Journal of Mental Health Policy and Economics最新文献

{"title":"Identifying factors affecting the placement of mentally ill patients","authors":"Eamon O'Shea,&nbsp;Jenny Hughes,&nbsp;Siobhán O'Reilly","doi":"10.1002/(SICI)1099-176X(199912)2:4<177::AID-MHP61>3.0.CO;2-3","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199912)2:4<177::AID-MHP61>3.0.CO;2-3","url":null,"abstract":"<p><b>Background</b>: There is now general agreement that a comprehensive psychiatric service can operate with the minimum use of in-patient facilities. Consequently, the emphasis in most European countries is on reducing the number of inpatient beds and expanding the range of community care facilities, including day hospital services, available to mentally ill patients. Decision-making with respect to placement is now even more important given the changes currently taking place on the supply side.<b>Method</b>: The study examines the factors that influence placement decision-making between inpatient care and day hospital care in one Health Board in Ireland. Placement was examined over a 9 month period for all patients presenting for treatment in one particular area with a population of 39000 people. Patients were not randomized between the two settings due to ethical concerns about the randomization process. The issue of placement is analysed using a logit estimation procedure.<b>Results</b>: The results suggest that two variables have a significant affect on placement for the population under review: whether the patient is accompanied at the time of admission and the domicile of the patient.<b>Conclusions</b>: Greater flexibility with respect to the opening hours of day hospital facilities, linked to improved transport facilities, together with further analysis on the process of admission to hospital, particularly the dynamics of the interaction between providers, patients, and accompanying persons, may improve placement decision-making for mentally ill patients. Copyright © 1999 John Wiley &amp; Sons, Ltd.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 4","pages":"177-182"},"PeriodicalIF":1.6,"publicationDate":"2000-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199912)2:4<177::AID-MHP61>3.0.CO;2-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72170247","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":"Organizational determinants of psychosocial treatment activity of providers in Va mental health facilities","authors":"Jeffrey A. Alexander,&nbsp;Joan R. Bloom,&nbsp;James L. Zazzali,&nbsp;Kimberly Jinnett","doi":"10.1002/(SICI)1099-176X(199912)2:4<153::AID-MHP63>3.0.CO;2-7","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199912)2:4<153::AID-MHP63>3.0.CO;2-7","url":null,"abstract":"<p><b>Objective</b>: To identify the determinants of level and intensity of psychosocial treatment activity among staff who deliver services to the severely and mentally ill.<b>Methods</b>: The study sample consisted of 769 treatment providers working in 77 units in 29 VA mental health facilities. Level of psychosocial care was measured as the number of patient contacts and total hours spent in psychosocial care over a 1 week period. Intensity of psychosocial care was measured as the average time per patient contact. We used hierarchical linear modeling (HLM) to examine the association between level and intensity of care and three categories of determinants—individual provider attributes, work characteristics and treatment setting characteristics.<b>Results</b>: Providers' occupation is related to both the level and intensity of care. Providers with administrative responsibilities also have fewer patient contacts and lower intensity of such contacts. Providers who perceived their pay and benefits more positively had fewer patient contacts and less intensive patient contacts. Positive relationships with patients and providers were also associated with greater levels and intensity of psychosocial treatment activity among providers. Finally, statistically significant differences in psychosocial treatment activity among units were identified although such differences are not attributable to unit size, patient cohort severity or unit workload.<b>Conclusions</b>: Level and intensity of psychosocial treatment activity vary systematically by individual attributes of providers, characteristics of the work they perform and attributes of the treatment setting. These factors may provide the basis for designing interventions to modify provider behavior in a manner consistent with emerging financial pressures and treatment modalities for the seriously mentally ill. Copyright © 1999 John Wiley &amp; Sons, Ltd.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 4","pages":"153-162"},"PeriodicalIF":1.6,"publicationDate":"2000-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199912)2:4<153::AID-MHP63>3.0.CO;2-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72170248","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 and mental health: sparse past . . . fertile future?","authors":"Martin Knapp","doi":"10.1002/(SICI)1099-176X(199912)2:4<163::AID-MHP64>3.0.CO;2-1","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199912)2:4<163::AID-MHP64>3.0.CO;2-1","url":null,"abstract":"&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;: Demands for economic inputs to mental health policy-making, practice decisions and research evaluations have grown considerably in recent years, but the overall supply response has been modest and uneven.