares CN, Wang Z, Xu Y, Liu J. EMBED Phase 2 study protocol v.1.4: A cluster randomized controlled trial of enhanced versus standard measurement-based care implementation for depression [Internet]. OSF Preprints August 26, 2021; doi: 10.31219/osf.io/9z82u.
• Cheung BSW, Murphy JK, Michalak EE, Liu J, Yang X, Wang X, Chen J, Lam RW. Barriers and facilitators to technology-enhanced measurement-based care for depression among Canadian clinicians and patients: Results of an online survey. Journal of Affective Disorders 320:1-6, 2023.

MBC Training Program

As part of the EMBED implementation plan, we developed an MBC Training Program for Chinese physicians. Narrated by Dr. Raymond Lam, these 3 presentations cover the evidence for effectiveness of MBC to improve outcomes in patients treated with depression, the recommended scales and tools for MBC for depression, and a simple medication algorithm to use alongside MBC.

Learning objectives: At the end of these presentations, participants will be able to:

1. Describe the rationale and principles of measurement-based care (MBC).
2. Identify barriers and facilitators to using MBC.
3. Describe the EMBED project in Shanghai.
4. Describe important factors to consider for using scales in MBC.
5. Use 2 symptom scales for use in MBC for depression.
6. Use 2 scales to assess functioning and side effects.
7. Describe the rationale for treatment algorithms.
8. Use a simple algorithm for selecting an antidepressant.
9. Compare and contrast switching versus adjunctive strategies for inadequate response to an antidepressant

Presentations in English and Chinese Text (available on the EMBED YouTube channel)

Presentation (English)	Video	Slides – pdf
1: About Measurement-Based Care	1. About MBC	1. About MBC
2: Scales and Tools to Support MBC	2. Scales and Tools	2. Scales and Tools
3: Medication Algorithms to Support MBC	3. Algorithms	3. Treatment algorithms

.

The presentations are also available with Chinese text and subtitles.

Presentation (Chinese)	Video	Slides – pdf
1: About Measurement-Based Care	1. About MBC, Chinese text & subtitles	1. About MBC, Chinese
2: Scales and Tools to Support MBC	2. Scales and Tools, Chinese text & subtitles	2. Scales and Tools, Chinese
3: Medication Algorithms to Support MBC	3. Algorithms, Chinese text & subtitles	3. Treatment algorithms, Chinese

Grant details:

Grant Title: Enhanced Measurement-Based Care Effectiveness for Depression (EMBED): A Canada-China Implementation Project

Funding Amount: 2.1 million over 5 years

Funding Agencies: Canadian Institutes of Health Research (CIHR) Roadmap Accelerator Fund (RAF) in partnership with the National Natural Science Foundation of China (NSFC)

Investigators:

Principal Investigator, Canada:

Dr. Raymond W. LAM, MD, FRCPC
Professor and BC Leadership Chair in Depression Research;
Associate Head for Research and International Affairs, Department of Psychiatry, University of British Columbia;
Director, Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health;

Principal Investigator, China:

Dr. Jun CHEN, MD, PhD
Director & Chief Physician, Depressive Disorders Program, Division of Mood Disorders
Director, Office of Clinical Research Center
Director, Office of Shanghai Clinical Center for Mental Disorders
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine (SMHC)

Co-Investigators:

Dr. Heather COLQUHOUN	University of Toronto
Dr. Larry CULPEPPER	Boston University
Dr. Carolyn DEWA	University of California, Davis
Dr. Andrew GREENSHAW	University of Alberta
Dr. Yanling HE	Shanghai CDC for Mental Health
Dr. Sidney KENNEDY	University of Toronto
Dr. Xin-Min LI	University of Alberta
Dr. TianLi LIU	Peking University
Dr. Erin MICHALAK	University of British Columbia
Dr. Jill MURPHY	University of British Columbia
Dr. Chee NG	University of Melbourne, Australia
Dr. Sagar PARIKH	University of Michigan, Ann Arbor
Dr. Claudio SOARES	Queen’s University
Mr. Phil UPSHALL	Mood Disorders Society of Canada
Dr. Zuowei WANG	Shanghai Mental Health Center/Hongkou District Mental Health Center of Shanghai, Shanghai JiaoTong University School of Medicine
Dr. Yifeng XU	Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine (SMHC)

Abstract:

Depression affects 300+ million people globally and is now the leading cause of disability and burden of disease worldwide. In China, the National Mental Health Work Plan 2015-20 specifies improving the ability of healthcare facilities to identify depression and increase the treatment rate by 50%. Measurement-based care (MBC) – the routine use of validated outcomes such as the PHQ-9 depression questionnaire to guide clinical decision-making – is a simple evidence-based practice (EBP) that may help meet these objectives. However, there is still a significant care gap in the implementation of MBC in China and elsewhere. In Canada, we have adopted the concept of enhanced MBC (eMBC), in which technology can engage both patients & physicians in using MBC; eMBC enhancements include internet and mobile app tools for patients to track their own progress with the PHQ-9, and an evidence-based, low-cost, low-intensity psychological treatment (computer/internet guided self-management with telephone/WeChat lay coaches) that has embedded patient measurement and feedback to physicians.

EMBED: a Canada-China implementation project, proposes to develop a novel EBP implementation strategy by adapting, implementing and evaluating eMBC in diverse community mental health clinics in Shanghai, modeled on programs implemented in Canada. EMBED addresses 4 broad aims: 1) identify contextual enablers & barriers to MBC implementation; 2) explore physician- and patient-level factors as mediators for an EBP implementation; 3) provide clinical & health economic outcomes to establish effectiveness of eMBC; and 4) build knowledge & capacity for scale up of eMBC in China and beyond. Our hypothesis is that physician & patient factors that are barriers for implementation of standard MBC will be enablers for implementation of eMBC.

To achieve these aims, we will first conduct a Situational Analysis to determine the key barriers & enablers for MBC implementation in Shanghai. We will adapt a Canadian eMBC program for the Chinese context, then will use a hybrid implementation-effectiveness design (an adaptive cluster randomized evaluation) to compare eMBC with standard MBC implementation in 12 community clinics, 240 physicians, and 1200 patients. We hypothesize that eMBC implementation will lead to superior implementation, patient and cost-effectiveness outcomes, compared to standard MBC.

EMBED will advance the international literature on MBC broadly by focusing on the understudied role of patients in implementation of MBC. EMBED will also further implementation science by creating new knowledge on contextual factors, including mediating effects of physician- and patient-level factors, together, on EBP implementation outcomes. Moreover, the unique partnership of the EMBED team with the APEC Digital Hub for Mental Health will ensure a pathway for integrated knowledge & policy translation so that findings will have significant scale-up and spread potential in other regions in China, the Asia-Pacific and worldwide.