Journal of Mental Health Policy and Economics最新文献

{"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}

{"title":"Economic Burden of Major Depressive Disorder (MDD), Panic Anxiety, and Generalized Anxiety Disorder (GAD).","authors":"Ali Abdollahi Najand Asl, Ali Imani, Mostafa Farahbakhsh, Parvin Sarbakhsh","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Considering the importance of depression and anxiety disorders in the new century and one of the important causes of disability and lost years worldwide and imposing a huge cost on the global economy, economic burden studies to determine the location of costs and the consumption of medical resources in recent years have contributed a lot to health policymaking. During the studies, it was found that the prevalence of these disorders increased significantly in Iran. This reason, along with the difference in the results of studies on the economic burden of depression and anxiety published in Iran in recent years, was one of the reasons for conducting a study of the economic burden related to these disorders in the East Azarbaijan province of Iran.</p><p><strong>Method: </strong> A retrospective, non-interventional, cross-sectional, social perspective study was conducted using a bottom-up approach for direct costs and a human capital approach for indirect costs. The data was collected from outpatients over the first four months of 2022 and from inpatients over the first nine months of the same year. Patients without age limits and suffering from at least one major depressive disorder (F32.0-F33.9), panic anxiety (F41.0), and generalized anxiety disorder (F41.1) and natives of East Azerbaijan province were included in the study. In the study for direct costs, the cost of measures that are paid directly in the process of diagnosis and treatment (medical and non-medical) were examined separately for outpatients and inpatients. For indirect costs, lost productivity due to absenteeism and premature death was calculated. For outpatients, a researcher's fee checklist form was made, and for the data of inpatients, the financial statement available in the medical file of the hospital's accounting system was used. Razi Tabriz and Imam Khomeini Benab hospitals and mental health centers of Tabriz were used as public centers, and specialist psychiatrists' offices of Tabriz were used as private centers. Patients with more than one comorbidity were excluded from the study. Total costs are reported at purchasing power parity rates.</p><p><strong>Results: </strong> The data of 145 outpatients and 198 inpatients were analyzed to calculate the economic burden of MDD, Panic Anxiety, and GAD. The total economic burden for these disorders was obtained by 142.2 million purchasing power parity (ppp) dollars in 2022 for the East Azarbaijan province of Iran, with a population of more than 3.5 million people. The economic burden was divided into direct costs of 35.4 million dollars ppp and indirect costs of 106.79 million dollars ppp, representing 24.9% and 75.1%, respectively. The share of direct expenses of the outpatient group is 23.1% of this percentage, and the remaining 1.8% is for the inpatient group. In the case of indirect cost, from the percentage related to this sector, the share of lost productivity due to lost working days is 65.84%","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"28 2","pages":"51-58"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498352","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":"Work from Home and Mental Health: Evidence from the First Lockdown.","authors":"Kai Kruk","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Aims of the study: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Discussion: </strong>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 2","pages":"67-72"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498354","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":"Do Current and Lifetime Mental Health Issues Influence Subjective Social Status?","authors":"Michael T French, Karoline Mortensen, Yang Wen","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Mental health issues can impact overall health status, personal relationships, workplace productivity, and other outcomes.</p><p><strong>Aims of the study: </strong>The primary objective of this study is to determine whether recent and lifetime mental health problems are significantly related to respondents' subjective social status (SSS).</p><p><strong>Methods: </strong>Respondents to Waves IV (2008-2009) and V (2016-2018) of the National Longitudinal Survey of Adolescent to Adult Health (Add Health) provide the data for our research. Our empirical approach estimates Spearman correlation coefficients between self-reported mental health measures and SSS followed by multivariate regression models. The final empirical models estimate fixed-effects regressions to control for potential bias due to time-invariant unobserved heterogeneity. SSS is measured on a scale from 1 to 10, with 10 indicating perceived highest place in society.</p><p><strong>Results: </strong>All four explanatory mental health measures (ever been diagnosed with depression, ever been diagnosed with PTSD, ever been diagnosed with anxiety or panic disorder, and past 12 month psychological or emotional counseling) are negatively and significantly (p < 0.05) associated with the outcome variable, SSS.</p><p><strong>Discussion: </strong>Relative placement in society is associated with overall health and well-being. This study contributes in a methodologically meaningful way to the existing literature by employing empirically advanced statistical techniques to panel data. The main findings clearly demonstrate that mental health issues are negatively associated with SSS.</p><p><strong>Implications: </strong>These findings have important policy implications for mental health counselors, employers, and society in general as mental health problems become more common and less stigmatized in the U.S.