WhatsMyM3?

NBC-4 News Clip from Doreen Gentzler (May 16, 2012)

What’s your mental health number?

This is the question that the Bipolar Collaborative is asking, using its WhatsMyM3 screening tool [PubMed]. “Many other illnesses have a 'number' that one can track – cholesterol, high blood pressure, diabetes. What’s the number for mental health?” asks Michael Byer, president of M3 Information, based in Bethesda, Md.

~from Clinical Psychiatry News

Today's USA Today newspaper ran a story titled, "Screening for mental illness? Yes, there's an app for that," by Michelle Healy.


WhatsMyM3 is a validated, 3-minute tool that screens for symptoms of depression, bipolar disorder, PTSD, and anxiety, and can be used to monitor changes in symptom severity over time.

One of the developers, Michael Byer, approached me about a year ago for my opinions on development and use of the screening tool. Disclosure: After reviewing the research and seeing how useful it is, I have become more involved in the organization, becoming an adviser to the group that was started nearly ten years ago by past NIMH chief, Robert Post MD. (listen to podcast #63)

It differs from other mental health screening tools, such as the PHQ-9 and the MDQ, in that these are all unidimensional -- they only measure one domain of symptoms. The M3 is multidimensional, measuring four areas of symptoms. Furthermore, when compared to results from the standardized interview tool, the Mini International Neuropsychiatric Interview (the MINI measures for 15 different mental illness diagnoses), WhatsMyM3 provides a total mental health score that is 83% sensitive in finding true positives and 76% specific in finding true negatives. In addition to the total score, there are four subscores, one each for depression, bipolar, PTSD, and anxiety.

Put another way, the negative predictive value of the total score is 89%, meaning that if you score under the threshold, there is an 89% chance that you do not have any mental health diagnosis by the MINI. As with most screening tests, you want the negative predictive value to be high so that you don't have to subject the "negatives" to more specific testing. The positive predictive value, or PPV, is generally lower for screening tests. It is 65% for WhatsMyM3, meaning that if you score positive (total score >= 33 and positive for functional impairment), the odds of you having a diagnosis is almost two-thirds. A clinical evaluation can then help to determine if you do have a diagnosis. (Note: this tool cannot give you a diagnosis; it can only describe your relative risk of having, or not, a diagnosis.)

What people have found to be most helpful is using WhatsMyM3 to monitor their symptoms over time once they do have a diagnosis. This can be done for free on the website, or for $2.99 using the iPad or iPhone apps, or the Android app. For mental health clinicians, they can download the free M3Clinician iPad app and then screen their own patients. For about a dollar per screen, they can register their patients who want to track their symptoms over time and share their scores with the clinician. Primary care providers also purchase screens, and can even obtain insurance reimbursement by billing for an annual health risk assessment. The patient reports can be viewed by logging into m3clinician.com.

A sample report for a fake patient can be viewed here.

I think this sort of tool, or app, is exactly the sort of mHealth thing that empowers consumers to better manage and become engaged in their health care needs. This is happening in other areas, like diabetes, heart disease, and obesity. Mental health is also making great strides in mHealth.

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I should also point out here that the folks at M3 Information were the only ones to take us up on our offer of a free "advertisement" on Shrink Rap in return for donating at least $200 to our NAMIWalk for Mental Health Month (we don't typically accept display ads). A logo ad will be running soon on Shrink Rap soon for two weeks in recognition of their charitable donations. It will look like this and link to the iPhone and Droid apps. [We received no money ourselves from M3 nor from NAMI. We've never accepted any money from Pharma companies, nor does M3.]

Harvard Online

Okay, it's not psychiatry, but it's my blog and I'll divert if I want to. So this looks cool, you can take a popular Harvard course for free and in the comfort of your own home. You know I'm there:

http://justiceharvard.org/

[addition by Roy:]

And don't forget iTunesU, which has a slew of full courses from major teaching facilities available free via iTunes. Places such as:
> Stanford
> Berkeley
> MIT
> Texas A&M
> Harvard
> Penn State
> Vanderbilt
> Columbia
> Yale
> Carnegie Mellon
> UNC
> Boston University
> Oxford
> University of Maryland
> Johns Hopkins School of Nursing
[Note back from Dinah] The Harvard "Justice" Course is not just on line, it's being Televised on public TV (there's a link on the website).
Readers: If you try a class, please let the rest of us know what you think of it. [-Roy]

Go to iTunes U and Become a Psychiatrist

An interesting convergence of themes occurred today, from three separate threads. From this remarkable thematic convergence, I have come to the conclusion that one can become a psychiatrist just by sleeping.  Please, follow along.

I couldn't fall asleep last night and could no longer focus on writing a chapter for our book, and so was cruising iTunes U, looking to see what sort of interesting lectures they had there.  (Yes, it is ironic that, despite my above-stated conclusion, I was already a psychiatrist yet could not sleep.)

If you aren't familiar with iTunes U, they make audio and video podcasts of

 college lectures from MIT, Yale, Stanford, and other participating universities, available for free. No enrollment fee. No 8am lectures. No uncomfortable chairs. Alas, no credit, but you get to learn for free.

Believe it or not, I spent 45 minutes watching a Stanford engineering course on Fourier transforms -- and didn't fall asleep!  At 3:00 AM!!  Thank you, Brad Osgood (iTunes link HERE).  I did not take any notes, btw.

So, that was the first thread.  

After a fitful four hours of sleep, dreaming of wavelengths and lambda, I begin my Sunday morning with blueberry and ginger pancakes.  Since this is 2009 and all, I am reading -- not the Sunday paper -- but the Sunday blogs and news on the computer.  I come across a post by a fellow psychiatrist blogger in the Netherlands, DrShock, about a just-published article from Computers & Education, entitled "iTunes University and the Classroom: Can Podcasts Replace Professors?", and written by SUNY psychologist, Dani McKinney et al.  This was a very interesting second thread, which related to the first.  What Dr McKinney did was have two different groups of psychology students receive a lecture on "perception."  One group attended a traditional class lecture and the other received the lecture as a podcast.  They were later tested on their recall of information from the lecture.  Alas, there was no random group assignment, which is a relative weakness of the study design.  

But the findings suggest that a podcast lecture provided more opportunity to re-listen and take notes than the live lecture, as the podcast group scored significantly higher than the live lecture group.  Of those students who took an average amount of notes, the podcast students scored an average letter grade (10 points) higher than the classroom students.  (If you'd like a copy of the entire article, you may write Dr McKinney at mckinneyATfredoniaDOTedu.)

Most of the podcast students listened to the lecture more than once, so they had more opportunity to learn the material.  This is one of the benefits of having a recording of the lecture.

Here's what made me go "Hey, wait a minute, this is quite a coincidence!" -- I have had dinner with Dani McKinney before.  She is, in fact, a close friend of one of my close friends.

So, the third thread of this convergence of ideas hits me when I go to Shrink Rap and see that the Google ad on the right sidebar says,

"Be a Psychiatrist.  Advance your career - earn a degree in Psychiatry completely online."

Well, I can see the handwriting on the wall.  THIS is the 7th future trend in Psychiatry.  Online medical degrees.  You don't even need to go to class.  Just listen to the podcast (at least twice for better retention) and take notes while you listen, and you can advance your career in no time.  I suppose if you are really lazy, you could play the podcasts while you sleep.  I'm not sure if there would be adequate retention to pass the tests under this condition, but Dani assures me that she will be testing out this hypothesis with the next group of psychology students.  Wake me up when we get there.  In the meantime, I'm heading over to iTunes U to take some neurosurgery classes.  Reimbursement for procedures is much better than for cognitive services.