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Hooshmand Zaferanieh M, Shi L, Jindal M, Chen L, Zhang L, Lopes S, Jones K, Wang Y, Meggett K, Walker CB, Falgoust G, Zinzow H. Web-Based Mindfulness-Based Cognitive Therapy for Adults With a History of Depression: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e53966. [PMID: 38888958 PMCID: PMC11220437 DOI: 10.2196/53966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/03/2024] [Accepted: 03/21/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Depression poses a major threat to public health with an increasing prevalence in the United States. Mindfulness-based interventions, such as mindfulness-based cognitive therapy (MBCT), are effective methods for managing depression symptoms and may help fortify existing efforts to address the current disease burden. The in-person group format of MBCT, however, incurs barriers to care such as expenses, childcare needs, and transportation issues. Alternate delivery modalities such as MBCT delivered via the web can be investigated for their capacity to overcome these barriers and still reduce symptoms of depression with adequate feasibility and efficacy. OBJECTIVE This study protocol aims to examine the feasibility and efficacy of MBCT delivered via the web for the treatment of depression. METHODS To attain study aims, 2 phases will be implemented using a waitlist control design. A total of 128 eligible participants will be randomized into either an 8-week MBCT intervention group plus treatment as usual (MBCT + TAU; group 1) or an 8-week waitlist control group (group 2). In phase I (8 weeks), group 1 will complete the intervention and group 2 will proceed with TAU. In phase II (8 weeks), group 2 will complete the intervention and group 1 will continue with TAU until reaching an 8-week follow-up. TAU may consist of receiving psychotherapy, pharmacotherapy, or combined treatment. Data collection will be completed at baseline, 8 weeks (postintervention for group 1 and preintervention for group 2), and 16 weeks (follow-up for group 1, postintervention for group 2). The primary outcomes will include (1) current, residual, or chronic depression symptoms and (2) psychiatric distress. Secondary outcomes will include perceived stress and facets of mindfulness. The feasibility will be measured by assessing protocol adherence, retention, attendance, and engagement. Finally, the extent of mindfulness self-practice and executive functioning skills will be assessed as mediators of intervention outcomes. RESULTS This study began screening and recruitment in December 2022. Data collection from the first cohort occurred in January 2023. By November 2023, a total of 30 participants were enrolled out of 224 who received screening. Data analysis began in February 2024, with an approximate publication of results by August 2024. Institutional review board approval took place on September 11, 2019. CONCLUSIONS This trial will contribute to examining mindfulness-based interventions, delivered via the web, for improving current, residual, or chronic depression symptoms. It will (1) address the feasibility of MBCT delivered via the web; (2) contribute evidence regarding MBCT's efficacy in reducing depression symptoms and psychiatric distress; and (3) assess the impact of MBCT on several important secondary outcomes. Findings from this study will develop the understanding of the causal pathways between MBCT delivered via the web and depression symptoms further, elucidating the potential for future larger-scale designs. TRIAL REGISTRATION ClinicalTrials.gov NCT05347719; https://www.clinicaltrials.gov/ct2/show/NCT05347719. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53966.
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Affiliation(s)
| | - Lu Shi
- Department of Health Sciences, College of Health Professions, Pace University, New York, NY, United States
| | - Meenu Jindal
- Department of Internal Medicine, Prisma Health, Greenville, SC, United States
| | - Liwei Chen
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
| | - Lingling Zhang
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
| | - Snehal Lopes
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Karyn Jones
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Yucheng Wang
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Kinsey Meggett
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Cari Beth Walker
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Grace Falgoust
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Heidi Zinzow
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
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O'Mahony BW, Nelson-Sice R, Nielsen G, Hunter R, Cope S, Agarwal N, Edwards MJ, Yogarajah M. Cross-sectional evaluation of health resource use in patients with functional neurological disorders referred to a tertiary neuroscience centre. BMJ Neurol Open 2024; 6:e000606. [PMID: 38800070 PMCID: PMC11116875 DOI: 10.1136/bmjno-2023-000606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/13/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Functional neurological disorder (FND) is a common cause of referral to neurology services. FND has been shown to lead to significant healthcare resource use and is associated with significant disability, comorbidity and distress. This leads to substantial direct, indirect and intangible costs to the patient and society. Methods We recruited consecutive patients with FND referred to a tertiary FND specialist clinic. We assessed health and social care resource use in the 6 months preceding their consultation through a modified version of the Client Service Receipt Inventory in the form of a postal questionnaire. The total cost was estimated by combining the number and frequency of health resource use with standard national unit costs. We also assessed indirect costs such as informal care and loss of income. Results We collected data on 118 subjects. Patients with comorbid anxiety or depression had higher costs in the preceding 6 months, as did patients who had a longer duration of FND symptoms. Indirect costs were higher than the already substantial direct costs and a large proportion of patients with FND were receiving government support. Conclusion This study highlights the high cost of FND to both patients and health systems. Adequate reform of the patient pathway and reorganisation of services to make diagnoses and initiate treatment more quickly would likely reduce these costs.
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Affiliation(s)
- Brian William O'Mahony
- Institute of Psychiatry at the Maudsley, London, UK
- University Hospital Galway, Galway, Ireland
| | | | - Glenn Nielsen
- Institute of Molecular and Clinical Sciences, St George's University, London, UK
| | - Rachael Hunter
- Primary Care and Population Health, University College London, London, UK
| | - Sarah Cope
- South West London and Saint George's Mental Health NHS Trust, London, UK
| | - Niruj Agarwal
- Department of Neuropsychiatry, South West London and St George's Mental Health NHS Trust, London, UK
| | | | - Mahinda Yogarajah
- Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, London, UK
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Raya-Tena A, Fernández-San-Martín MI, Martín-Royo J, Casajuana-Closas M, Jiménez-Herrera MF. Cost-effectiveness and cost-utility study of a psychoeducational group intervention for people with depression and physical comorbidity in primary care. ENFERMERIA CLINICA (ENGLISH EDITION) 2024; 34:108-119. [PMID: 38508236 DOI: 10.1016/j.enfcle.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/26/2023] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To evaluate the cost-effectiveness and cost-utility of a psychoeducational group intervention led by primary care (PC) nurses in relation to customary care to prevent the depression and improve quality of life in patients with physical comorbidity. DESIGN Economic evaluation based on data from randomized, multicenter clinical trial with blind response variables and a one-year follow-up, carried in the context of the PSICODEP study. LOCATION 7 PC teams from Catalonia. PARTICIPANTS >50 year-old patients with depression and some physical comorbidity: diabetes mellitus type 2, ischemic heart disease, chronic obstructive pulmonary disease, and/or asthma. INTERVENTION 12 psychoeducational group sessions, 1 per week, led by 2 PC nurses with prior training. MEASUREMENTS Effectiveness: depression-free days (DFD) calculated from the BDI-II and quality-adjusted life years (QALYs) from the Euroqol-5D. Direct costs: PC visits, mental health, emergencies and hospitalizations, drugs. Indirect costs: days of temporary disability (TD). The incremental cost-effectiveness ratios (ICER), cost-effectiveness (ΔCost/ΔDLD) and cost-utility (ΔCost/ΔQALY) were estimated. RESULTS The study includes 380 patients (intervention group [IG] = 204; control group [CG] = 176). 81.6% women; mean age 68.4 (SD = 8.8). The IG had a higher mean cost of visits, less of hospitalizations and less TD than the CG. The difference in costs between the IG and the CG was -357.95€ (95% CI: -2026.96 to 1311.06) at one year of follow-up. There was a mean of 11.95 (95% CI: -15.98 to 39.88) more DFD in the IG than in the CG. QALYs were similar (difference -0.01, 95% CI -0.04 to 0.05). The ICERs were 29.95€/DLD and 35,795€/QALY. CONCLUSIONS Psychoeducational intervention is associated with an improvement in DFD, as well as a reduction in costs at 12 months, although not significantly. QALYs were very similar between groups.
