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Journal of
eISSN: 2373-6445

Psychology & Clinical Psychiatry

Research Article Volume 2 Issue 3

Results of Operation the Online Medical Care System in High Schools

Mahsa Houshdar

Hooshdar Medical Technology Company, Iran

Correspondence: ahsa Houshdar, Hooshdar Medical Technology Company, Iran - Karaj - Taleghani Ave - No 455 - Second Floor, Tel 009832264770, 00989354928132

Received: December 10, 2014 | Published: March 19, 2015

Citation: Houshdar M (2015) Results of Operation the Online Medical Care System in High Schools. J Psychol Clin Psychiatry 2(3): 00075. DOI: 10.15406/jpcpy.2015.02.00075

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Abstract

Introduction: Online Medicare is a method in which parts of a medical process - whether its diagnostics, monitoring or the treatment itself will be done by using online services. This system has been operated in one boys high school, one girls high school and one high school in deprived aria.

Method: At the first step the students registered for using the system. It was not mandatory and not free. They participated in estimating depression scale, anxiety scale and clinical interview by online medical care system. During this estimation, we could find the existence and severity of depression and anxiety in each one of the participants, also we could find the consequent needs of each one, such as supportive therapy in mild depression or anxiety, need to visited by psychologist in moderate cases, need to visited by psychiatrist in moderate-severe cases, need to visited by psychiatrist and psychologist in severe cases and need to perform medical lab examination tests. The lab examination tests were performed on persons specified by the system. In the lab examinations were included: serum level of vitamin D, serum level of vitamin B12, serum level of calcium, fasting blood sugar, HbA1c, thyroid function tests and CBC. All of the students were solely treated by vitamins or minerals therapy and/ or treatment of medical problem (such as hypothyroidism).

Results: In girls high school: the existence and severity of depression significantly decreased (P value= 0.018<0.05), but results about anxiety was not significant. In boys high school: the existence and severity of depression significantly decreased (P value= 0.023<0.05), but results about anxiety was not significant in high school in deprived area the students did not have any problem paying for participating in the project, but they could not pay for medical lab examination tests. Thus, operation of the system was not possible in deprived area without a sponsor.

Conclusion: This online medical system was successful in creating medical and psychiatric profile without attending physician. It was successful in decreasing depression without using antidepressants, but it was not successful in decreasing anxiety.

Introduction

Online Medicare is a method in which parts of a medical process, whether its diagnosing, monitoring or the treatment itself, will be done by using online services. The website (www.hooshdar.com) is an effort to bring fairness in health to people across the globe using modern methods. We choose psychiatric disorder depression and anxiety to be our focus in phase one. Why we choose depression and anxiety in the first line of online Medicare?

The prevalence: The global mean prevalence for depression is about %17 in the life period.1 This is about %14 to %24 in adolescent.2 The global mean for anxiety is %25 in total. It is %30.5 in women and %19.2 in men.3

The second reason for this choice is the morbidities that can be caused by these two diseases. Depression & anxiety can cause decrease in concentration that will reduce interest in doing homework. It can cause fatigue and drowsiness, all of which cause academic failure.4 Depression can cause antisocial behavior in adults, disobedience of rules is its consequence.5 It can cause conduct disorder in adolescents too. It can increase the chance of addiction to opium or alcohol.4 Conduct disorders can cause following problems in adolescents: aggressive behavior causing bodily harm to oneself or others, destruction of property, theft and fraud, disturbing law and order related to their age.6,7

Neither depression nor anxiety doesn’t always occur spontaneously, in many cases they are created because of some other diseases, such as diabetes or hypo or hyperthyroidism.1

Thus, if we can diagnose depression & anxiety, finally we can find the medical diseases which trigger them. Then we can use a plan for a combined treatment. By this way we can prevent many academic failure and aggressive behavior in the high schools.

For finding the main diseases which should be considered

First, I considered the 13 to 19year old depressed or anxious patients, who were referred to my personal office for medical disorders, they showed:

  1. Hypothyroidism (%11.1)
  2. Impaired GTT (%8.33)
  3. Reactive hypoglycemia (%5.5)
  4. Hypocalcaemia (%13.88)
  5. Vitamin b12 deficiency (%38.88)
  6. Poly cystic ovary(%2,52)
  7. Thalassemia (%2.52).

