Journal of Mental Health Policy and Economics最新文献

{"title":"Unveiling the Value of Early Depression Screening in U.S. Adults: A Systematic Review of Clinical Benefits and Economic Returns.","authors":"Ya'akov M Bayer, Tzion Dadon, Ephraim Schreiber","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Major depressive disorder (MDD) in U.S. adults is common, disabling, and costly. Screening is recommended when follow-up is available, yet uptake remains uneven, and digital tools raise governance risks.</p><p><strong>Aims of the study: </strong>To synthesize U.S. evidence on depression burden, screening uptake, and test performance, and the clinical and economic value of early detection linked to structured follow-up, including digital and AI-based approaches.</p><p><strong>Methods: </strong>Systematic review guided by PRISMA 2020 (2000 through March 2025) across four databases and U.S. reports; dual screening and descriptive synthesis using predefined inclusion criteria and standardized extraction templates were conducted independently.</p><p><strong>Results: </strong>From 3,224 records, 112 studies were included. Depression prevalence reached 8.3 percent in adults and over 20 percent in young adults by 2022. While primary care screening rates vary (48 to 60 percent), PHQ-9 performance remains robust (88 percent sensitivity and specificity). Linking screening to collaborative care doubled remission rates (from 18 to 40 percent), cut hospitalizations by 20 percent, and reduced missed workdays from 9 to 4. Economically, integrated care is highly efficient (ICER: 15,000 to 35,000 dollars per QALY) with a 5 to 1 ROI in older adults. Digital tools reduce costs but face over 40 percent attrition; passive sensing shows high accuracy (0.89) but remains limited by privacy concerns.</p><p><strong>Discussion: </strong>Value concentrates where systems deliver timely follow-up, treatment initiation, and monitoring; screening without capacity yields limited benefit. Limitations include heterogeneous comparators, model dependence on adherence and fidelity, and privacy, bias, and equity risks for digital tools.</p><p><strong>Implications for health care provision and use: </strong>Standardize PHQ 2 then PHQ 9 workflows with EHR and portal automation, clear follow-up timelines, and stepped-care escalation.</p><p><strong>Implications for health policies: </strong>Tie incentives to screening plus documented follow-up, support under-served settings, and require privacy and bias-monitoring standards for digital screening.</p><p><strong>Implications for further research: </strong>Run pragmatic payer-specific evaluations and head-to-head cost-utility comparisons of digital versus questionnaire-based screening with longer follow-up and equity endpoints.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"29 1","pages":"3-14"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PERSPECTIVE: Community Health Centers: The Missed Opportunity to Widely Integrate Mental and Primary Health Care in France.","authors":"Matthias Brunn, Wladimir Hindryckx, Elodie Malvezin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Access to mental health care and its integration with primary care remain critical challenges worldwide. In France, these problems are compounded by fragmented provision, poor coordination, and limited reimbursement for psychotherapy, despite the country's high levels of health expenditure.</p><p><strong>Aims: </strong>This perspective examines how community health centers (centres de santé) can contribute to integrated care, understood as the systematic coordination of physical and mental health services across providers. We analyze the case of the Centre de Santé de Belleville in Paris as an illustration of how CDS can host significant mental health capacity for vulnerable populations, and explore why the model remains marginal in the French health system.</p><p><strong>Methods: </strong>We combine analysis of national policy reports, academic literature, and internal audit data from the Belleville center to situate CDS within French health system dynamics. A Strengths, Weaknesses, Opportunities, and Threats (SWOT) grid is used to summarize the model.</p><p><strong>Results and discussion: </strong>The Belleville case illustrates that CDS can deliver integrated mental and primary care, with salaried teams of general practitioners, psychologists, and a psychiatrist serving a disproportionately vulnerable population. However, structural weaknesses - financial fragility, fragmented representation, reputational risks, and the enduring dominance of the self-employed, independent physician (\"liberal medicine\") - limit their wider diffusion. Policy windows linked to financing reform, workforce shortages, and broader frames such as sustainability occasionally elevate CDS on the agenda, but institutional path dependency keeps them peripheral.</p><p><strong>Implications: </strong>Community health centers in France illustrate how institutional legacies and professional power can constrain the adoption of organizational models aligned with policy goals. For international readers, the case underlines the importance of political economy and system values - in this case, liberal universalism - in shaping the possibilities for integrating mental and primary health care.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"29 1","pages":"15-22"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Cost-Utility of a Workplace Mental Health Program for Employees with Common Mental Disorders (FRIAA Project).","authors":"Nadine Mulfinger, Tamara Waldmann, Regina Herold, Jeannette Weber, Meike Heming, Manuel Feißt, Christoph Kröger, Marieke Hansmann, Harald Gündel, Nicole R Hander, Eva Rothermund-Nassir, Reinhold Kilian","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Common mental disorders (CMDs) are a leading cause of sickness absence and early retirement due to health problems. Early identification and treatment of CMDs may have a positive impact on prognosis and associated economic costs, including healthcare expenditure, lost productivity, and the societal burden. The effectiveness of workplace psychotherapeutic interventions has been studied, but information on cost-effectiveness in this population is lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;This study evaluates the cost-effectiveness of the FRIAA intervention for employees with CMDs compared to care as usual (CAU), with the aim of reducing sickness absence and preventing early retirement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used data from a multicenter randomized controlled trial involving 549 employees with mental health problems in different companies located near five study centers in Germany, who provided data at nine- and 15-month follow-up. A total of 545 records were available for the economic evaluation (EE). 