&lt;b&gt;Aims&lt;/b&gt;: This paper examines the key historical phases in the development of mental health economics research, and what they imply for the way economics is received and employed. Focusing on the quest for cost-effectiveness, the paper considers challenges for mental health economics.&lt;b&gt;Methods&lt;/b&gt;: An informal review of the growing demand for mental health economics (and how that demand has been expressed), and how economists have responded.&lt;b&gt;Results&lt;/b&gt;: Five historical development phases characterize this growth. Initially, the dominant feature is innocence or neglect of scarcity. Cost measures are rarely calculated, cost-effectiveness is not part of the decision-making lexicon and the potential for inefficiency is huge.&lt;/p&gt;&lt;p&gt;In the second phase, innocence turns to criticism of attempts to introduce resource rationality, and many clinicians actively reject economics. Health is seen as priceless, and not to be compromised by the pursuit of efficiency.&lt;/p&gt;&lt;p&gt;After a period of reluctance there follows impetuosity as the need for economic insights is recognized, but the search for data is desperate and undiscriminating. Poor quality research is conducted, with the risk that decisions are misinformed and perhaps damaging. Once again, resources are inappropriately used.&lt;/p&gt;&lt;p&gt;Next follows the constructive development phase: previous mistakes are appreciated and the standards of evaluation improve markedly. Studies are better designed, more likely to be integrated into clinical or policy evaluations, carefully conducted and sensibly interpreted. Inefficiency should be reduced, along with inequity.&lt;/p&gt;&lt;p&gt;Finally, there is perhaps a nirvana-like fifth phase in which sophisticated economic studies are widely undertaken, where systematic reviews and meta-analyses help to reveal the wider picture and where findings are readily available to clinicians, managers and providers. Whether such a stage is attainable is open to question.&lt;b&gt;Discussion&lt;/b&gt;: Although the number and sophistication of economic evaluations have both increased noticeably over recent years, there remain imbalances. There is little economics evidence on care arrangements or treatments for dementia, most of the neuroses and the disorders of childhood and adolescence. There are many fewer good evaluations of psychological interventions than of drug treatments. Geographically, few economic evaluations are conducted outside Western Europe, North America or Australasia.&lt;b&gt;Implications for decision-makers and research&lt;/b&gt;: Many challenges consequently face the next generation of mental health economics evaluations, both for research economists and for those health care decision-makers who find themselves increasingly having to draw on economics evidence. One challenge","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 4","pages":"163-167"},"PeriodicalIF":1.6,"publicationDate":"2000-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199912)2:4<163::AID-MHP64>3.0.CO;2-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72170249","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":"Antidepressant treatment for depression: total charges and therapy duration†","authors":"Deborah G. Dobrez,&nbsp;Catherine A. Melfi,&nbsp;Thomas W. Croghan,&nbsp;Professor Thomas J. Kniesner,&nbsp;Robert L. Obenchain","doi":"10.1002/mhp.95","DOIUrl":"https://doi.org/10.1002/mhp.95","url":null,"abstract":"BACKGROUND: The economic costs of depression are significant, both the direct medical costs of care and the indirect costs of lost productivity. Empirical studies of antidepressant cost-effectiveness suggest that the use of selective serotonin reuptake inhibitors (SSRIs) may be no more costly than tricyclic antidepressants (TCAs), will improve tolerability, and is associated with longer therapy duration. However the success of depression care usually involves multiple factors, including source of care, type of care, and patient characteristics, in addition to drug choice. The cost-effective mix of antidepressant therapy components is unclear. AIMS OF THE STUDY: Our study evaluates cost and antidepressant-continuity outcomes for depressed patients receiving antidepressant therapy. Specifically, we determined the impact of provider choice for initial care, concurrent psychotherapy, and choice of SSRI versus TCA-based pharmacotherapies on the joint outcome of low treatment cost and continuous antidepressant therapy. METHODS: A database of private health insurance claims identifies 2678 patients who received both a diagnosis of depression and a prescription for an antidepressant during 1990-1994. Patients each fall into one of four groups according to whether their health care charges are high versus low (using the median value as the break point) and by whether their antidepressant usage pattern is continuous versus having discontinued pharmacotherapy early (filling fewer than six prescriptions). A bivariate probit model controlling for patient characteristics, co-morbidities, type of depression and concurrent treatment is the primary multivariate statistical vehicle for the cost-effective treatment situation. RESULTS: SSRIs substantially reduce the incidence of patients discontinuing pharmacotherapy while leaving charges largely unchanged. The relative effectiveness of SSRIs in depression treatment is independent