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"28 1","pages":"17-32"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558332","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":"Prevalence and Correlates of Probable Anxiety and Depression among U.S. Individuals with Long COVID.","authors":"Lanlan Chu, Isabel Honzay","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The enduring repercussions of long COVID have emerged as a distinct health concern, encompassing both physical and mental health challenges, such as symptoms indicative of anxiety and depression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;This study primarily aims to assess the prevalence of mental health issues among individuals in the United States grappling with long COVID. Additionally, it seeks to quantify the correlations between long COVID and both probable anxiety and probable depression. The research also endeavors to unravel socio-economic mechanisms contributing to these correlations and explore potential disparities in these associations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Utilizing a nationally representative dataset from the Household Pulse Survey, this study employs the probit model to investigate the associations between long COVID and probable anxiety as well as probable depression. To ensure robustness, complementary techniques, including alternative models and measures, are employed. A mechanism analysis is incorporated to identify socio-economic mediators that contribute to probable anxiety and depression in individuals with long COVID. Subgroup analyses explore variations in these associations across diverse groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Individuals with long COVID show a significantly higher prevalence of probable anxiety and depression compared to those without the condition. Through alternative techniques, the study confirms a significant correlation between long COVID and an increased likelihood of both probable anxiety and probable depression. Socio-economic mediators, specifically expense difficulty and concerns about job loss, significantly contribute to these associations. Additionally, females, individuals under 30, Hispanic individuals, non-Hispanic Black individuals, and those with disabilities are more likely to experience mental health challenges when dealing with long COVID.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The results offer quantitative evidence of a significant correlation between long COVID and mental health issues, emphasizing the critical need to address the challenges associated with prolonged COVID-19 symptoms. However, the study's reliance on a cross-sectional dataset underscores the importance of future research incorporating longitudinal data for a more comprehensive assessment of dynamic changes in mental health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Policy implications: &lt;/strong&gt;This study emphasizes the necessity for specialized mental health support programs tailored for individuals dealing with long COVID. Policymakers should consider adopting financial assistance measures and advocating for employers to accommodate those facing long COVID. Targeted mental health support and outreach initiatives are crucial for addressing the unique needs of at-risk populations and communities, mitigating the adverse consequences of long COVID on mental well-being and facilitating a return to pre-C","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"28 1","pages":"3-16"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558263","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 Effects of Child Mental Health on Juvenile Criminal Justice Contact and Victimization.","authors":"Dohyung Kim","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There is extensive evidence on the associations between mental disorders such as attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), oppositional/defiant disorder (ODD), and anxiety/depression and delinquency among youths. However, research has largely overlooked the potential confounding from comorbidity of these mental disorders as well as unobserved familial heterogeneity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;This study aims to estimate the causal effects of mental health in childhood (age 4-12) on delinquency in adolescence (age 13-18) by adjusting for comorbid mental disorders and unobserved maternal heterogeneity in a longitudinal setup.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 721 sibling pairs from the Child Development Supplement of the Panel Study of Income Dynamics (PSID), a nationally representative US longitudinal survey, are followed from 1997 to 2019. The Behavior Problems Index (BPI) was used to measure the mental health of children. The hyperactive, antisocial, oppositional, and anxiety/depression subscales of the BPI measuring the symptoms of ADHD, CD, ODD, and anxiety/depression were assessed by their biological mothers who were the primary caregivers. We further consider early-onset cannabis use, a symptom of substance use/abuse, as a risk factor for subsequent delinquency. Delinquency is measured by self-reported retrospective lifetime contact with the criminal justice system and victimization by age 18. The types of contact include arrest, probation, and incarceration, and victimization from physical assault and rape, whose information is drawn from the Transition into Adulthood Supplements of the PSID.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;When comorbidity and family-specific unobserved factors are accounted for, we find little evidence for the effects of ADHD, ODD, and depression/anxiety on lifetime contact with criminal justice system in adolescence whereas the symptom scores for CD in childhood are modestly associated with having been attacked in adolescence (p=0.001). Rather, we find that early-onset cannabis use strongly and robustly predicts lifetime arrest (p=0.013), probation (p=0.034), and incarceration (p=0.093) by age 18. These estimated effects of CD and cannabis use on juvenile delinquency are mostly driven by boys.