After this research we decided to search Hypothyroidism, vitamin B12 deficiency, Hypocalcaemia, diabetes, impaired fasting glucose level, hypoglycemia, and anemia in persons, who were presented for lab examination by the system. After two years we decided to change hypocalcaemia with vitamin d deficiency.

With Ministry of Education’s permission, we decided to operate this system in high schools. As pilot study during three years we operated the system in one girls high school, one boys high school and one high school in a deprived aria. Participating in this program was neither mandatory nor free, thus the results cannot be generalized, but it can show the relationship between depression and anxiety with medical diseases in Iran and the effectiveness of operating the system in schools in decreasing these two problems. Results in high school in deprived area:

We can show the results by using a few tables (Table 1-3):

  1. As you see: Only %10 persons from %43 persons who chosen by system for lab examinations, could pay the price of lab examination in the high school of deprived area. These pilot studies show that participating in this program in high schools in deprived areas without sponsor is not possible.
  2. Results in girls high schools: The results in girls high schools show that, operating the system can reduce the rate and severity of depression significantly. Because of low participation, we cannot reach statistically significant results about anxiety. We can show the results by using a few tables (Table 4-6):
    After four month we come back to the high school, and measured the severity of depression and anxiety in the participants who treated by folic acid, Fe, levothyroxine and vitamin b12. No one treated by ant anxiety or antidepressant. Results show:

Normal

Severe

Moderately

Moderate

Mean ± SD

Total participants

depression

severe

depression

Refer to

depression

Refer to

Psychiatrist & psychologist

Refer to

Psychologist

Doing lab exam

psychiatrist

Doing lab exam

 

 

Doing lab exam

 

 

13

10

11

22

15

71

18.30%

14%

15.50%

31.90%

21.10%

100%

Table 1 Severity of Depression in Total Participants, and their needs according to the severity of depression in deprived high school

Normal

Severe

Moderately

Moderate

Mild

Total

Anxiety

severe

Anxiety

Anxiety

participants

Refer to

Anxiety

Refer to

Supportive

Psychiatrist &

Refer to

Psychologist

Therapy

psychologist

psychiatrist

Doing lab

Doing lab

Doing lab

Exam

 

Exam

Exam

 

 

 

12

1

8

21

29

71

17%

1.50%

11%

29.50%

41%

100%

Table 2 Severity of Anxiety in Total Participants, and their needs according to the severity of Anxiety in deprived high school

c

Low

200< Vitamin b12<350

Vitamin b12<200

Total

calcium

participants

blood

 

level

 

 

 

1

1

5

1

7

Hypothyroidism

High

Impaired

Diabetes

Total

Cholesterol

fasting

participants

or TG

glucose

blood level

0

0

0

0

7

Table 3 The rate of medical diseases in the participants who chosen by the system for lab exam

Normal

Severe

Moderately

Moderate

Mild

Total

depression

severe

depression

depression

participants

Refer to

depression

Refer to

Supportive

Psychiatrist & psychologist Doing lab

Refer to

Psychologist

Therapy

exam

psychiatrist

Doing lab

Doing lab

Exam

 

 

exam

 

 

 

28

2

7

13

25

75

37.30%

2.6

9.30%

17.30%

33.30%

100%

Table 4 Severity of Depression in Total Participants, and their needs according to the severity

Normal

Severe

Moderately

Moderate

Mild

Total

Anxiety

severe

Anxiety

Anxiety

participants

Refer to

Anxiety

Refer to

Supportive

Psychiatrist &

Refer to

Psychologist

Therapy

psychologist

psychiatrist

Doing lab

Doing lab

Doing lab

exam

 

exam

exam

 

 

 

100

38

31

4

0

28

100%

38%

31%

4%

0%

28%

Table 5 Severity of Anxiety in Total Participants, and their needs according to the severity of Anxiety in deprived high school

Total

Vit b12<200

200<vit b12<350

Diabetes

Hypo

Impaired FBS

participants

 

 

glycemia

 

20

2

15

0

0

0

100%

10%

75%

0%

0%

0%

Total

Anemia

Hypo calcemia

Hypothyroid

Without problem

High

participants

Cholesterol

or TG

 

 

 

 

 

blood level

20

1

0

1

2

0

100%

5%

0%

5%

10%

0%

Table 6 The rate of medical diseases in the persons, chosen by the system for lab exam

  1. Statistical results in anxiety scale test GAD7.
  2. The P value is 0.1244 (> 0.05, Signed rank test comparing the mean versus 0). The lack of difference may be due to lack of statistical power, (with more subjects, we could perhaps show a significant difference).
  3. Statistical results in depression scale test PHQ9.
  4. The mean difference between baseline and final endpoint is -2.9 with a standard deviation of 3.96, the 95 % Confidence interval is -4.9; -0.9 and don’t contains 0, so the difference between before and after is statistically significant for this parameter. On the other hand the P value is 0.018 (<0.05, Signed rank test comparing the mean versus 0).