of the patient's personal characteristics and dominates the consequences of other treatment dimensions such as seeing a mental health specialist and receiving concurrent psychotherapy. Initial provider specialty is irrelevant to the continuity of pharmacotherapy, and concurrent psychotherapy creates a tradeoff through reduced pharmacotherapy interruption with higher costs. DISCUSSION: Longer therapy duration is associated with SSRI-based pharmacotherapy (relative to TCA-based pharmacotherapy) and with concurrent psychotherapy. High cost is associated with concurrent psychotherapy and choice of a specialty provider for initial care. In our study cost-effective care includes SSRI-based pharmacotherapy initiated with a non-specialty provider. Previous treatment history and other unobserved factors that might affect antidepressant choice are not included in our model. IMPLICATIONS FOR HEALTH CARE PROVISION: The decision to use an SSRI-based pharmacotherapy need not consider carefully the patient's personal characteristics. Shifting depressed p","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 4","pages":"187-197"},"PeriodicalIF":1.6,"publicationDate":"2000-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/mhp.95","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72160694","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":"Rational decision-making in mental health: the role of systematic reviews","authors":"Simon M Gilbody,&nbsp;Mark Petticrew","doi":"10.1002/(SICI)1099-176X(199909)2:3<99::AID-MHP51>3.0.CO;2-C","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199909)2:3<99::AID-MHP51>3.0.CO;2-C","url":null,"abstract":"&lt;p&gt;Background: ‘Systematic reviews’ have come to be recognized as the most rigorous method of summarizing confusing and often contradictory primary research in a transparent and reproducible manner. Their greatest impact has been in the summarization of epidemiological literature—particularly that relating to clinical effectiveness. Systematic reviews also have a potential to inform rational decision-making in healthcare policy and to form a component of economic evaluation. Aims of the study: This article aims to introduce the rationale behind systematic reviews and, using examples from mental health, to introduce the strengths and limitations of systematic reviews, particularly in informing mental health policy and economic evaluation. Methods: Examples are selected from recent controversies surrounding the introduction of new psychiatric drugs (anti-depressants and anti-schizophrenia drugs) and methods of delivering psychiatric care in the community (case management and assertive community treatment). The potential for systematic reviews to (i) produce best estimates of clinical efficacy and effectiveness, (ii) aid economic evaluation and policy decision-making and (iii) highlight gaps in the primary research knowledge base are discussed. Lastly examples are selected from outside mental health to show how systematic reviews have a potential to be explicitly used in economic and health policy evaluation. Results: Systematic reviews produce the best estimates of clinical efficacy, which can form an important component of economic evaluation. Importantly, serious methodological flaws and areas of uncertainty in the primary research literature are identified within an explicit framework. Summary indices of clinical effectiveness can be produced, but it is difficult to produce such summary indices of cost effectiveness by pooling economic data from primary studies. Modelling is commonly used in economic and policy evaluation. Here, systematic reviews can provide the best estimates of effectiveness and, importantly, highlight areas of uncertainty that can be used in ‘sensitivity analysis’. Discussion: Systematic reviews are an important recent methodological advance, the potential for which has only begun to be realized in mental health. This use of systematic reviews is probably most advanced in producing critical summaries of clinical effectiveness data. Systematic reviews cannot produce valid and believable conclusions when the primary research literature is of poor quality. An important function of systematic reviews will be in highlighting this poor quality research which is of little use in mental health decision making. Implications for health provision: Health care provision should be both clinically and cost effective. Systematic reviews are a key component in ensuring that this goal is achieved. Implications for health policies: Systematic reviews have potential to inform health policy. Examples presented show that health policy is often m","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 3","pages":"99-106"},"PeriodicalIF":1.6,"publicationDate":"1999-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199909)2:3<99::AID-MHP51>3.0.CO;2-C","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72163087","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 drug abuse to society","authors":"William S. Cartwright","doi":"10.1002/(SICI)1099-176X(199909)2:3<133::AID-MHP53>3.0.CO;2-B","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199909)2:3<133::AID-MHP53>3.0.CO;2-B","url":null,"abstract":"<p>Background: The costs of substance abuse in the USA are enormous and varied. Seldom are they comprehensively assessed. A new study jointly published by the National Institute on Drug Abuse (NIDA) and the National Institute on Alcoholism