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The findings suggest that childhood mental disorders are a risk factor for juvenile delinquency, but the associations may not be causal except for CD and substance use disorder. Crime is often seen as a rational choice of individuals with low educational attainment, yet our findings show that childhood ADHD, which has been shown to generate substantial educational gaps, does not necessarily lead to a higher probability of delinquency in adolescence. Study limitations include mother-reported measures of child mental disorders, lack of information on treatment for mental disorders, especially ADHD, and partial gene","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"28 1","pages":"33-46"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558265","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":"Food Security and Mental Health in the United States: Evidence from the Medical Expenditure Panel Survey.","authors":"Chandler B McClellan, Samuel H Zuvekas","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;With over 40 million food insecure Americans, access to food is a significant policy challenge. Food insecurity is associated with many adverse health conditions, including poorer mental health outcomes. However, previous research generally does not address that poor mental health can both be a cause and a consequence of food insecurity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;We estimate the directional causal effect of food insecurity on mental health status and mental health treatment using bounding methods to partially identify the causal effects from food insecurity to mental health status and mental health treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data on food security, mental health status, mental health treatment, and individual and family socioeconomic characteristics for adults come from the nationally representative 2016 and 2017 Medical Expenditure Panel Survey. We use both the continuous score (0-10) of a 10-question module on food security as well as classifying adults as living in households that are food secure (0) or having marginal (1-2), low (3-5), or very low food security (6-10). Mental health status is measured using the Kessler-6 (K6) and the PHQ2 depression screening scales. A K6 score of 13 or greater indicates serious psychological distress while a score of 7 to 12 indicates moderate distress. A score of 3 or more on the PHQ-2 indicates probable depression. Mental health treatment is measured by ambulatory mental health visits, prescriptions for psychotropic medications, and total mental health expenditures. Standard parametric regression models are used as a baseline for partial identification models that bound the effects of food security on mental health. In our preferred specification, we impose the following assumptions: monotone treatment selection (MTS), monotone treatment response (MTR), and monotone instrumental variables (MIV) using household income as an instrument.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Those living in food insecure households are more likely to experience psychological distress and depression than those who in food secure households, but do not seek commensurately more mental health treatment. Non-parametric bounds suggest food insecurity increases the probability of moderate psychological distress by no more than 7.2 percentage points, serious psychological distress by no more than 3 percentage points, and probable depression by no more than 4.2 percentage points. The estimated effect sizes of food security on mental health treatment are much smaller, with treatment uptake increasing by no more than 2.4 percentage points.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Our parametric results are consistent with prior findings on the relationship between food security and mental health. We provide evidence for a causal effect of food insecurity which may account for about half the observed association of food security on mental health. A new and previously unreported result in","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"27 4","pages":"115-128"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392294","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: Has Value-Based Reimbursement Arrived for Behavioral Health? A Payer Perspective.","authors":"Stuart L Lustig, Vikram Shah, Lisa Kay, Andrew DiGiacomo, Douglas A Nemecek","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Value-based reimbursement (VBR) has become increasingly common among medical practitioners but mental health practitioners (MHPs) have largely remained in fee-for-service (FFS) arrangements. Aligning payment incentives to clinical outcomes rather than volume of services, VBR aspires to achieve health care's quadruple aim, namely improved patient experience, improved population health, reduced costs, and improved work life of health care providers.</p><p><strong>Aims of the study: </strong>(i) Describe both the historical challenges to implementing VBR for mental health care within the United States, along with the shifting healthcare landscape which now enables VBR arrangements between payers and MHPs; (ii) Highlight considerations for defining quality care and establishing VBR contracting.</p><p><strong>Results, discussion and implications: </strong>Historically, VBR has been challenging to implement due to a shortage of MHPs in payer networks. Technological challenges such as the absence of electronic medical records required for efficient data analysis and immature data-sharing capabilities, have hindered VBR, as has a culture of clinical practice that relies on clinical intuition as opposed to measured outcomes. VBR is now gaining traction based on overwhelming evidence for measurement-based care, a prerequisite for outcome reporting that larger practices have begun to achieve. Multiple stakeholder organizations have been advocating for measurement-based care. Payers and MHPs can and should collaboratively structure VBR contracts to align greater reimbursements with achievable increases in quality across multiple domains. Contracts can focus on numerous process metrics, such as time to care, treatment adherence, and appropriate avoidance of emergency care, along with clinical and functional outcomes. In some instances, case rates for episodes of care can meanwhile help payer and MHPs transition from FFS to VBR.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"27 4","pages":"109-113"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392295","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":"Economic Evaluation of Self-Management for Patients with Persistent Depressive Disorder and their Caregivers.","authors":"Ericka C Solis, Ingrid V E Carlier, Noelle Kamminga, Albert M van Hemert, M Elske van den Akker-van Marle","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Persistent depressive disorder (PDD; chronic depression) is associated with high personal, economic, and societal burden. Patients with PDD often fail to respond to treatment, despite long-term, intensive care, suggesting that future treatment should focus more on functional recovery. The \"Patient and Partner Education Program for All Chronic Diseases-Persistent Depressive Disorder\" (PPEP4All-PDD) is a brief self-management program for patients with PDD with nine weekly sessions, provided in group or individual format. Its focus on functional recovery may increase quality of life and shorten treatment duration, thus reducing healthcare and societal costs. This study examined the cost-effectiveness of PPEP4All-PDD for adults and elderly with PDD and their partners/caregivers compared to care-as-usual (CAU).