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Affiliation(s)
- Antonia Raya-Tena
- Centre d'Atenció Primària Dr. Lluís Sayé, ABS Raval Nord, Institut Català de la Salut, Barcelona, Spain; Línea d'Investigació en Biomedicina, Epidemiologia i Pràctica Clínica Avançada, Facultat de Infermeria, Universitat Rovira i Virgili, Tarragona, Spain.
| | - María Isabel Fernández-San-Martín
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Unitat Docent Multiprofesional, Gerència Territorial Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Jaume Martín-Royo
- Unitat Bàsica de Prevenció, Gerència Territorial Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Marc Casajuana-Closas
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - María Francisca Jiménez-Herrera
- Línea d'Investigació en Biomedicina, Epidemiologia i Pràctica Clínica Avançada, Facultat de Infermeria, Universitat Rovira i Virgili, Tarragona, Spain
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Ng QX, Ong C, Yaow CYL, Chan HW, Thumboo J, Wang Y, Koh GCH. Cost-of-illness studies of inherited retinal diseases: a systematic review. Orphanet J Rare Dis 2024; 19:93. [PMID: 38424595 PMCID: PMC10905859 DOI: 10.1186/s13023-024-03099-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND While health care and societal costs are routinely modelled for most diseases, there is a paucity of comprehensive data and cost-of-illness (COI) studies for inherited retinal diseases (IRDs). This lack of data can lead to underfunding or misallocation of resources. A comprehensive understanding of the COI of IRDs would assist governmental and healthcare leaders in determining optimal resource allocation, prioritizing funding for research, treatment, and support services for these patients. METHODS Following PRISMA guidelines, a literature search was conducted using Medline, EMBASE and Cochrane databases, from database inception up to 30 Jun 2023, to identify COI studies related to IRD. Original studies in English, primarily including patients with IRDs, and whose main study objective was the estimation of the costs of IRDs and had sufficiently detailed methodology to assess study quality were eligible for inclusion. To enable comparison across countries and studies, all annual costs were standardized to US dollars, adjusted for inflation to reflect their current value and recalculated on a "per patient" basis wherever possible. The review protocol was registered in PROSPERO (registration number CRD42023452986). RESULTS A total of nine studies were included in the final stage of systematic review and they consistently demonstrated a significant disease burden associated with IRDs. In Singapore, the mean total cost per patient was roughly US$6926/year. In Japan, the mean total cost per patient was US$20,833/year. In the UK, the mean total cost per patient with IRD ranged from US$21,658 to US$36,549/year. In contrast, in the US, the mean total per-patient costs for IRDs ranged from about US$33,017 to US$186,051 per year. In Canada, these mean total per-patient costs varied between US$16,470 and US$275,045/year. Non-health costs constituted the overwhelming majority of costs as compared to healthcare costs; 87-98% of the total costs were due to non-health costs, which could be attributed to diminished quality of life, poverty, and increased informal caregiving needs for affected individuals. CONCLUSION IRDs impose a disproportionate societal burden outside health systems. It is vital for continued funding into IRD research, and governments should incorporate societal costs in the evaluation of cost-effectiveness for forthcoming IRD interventions, including genomic testing and targeted therapies.
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Affiliation(s)
- Qin Xiang Ng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore.
| | - Clarence Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Clyve Yu Leon Yaow
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hwei Wuen Chan
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Julian Thumboo
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Gerald Choon Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Yang X, Yan J, Lai S, Shen C, Duan N. What affects the direct economic burden of non-communicable diseases on middle-aged and older adult people in Shaanxi Province? Front Public Health 2023; 11:1219199. [PMID: 38186709 PMCID: PMC10766749 DOI: 10.3389/fpubh.2023.1219199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Non-communicable diseases (NCDs) are the leading cause of death worldwide. NCDs affect the health status and the quality of life. In addition, continuous NCDs treatment expenses place a heavy economic burden on families and cause huge economic losses to the society. The prevention and treatment of NCDs and reduction of their economic burden are key public health issues. Considering middle-aged and older adult people as the focus, their basic socio-demographic characteristics and health behavior status of this group, and a pooled cross-sections regression model was then used to analyze the main factors affecting the direct economic burden. The results showed that from 2013 to 2018, the prevalence of NCDs among the middle-aged and older adult people in Shaanxi province as well as the direct economic burden of NCDs increased. The effect factors primarily included sex, age, employment status, income level, type of medical insurance, urban or rural residency, level of the health care-providing institutions, visiting times of 2-week, and length of hospital stay. Several measures can be taken to control the onset of NCDs and reduce their direct economic burden.
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Affiliation(s)
- Xiaowei Yang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Ju’e Yan
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Sha Lai
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Chi Shen
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Ning Duan
- Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Collins B, Downing J, Head A, Comerford T, Nathan R, Barr B. Investigating the impact of undiagnosed anxiety and depression on health and social care costs and quality of life: cross-sectional study using household health survey data. BJPsych Open 2023; 9:e201. [PMID: 37886809 PMCID: PMC10753950 DOI: 10.1192/bjo.2023.596] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND There is uncertainty around the costs and health impacts of undiagnosed mental health problems. AIMS Using survey data, we aim to understand the costs and health-related quality-of-life decrements from undiagnosed anxiety/depression. METHOD We analysed survey data from two waves of the North West Coast Household Health Survey, which included questions on disease, medications, and Patient Health Questionnaire 9 (PHQ-9) and Generalised Anxiety Disorder 7 (GAD-7) scores (depression and anxiety scales). People were judged as having undiagnosed anxiety/depression problems if they scored ≥5 on the PHQ-9 or GAD-7, and did not declare a mental health issue or antidepressant prescription. Linear regression for EuroQol 5-Dimension 3-Level (EQ-5D-3L) index scores, and Tweedie regression for health and social care costs, were used to estimate the impact of undiagnosed mental health problems, controlling for age, gender, deprivation and other health conditions. RESULTS Around 26.5% of participants had undiagnosed anxiety/depression. The presence of undiagnosed anxiety/depression was associated with reduced EQ-5D-3L index scores (0.040 lower on average) and increased costs (£250 ($310) per year on average). Using a higher cut-off score of 10 on the PHQ-9 and GAD-7 for undiagnosed anxiety/depression had similar increased costs but a greater reduction in EQ-5D-3L index scores (0.076 on average), indicating a larger impact on health-related quality of life. CONCLUSIONS Having undiagnosed anxiety or depression increases costs and reduces health-related quality of life. Reducing stigma and increasing access to cost-effective treatments will have population health benefits.
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Affiliation(s)
- Brendan Collins
- Department of Public Health, Policy and Systems, University of Liverpool, UK
| | - Jennifer Downing
- Department of Public Health, Policy and Systems, University of Liverpool, UK
| | - Anna Head
- Department of Public Health, Policy and Systems, University of Liverpool, UK
| | - Terence Comerford
- Department of Public Health, Policy and Systems, University of Liverpool, UK
| | - Rajan Nathan
- Forensic Psychiatry, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Benjamin Barr
- Department of Public Health, Policy and Systems, University of Liverpool, UK
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Zhao S, Wu J, Liu X, Du Y, Wang X, Xia Y, Sun H, Huang Y, Zou H, Wang X, Chen Z, Zhou H, Yan R, Tang H, Lu Q, Yao Z. Altered resting-state brain activity in major depressive disorder comorbid with subclinical hypothyroidism: A regional homogeneity analysis. Brain Res Bull 2023; 202:110754. [PMID: 37683703 DOI: 10.1016/j.brainresbull.2023.110754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/15/2023] [Accepted: 09/04/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Major depressive disorder (MDD), a common mental disorder worldwide, frequently coexists with various physical illnesses, and recent studies have shown an increased prevalence of subclinical hypothyroidism (SHypo) among MDD patients. However, the neural mechanisms shared and unique to these disorders and the associated alterations in brain function remain largely unknown. This study investigated the potential brain function mechanisms underlying comorbid MDD and SHypo. METHOD Thirty MDD patients (non-comorbid group), 30 MDD patients comorbid with SHypo (comorbid group), 26 patients with SHypo, and 30 healthy controls were recruited for resting-state functional magnetic resonance imaging (rs-fMRI). We used regional homogeneity (ReHo) to examine differences in internal cerebral activity across the four groups. RESULTS Compared with the non-comorbid group, the comorbid group exhibited significantly higher ReHo values in the right orbital part of the middle frontal gyrus (ORBmid) and bilateral middle frontal gyrus; decreased ReHo values in the right middle temporal gyrus, right thalamus, and right superior temporal gyrus, and right insula. Within the comorbid group, serum TSH levels were negatively associated with the ReHo values of the right insula; the ReHo values of the right Insula were negatively associated with the retardation factor score; the ReHo values of the right ORBmid were positively correlated with the anxiety/somatization factor scores. CONCLUSIONS These findings provide valuable clues for exploring the shared neural mechanisms between MDD and SHypo and have important implications for understanding the pathophysiological mechanisms of the comorbidity of the two disorders.
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Affiliation(s)
- Shuai Zhao
- Department of Psychiatry, the Affiliated Psychological Hospital of Anhui Medical University, Hefei, China; Hefei Fourth People's Hospital, Hefei, China; Anhui Mental Health Center, Hefei, China; Anhui Clinical Research Center for Mental Disorders, China; Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jindan Wu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaomei Liu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yishan Du
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiaoqin Wang
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yi Xia
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hao Sun
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yinghong Huang
- Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing 210093, China
| | - Haowen Zou
- Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing 210093, China
| | - Xumiao Wang
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhilu Chen
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hongliang Zhou
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Rui Yan
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hao Tang
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Qing Lu
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China.
| | - Zhijian Yao
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing 210093, China.