and Alcohol Abuse (NIAAA) has done just this. Aims: Researchers for the economic cost of alcohol and drug abuse in the United States, 1992 used systematic cost-of-illness measurement methods to evaluate the burden drug abuse and dependency place on the US economy. This burden includes widespread disability, morbidity, premature death, and diversion of economic resources to drug-related activities. Conceptualizing, identifying, and measuring this burden was a major undertaking; the report describes the methods in detail. Method: Costs are measured as the value of resources used (direct costs) or lost during a one year period. As adopted here, the human capital approach estimates an individual’s value to society in terms of his or her production potential. The value of future lost earnings is discounted to present time. Finally, the study adopts a societal point of view that is consistent with the recommendations of the Panel on Cost-Effectiveness in Health and Medicine that was convened by the U.S. Public Health Service in 1993. Therefore, this study considers all health and non-health outcomes and costs created by drug abuse and dependency for the entire population. Results: For drug abuse, the annual cost in 1992 is estimated at $98 billion. By 1995, this estimate rose to $110 billion after adjusting for inflation and population change. For 1988, a previous and similar study estimated a cost of $58 billion. The distribution of costs is of particular concern.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 3","pages":"133-134"},"PeriodicalIF":1.6,"publicationDate":"1999-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199909)2:3<133::AID-MHP53>3.0.CO;2-B","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72191529","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":"Measuring costs of guideline-driven mental health care: the Texas Medication Algorithm Project","authors":"T. Michael Kashner,&nbsp;A. John Rush,&nbsp;Kenneth Z. Altshuler","doi":"10.1002/(SICI)1099-176X(199909)2:3<111::AID-MHP52>3.0.CO;2-M","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199909)2:3<111::AID-MHP52>3.0.CO;2-M","url":null,"abstract":"<p>Background: Algorithms describe clinical choices to treat a specific disorder. To many, algorithms serve as important tools helping practitioners make informed choices about how best to treat patients, achieving better outcomes more quickly and at a lower cost. Appearing as flow charts and decision trees, algorithms are developed during consensus conferences by leading experts who explore the latest scientific evidence to describe optimal treatment for each disorder. Despite a focus on ‘optimal’ care, there has been little discussion in the literature concerning how costs should be defined and measured in the context of algorithm-based practices. Aims of the study: This paper describes the strategy to measure costs for the Texas Medication Algorithm project, or TMAP. Launched by the Texas Department of Mental Health and Mental Retardation and the University of Texas Southwestern Medical Center at Dallas, this multi-site study investigates outcomes and costs of medication algorithms for bipolar disorder, schizophrenia and depression. Methods: To balance costs with outcomes, we turned to cost-effectiveness analyses as a framework to define and measure costs. Alternative strategies (cost–benefit, cost–utility, cost-of-illness) were inappropriate since algorithms are not intended to guide resource allocation across different diseases or between health- and non-health-related commodities. ‘Costs’ are operationalized consistent with the framework presented by the United States Public Health Service Panel on Cost Effectiveness in Medicine.</p><p>Patient specific costs are calculated by multiplying patient units of use by a unit cost, and summing over all service categories. Outpatient services are counted by procedures. Inpatient services are counted by days classified into diagnosis groups. Utilization information is derived from patient self-reports, medical charts and administrative file sources. Unit costs are computed by payer source. Finally, hierarchical modeling is used to describe how costs and effectiveness differ between algorithm-based and treatment-as-usual practices. Discussion: Cost estimates of algorithm-based practices should (i) measure opportunity costs, (ii) employ structured data collection methods, (iii) profile patient use of both mental health and general medical providers and (iv) reflect costs by payer status in different economic environments. Implication for health care provision and use: Algorithms may help guide clinicians, their patients and third party payers to rely on the latest scientific evidence to make treatment choices that balance costs with outcomes. Implication for health policies: Planners should consider consumer wants and economic costs when developing and testing new clinical algorithms. Implications for further research: Future studies may wish to consider similar methods to estimate costs in evaluating algorithm-based practices. Copyright © 1999 John Wiley &amp; Sons, Ltd.