Healthcare and social sector partners develop new AI tool for early signs of depression in seniors

As part of a three-year research study and programme named SoundKeepers, seven partners from the healthcare and social sectors have come together to launch an AI tool that uses voice biomarkers to detect early signs of depression in seniors, and introduce a community intervention programme to manage depression in seniors outside of current healthcare settings.

Besides the seven main partners that comprise of Nanyang Technological University, Singapore’s Lee Kong Chian School of Medicine, the College of Computing and Data Science, the National Healthcare Group and the National Healthcare Group Polyclinics, the Institute of Mental Health, Fei Yue Community Services and Club HEAL, and the Lien Foundation. In addition, 20 GP clinics in Hougang and Woodlands also play a supporting role.

Aiding those with SSD before it develops into something more severe

SoundKeepers involves over 600 seniors aged 55 years old and above and suffering from subsyndromal depression (SSD) in the study. SSD is where depressive symptoms are starting to emerge but are not yet severe enough to warrant a diagnosis and is a largely unaddressed health risk among seniors.

Dr Mythily Subramaniam, Assistant Chairman, Medical Board (Research), IMH and Co-Principal Investigator of SoundKeepers, said:

Currently SSD is not actively diagnosed or treated. However, with the focus on early detection and treatment emphasised by both HealthierSG and the National Mental Health and Well-Being Strategy, this project becomes extremely relevant as it can facilitate the early detection and diagnosis of SSD with a tool that can be easily used in the community setting.

As Dr Subramaniam said, this is important as Seniors with SSD are five times more likely to develop depression within a year and have a 12 times higher risk of dementia. It is one of the most common mental health conditions to affect seniors in Singapore, with 13.4% of community-dwelling seniors older than 60 affected by it, a likely under-estimation as it is based on self-reported assessments.

This places an additional burden on Singapore’s healthcare system as Seniors with SSD incur higher healthcare costs than those without SSD and have comparable use of outpatient services to those with depression. Chronic diseases and disability, conditions that commonly plague seniors, exacerbate SSD.

How the pilot will work

Recruitment of participants will begin at the Hougang and Woodlands Polyclinics with two components to the programme structure:

How it works now

Currently, a patient’s mental health is mainly assessed via self-reported data, in the form of questionnaires provided by healthcare and social service professionals to be completed by patients. Accuracy often hinges on the ability of patients to recall accurately, and each patient’s subjective assessment. Those who prefer to keep their mental condition under wraps can do so easily by providing inaccurate answers. As a result, healthcare providers sometimes struggle with reconciling questionnaire results with their intuition. This challenge is often accentuated when working with seniors who are reluctant to share their mental health issues.

The collection of voices will be carried out at the polyclinics and IMH with the development of the voice biomarker tool at CCDS. 

Researchers will collect a voice sample of several minutes long from each patient with his or her consent via a casual conversation or passage reading. Deterioration in mental health often leads to physiological changes in the muscles used in voice production.

For example, stress can cause muscle tension in the throat, neck, and jaw, affecting the vocal cords and therefore, the pitch and tone of the voice generated. Strong emotions may lead to physiological arousal such as faster speech or a trembling voice. Shallow or irregular breathing, commonly seen in patients with anxiety, can affect vocal projection and clarity. Insomnia can lead to difficulty in concentrating, affecting speech rate, fluency, and articulation. Fatigue can affect vocal stamina and volume.

The voice samples will be used to build the algorithm for detecting SSD using a designated smartphone. As AI data models can pick these up via analysis of the acoustic properties in a voice sample, which range from commonly known ones such as pitch and volume, to lesser-known ones such as timbre, rhythm, shimmer, jitter, Harmonics-to-Noise Ratio, and others.

Working towards a goal

The goal is to develop an AI model with a representative sample of the population that comprises the well, patients with SSD, and patients with depression, as well as in the same patient across time. Once developed, the voice biomarker will provide an indication of the state of a patient’s mental health of depression or SSD in an objective manner, similar to how doctors currently take readings of a patient's temperature or blood pressure.

The goal of SoundKeepers is not to replace existing screenings, for the rapport forged through the conversations and manual screenings is vital. Rather, the voice biomarker tool will complement by helping professionals make their assessments with greater confidence and consistency by providing another reference point.

Part two

Part two will see a referral process for identified seniors from the polyclinics to the SSAs where they will attend a 24-week community-based early intervention programme.

Co-developed by IMH, NHGP and the SSAs, it will comprise psychoeducation, community activities, and befriending. Psychoeducation will come in the form of seven modules that will equip individuals with a range of strategies and techniques to combat SSD. Some of these strategies include making lifestyle changes such as exercising more frequently and eating well, as well as learning ways to establish achievable goals and identifying a trusted confidant who can help them tide through emotionally challenging periods.

Seniors will also be encouraged to participate in community activities that improve sociability and mood, such as exercise, outings, skills learning, recreational activities, and assistance with job search. The simplicity of these activities is intentional: They are selected precisely because they are low-intensity, cost-efficient and short-term, which will aid adoption and scalability of the programme. Staff from the SSAs will check in with the seniors every fortnight in the first 12 weeks and monthly for the next 12 weeks.

“In mental health, it is important to intervene early before a condition escalates. The challenge is that there are not many effective ways to do so, which is what we hope SoundKeepers will change. Through it, seniors can potentially benefit from a seamless continuum of care – from early detection at the polyclinics to comprehensive, community-based interventions,” said Rabi’atull Syerida Juma’at, Manager of the Recovery Wellness Programme (RWP) of Club Heal.

The ultimate goal

“The goal is for SoundKeepers, if successful, to eventually become part of the national mental health ecosystem, perhaps in the form of a ‘CREST Plus’, slotting in between CREST and COMIT,” said Lee Poh Wah, Chief Executive Officer of the Lien Foundation. The Lien Foundation is providing S$5.6m in funding

CREST and COMIT are two government-funded community mental health programmes that serve the general public who are at risk of mental illness (in the case of CREST) and those with mental health needs (in the case of COMIT). It is hoped that SoundKeepers will be expanded to more polyclinics, GP clinics, and patient profiles.

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