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Kondapura MB, Manjunatha N, Nagaraj AKM, Praharaj SK, Kumar CN, Math SB, Rao GN. Cost of Illness Analysis of Common Mental Disorders: A Study from an Indian Academic Tertiary Care Hospital. Indian J Psychol Med 2023; 45:519-525. [PMID: 37772137 PMCID: PMC10523518 DOI: 10.1177/02537176221108867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Background The cost of illness (COI) for common mental disorders (CMDs) that include depression, anxiety, and somatoform disorder is less studied in India. Hence, we studied the COI and disability of CMDs and their relationship in patients with depression, anxiety, and somatoform disorders. Methods In this cross-sectional study, we recruited 220 patients (110 with depression, 58 with anxiety disorders, and 52 with somatoform disorders) and evaluated disability using the Sheehan Disability Scale (SDS). The schedule for the cost of illness (S-COI) was used for evaluating COI for the last year. Results The annual COI of CMDs from the patient perspective was ₹21,620 (interquartile range [IQR], ₹47,761; ≈US$290). The median annual direct COI was ₹4,907 (IQR ₹7,502), and indirect COI was ₹12,900 (IQR ₹37744). The direct COI was 18%, whereas the indirect COI was 82%. The direct and indirect COI in the three groups were similar. In all three groups with ongoing treatment, the mean scores indicated a mild level of disability. Total and indirect COI, but not the direct COI, correlated positively with the severity of illness and disability. Conclusion All the CMDs with ongoing treatment are associated with a mild level of disability and are a significant financial burden, with higher indirect costs.
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Affiliation(s)
- Manjunatha B. Kondapura
- Dept. of Psychiatry, National
Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Dept. of Psychiatry, National
Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anil Kumar Mysore Nagaraj
- Dept. of Psychiatry, Kasturba Medical
College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka,
India
| | - Samir Kumar Praharaj
- Dept. of Psychiatry, Kasturba Medical
College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka,
India
| | | | - Suresh Bada Math
- Dept. of Psychiatry, National
Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Dept. of Epidemiology, Centre for
Public Health, National Institute of Mental Health and Neurosciences, Bengaluru,
Karnataka, India
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Ngo VK, Vu TT, Vu QA, McBain R, Yu G, Nguyen NB, Mai Thi Nguyen H, Ho HT, Van Hoang M. Study protocol for type II hybrid implementation-effectiveness trial of strategies for depression care task-sharing in community health stations in Vietnam: DEP Project. BMC Public Health 2023; 23:1450. [PMID: 37507720 PMCID: PMC10386582 DOI: 10.1186/s12889-023-16312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND It is not clear what the most effective implementation strategies are for supporting the enactment and sustainment of depression care services in primary care settings. This type-II Hybrid Implementation-Effectiveness study will compare the effectiveness of three system-level strategies for implementing depression care programs at 36 community health stations (CHSs) across 2 provinces in Vietnam. METHODS In this cluster-randomized controlled trial, CHSs will be randomly assigned to one of three implementation conditions: (1) Usual Implementation (UI), which consists of training workshops and toolkits; (2) Enhanced Supervision (ES), which includes UI combined with bi-weekly/monthly supervision; and (3) Community-Engaged Learning Collaborative (CELC), which includes all components of ES, combined with bi-monthly province-wide learning collaborative meetings, during which cross-site learning and continuous quality improvement (QI) strategies are implemented to achieve better implementation outcomes. The primary outcome will be measured based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation quality, and Maintenance) using indicators on implementation, provider, and client factors. The secondary outcome examines factors associated with barriers and facilitators of quality implementation, while the tertiary outcome evaluates the incremental cost-effectiveness ratio of services provided in the ES and CELC conditions, relative to UI condition for depression care. A total of 1,296 clients receiving depression care at CHSs will be surveyed at baseline and 6-month follow-up to assess mental health and psychosocial outcomes (e.g., depression and anxiety severity, health function, quality of life). Additionally, 180 CHS staff and 180 non-CHS staff will complete pre- and post-training evaluation and surveys at baseline, 6, 12, and 24 months. DISCUSSION We hypothesize that the additional implementation supports will make mental health service implementation superior in the ES and CELC arms compared to the UI arm. The findings of this project could identify effective implementation models and assess the added value of specific QI strategies for implementing depression care in primary care settings in Vietnam, with implications and recommendations for other low- and middle-income settings. More importantly, this study will provide evidence for key stakeholders and policymakers to consider policies that disseminate, scale up, and advance quality mental health care in Vietnam. TRIAL REGISTRATION NCT04491045 on Clinicaltrials.gov. Registered July 29, 2020.
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Affiliation(s)
- Victoria Khanh Ngo
- Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, US
- Department of Community Health & Social Sciences, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, US
| | - Thinh Toan Vu
- Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, US.
- Department of Community Health & Social Sciences, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, US.
| | - Quan Anh Vu
- Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, US
| | | | - Gary Yu
- Columbia University, New York, US
| | | | | | - Hien Thi Ho
- Hanoi University of Public Health, Hanoi, Vietnam
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10
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Iordache MM, Sorici CO, Aivaz KA, Lupu EC, Dumitru A, Tocia C, Dumitru E. Depression in Central and Eastern Europe: How Much It Costs? Cost of Depression in Romania. Healthcare (Basel) 2023; 11:healthcare11060921. [PMID: 36981578 PMCID: PMC10048715 DOI: 10.3390/healthcare11060921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE The present study aims to estimate the public cost of depression in Romania during a seven-year time span to complement existing papers with data from Central and Eastern Europe and to identify and propose measures that allow efficient use of funds. METHODS We used data collected from the National Health Insurance System to analyze the main components of the cost. FINDINGS Indirect costs exceed direct costs. Within the direct costs, hospitalization and medicines still have an important share but are decreasing due to the intervention of outpatient services such as psychiatrists and psychotherapists. CONCLUSION Since the goal is mental health, it is necessary to act early and quickly to decrease the burden in the long run. Annually, the mean direct cost of depression per patient is EUR 143 (part of it is represented by hospitalization, i.e., EUR 67, and psychotherapy, i.e., EUR 5), the mean cost of sick leaves per patient is EUR 273, and the total cost per patient is EUR 5553. Indirect costs (cost of disability and lost productive years) represent 97.17% of the total cost. An integrated approach to early diagnosis, effective treatment, monitoring, and prevention as well as included economic and social programs are needed to optimize indirect costs.
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Affiliation(s)
- Miorita Melina Iordache
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Alley, 900470 Constanta, Romania
- Prof. Alexandru Obregia Psychiatry Hospital, 10 Berceni Str., 041914 Bucharest, Romania
| | - Costin Octavian Sorici
- Faculty of Economics, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania
| | - Kamer Ainur Aivaz
- Faculty of Economics, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania
| | - Elena Carmen Lupu
- Faculty of Pharmacy, Ovidius University of Constanta, 900001 Constanta, Romania
| | - Andrei Dumitru
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Alley, 900470 Constanta, Romania
- "St. Apostol Andrew" Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Cristina Tocia
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Alley, 900470 Constanta, Romania
- "St. Apostol Andrew" Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Eugen Dumitru
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Alley, 900470 Constanta, Romania
- "St. Apostol Andrew" Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
- Research Center for the Morphological and Genetic Study in Malignant Pathology (CEDMOG), Ovidius University of Constanța, 145 Tomis Avenue, 900591 Constanta, Romania
- Academy of Romanian Scientists, 3 Ilfov Street, 050045 Bucharest, Romania
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11
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Sveen CA, Pedersen G, Ulvestad DA, Zahl KE, Wilberg T, Kvarstein EH. Societal costs of personality disorders: A cross-sectional multicenter study of treatment-seeking patients in mental health services in Norway. J Clin Psychol 2023. [PMID: 36916214 DOI: 10.1002/jclp.23504] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 01/30/2023] [Accepted: 02/25/2023] [Indexed: 03/15/2023]
Abstract
OBJECTIVE There is a relatively small body of research on the cost-of-illness of personality disorders (PDs). Most studies only include borderline PD. The aim of this study was to investigate mean societal costs, including its components, (direct) health service costs and (indirect) productivity loss, among treatment-seeking patients with the broad range of all PDs according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). METHODS Cross-sectional data from 911 patients diagnosed with at least 1 PD were retrieved from the quality register of the Norwegian Network for Personality Disorders-a collaboration of PD treatment units within specialist mental health services. The patients were referred in the time period 2017-2020. Estimation of costs was based on a bottom-up approach, using information from a structured interview covering the 6-month period before assessment, whereas unit costs were retrieved from public reports, public records, or public agencies. The human capital approach was used to calculate productivity loss. Diagnoses were determined by semi-structured diagnostic interviews (Structured Clinical Interview for DSM-5-PD [SCID-5-PD]). RESULTS The mean societal costs were €20.260 during the 6-month period before specialized treatment. The largest cost component was productivity loss (65%), whereas health service costs constituted 35%. The main contributors to societal costs from the underlying health service cost components were inpatient treatment (20.5%) and individual outpatient treatment (10.5%). CONCLUSION Societal costs were substantial among treatment-seeking patients with the broad range of DSM-5 PDs, comparable to the societal costs of schizophrenia, and significantly higher than the societal costs of both depression and anxiety disorders. The cost estimates converged with recent, register-based cost-of-illness studies of different PDs but exceeded previous findings from other bottom-up studies. Furthermore, the results underscore the importance of implementing effective and specialized treatment for patients with a broad range of PDs, not only to alleviate individual suffering but also to reduce the level of societal costs. The emphasis on productivity loss as a main contributor to the overall societal costs is substantiated, hence underlining the relevance of interventions focusing on improving occupational functioning.
