Journal of Mental Health Policy and Economics最新文献

{"title":"PERSPECTIVE: Current US COVID-19 Pandemic Substance Use Research and Ideas for Research That May Help Us Learn More.","authors":"Sarah Q Duffy","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic likely had and will continue to have severe implications for those who use addictive substances, have substance use disorders, or use substance use related health care services. Policy and services research, particularly health economics research, can illuminate these effects on individuals, uncover the effects of the rapidly imposed changes in policy on how services were delivered, promote efficient and effective provision of services, and inform responses to future pandemics.</p><p><strong>Aims of the study: </strong>To identify potential substance use related effects of COVID-19 and pandemic mitigation policies, highlight themes in current research, and suggest areas for further high-quality policy and services research, with an emphasis on health economics research.</p><p><strong>Methods: </strong>Review of recent published commentaries, government documents, and initial research findings to describe potential impacts, and review of current COVID-19 related research grants funded by the United States National Institutes of Health to identify themes.</p><p><strong>Results: </strong>Potential impacts include increased risk for and severity of COVID-19 illness among those who use substances, mitigation measures causing increased substance use and development of use disorders, and fundamental changes in the way treatment is provided. Current research may provide initial findings that may be useful in generating hypotheses for future rigorous research.</p><p><strong>Discussion: </strong>Research on these and other areas could enhance our fundamental understanding of the needs of individuals who use substances and how to best address those needs in the most efficient, effective way. Though this brief review highlights some areas of potential interest, its focus is mainly on treatment and on the United States context. Research on additional services and contexts likely could inform advances as well.</p><p><strong>Implications for health care provision and use: </strong>Health care providers rapidly and under considerable stress made needed changes that likely mitigated SARS-CoV-2 transmission. Rigorous research can help determine what worked best and for whom, what could be kept, and what might better be discarded.</p><p><strong>Implications for health policies: </strong>Research on the effects of mitigation policies may inform the development of policies to reduce negative effects when addressing future pandemics, whether to permanently allow at least some substance use treatment flexibilities, and whether research on other restrictive policies might lead to improvement.</p><p><strong>Implications for further research: </strong>This extraordinary event brought into sharp relief the numerous vulnerabilities of those who use substances and those with substance use disorders while also leading to vast changes in the services that address them. Rigorous research into those effects could result in si","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 4","pages":"125-135"},"PeriodicalIF":1.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8794236/pdf/nihms-1748810.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39726826","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: A Mental Health Services Research Agenda in the Era of COVID-19: Steadfast Commitment to Addressing Evolving Challenges.","authors":"Michael C Freed","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Decades of research that predate the COVID-19 pandemic demonstrate that most people with mental health needs are not receiving adequate care. The inequities between those who need care and those who receive adequate care are larger for racial and ethnic minority groups and people living in underserved communities. The pandemic is associated with an exacerbation of these inequities, resulting in increased morbidity and mortality for the most vulnerable populations.</p><p><strong>Aims: </strong>This Perspective summarizes longstanding and evolving challenges to the provision of high quality care for people with mental illness, describes the National Institute of Mental Health's (NIMH) commitment to addressing those challenges, and embeds salient research priorities most germane to the health policy readership of this journal.</p><p><strong>Methods: </strong>Example funding announcements and extant funding priorities are highlighted to demonstrate NIMH's commitment to health services research during the pandemic. The collaborative care model is presented as an evidence-supported service delivery model that could be delivered via telehealth. Recent studies that compare the utilization of routine telehealth services during the pandemic, when compared to in-person services pre-pandemic, are summarized.</p><p><strong>Results: </strong>In FY2020, NIMH invested $171,194,275 in health services research. Over the past two years, NIMH led or participated on dozens of funding announcements that call for mental health services research to help improve the provision of care for people with mental illness. Service delivery models like collaborative care can offer effective intervention via telehealth. The practice community can deliver routine services via telehealth at volumes similar to pre-pandemic in-person levels. However, wide variation in telehealth utilization exists, with inequities associated with racial and ethnic groups and underserved rural locations. A limitation is that clinical outcomes are not routinely available from administrative datasets.</p><p><strong>Discussion: </strong>There continues to be an urgent need for health policy research and collaboration with the health policy community as part of the research enterprise.</p><p><strong>Implications for health care provision and use: </strong>NIMH encourages and often requires strong research practice partnerships to help ensure findings will be of value to end users and make their way into the practice setting. There is a need to study pandemic related changes in financing, delivery, receipt, and outcomes of mental health care.