278 participants were assigned to the intervention group (FRIAA), and 267 participants were assigned to the CAU condition. On average, intervention participants received eight intervention sessions. The use of health and social care services was assessed using the Client Sociodemographic and Service Receipt Inventory (CSSRI) at nine- and 15-month follow-up. Data were transformed to a 12-month reference period. Quality of life was measured using the EQ-5D-5L questionnaire. Cost-utility analysis was performed by calculating additional costs per one additional quality adjusted life year (QALY).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The annual cost difference between FRIAA and CAU was euro 3,484.29 (95 % confidence interval [CI] euro 1,033.91 to euro 5,934.67), which was significant (p = 0.005). We estimated the average QALY in the CAU group to be 0.768 (SD = 0.200) and in the FRIAA-group to be 0.789 (SD = 0.192). The difference in QALY between FRIAA and CAU was 0.021 (95 % CI -0.013 to 0.055), which was not significant (p = 0.203). The incremental cost-utility ratio (ICUR) showed that the intervention was associated with costs of euro 165,918.57 for one additional year of full health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;As far as we know, this was the first EE of a psychotherapeutic consultation at work called FRIAA. Compared to CAU, FRIAA did not result in improved quality of life in terms of QALYs, nor favourable cost-utility for FRIAA compared with CAU. The FRIAA intervention cannot be considered cost-effective compared to CAU.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications: &lt;/strong&gt;This EE found that differences in costs were significant (with higher costs in the FRIAA group), while no statistically significant differences in QALYs were observed between the study groups. In addition, the cost-utility for FRIAA compared with CAU was not favourable. Participants with CMDs may need more time to integrate what they discuss in p","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"29 1","pages":"23-35"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Transcranial Magnetic Stimulation for Methamphetamine Use Disorder during Pregnancy.","authors":"Rana Jawish, Abdelrahman G Tawfik, Brian Mickey, Adam J Gordon, Robert Silver, Marcela C Smid, Casey R Tak","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Methamphetamine use disorder (MUD) during pregnancy is associated with adverse maternal and perinatal outcomes, including increased risk of preterm birth, cesarean delivery, neonatal intensive care unit admission, placental abruption, and maternal or perinatal death. For the few evidence-based treatments for MUD, including transcranial magnetic stimulation (TMS) and injectable naltrexone with bupropion combination, there are few data available for pregnant individuals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;We completed an exploratory model applying existing knowledge in clinical practice and available research to examine the potential cost-effectiveness of TMS compared to the combination of injectable naltrexone with bupropion or care as usual in a population of pregnant individuals with MUD. We aim to utilize the outcome of this analysis to inform future trial designs that examine TMS efficacy and safety in MUD during pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A decision tree model was developed to evaluate the direct medical costs and clinical outcomes of TMS compared to injectable naltrexone with bupropion or usual care for pregnant individuals with MUD. The analysis included three strategies from the start of pregnancy through delivery, focusing on mode of delivery, gestational age, and infant birth weight. The primary outcome was the percentage of full-term vaginal deliveries of infants with normal birth weight. The analysis was conducted from a third-party payer perspective, considering only direct medical costs, and used a $50,000 willingness-to-pay threshold to determine cost-effectiveness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In this experimental model, TMS demonstrated the lowest overall cost and highest effectiveness, yielding 76% full-term vaginal deliveries with normal-weight infants, compared to 44% for injectable naltrexone with bupropion combination and 39% for no intervention. Sensitivity analyses confirmed the robustness of TMS as a cost-effective intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Our exploratory model found that TMS was cost-effective compared to injectable naltrexone and bupropion or usual care, potentially improving outcomes at low costs. This study provides preliminary data supporting TMS being a promising cost saving option for MUD during pregnancy. The study's limitations include absence of direct TMS efficacy data in pregnant populations, necessitating the use of extrapolated data, small sample size, and short-term nature of efficacy data in non-pregnant populations. Additionally, there was insufficient data on the adverse effects of the interventions on fetuses and infants, highlighting the need for studies to confirm safety and efficacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;Both TMS and the combination of injectable naltrexone and bupropion show potential for treating pregnant individuals with MUD. However, neither treatment is FDA-approved ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"28 4","pages":"125-132"},"PeriodicalIF":1.