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Affiliation(s)
- C A Sveen
- Department of Child and Adolescent Psychiatry, Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway
| | - G Pedersen
- Network for Personality Disorder, Section for Personality Psychiatry and specialized treatments, Department for National and Regional Functions, Division of Mental health and Addiction, Oslo University Hospital, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - D A Ulvestad
- Outpatient Clinic for Specialized Treatment of Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - K E Zahl
- Group Therapy Section, Follo District Psychiatric Centre, Division of Mental Health, Akershus University Hospital, Ski, Norway
| | - T Wilberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Section for Treatment Research, Department for Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - E H Kvarstein
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Section for Personality Psychiatry and specialized treatments, Department for National and Regional Functions, Division of Mental health and Addiction, Oslo University Hospital, Oslo, Norway
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12
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Eysenbach G, Jang EH, Lee SH, Choi KY, Park JG, Shin HC. Automatic Depression Detection Using Smartphone-Based Text-Dependent Speech Signals: Deep Convolutional Neural Network Approach. J Med Internet Res 2023; 25:e34474. [PMID: 36696160 PMCID: PMC9909514 DOI: 10.2196/34474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 05/20/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Automatic diagnosis of depression based on speech can complement mental health treatment methods in the future. Previous studies have reported that acoustic properties can be used to identify depression. However, few studies have attempted a large-scale differential diagnosis of patients with depressive disorders using acoustic characteristics of non-English speakers. OBJECTIVE This study proposes a framework for automatic depression detection using large-scale acoustic characteristics based on the Korean language. METHODS We recruited 153 patients who met the criteria for major depressive disorder and 165 healthy controls without current or past mental illness. Participants' voices were recorded on a smartphone while performing the task of reading predefined text-based sentences. Three approaches were evaluated and compared to detect depression using data sets with text-dependent read speech tasks: conventional machine learning models based on acoustic features, a proposed model that trains and classifies log-Mel spectrograms by applying a deep convolutional neural network (CNN) with a relatively small number of parameters, and models that train and classify log-Mel spectrograms by applying well-known pretrained networks. RESULTS The acoustic characteristics of the predefined text-based sentence reading automatically detected depression using the proposed CNN model. The highest accuracy achieved with the proposed CNN on the speech data was 78.14%. Our results show that the deep-learned acoustic characteristics lead to better performance than those obtained using the conventional approach and pretrained models. CONCLUSIONS Checking the mood of patients with major depressive disorder and detecting the consistency of objective descriptions are very important research topics. This study suggests that the analysis of speech data recorded while reading text-dependent sentences could help predict depression status automatically by capturing the characteristics of depression. Our method is smartphone based, is easily accessible, and can contribute to the automatic identification of depressive states.
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Affiliation(s)
| | - Eun Hye Jang
- Medical Information Research Section, Electronics and Telecommunications Research Institute, Dajeon, Republic of Korea
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea.,Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Goyang, Republic of Korea.,Bwave Inc, Goyang, Republic of Korea
| | - Kwang-Yeon Choi
- Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jeon Gue Park
- Artificial Intelligence Research Laboratory, Electronics and Telecommunications Research Institute, Dajeon, Republic of Korea.,Tutorus Labs Inc, Seoul, Republic of Korea
| | - Hyun-Chool Shin
- Department of Electronics Engineering, Soongsil University, Seoul, Republic of Korea
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13
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Pedretti RFE, Hansen D, Ambrosetti M, Back M, Berger T, Ferreira MC, Cornelissen V, Davos CH, Doehner W, de Pablo Y Zarzosa C, Frederix I, Greco A, Kurpas D, Michal M, Osto E, Pedersen SS, Salvador RE, Simonenko M, Steca P, Thompson DR, Wilhelm M, Abreu A. How to optimize the adherence to a guideline-directed medical therapy in the secondary prevention of cardiovascular diseases: a clinical consensus statement from the European Association of Preventive Cardiology. Eur J Prev Cardiol 2023; 30:149-166. [PMID: 36098041 DOI: 10.1093/eurjpc/zwac204] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 01/27/2023]
Abstract
A key factor to successful secondary prevention of cardiovascular disease (CVD) is optimal patient adherence to treatment. However, unsatisfactory rates of adherence to treatment for CVD risk factors and CVD have been observed consistently over the last few decades. Hence, achieving optimal adherence to lifestyle measures and guideline-directed medical therapy in secondary prevention and rehabilitation is a great challenge to many healthcare professionals. Therefore, in this European Association of Preventive Cardiology clinical consensus document, a modern reappraisal of the adherence to optimal treatment is provided, together with simple, practical, and feasible suggestions to achieve this goal in the clinical setting, focusing on evidence-based concepts.
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Affiliation(s)
| | - Dominique Hansen
- REVAL/BIOMED, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta D'Adda, Italy
| | - Maria Back
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Thomas Berger
- Cardiomed Linz, St.John of God Hospital Linz, Linz, Austria
| | - Mariana Cordeiro Ferreira
- Psychologist, Centro de Reabilitação Cardiovascular do Centro Universitário Hospitalar Lisboa Norte, Portugal
| | | | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Wolfram Doehner
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin and German, Berlin, Germany
- Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ines Frederix
- Heart Centre Hasselt, Jessa Hospital Hasselt Belgium, Hasselt University, Hasselt, Belgium
- Faculty of Medicine and Life Sciences Diepenbeek Belgium, University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences Antwerp Belgium, Antwerp University Hospital, Edegem, Belgium
| | - Andrea Greco
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Donata Kurpas
- Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Elena Osto
- Institute of Clinical Chemistry & Department of Cardiology, Heart Center, University & University Hospital Zurich, Zurich, Switzerland
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Maria Simonenko
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Patrizia Steca
- Department of Psychology, University of Milan-Bicocca, Milano, Italy
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Matthias Wilhelm
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ana Abreu
- Department of Cardiology of Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Institute of Preventive Medicine and Institute of Environmental Health of the Faculty of Medicine of University of Lisbon, Centre of Cardiovascular Investigation of University of Lisbon (CCUL) and Academic Centre of Medicine of University of Lisbon (CAML), Lisbon, Portugal
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14
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Cost of Lung Cancer: A Systematic Review. Value Health Reg Issues 2023; 33:17-26. [PMID: 36201970 DOI: 10.1016/j.vhri.2022.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/22/2022] [Accepted: 07/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We performed a systematic review of studies estimating the cost of illness of lung cancer to compare costs between studies and examine cost drivers, emphasizing generalizability and methodological choices. METHODS A systematic search on studies published in English on cost of illness of lung cancer was performed in MEDLINE (PubMed), Embase, Web of Science, and Scopus. Databases were searched in January 2017, and records were screened based on eligibility criteria. The systematic search was updated on May 7, 2020. The quality of included studies was appraised using a modified Drummond checklist. RESULTS Of the 4891 records screened, 19 records were included. Most of the studies were cross-sectional and retrospective and used a prevalence-based approach and a bottom-up approach. Direct medical costs ranged from 4484.13 US dollars purchasing power parity to 45 364.48 US dollars purchasing power parity. Total medical costs as a percentage of total gross domestic product (GDP) ranged from 0.00248 to 0.1326 (median 0.0217), and total medical costs as a percentage of total health expenditure ranged from 0.038 to 0.836 (median 0.209). CONCLUSIONS There was considerable methodological heterogeneity that made it difficult to compare results between studies. The costs of lung cancer are substantial and impose a substantial economic burden on patients, healthcare systems, and societies. By comparing cancer costs with total health expenditures and GDP per capita, it can be concluded that lung cancer imposes a considerable economic burden on patients and healthcare systems in countries with lower GDP per capita and higher incidence rate.