</p><p><strong>Implications for health policies: </strong>Despite robust evidence, clinical practice guideline recommendations, and established financing mechanisms, uptake of service delivery models that can be delivered in part or in full via telehealth (e.g., the collaborative care model) is poor.</p><p><strong>Implications for further","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 4","pages":"137-142"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39726827","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":"Exploratory Economic Evaluation of Buprenorphine Treatment in Opioid Use Disorder.","authors":"Hesham Farouk Elarabi,&nbsp;Hamad Al Ghaferi,&nbsp;Nael Hasan,&nbsp;Amanda J Lee,&nbsp;Mansour Shawky,&nbsp;Helal Al Kathiri,&nbsp;Abuelgasim Elrasheed,&nbsp;Samya Al Maamari,&nbsp;Tarek A Gawad,&nbsp;Doaa Radwan,&nbsp;Abdu Adem,&nbsp;John Marsden","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Burden of opioid use disorder (OUD) is expressed in economic values or health metrics like Disability Adjusted Life Years (DALYs). Disability Weight (DW), a component of DALYs is estimated using economic methods or psychometric tools. Estimating DW at patient level using psychometric tools is an alternative to non-population specific DW overestimated by economic methods. Providing Medication Assisted Treatment (MAT) using buprenorphine/naloxone film (BUP/NX-F) for OUD is limited by financial constraints.</p><p><strong>Aim: </strong>To estimate the burden of OUD at patient level and explore the cost-benefit of two buprenorphine treatment interventions.</p><p><strong>Methods: </strong>The present study was conducted alongside a randomized controlled trial of 141 adults with OUD stabilized on BUP/NX-F and randomized to BUP/NX-F with Incentivized Abstinence and Adherence Monitoring (experimental, n=70) and BUP/NX-F in usual care (control, n=71). The cost of illness was estimated applying a societal perspective. The Impairment Weight (IW) was estimated over a '0' to '1' scale, where '0' represents no impairment and '1' full impairment using the Work and Social Adjustment Scale (WSAS).</p><p><strong>Results: </strong>Median (interquartile range) annual cost of OUD per participant was AED 498,171.1 (413,499.0 -635,725.3) and AED 538,694.4 (4,211,398.0 - 659,949.0) in the experimental and control groups, respectively (p=0.33). Illicit drug purchase represented 60 % of the annual cost of illness. At baseline, the mean Impairment Weight (IW) was 0.55 (SD 0.26) and 0.62 (SD 0.24) in the experimental and control groups, respectively. At end of the study, the IW was 0.26 (SD 0.28) representing 51% reduction in the experimental group compared to 0.42 (SD 0.33) in the control group representing a 27% reduction. Excluding imprisonment, the cost-benefit of treatment was not realized. In contrast, accounting for imprisonment, cost benefit expressed as a return-on-investment was established at 1.55 and 1.29 in the experimental and control groups, respectively.</p><p><strong>Implications for mental health policy: </strong>Cost benefit analysis can serve as a simple and practical tool to evaluate the cost benefit of treatment interventions. Demonstrating the cost benefit of buprenorphine treatment has the potential to facilitate public funding and accessibility to opioid assisted treatment.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 3","pages":"89-95"},"PeriodicalIF":1.6,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39441619","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: The Digital Health App Policy Landscape: Regulatory Gaps and Choices Through the Lens of Mental Health.","authors":"Kelila Kahane,&nbsp;Josie François,&nbsp;John Torous","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Interest in and use of mental health apps have grown over the past decade, and now further with the COVID-19 pandemic. Digital mental health offers potential to increase access to care, but tangible risks around safety and poor efficacy remain common.</p><p><strong>Methods: </strong>We conduct a select analysis of U.S. and international published evidence, government websites, grey literature, and media outlets. We present the marked discordance around digital mental health policy, as these frameworks grapple with the challenges of regulating in this sphere.</p><p><strong>Results: </strong>Across the world, there is no consensus around evaluation with countries piloting or proposing different models. Common barriers include the defining the scope and risk of health apps, creating processes able to update evaluation with software updates, lacking better data to inform evaluation, and educating users to the risks and benefits.</p><p><strong>Discussion: </strong>We propose four next steps for guiding any future policy: (i) clear clarification of the categorical status of mental health apps; (ii) objective methodology for assessing apps on a premarket basis which does not solely rely on self-reporting; (iii) well-designed, detailed procedures for iterative post-market app review; (iv) clinician and patient education which empowers users to make smart mental health app choices.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 3","pages":"101-108"},"PeriodicalIF":1.6,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39441621","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":"LETTER: Medicaid Expansion and Mental Health Care and Coverage: Reply.","authors":"Samuel H Zuvekas,&nbsp;Chandler B McClellan,&nbsp;Mir M Ali,&nbsp;Ryan Mutter","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>No abstract available.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 3","pages":"109-111"},"PeriodicalIF":1.6,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39441622","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":"COMMENTARY: Medicaid Expansion and Mental Health Care and Coverage.","authors":"Richard G Frank","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>No abstract available.