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 3","pages":"111-121"},"PeriodicalIF":1.6,"publicationDate":"1999-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199909)2:3<111::AID-MHP52>3.0.CO;2-M","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72191524","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":"Abstracts translations","authors":"Dr Ella Rytik","doi":"10.1002/(SICI)1099-176X(199909)2:3<93::AID-MHP60>3.0.CO;2-K","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199909)2:3<93::AID-MHP60>3.0.CO;2-K","url":null,"abstract":"","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 3","pages":"93-95"},"PeriodicalIF":1.6,"publicationDate":"1999-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199909)2:3<93::AID-MHP60>3.0.CO;2-K","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72191528","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 patterns of major depressive disorder in the United States labor force","authors":"Dave E. Marcotte,&nbsp;Virginia Wilcox-Gök,&nbsp;D. Patrick Redmon","doi":"10.1002/(SICI)1099-176X(199909)2:3<123::AID-MHP55>3.0.CO;2-8","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199909)2:3<123::AID-MHP55>3.0.CO;2-8","url":null,"abstract":"&lt;p&gt;Background and Aims of the Study: In this paper, we identify the 12-month and lifetime prevalence of major depressive disorder in and out of the labor force, and among the employed and unemployed. We examine whether prevalence by labor force and employment status varies by gender and over the life cycle. Finally, we examine whether people can ‘recover’ from depression with time by identifying patterns of labor force participation and employment as time since most recent episode passes. Methods: We examine data collected as part of the National Comorbidity Survey, a survey representative of the population of the United States designed to identify the prevalence of major mental illnesses. The National Comorbidity Study identified cases of major depression via the Composite International Diagnostic Interview. Using these data, we estimate univariate and bivariate frequency distributions of major depressive disorder. We also estimate a set of multivariate models to identify the effect of a variety of dimensions of major depression on the propensity to participate in the labor force, and be employed if participating. Results: Lifetime and 12-month prevalence rates of depression are similar in and out of the labor force. Within the labor force, however, depression is strongly associated with unemployment. The negative relationship between depressive disorder and employment is particularly strong for middle age workers. Depression and the number of depressive episodes have a differing pattern of effects on labor market outcomes for men and women. We find evidence that labor force participation and employment rates for people with a history of depression increase significantly over time in the absence of additional depressive episodes. Discussion: Labor market status represents an important dimension along which prevalence of major depression varies. The relationship between depression and employment status is particularly strong for middle aged persons, but becomes weaker as time passes since the last depressive episode. Continued exploration of the association between work (or lack of work) and depression may ultimately help in the prediction, treatment and assessment of the illness. Implications for Practice and Policy: These results present a basic set of facts about the relationship between major depressive disorder and labor market outcomes. We have not, however, attempted to sort out the complexities of this relationship here. These complexities arise at almost every turn. For instance, the high level of prevalence of depression among the unemployed may be due to the possibility that the stresses associated with unemployment trigger depressive episodes or to the possibility that workers who are depressed are more likely to be fired or quit. Implications for Further Research: Our continuing research attempts to address these problems. Understanding when and how depression affects labor market outcomes and when and how labor market outcomes affec","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 3","pages":"123-131"},"PeriodicalIF":1.6,"publicationDate":"1999-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199909)2:3<123::AID-MHP55>3.0.CO;2-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72162847","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: The benefits of collaboration in research: who will pay?","authors":"Barbara Dickey, Ph.D.","doi":"10.1002/(SICI)1099-176X(199909)2:3<135::AID-MHP58>3.0.CO;2-V","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199909)2:3<135::AID-MHP58>3.0.CO;2-V","url":null,"abstract":"<p>Collaboration between MCOs and researchers holds promise for benefiting consumers by working on quality-of-care-related research. There are at least three areas of collaboration that might benefit both researchers and MCOs: (1) the developing and validating of management and fiscal indicators, (2) developing and validating clinical indicators and (3) studying access to treatment for vulnerable populations. These three areas offer benefits to the MCO and unusual research opportunities for investigators. Barriers for both MCOs and researchers must be overcome before this work can be carried out, not the least of which is who will pay for the work to be done.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 3","pages":"135-136"},"PeriodicalIF":1.6,"publicationDate":"1999-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199909)2:3<135::AID-MHP58>3.0.CO;2-V","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72191530","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}