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Healthcare use and costs among individuals receiving mental health services for depression within primary care in Nepal. BMC Health Serv Res 2022; 22:1596. [PMID: 36585707 PMCID: PMC9804956 DOI: 10.1186/s12913-022-08969-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 12/14/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Integrating mental health services into primary care is a key strategy for reducing the mental healthcare treatment gap in low- and middle-income countries. We examined healthcare use and costs over time among individuals with depression and subclinical depressive symptoms in Chitwan, Nepal to understand the impact of integrated care on individual and health system resources. METHODS Individuals diagnosed with depression at ten primary care facilities were randomized to receive a package of integrated care based on the Mental Health Gap Action Programme (treatment group; TG) or this package plus individual psychotherapy (TG + P); individuals with subclinical depressive symptoms received primary care as usual (UC). Primary outcomes were changes in use and health system costs of outpatient healthcare at 3- and 12-month follow up. Secondary outcomes examined use and costs by type. We used Poisson and log-linear models for use and costs, respectively, with an interaction term between time point and study group, and with TG as reference. RESULTS The study included 192 primary care service users (TG = 60, TG + P = 60, UC = 72; 86% female, 24% formally employed, mean age 41.1). At baseline, outpatient visits were similar (- 11%, p = 0.51) among TG + P and lower (- 35%, p = 0.01) among UC compared to TG. Visits increased 2.30 times (p < 0.001) at 3 months among TG, with a 50% greater increase (p = 0.03) among TG + P, before returning to baseline levels among all groups at 12 months. Comparing TG + P to TG, costs were similar at baseline (- 1%, p = 0.97) and cost changes did not significantly differ at three (- 16%, p = 0.67) or 12 months (- 45%, p = 0.13). Costs among UC were 54% lower than TG at baseline (p = 0.005), with no significant differences in cost changes over follow up. Post hoc analysis indicated individuals not receiving psychotherapy used less frequent, more costly healthcare. CONCLUSION Delivering psychotherapy within integrated services for depression resulted in greater healthcare use without significantly greater costs to the health system or individual. Previous research in Chitwan demonstrated psychotherapy determined treatment effectiveness for people with depression. While additional research is needed into service implementation costs, our findings provide further evidence supporting the inclusion of psychotherapy within mental healthcare integration in Nepal and similar contexts.
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Mei W, Wu J, Zoghbi-Manrique-de-Lara P, Liu L, He Y, Song M. Lose at sunrise, but gain at sunset: Linking social cyberloafing to psychological detachment, personal life enhancement of work, and mental health. Work 2022; 75:339-348. [PMID: 36591686 DOI: 10.3233/wor-220126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Previous research has demonstrated that the personal use of social media, i.e., social cyberloafing, is associated with employee mental health. However, the underlying mechanism through which social cyberloafing is related to mental health has received limited attention. OBJECTIVE Drawing on conservation of resource theory and work/nonwork enhancement literatures, we developed and tested a model that examines health effect of social cyberloafing. As such, employees' social cyberloafing is posited as positively related to psychological detachment and personal life enhancement of work, which in turn would act as mediators that explain why social cyberloafing improves mental health. METHODS Data from 375 Chinese employees were analyzed to test research hypotheses using the structural equation modeling and bias-corrected bootstrap method with Mplus 7.4. RESULTS The results found that social cyberloafing is positively related to psychological detachment, but not with personal life enhancement of work. Social cyberloafing was positively related to employees' mental health through both psychological detachment and through psychological detachment and personal life enhancement of work serially. CONCLUSION Psychological detachment alone and alongside personal life enhancement of work form part of the mechanisms explaining how and why engaging in social cyberloafing is positively associated with employees' mental health. These mechanisms offer insights to organizations into how the mental health of employees can be improved in the digital workplace.
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Affiliation(s)
- Wenjuan Mei
- School of Management, Jinan University, Guangzhou, P.R. China
| | - Jinnan Wu
- Research Institute of Decision and Behavior Science, School of Business, Anhui University of Technology, Ma'anshan, P.R. China
| | | | - Lin Liu
- School of Management Science and Engineering, Anhui University of Technology, Ma'anshan, P.R. China
| | - Ying He
- Research Institute of Decision and Behavior Science, School of Business, Anhui University of Technology, Ma'anshan, P.R. China
| | - Mengmeng Song
- School of Management, Xi'an Jiaotong University, Xi'an, P.R. China
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Alfaifi AA, Althemery AU. Sociodemographic characteristics and health-related quality of life of individuals undergoing antidepressant therapy. Sci Rep 2022; 12:17518. [PMID: 36266422 DOI: 10.1038/s41598-022-22164-6a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 10/11/2022] [Indexed: 05/28/2023] Open
Abstract
An important factor for averting depression and creating awareness about clinical treatment is patient preference. Therefore, investigating health-related quality of life associated with different antidepressants is necessary. A retrospective cohort study was performed using the 2018 Medical Expenditure Panel Survey. The MEPS is a nationally representative database of the civilian and noninstitutionalized population spanning different ages, both sexes, and a wide range of sociodemographic and economic backgrounds. Differences in clinical and sociodemographic characteristics among patients using different antidepressant classes were explored. The differences in Veterans RAND 12-Item Health Survey (VR-12) results among groups were examined. The VR-12 metric was used since it measures a patient's overall perspective of their health. Approximately 34.6 million of the patients reported using at least one antidepressant during 2018. Most patients receiving tricyclic therapy reported substantially better mental HRQoL than patients receiving selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or combination therapy. Patients receiving atypical antidepressants reported substantially better mental HRQoL than those receiving other types of antidepressants. Most patients reported a substantial decline in HRQoL after SNRIs or combination therapy. This study found that HRQoL varied across antidepressant users. Thus, health care providers could benefit from taking into consideration quality of life when prescribing antidepressant agents. Moreover, further research is needed to explore other factors that could contribute to the quality of care for patients with depression.
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Affiliation(s)
- Abdullah A Alfaifi
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia.
| | - Abdullah U Althemery
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
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Alfaifi AA, Althemery AU. Sociodemographic characteristics and health-related quality of life of individuals undergoing antidepressant therapy. Sci Rep 2022; 12:17518. [PMID: 36266422 PMCID: PMC9584901 DOI: 10.1038/s41598-022-22164-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 10/11/2022] [Indexed: 01/12/2023] Open
Abstract
An important factor for averting depression and creating awareness about clinical treatment is patient preference. Therefore, investigating health-related quality of life associated with different antidepressants is necessary. A retrospective cohort study was performed using the 2018 Medical Expenditure Panel Survey. The MEPS is a nationally representative database of the civilian and noninstitutionalized population spanning different ages, both sexes, and a wide range of sociodemographic and economic backgrounds. Differences in clinical and sociodemographic characteristics among patients using different antidepressant classes were explored. The differences in Veterans RAND 12-Item Health Survey (VR-12) results among groups were examined. The VR-12 metric was used since it measures a patient's overall perspective of their health. Approximately 34.6 million of the patients reported using at least one antidepressant during 2018. Most patients receiving tricyclic therapy reported substantially better mental HRQoL than patients receiving selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or combination therapy. Patients receiving atypical antidepressants reported substantially better mental HRQoL than those receiving other types of antidepressants. Most patients reported a substantial decline in HRQoL after SNRIs or combination therapy. This study found that HRQoL varied across antidepressant users. Thus, health care providers could benefit from taking into consideration quality of life when prescribing antidepressant agents. Moreover, further research is needed to explore other factors that could contribute to the quality of care for patients with depression.