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PERSPECTIVE: Self-Funded Group Health Plans: A Public Mental Health Threat to Employees?","authors":"Meiram Bendat, Katherine G Kennedy","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>With nearly one in four Americans estimated to have a mental illness and only half of them receiving treatment in a given year, access to affordable, quality mental health care remains out of reach for many. Although health insurance is intended to promote access to mental health care, approximately 35 million Americans covered by self-funded group health plans sponsored by private employers may be unaware that their health plans are not subject to federal standards for medical necessity and network adequacy, key terms that determine the availability of coverage and can significantly limit their access to essential treatment. The Employee Retirement and Security Act of 1974 (\"ERISA\") governing self-funded group health plans does not require them to base their definitions of medical necessity for covered services on generally accepted standards of care. Nor does ERISA require them to follow or disclose network adequacy standards. To the extent network adequacy standards are often undisclosed, if they exist at all, plan participants can be exposed to significant out-of-network financial liabilities when in-network mental health services are unavailable. ERISA's judicial review provisions further disadvantage plan participants by requiring courts to defer to employer benefit interpretations and by severely restricting available relief. To improve access to affordable, high quality mental healthcare for participants in self-funded health plans, the following reforms are crucial: a federal definition of medical necessity, time and distance standards for network adequacy, hold harmless provisions for out-of-network costs due to network inadequacy, and removal of restrictions on judicial review and available remedies.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"28 4","pages":"121-124"},"PeriodicalIF":1.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Utility of Repetitive Transcranial Magnetic Stimulation (rTMS) among Treatment Resistant Depression Patients.","authors":"Anna-Kaisa Vartiainen, Elisa Rissanen, Ismo Linnosmaa","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Depression has a high prevalence worldwide and because of its recurrent nature, it represents a major economic burden on society. It is important to identify and evaluate effective treatments to avoid the health disutilities and costs related to poor health. Repetitive transcranial magnetic stimulation (rTMS) is a neuromodulatory technique which is clinically safe, non-invasive, and effective for major depressive disorder and it is used for treatment after at least two failed antidepressant medication trials. The availability of rTMS treatment is still limited in many countries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;The main study objective was to evaluate the cost-effectiveness of add-on rTMS therapy compared with pharmacotherapy in patients with treatment-resistant depression in Finland from a societal perspective.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A one-year Markov-model with two-month cycles was analysed to compare costs and quality adjusted life years (QALYs). Medical and productivity costs were included in the analysis. The data for the model (transition probabilities, resource utilization, utilities) were sourced from published literature, a national unit cost report, and Finnish expert opinions. Incremental cost-effectiveness ratio was calculated. Uncertainty was assessed using univariate and multivariate probabilistic sensitivity analyses and scenario analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;rTMS patients gained an average of 0.041 additional QALYs over one year time horizon with an incremental cost of 3,514 EUR compared to pharmacotherapy alone. The result corresponds to incremental cost-effectiveness ratio (ICER) of 85,133 EUR per QALY. Sensitivity analysis points out that one of the key parameters relating to uncertainty and driving ICER is the high unit cost of rTMS treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;rTMS as an add-on treatment for depression has a beneficial clinical effect compared to pharmacotherapy alone, with greater costs. However, ICER was very high suggesting that rTMS may not be cost-effective acute treatment for TRD patients in Finland. If the unit cost of the rTMS treatment can be reduced, the treatment could be cost-effective. The main limitation of this study was the short time horizon. In addition, modelling studies include assumptions, which contain uncertainty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;The cost-effectiveness of interventions depends on the health care decision-maker's willingness to pay. rTMS can be effective in treating depression; however, in high price level countries (high unit costs) with limited access to treatment, rTMS may not provide value for money for treating acute phase TRD patients, and it may not be recommended for public health care resources investments. It should be still noted that mental health conditions can be complex and have broad effects on an individual's life. When conducting economic evaluations of m","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"28 4","pages":"133-146"},"PeriodicalIF":1.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PERSPECTIVE: Social Determinants: New Possibilities for Intervention Research in Global Mental Health.","authors":"Crick Lund","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Since its launch in 2007, the field of global mental health has generated substantial research on the social determinants of mental health. Yet relatively little is known about how to intervene to address these social determinants: are such interventions feasible and effective? If they are effective, what are the mechanisms of these effects?