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 3","pages":"97-99"},"PeriodicalIF":1.6,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39441620","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 Care Environments for Improving the Mental Health of Orphaned and Separated Children and Adolescents in Kenya","authors":"Marta Wilson-Barthes,&nbsp;Stavroula A Chrysanthopoulou,&nbsp;Lukoye Atwoli,&nbsp;David Ayuku,&nbsp;Paula Braitstein,&nbsp;Omar Galárraga","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Institutionalization has shown contradictory effects on the mental health of orphaned and separated children and adolescents (OSCA) in sub-Saharan Africa. There is a paucity of data surrounding the cost-effectiveness of different care environments for improving OSCA's mental health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;The goal of this analysis was to evaluate the cost-effectiveness of Charitable Children's Institutions (orphanages) compared to family-based settings serving OSCA in East Africa in terms of USD/unit reduction in mental health diagnoses (depression, anxiety, post-traumatic stress disorder, suicidality) and quality-adjusted life-year (QALY) gained.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This economic analysis was conducted from a societal perspective as part of the Orphaned and Separated Children's Assessments Related to their (OSCAR's) Health and Well-Being Project, a 10-year longitudinal cohort study evaluating the effects of different care environments on OSCA's physical and psychological health in western Kenya. Cost data were ascertained from 9 institutions and 225 family-based settings in the OSCAR cohort via survey assessments, budget reports, and expert interviews. Monthly per-child costs were calculated as the sum of recurrent and capital costs divided by the environment's maximum residential capacity, and cost differences between care environments were estimated using two-part models. Mental health effectiveness outcomes were derived from prior survival regression analyses conducted among the OSCAR cohort. We used Child Depression Inventory Short-Form scores at baseline and follow-up to calculate the number of depression-free days (DFDs) over the follow-up period, and translated DFDs into QALYs using established utility weights. Incremental cost-effectiveness ratios (ICERs) were calculated as the difference in monthly per-child cost divided by the difference in each mental health outcome, comparing institutions to family-based settings. Sampling uncertainty in the ICERs was handled using nonparametric bootstrapping with 1,000 replications. We assumed a willingness-to-pay threshold of three times Kenya's per capita gross domestic product.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Charitable Children's Institutions cost USD 123 more on average than family-based settings in terms of monthly per-child expenditures (p&lt;0.001). Compared to family-based care, institutional care resulted in an ICER of USD 236, USD 280, USD 397, and USD 456 per unit reduction in depression, anxiety, PTSD, and suicidal diagnosis among OSCA, respectively. The incremental cost per additional QALY was USD 4,929 (95% CI: USD 3096 -- USD 6740). The probability of Charitable Children's Institutions being more cost-effective than family-based settings was greater than 90% for willingness-to-pay thresholds above USD 7,000/QALY.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Only a subset of institutions in the cohort were willing to provide budgetary ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 2","pages":"31-41"},"PeriodicalIF":1.6,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39251782","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":"Characteristics and Healthcare Burden of Patients with Schizophrenia Treated in a US Integrated Healthcare System.","authors":"Rohan Mahabaleshwarkar,&nbsp;Dee Lin,&nbsp;Kruti Joshi,&nbsp;Jesse Fishman,&nbsp;Todd Blair,&nbsp;Timothy Hetherington,&nbsp;Pooja Palmer,&nbsp;Charmi Patel,&nbsp;Constance Krull,&nbsp;Oleg V Tcheremissine","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Schizophrenia is one of 15 major causes of disability worldwide and is responsible for more than USD 150 billion in annual healthcare costs in the United States. Although the burden of schizophrenia as measured by healthcare resource utilization (HRU) is known to be considerable, data generally come from claims databases or healthcare systems/payors representing only a subset of patients, such as Medicare/Medicaid recipients. A broader understanding of HRU across the schizophrenia patient population would help identify underserved groups and inform strategies for improving healthcare delivery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;This observational study examined overall HRU and the influence of sociodemographic factors in adult patients with schizophrenia receiving care in a US integrated healthcare system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective cohort study was conducted using data from electronic medical records (EMRs). Patients were required to have at least two diagnostic codes for schizophrenia recorded in the EMR within a 12-month period from January 2009 to June 2018, and to have received active care (≥ 1 in-system healthcare visit every six months) for at least 12 months before and after the index date (the earlier of the schizophrenia diagnosis dates). Patients were followed until no longer receiving active care or the end of the study. Patient characteristics were assessed during the 12-month pre-index period, and inpatient, readmission, emergency room (ER), and outpatient visits and antipsychotic prescriptions were described during follow-up. Findings were reported overall and in subgroups by race/ethnicity, age, and sex.