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Affiliation(s)
- Abdullah A. Alfaifi
- grid.449553.a0000 0004 0441 5588Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942 Saudi Arabia
| | - Abdullah U. Althemery
- grid.449553.a0000 0004 0441 5588Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942 Saudi Arabia
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Excess healthcare resource utilization and healthcare costs among privately and publicly insured patients with major depressive disorder and acute suicidal ideation or behavior in the United States. J Affect Disord 2022; 311:303-310. [PMID: 35597466 DOI: 10.1016/j.jad.2022.05.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/25/2022] [Accepted: 05/15/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND This study assessed the healthcare resource utilization (HRU) and cost burden of patients with major depressive disorder (MDD) and acute suicidal ideation or behavior (SIB; MDSI) versus those with MDD without SIB and those without MDD. METHODS Adults were selected from the MarketScan® Databases (10/2015-02/2020). The MDSI cohort received an MDD diagnosis within 6 months of a claim for acute SIB (index date). The index date was a random MDD claim in the MDD without SIB cohort and a random date in the non-MDD cohort. Patients had continuous eligibility ≥12 months pre- and ≥1 month post-index. HRU and costs were compared during 1- and 12-month post-index periods between MDSI and control cohorts matched 1:1 on demographics. RESULTS The MDSI cohort included 73,242 patients (mean age 35 years, 60.6% female, 37.2% Medicaid coverage). At 1 month post-index, the MDSI cohort versus the MDD without SIB/non-MDD cohorts had 12.8/67.2 times more inpatient admissions and 3.3/8.9 times more emergency department visits; they had 2.9 times more outpatient visits versus the non-MDD cohort (all p < 0.001). The MDSI cohort had incremental mean healthcare costs of $5255 and $6674 per-patient-month versus the MDD without SIB and non-MDD cohorts (all p < 0.001); inpatient costs drove up to 89.5% of incremental costs. At 12 months post-index, HRU and costs remained higher in MDSI versus control cohorts. LIMITATIONS SIB are underreported in claims; unobserved confounders may cause bias. CONCLUSIONS MDSI is associated with substantial excess healthcare costs driven by inpatient costs, concentrated in the first month post-index, and persisting during the following year.
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Bodden DHM, van den Heuvel MWH, Engels RCME, Dirksen CD. Societal costs of subclinical depressive symptoms in Dutch adolescents: a cost-of-illness study. J Child Psychol Psychiatry 2022; 63:771-780. [PMID: 34496447 PMCID: PMC9290583 DOI: 10.1111/jcpp.13517] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Subclinical depressive symptoms are highly prevalent among adolescents and are associated with negative consequences, which may pose an economic burden for society. We conducted a prevalence-based cost-of-illness study using a societal perspective to investigate the cost-of-illness of subclinical depressive symptoms among adolescents. METHODS Using a bottom-up approach, cost questionnaires were assessed to measure costs from 237 Dutch families with an adolescent aged 11-18 with subclinical depressive symptoms (of which 34 met the criteria of a depressive disorder). The study is registered in the Dutch Trial Register (Trial NL5584/NTR6176; www.trialregister.nl/trial/5584). RESULTS Our calculations show that adolescents with subclinical depressive symptoms cost the Dutch society more than €42 million annually, expressed in costs related to depressive symptoms. Secondary analyses were performed to test the reliability and stability of the costs. When costs related to psychological problems were considered, the annual costs amounted to €67 million. The total societal costs related to physical problems amounted to approximately €126 million. All costs combined (depressive, psychological, behavioural and physical problems and other reasons) amounted to a €243 million. Total costs were highest for physical-related problems of the adolescent (52% of the total costs), followed by psychological (28%), depressive (17%) and behavioural problems (1%). Using an international prevalence rate, societal costs related to depressive symptoms resulted in €54 million a year. CONCLUSIONS Cost-effective prevention programmes seem warranted given the high societal costs and risk of future costs as subclinical depressive symptoms could be a precursor of clinical depression later in life.
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Affiliation(s)
- Denise H. M. Bodden
- Child and Adolescent StudiesUtrecht UniversityUtrechtThe Netherlands,Altrecht Child and Youth PsychiatryUtrechtThe Netherlands
| | - Marieke W. H. van den Heuvel
- Erasmus School of Social and Behavioural SciencesErasmus University RotterdamRotterdamThe Netherlands,Netherlands Institute of Mental Health and AddictionTrimbos InstituteUtrechtThe Netherlands
| | - Rutger C. M. E. Engels
- Erasmus School of Social and Behavioural SciencesErasmus University RotterdamRotterdamThe Netherlands
| | - Carmen D. Dirksen
- Care and Public Health Research InstituteMaastricht University Medical CenterMaastrichtThe Netherlands
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Zare H, Meyerson NS, Nwankwo CA, Thorpe RJ. How Income and Income Inequality Drive Depressive Symptoms in U.S. Adults, Does Sex Matter: 2005-2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6227. [PMID: 35627767 PMCID: PMC9140340 DOI: 10.3390/ijerph19106227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Depression is one of the leading causes of disability in the United States. Depression prevalence varies by income and sex, but more evidence is needed on the role income inequality may play in these associations. OBJECTIVE To examine the association between the Poverty to Income Ratio (PIR)-as a proxy for income-and depressive symptoms in adults ages 20 years and older, and to test how depression was concentrated among PIR. DESIGN Using the 2005-2016 National Health and Nutrition Examination Survey (NHANES), we employed Negative Binomial Regression (NBRG) in a sample of 24,166 adults. We used a 9-item PHQ (Public Health Questionnaire, PHQ-9) to measure the presence of depressive symptoms as an outcome variable. Additionally, we plotted a concentration curve to explain how depression is distributed among PIR. RESULTS In comparison with high-income, the low-income population in the study suffered more from greater than or equal to ten on the PHQ-9 by 4.5 and 3.5 times, respectively. The results of NBRG have shown that people with low-PIR (IRR: 1.30, 95% CI: 1.23-1.37) and medium-PIR (IRR: 1.55, 95% CI: 1.46-1.65) have experienced a higher relative risk ratio of having depressive symptoms. Women have a higher IRR (IRR: 1.29, 95% CI: 1.24-1.34) than men. We observed that depression was concentrated among low-PIR men and women, with a higher concentration among women. CONCLUSION AND RELEVANCE Addressing depression should target low-income populations and populations with higher income inequality.
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Affiliation(s)
- Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (N.S.M.); (C.A.N.)
- School of Business, University of Maryland Global Campus (UMGC), Adelphi, MD 20774, USA
| | - Nicholas S. Meyerson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (N.S.M.); (C.A.N.)
| | - Chineze Adania Nwankwo
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (N.S.M.); (C.A.N.)
| | - Roland J. Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
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22
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Visnovcova Z, Kozar M, Kuderava Z, Zibolen M, Ferencova N, Tonhajzerova I. Entropy Analysis of Neonatal Electrodermal Activity during the First Three Days after Birth. ENTROPY 2022; 24:e24030422. [PMID: 35327932 PMCID: PMC8947523 DOI: 10.3390/e24030422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 12/04/2022]
Abstract
The entropy-based parameters determined from the electrodermal activity (EDA) biosignal evaluate the complexity within the activity of the sympathetic cholinergic system. We focused on the evaluation of the complex sympathetic cholinergic regulation by assessing EDA using conventional indices (skin conductance level (SCL), non-specific skin conductance responses, spectral EDA indices), and entropy-based parameters (approximate, sample, fuzzy, permutation, Shannon, and symbolic information entropies) in newborns during the first three days of postnatal life. The studied group consisted of 50 healthy newborns (21 boys, average gestational age: 39.0 ± 0.2 weeks). EDA was recorded continuously from the feet at rest for three periods (the first day—2 h after birth, the second day—24 h after birth, and the third day—72 h after birth). Our results revealed higher SCL, spectral EDA index in a very-low frequency band, approximate, sample, fuzzy, and permutation entropy during the first compared to second and third days, while Shannon and symbolic information entropies were lower during the first day compared to other periods. In conclusion, EDA parameters seem to be sensitive in the detection of the sympathetic regulation changes in early postnatal life and which can represent an important step towards a non-invasive early diagnosis of the pathological states linked to autonomic dysmaturation in newborns.