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;In this economic evaluation, we examined whether a favorable cost-utility of PPEP4All-PDD compared to CAU could be attained.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;In this multicenter pragmatic randomized controlled trial, 70 patients with PDD and 14 partners/caregivers were included. Data were collected at 0, 3, 6, and 12 months. Health-related quality of life was measured using the EuroQoL 5-Dimensions/Levels (EQ-5D-5L). Cost of healthcare utilization and productivity loss were assessed using the Trimbos questionnaire for Costs associated with Psychiatric illness (TiC-P). We examined incremental costs per quality-adjusted life years (QALYs) after one year.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In relation to PPEP4All-PDD, 62% (n = 23) of patients had no participating PPEP4All-PDD partner/caregiver, and 89% (n = 33) of patients participated in group format. On average, PPEP4All-PDD cost €232 including the PPEP4All-PDD partner/caregiver, or €166 excluding the partner/caregiver. There was no statistical difference in mean costs per patient for (mental) healthcare, non-healthcare, and societal costs nor in QALYs between PPEP4All-PDD and CAU. The probability that PPEP4All-PDD is cost-effective compared to CAU remained below 50% for all acceptable values of willingness-to-pay for a QALY.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;This was the first economic evaluation of PPEP4All-PDD. Compared to CAU, PPEP4All-PDD did not lead to lower total healthcare costs nor higher quality of life in the one-year follow-up period. PPEP4All-PDD patients continued to receive additional mental healthcare sessions, showing that the process of ending treatment after a self-management intervention is not clear. The COVID-19 situation may have also affected this process after PPEP4All-PDD, due to higher levels of anxiety and loneliness. We could not confirm that involvement of the partner/caregiver was beneficial to patient treatment outcomes and requires further examination.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications: &lt;/strong&gt;This economic evaluation failed to find significant differences in costs between PPEP4All-PDD and CAU over","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"27 4","pages":"129-143"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392251","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 Digital Preventive Parent Training for Early Childhood Disruptive Behaviour.","authors":"Elisa Rissanen, Virpi Kuvaja-Köllner, Eila Kankaanpää","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Childhood disruptive behaviour disorder associates with various, also costly problems. Parent training is effective in reducing childhood disruptive behaviour. Only a few studies have evaluated the cost-effectiveness of digital parent training in reducing children's disruptive behaviour.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;We evaluated the two-year cost-effectiveness of an Internet and telephone assisted parent training intervention called the Strongest Families Smart Website (SFSW) for prevention of children's disruptive behaviour compared to education control (EC) from the combined perspective of the health care funder and parents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study used data from a randomized controlled trial (RCT). The trial screened a population-based sample of 4,656 four-year-olds at annual child health clinic check-ups in Finnish primary care. A total of 464 disruptively behaving children participated in the RCT; half received the SFSW and half EC. We evaluated intention-to-treat based incremental net monetary benefit with a range of willingness to pay values. Costs contained the interventions' and parents' time-use costs. The effectiveness measure was the Child Behavior Checklist (CBCL/1.5-5) externalizing score. The trial is registered at Clinicaltrials.gov (NCT01750996).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;From the health care funder's perspective, SFSW costs per family were €1,982 and EC €661, and from the parents' perspective SFSW costs per family were €462 and EC €77. From the combined health care funder and parents' perspective, costs were €1,707 higher in the SFSW intervention than in EC. The SFSW decreased the CBCL externalizing score (1.94, SE=0.78, p=0.01) more in comparison to the EC group. In cost-effectiveness analysis using the combined perspective, the incremental net monetary benefit was zero [95% CI €-1,524 to €1,524] if the willingness to pay for one extra point of CBCL externalizing score reduced was €879. If the willingness to pay was more than €879, the average incremental net monetary benefit was positive.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The cost-effectiveness of the SFSW depends on the decision makers' willingness to pay, which is not stated for CBCL outcomes. Also, the decision maker should consider the uncertainty of cost-effectiveness estimates. The lack of other service use information and micro-costing of SFSW and EC intervention costs weakens our conclusions. However, our study had multiple strengths, such as population-based screening, high sample size, 2-year follow-up, and use of proper methods to conduct a full economic evaluation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;The SFSW is effective in reducing children's disruptive behaviour. Although digitally provided, the SFSW intervention included professional time and, thus, costs. The costs of intervention to the healthcare provider and time cost to families should be taken into ac","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"27 3","pages":"85-98"},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298333","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}