Results in boys high schools

  1. The results in boy’s high schools show that; operating the system can reduce the rate and severity of depression significantly in treated patients compared with non treated patients and semi treated patients. Although we cannot reach statistically significant results about anxiety. We can show the results by using a few tables (Table 7-9).

Total

Mild

Moderate depression

Moderately severe depression

severe depression

Normal

participant

depression

Refer to psychologist Doing

Refer to psychiatrist

Refer to psychiatrist, psychologist

Supportive

lab exam

Doing

Doing

 

therapy

 

lab exam

lab exam

 

109

27

30

20

15

17

100%

24.70%

27.50%

18.30%

13.70%

15.60%

Table 7 Severity of depression in total participants, and their needs according to the severity of their depression

Total

Mild anxiety

Moderate

Moderately severe anxiety

severe

Normal

participant

Supportive

anxiety

Refer to psychiatrist

anxiety

therapy

Refer to psychologist Doing

Doing

Refer to psychiatrist, psychologist

lab exam

lab exam

Doing

 

 

 

 

lab exam

 

109

34

35

21

0

19

100%

31.20%

32.10%

19.20%

0%

17.40%

Table 8 Severity of anxiety in total participants and their needs according to the severity of their anxiety

Impaired

Hypo

Diabetes

10<

Vitamin D

Total

Fasting

glycemia

Vitamin D

<10

Participants

Glucose

<30

Level

 

 

 

 

 

8

1

1

33

4

38

21%

2.50%

2.50%

86.80%

10.50%

100%

Normal

Hypo or

Anemia

200<

Vitamin B12

Total

Hyper

Vitamin B12<

<200

Participants

 

Thyroid

 

350

 

 

0

0

0

27

2

38

0%

0%

0%

71%

5%

100%

Table 9 The rate of medical diseases in the persons, chosen by the system for lab exam

All of the students that the system had recommended to be visited by a physician or a psychiatrist, have been visited, and got a credit for future visit, if necessary. They treated via using vitamin D, vitamin b12, vitamin b2 for impaired fasting glucose, proper diet, no one treated by antidepressant or ant anxiety. After four month we came back to the high school to find out whether this system was effective in reducing depression or anxiety or not.

The results after three month

The participants divided to three groups

  1. Group one: treated patients, ones who continue treatment during four month.
  2. Group two: semi treated patients, ones who began the treatment but they not continue it for four month, they told us while they use what had prescribed they feel better.
  3. Group three: no treated patients, ones who have not begun treatment during four month.

Statistical results of PHQ9 changes in treated patients between May and Oct 2014: it is significant with P value 0.023 < 0.05.

  1. Statistical results of PHQ9 changes in non treated patients between May and Oct 2014: it is notsignificant.(P value = 0.331 > 0.05)
  2. Statistical results of PHQ9 changes in semi treated patients between May and Oct 2014: it is not significant.(P value = 0.055 > 0.05)
  3. Statistical results of GAD7 changes in treated patients between May and Oct 2014: it is not significant.(P value = 0.069 > 0.05)
  4. Statistical results of GAD7 changes in non treated patients between May and Oct 2014: it is not significant.(P value = 0.103 > 0.05)
  5. Statistical results of GAD7 changes in semi treated patients between May and Oct 2014: it is no significant.(GAD7 before and after treatment is equal)

Conclusion

  1. By using this system: we can decrease the rate of depression without using any antidepressants.
  2. We can create medical and psychiatrically profile for several people without direct attending physicians or psychiatrists.
  3. We could saw there were different results in lab examinations in boys’ high schools and girls’ high schools. We need more practice with this system to can consider the best for each group.

Acknowledgments

None.

Conflicts of interest

Author declares there are no conflicts of interest.

Funding

None.

References

Creative Commons Attribution License

©2015 Houshdar. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.