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Affiliation(s)
- Zuzana Visnovcova
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4D, 036 01 Martin, Slovakia; (Z.V.); (N.F.)
| | - Marek Kozar
- Neonatal Clinic, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Kollarova 2, 036 59 Martin, Slovakia; (M.K.); (Z.K.); (M.Z.)
| | - Zuzana Kuderava
- Neonatal Clinic, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Kollarova 2, 036 59 Martin, Slovakia; (M.K.); (Z.K.); (M.Z.)
| | - Mirko Zibolen
- Neonatal Clinic, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Kollarova 2, 036 59 Martin, Slovakia; (M.K.); (Z.K.); (M.Z.)
| | - Nikola Ferencova
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4D, 036 01 Martin, Slovakia; (Z.V.); (N.F.)
| | - Ingrid Tonhajzerova
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4C, 036 01 Martin, Slovakia
- Correspondence: or ; Tel.: +421-43-2633-404
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Robinson LS, Brown T, O'Brien L. Cost, profile, and postoperative resource use for surgically managed acute hand and wrist injuries with emergency department presentation. J Hand Ther 2021; 34:29-36. [PMID: 32360062 DOI: 10.1016/j.jht.2019.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 09/05/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective cost-of-illness study. INTRODUCTION Injuries to the hand and wrist are common. Most uncomplicated and stable upper extremity injuries recover with conservative management; however, some require surgical intervention. The economic burden on the health care system from such injuries can be considerable. PURPOSE OF THE STUDY To estimate the economic implications of surgically managed acute hand and wrist injuries at one urban health care network. METHODS Using 33 primary diagnosis ICD-10 codes involving the hand and wrist, 453 consecutive patients from 2014 to 2015 electronic billing records who attended the study setting emergency department and received consequent surgical intervention and outpatient follow-up were identified. Electronic medical records were reviewed to extract demographic data. Costs were calculated from resource use in the emergency department, inpatient, and outpatient settings. Results are presented by demographics, injury type, mechanism of injury, and patient pathway. RESULTS Two hundred and twenty-six individuals (n 1⁄4 264 surgeries) were included. The total cost of all injuries was $1,204,606. The median cost per injury for non-compensable cases (n = 191) was $4508 [IQR $3993-$6172] and $5057 [IQR $3957-$6730] for compensable cases (n = 35). The median number of postoperative appointments with a surgeon was 2.00 (IQR 1.00-3.00) for both compensable and non-compensable cases. The number of hand therapy appointments for non-compensable cases and compensable cases was 4 [IQR 2-6] and 2 [IQR 1-3], respectively. DISCUSSION Findings of this investigation highlight opportunities for health promotion strategies for reducing avoidable injuries and present considerations for reducing cost burden by addressing high fail to attend (FTA) appointment rates. CONCLUSION Surgically managed hand and wrist injuries contribute to a significant financial burden on the health care system. Further research using stringent data collection methods are required to establish epidemiological data and national estimates of cost burden.
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Affiliation(s)
- Luke Steven Robinson
- Department of Occupational Therapy, Monash University, Peninsula Campus, Frankston, Victoria, Australia; Department of Occupational Therapy, Alfred Health, Melbourne, Victoria, Australia.
| | - Ted Brown
- Department of Occupational Therapy, Monash University, Peninsula Campus, Frankston, Victoria, Australia
| | - Lisa O'Brien
- Department of Occupational Therapy, Monash University, Peninsula Campus, Frankston, Victoria, Australia
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Lee DW, Hong YC, Seo HY, Yun JY, Nam SH, Lee N. Different Influence of Negative and Positive Spillover between Work and Life on Depression in a Longitudinal Study. Saf Health Work 2021; 12:377-383. [PMID: 34527400 PMCID: PMC8430443 DOI: 10.1016/j.shaw.2021.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/09/2021] [Accepted: 05/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background This study investigated the longitudinal associations between the degrees of positive and negative spillover in work–life balance (WLB) at baseline and reports of depressive mood at a 2-year follow-up in Korean women employees. Methods We used a panel study design data of 1386 women employees who participated in the Korean Longitudinal Survey of Women and Families in both 2014 and 2016. Depressive mood was measured using the “10-item Center for Epidemiologic Studies Depression Scale.” Associations between the positive and negative spillover in WLB at baseline and reports of new incidence of depressive mood at 2-year follow-up were explored using a multivariate logistic regression model. Results Negative spillover in WLB at baseline showed a significant linear association with reports of depressive mood at 2-yearfollow-up after adjusting for age, education level, marital status, number of children, and positive spillover (P = 0.014). The highest scoring group in negative spillover (fourth quartile) showed a significant higher odds ratio of 1.95 compared with the lowest scoring group (first quartile; P = 0.036). Conclusion Positive spillover in WLB showed a U-shaped association with depression. The degrees of positive and negative spillover in WLB among Korean women employees at baseline were associated with new incidence of depressive mood within 2 years. To prevent depression of female workers, more discrete and differentiated policies on how to maintain healthy WLB are required.
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Affiliation(s)
- Dong-Wook Lee
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Yun-Chul Hong
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hwo-Yeon Seo
- Public Health Medical Service, Seoul National University Hospital, Seoul, Republic of Korea
| | - Je-Yeon Yun
- Seoul National University Hospital, Seoul, Republic of Korea.,Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soo-Hyun Nam
- Human Rights Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Nami Lee
- Human Rights Center, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
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Caldieraro MA, Laufer-Silva T, Cassano P. Dosimetry and Clinical Efficacy of Transcranial Photobiomodulation for Major Depression Disorder: Could they Guide Dosimetry for Alzheimer's Disease? J Alzheimers Dis 2021; 83:1453-1469. [PMID: 34487045 DOI: 10.3233/jad-210586] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is prevalent and has significant impact on individuals and society. Cognitive symptoms are frequent in MDD and insufficiently treated by antidepressant medications. Transcranial photobiomodulation (t-PBM) is a novel device therapy which shows promise as an antidepressant and pro-cognitive treatment. To date, despite the encouraging results, the optimal stimulation parameters of t-PBM to treat MDD are not established, and clinical studies are very heterogeneous in terms of these parameters. While the literature provides guidance on the appropriate fluence to achieve therapeutic results, little is known on the other parameters. OBJECTIVE To evaluate the relationship between different parameters and the antidepressant effect of t-PBM. METHODS We reviewed clinical studies on MDD and on depressive symptoms comorbid with other diseases. We calculated the standardized effect size of the change in symptoms severity before and after t-PBM and we performed a descriptive analysis of the reviewed papers. RESULTS The greatest effect sizes for the antidepressant effect were found in studies using pulse-wave t-PBM with high peak irradiance (but low average irradiance) over large skin surface. One well-designed and sufficiently powered, double-blind, sham-controlled trial indicated that t-PBM with low irradiance over a small skin surface is ineffective to treat depression. CONCLUSION The use of t-PBM for Alzheimer's disease and for dementia is still at its inception; these dosimetry lessons from the use of t-PBM for depression might serve as guidance.
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Affiliation(s)
- Marco Antonio Caldieraro
- Centro de Pesquisa Experimental (CPE) e Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre -RS, Brasil.,Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Psiquiatria e Medicina Legal, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Porto Alegre -RS, Brasil
| | - Tatiana Laufer-Silva
- Centro de Pesquisa Experimental (CPE) e Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre -RS, Brasil.,Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Psiquiatria e Medicina Legal, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Porto Alegre -RS, Brasil
| | - Paolo Cassano
- Harvard Medical School, Boston, MA, USA.,MGH Division of Neuropsychiatry, Massachusetts General Hospital, Boston, MA, USA
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Health-economic evaluation of psychological interventions for depression prevention: Systematic review. Clin Psychol Rev 2021; 88:102064. [PMID: 34304111 DOI: 10.1016/j.cpr.2021.102064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 01/03/2023]
Abstract
Psychological interventions have been proven to be effective to prevent depression, however, little is known on the cost-effectiveness of psychological interventions for the prevention of depression in various populations. A systematic review was conducted using PubMed, PsycINFO, Web of Science, Embase, Cochrane Central Register of Controlled Trials, Econlit, NHS Economic Evaluations Database, NHS Health Technology Assessment and OpenGrey up to January 2021. Only health-economic evaluations based on randomized controlled trials of psychological interventions to prevent depression were included. Independent evaluators selected studies, extracted data and assessed the quality using the Consensus on Health Economic Criteria and the Cochrane Risk of Bias Tool. Twelve trial-based economic evaluations including 5929 participants from six different countries met the inclusion criteria. Overall, the quality of most economic evaluations was considered good, but some studies have some risk of bias. Setting the willingness-to-pay upper limit to US$40,000 (2018 prices) for gaining one quality adjusted life year (QALY), eight psychological preventive interventions were likely to be cost-effective compared to care as usual. The likelihood of preventive psychological interventions being more cost-effective than care as usual looks promising, but more economic evaluations are needed to bridge the many gaps that remain in the evidence-base. ETHICS: As this systematic review is based on published data, approval from the local ethics committee was not required.