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study cohort included 2,941 patients (mean age, 48.3 years; 54.5% male, 51.8% black, 45.8% with Medicare). During the follow-up period (mean, 4.6 years), inpatient hospital stays were common, with at least one all-cause, mental health-related, or schizophrenia-related inpatient visit occurring for 48.7%, 47.3%, and 38.8% of patients, respectively. Hospital readmissions within 30 days of an all-cause inpatient visit occurred in 20.4% of patients, with 14.5% of patients readmitted within 30 days of a schizophrenia-related inpatient visit. More than two-thirds of patients had ER visits, and 40.7% had schizophrenia-related ER visits. Only 46.7% of patients with a schizophrenia-related inpatient visit and 58.5% of patients with a mental health-related inpatient visit had a 30-day outpatient follow-up visit. Subgroup analyses revealed that a larger proportion of non-Hispanic black vs non-Hispanic white patients had 30-day outpatient follow-up visits, ER visits, mental health specialist visits, and antipsychotic prescriptions. Moreover, older age was associated with fewer ER and mental health specialist visits and less use of injectable and second-generation antipsychotics, and women were less likely than men to receive antipsychotic therapy, ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 2","pages":"47-59"},"PeriodicalIF":1.6,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39252915","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":"Farmer Suicides: Effects of Socio-Economic, Climate, and Mental Health Factors.","authors":"Suzan Odabasi,&nbsp;Valentina Hartarska","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>People working in agriculture, fishing, and forestry have elevated risks of suicide. The suicide rates for the occupations of \"agriculture, fishing, and forestry\" are significantly higher than any other occupation.</p><p><strong>Aims of study: </strong>This study evaluates whether the variability in socioeconomic and demographic factors and in climate as well as the support from mental health providers and social associations affected the suicide rates of farmers in the US.</p><p><strong>Methods: </strong>We estimate Poisson count data regression and county level-fixed effects regressions using data from the National Center for Health Statistics complemented with relevant socio-economic, climate data and data on mental health providers from a variety of sources.</p><p><strong>Results: </strong>The results show more suicides in counties with more farms and with higher share of population without health insurance, lower agricultural wages and, in non-rural counties higher poverty rate. Surprisingly, we find more suicides in counties with more social associations, while the availability of mental health providers is associated with fewer suicides in non-rural counties, and lower suicide rate in southern counties.</p><p><strong>Discussion: </strong>These results highlight the need for innovative targeted policy interventions instead of relying on one-size-fits-all approach. Farmers and farm workers are yet to be reached with modern and effective tools to improve mental health and prevent suicide. At the same time, factors such as the weather and climate as well as some more traditional factors such as social associations or religious participation play a limited role.</p><p><strong>Implications for health policies: </strong>Support mechanisms have a differential effect in rural and urban areas. It is important to identify the specific demographic, climate, and policy changes that serve as external stressors and affect farm workers' suicide and accidental death from on-farm injury.</p><p><strong>Implication for further research: </strong>Ideally, individual level data on farmers would be best in a study that evaluates what factors cause suicides.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 2","pages":"61-71"},"PeriodicalIF":1.6,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39251781","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":"Costs of Health Service Use among Unemployed and Underemployed People with Mental Health Problems.","authors":"Tamara Waldmann,&nbsp;Tobias Staiger,&nbsp;Nicolas Ruesch,&nbsp;Reinhold Kilian","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Unemployment is associated with a high risk of experiencing mental illness. This can lead to stigmatisation, reduced quality of life, and long-term costs like increased healthcare expenditure and productivity losses for society as a whole. Previous research indicates evidence for an association between unemployment and higher mental health service costs, but there is insufficient information available for the German healthcare system.</p><p><strong>Aim of the study: </strong>This study aims to identify costs and cost drivers for health and social service use among unemployed people with mental health problems in Germany.</p><p><strong>Methods: </strong>A sample of 270 persons participated at baseline and six-month-follow-up. Healthcare and social service use was assessed using the Client Socio-Demographic and Service Receipt Inventory. Descriptive cost analysis was performed. Associations between costs and potential cost drivers were tested using structural equation modelling.</p><p><strong>Results: </strong>Direct mean costs for 12 months range from EUR 1265.13 (somatic costs) to EUR 2206.38 (psychiatric costs) to EUR 3020.70 (total costs) per person. Path coefficients indicate direct positive effects from the latent variable mental health burden (MHB) on stigma stress, somatic symptoms, and sick leave.</p><p><strong>Discussion: </strong>The hypothesis that unemployed people with mental health problems seek help for somatic symptoms rather than psychiatric symptoms was not supported. Associations between MHB and costs strongly mediated by sick leave indicate a central function of healthcare provision as being confirmation of the inability to work.</p><p><strong>Implications for health policies: </strong>Targeted interventions to ensure early help-seeking and reduce stigma remain of key importance in reducing long-term societal costs.</p><p><strong>Implications for further research: </strong>Future research should explore attitudes regarding effective treatment for the target group.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 1","pages":"31-41"},"PeriodicalIF":1.6,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25495048","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}