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;This article interrogates some of the important challenges and potential approaches to consider when intervening to address the social determinants of mental health. Challenges include distal intervention targets, opaque mechanisms, intractable political and structural challenges, the need for interdisciplinary approaches, limited currently available datasets, ethical challenges when conducting trials in this field and challenges to research funders, who may be required to fund beyond their disciplinary silos and to convene inter-disciplinary review panels. Nevertheless, several approaches hold promise. First, we need to build more robust and precise theoretical models of how specific social and economic adversities lead to mental health outcomes. This is vital to clearly identify causal mechanisms that may be targeted in interventions. Second, we must test the specific mechanisms in these hypothesized causal pathways for example through including adequately powered mediation analyses in the design of our trials. Third, data need to be shared and where appropriate, pooled across multiple sites, to provide more statistical power and to take context into consideration. Finally, clear criteria need to guide the choice of which social determinants to target.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Recommendations for future research: &lt;/strong&gt;Regarding observational studies, more research is needed to measure the intergenerational transmission of poverty and mental illness and to explore the mechanisms of poverty and mental health over time. We need to understand more about the links between gender, poverty and mental health across the life course, including genetic, biological and socioeconomic risk and protective factors. In relation to intervention studies, research is needed on interventions that address proximal and more distal mechanisms, for example the impact of living environments, climate change and migration on mental health. We are on the threshold of a new era of heightened risk for a broad range of social and economic determinants triggered by climate change, conflict and migration. There is a great deal more that we could be doing to improve our resilience and responsiveness to these challenging circumstances.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Recommendations for policy: &lt;/strong&gt;Adopting a social determinants approach requires a broadened policy agenda. Global mental health advocacy must now also campaign for improved living environments, human rights and reductions in conflict to improve the mental health of populations and reduce inequities in the distribution of mental heal","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"28 3","pages":"97-103"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost Effects of Diagnose, Indicate, and Treat Severe Mental Illness (DITSMI) in Residential Psychiatry.","authors":"Mike H Veereschild, Eric O Noorthoorn, Peter Lepping, Anneke J Van der Veen, Giel J M Hutschemaekers","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The COVID-19 pandemic triggered widespread lockdown measures, including a sudden and substantial increase in working from home arrangements. While intended to reduce virus transmission, these measures may have had unintended consequences for mental health. Remote work limits in-person interactions and alters work-life boundaries, potentially influencing psychological well-being. However, empirical research on the mental health effects of working from home -especially under involuntary conditions- is still limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;This study investigates the impact of working from home on mental health during the first lockdown in Germany. Specifically, it aims to differentiate between selection effects (i.e., individuals who choose working from home based on their circumstances) and causal effects (i.e., the mental health consequences of working from home itself). The goal is to understand whether working from home, when imposed rather than voluntarily chosen, negatively affects mental well-being.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We use data from the Mannheim Corona Study (MCS), which collected high-frequency panel data from a representative sample of the German population during the first lockdown (March-July 2020). The analysis focuses on employed individuals and excludes those not working. We create a binary working from home indicator and analyze its association with four mental health measures: two indicators of depressive symptoms, one of loneliness, and one of social interaction frequency. Both pooled linear regressions and fixed effects models are employed to estimate associations while accounting for confounders and unobserved heterogeneity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Descriptive statistics reveal that working from home was more common among individuals with higher income and education, reflecting a socioeconomic selection effect. Pooled regression results show a significant association between working from home and increased loneliness, depressive symptoms, and reduced social interaction. These associations persist even after controlling for sociodemographic characteristics. Fixed effects panel regressions-focusing on within-individual changes-confirm a significant, though smaller, negative effect of working from home on mental health, particularly regarding loneliness and loss of interest. This strengthens the evidence for a causal link between working from home and reduced psychological well-being, independent of pre-existing personal characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The findings suggest that even privileged individuals working from home experienced a decline in mental health, highlighting the psychological costs of reduced social interaction during the lockdown. Limitations include the lack of pre-pandemic mental health data and the inability to distinguish between voluntary and enforced working from home beyond the lockdown context. Also, the relatively","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"28 3","pages":"105-116"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Access to Substance Use Disorder Treatment Associated with the 2008 U.S. Parity Law.","authors":"Timothy B Creedon, Constance M Horgan, Xiaodong Liu, Dominic Hodgkin","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Historically, U.S. health insurance plans included fewer and more restrictive benefits for mental health (MH) and substance use disorder (SUD) treatment compared to general medical care. The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) mandated that group-based private health plans covering MH/SUD treatment do so in a way no more restrictive than coverage for general medical care. Multiple rounds of rulemaking, including 2024 final rules most recently, have strengthened federal regulation of plans' non-quantitative treatment limits (NQTLs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;To investigate how SUD treatment rates, perceived unmet needs, and barriers to treatment changed for adults with group-based private insurance following MHPAEA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a secondary analysis of annual, cross-sectional data from the National Survey on Drug Use and Health (2006-2014) with a sample of adults aged 18-64 years meeting criteria for SUD treatment need. We used difference-in-differences models to estimate and compare outcomes between adults with group-based private insurance (GBPI) and multiple comparison groups including those with individual-based private insurance (IBPI) before (2006-2009) and after (2011-2014) MHPAEA implementation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 32,605 survey respondents with SUD (weighted N=16,108,465), 17,065 individuals had GBPI. For this group, adjusted rates of any past-year SUD treatment remained low, and we did not detect a statistically significant change following MHPAEA implementation (6.4% pre-parity vs. 7.0% post-parity; +0.5 percentage points, 95% CI: -1.1 to 2.2, p=0.514). Difference-in-differences analysis showed no significant difference in changes between those with GBPI and those with IBPI (+3.1 percentage points, 95% CI: -3.8 to 10.0, p=0.380). Self-identified unmet SUD treatment need also remained consistently low (3.9% pre-parity vs. 3.9% post-parity; +0.1 percentage points, 95% CI: -1.0 to 1.1, p=0.895). Among GBPI enrollees reporting unmet need, no significant changes were observed in barriers related to cost (14.9% post-MHPAEA), treatment accessibility (22.8%), ambivalence about seeking treatment (66.8%), or stigma (19.1%). Only half of GBPI enrollees knew their insurance covered SUD treatment, with nearly 40% reporting they didn't know.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;These findings align with other studies of U.S. parity laws, which have found little to no impact on SUD treatment rates despite potential improvements in financial protection. Limitations include reliance on self-reported data, inability to identify specific insurance plans exempt from MHPAEA, and lack of state-level identifiers to account for pre-existing state parity laws.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;Providers and health systems may consider new strategies to identify SUD treatment needs and improve awareness of i","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"28 3","pages":"77-96"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PERSPECTIVE: Improving Suicide Prevention Strategies and Interventions: A Co-produced Perspective.","authors":"Anton N Isaacs, Samantha McIntosh","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Suicide continues to be a major problem worldwide. Persons with a lived experience are being actively involved in suicide research and reports suggest that co-production of suicide research with persons with a lived experience significantly improves its quality and appropriateness.</p><p><strong>Aims of the study: </strong>The aims of this paper are (i) To identify challenges to Australian suicide prevention strategies and interventions and (ii) To offer recommendations to address these challenges.</p><p><strong>Methods: </strong>This perspective article is a co-production between an experienced mental health researcher and a person with a lived experience of suicidality, who has worked as a suicide prevention worker and has held leadership positions in government and non-government suicide prevention programs.</p><p><strong>Results: </strong>Challenges to Australian suicide prevention strategies and interventions include: the careless reporting of suicide in the media, the continuing stigma in seeking help, stigma as a barrier to gatekeeper training, the entry point of suicide prevention services and care of those with suicidal ideation/attempt. Recommendations include: that media must consider the responsible reporting of suicide as a duty of care; that the community response to help-seeking for suicide needs to be one of compassion; that gatekeeper training should be expanded to be universally accessible and messaging in suicide prevention training programs must pay attention to its rationale; that services for those with suicide ideation and attempt must commence with providing a safe space and empathetic support by peer workers and that continuing care after suicidal attempt must be informed by the individual's needs and include informal and family carers, as well as other community agencies.</p><p><strong>Discussion: </strong>Stigma related to suicide continues to be a major barrier to help seeking and suicide prevention training. The approach to suicide prevention and intervention services needs to focus on stigma reduction, responsible reporting by media and a person-centred approach to care. The perspectives identified here are by no means comprehensive but are merely our observations that we believe, need attention.</p><p><strong>Implications for health care provision and use: </strong>These perspectives have implications for the early identification and assistance of those at risk of suicide in the community as well as for suicide intervention services.</p><p><strong>Implications for health policies: </strong>These perspectives have implications for policies related to public health education including the expansion of gatekeeper training, journalism and media, as well as national and state suicide prevention strategies.</p><p><strong>Implications for further research: </strong>Further research might focus on suicide related stigma reduction measures within communities, improved suicide intervention serv","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"28 2","pages":"59-66"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}