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27
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Ouma S, Tumwesigye NM, Ndejjo R, Abbo C. Prevalence and factors associated with major depression among female sex workers in post-conflict Gulu district: a cross-sectional study. BMC Public Health 2021; 21:1134. [PMID: 34120613 PMCID: PMC8201688 DOI: 10.1186/s12889-021-11207-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 06/03/2021] [Indexed: 12/13/2022] Open
Abstract
Background Female sex workers operating in conflict-affected settings could be at a much greater risk of major depression. However, the epidemiology of major depression in this population remains understudied. We aimed to determine the prevalence and the factors associated with major depression among FSWs in the post-conflict Gulu district in Northern Uganda. Methods We conducted a cross-sectional study among 300 randomly selected adult female sex workers in Gulu. We utilized a pre-tested semi-structured questionnaire, embedded with MINI 7.0.0, to gather information from each participant through face-to-face interviews. We collected data on socio-demographic characteristics, sex-work-related characteristics, alcohol and drug use, HIV status, and major depression. Then, data were entered into EPI INFO 7 and analyzed using logistic regression with the aid of STATA 14.0. Results The mean age (SD) of the study participants was 26.4 (± 6) years, 57.7% attained primary education, 51.7% never married, and 42.1% were living with HIV. The prevalence of major depression among FSWs in the district was 47.7%. In addition, the majority of the FSWs with major depression (91.0%) had either severe (50.4%) or moderate (40.6%) depressive symptoms. Independently, life stress (adjusted OR = 10.8, 95%CI: 5.67–20.57), living with HIV (adjusted OR = 2.25, 95%CI: 1.25–4.05), verbal abuse (adjusted OR = 2.27, 95%CI: 1.27–4.08), and older age (adjusted OR = 1.06, 95%CI: 1.01–1.12) all showed positive associations with major depression. Conversely, provision of sexual services from clients’ homes (adjusted OR = 0.50, 95%CI: 0.25–0.97), use of a non-barrier modern family planning method (adjusted OR = 0.44, 95%CI: 0.24–0.82), and daily intake of alcohol (adjusted OR = 0.50, 95%CI: 0.28–0.88) all showed negative associations with major depression. Conclusions There is a high prevalence of major depression among female sex workers in post-conflict Gulu. The high prevalence of major depression underscores the need for government and development partners to urgently and adequately address the mental health needs of female sex workers. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11207-8.
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Affiliation(s)
- Simple Ouma
- Department of Research, The AIDS Support Organization (TASO), Kampala, Uganda. .,Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Nazarius Mbona Tumwesigye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Catherine Abbo
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Watson LM, Beshai S. Causal explanations of depression on perceptions of and likelihood to choose cognitive behavioural therapy and antidepressant medications as depression treatments. Psychol Psychother 2021; 94:201-216. [PMID: 32755009 DOI: 10.1111/papt.12300] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 05/29/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This research examined whether people's causal explanations of depression were associated with acceptability and efficacy-related treatment perceptions and likelihood to choose cognitive behavioural therapy (CBT) and antidepressant medication (ADM) as depression treatments. DESIGN A cross-sectional internet-based design was used. METHODS A general population sample was used over a clinical sample to study those who had not yet chosen to enter treatment. A total of 422 individuals were recruited through a crowdsourcing platform to complete an online survey. Measures included perceived causes of depression, perceived acceptability, efficacy and choice likelihood for ADM and CBT, and demographics. RESULTS Those with biological causal explanations of depression were more favourable towards ADM on all three perceptual measures of acceptability, efficacy and likelihood to choose ADM as a treatment for depression. Personality/character-related causal explanations of depression were positively related to perceived efficacy and likelihood to choose CBT as a depression treatment. Those endorsing environmental stress causes of depression were more likely to choose CBT as a treatment for depression. CONCLUSIONS Results indicated that people's beliefs about the causes of depression were related to their perceptions of and likelihoods to choose ADM and CBT as depression treatments. PRACTITIONER POINTS Provides evidence of how different causal explanations of depression influence sufferers' likelihoods to choose ADM and CBT as possible treatments for their depression. Provides support for exploring potential patients' causal explanations about depression prior to recommending a treatment regimen.
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Affiliation(s)
- Lisa M Watson
- Faculty of Graduate Studies and Research, University of Regina, Saskatchewan, Canada
| | - Shadi Beshai
- Faculty of Graduate Studies and Research, University of Regina, Saskatchewan, Canada
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Kan K, Lokkerbol J, Jörg F, Visser E, Schoevers RA, Feenstra TL. Real-World Treatment Costs and Care Utilization in Patients with Major Depressive Disorder With and Without Psychiatric Comorbidities in Specialist Mental Healthcare. PHARMACOECONOMICS 2021; 39:721-730. [PMID: 33723804 PMCID: PMC8166711 DOI: 10.1007/s40273-021-01012-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND The majority of patients with major depressive disorder (MDD) have comorbid mental conditions. OBJECTIVES Since most cost-of-illness studies correct for comorbidity, this study focuses on mental healthcare utilization and treatment costs in patients with MDD including psychiatric comorbidities in specialist mental healthcare, particularly patients with a comorbid personality disorder (PD). METHODS The Psychiatric Case Register North Netherlands contains administrative data of specialist mental healthcare providers. Treatment episodes were identified from uninterrupted healthcare use. Costs were calculated by multiplying care utilization with unit prices (price level year: 2018). Using generalized linear models, cost drivers were investigated for the entire cohort. RESULTS A total of 34,713 patients had MDD as a primary diagnosis over the period 2000-2012. The number of patients with psychiatric comorbidities was 24,888 (71.7%), including 13,798 with PD. Costs were highly skewed, with an average ± standard deviation cost per treatment episode of €21,186 ± 74,192 (median €2320). Major cost drivers were inpatient days and daycare days (50 and 28% of total costs), occurring in 12.7 and 12.5% of episodes, respectively. Compared with patients with MDD only (€11,612), costs of patients with additional PD and with or without other comorbidities were, respectively, 2.71 (p < .001) and 2.06 (p < .001) times higher and were 1.36 (p < .001) times higher in patients with MDD and comorbidities other than PD. Other cost drivers were age, calendar year, and first episodes. CONCLUSIONS Psychiatric comorbidities (especially PD) in addition to age and first episodes drive costs in patients with MDD. Knowledge of cost drivers may help in the development of future stratified disease management programs.
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Affiliation(s)
- Kaying Kan
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Interdisciplinary Centre for Psychopathology and Emotion Regulation, PO Box 30001, Hospital zip code CC72, 9700 RB, Groningen, The Netherlands.
| | - Joran Lokkerbol
- Centre of Economic Evaluation and Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Frederike Jörg
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Interdisciplinary Centre for Psychopathology and Emotion Regulation, PO Box 30001, Hospital zip code CC72, 9700 RB, Groningen, The Netherlands
- GGZ Friesland, Research Department, Leeuwarden, The Netherlands
| | - Ellen Visser
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, The Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, Groningen, The Netherlands
| | - Talitha L Feenstra
- University of Groningen, Department of Science and Engineering, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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van der Aa HP, van Rens GH, Verbraak FD, Bosscha M, Comijs HC, van Nispen RM. Anxiety and depression in patients who receive anti-VEGF treatment and the usability and feasibility of e-mental health support: the E-PsEYE pilot study. Ophthalmic Physiol Opt 2021; 41:808-819. [PMID: 34050550 PMCID: PMC8252528 DOI: 10.1111/opo.12837] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/07/2021] [Indexed: 01/09/2023]
Abstract
Purpose E‐PsEYE is an internet‐based, guided self‐help course, following the principles of cognitive behavioural therapy, to reduce anxiety and depression in patients with retinal exudative diseases who receive anti‐vascular endothelial growth factor (anti‐VEGF) treatment. The purpose of this study was to determine the prevalence and related factors of anxiety and depression in this population and evaluate the usability and feasibility of E‐PsEYE. Methods Symptoms of anxiety and depression and related factors were determined in 90 patients (mean age 77 years, 58% female), based on multiple logistic regression analysis. Five patients with mild to moderate depression/anxiety tested the usability of E‐PsEYE. They were asked to think aloud while completing two modules of the intervention and freely explore system features. The feasibility of the total E‐PsEYE intervention was tested in 14 patients with mild to moderate depression/anxiety, based on a single arm pre‐post study with a follow‐up of three months: fidelity, acceptability, feasibility of study methods and potential effectiveness were explored. Results Fifty‐three percent of the total study population experienced at least mild anxiety and/or depression symptoms. Especially female patients (odds ratio (OR) 3.89, 95% confidence interval (CI) 1.33–11.40), those who experienced limitations in daily life activities due to vision loss (OR 9.67; 95% CI 3.18–29.45) and those who experienced loneliness (OR 3.53, 95% CI 1.14–10.95) were more likely to have anxiety/depression. The usability study raised several possibilities for improvement, based on which E‐PsEYE was improved. The feasibility study showed adequate fidelity and acceptability. Most participants were satisfied with the results (79%). There was a high response rate, no loss to follow‐up and mental health problems decreased in more than half of the patients. The Wilcoxon signed rank test indicated lower post‐test ranks compared to pre‐test ranks (depression Z −1.34, p = 0.18; anxiety Z −1.45, p = 0.15). Conclusions Mental health problems are prevalent in patients who receive anti‐VEGF treatment. Healthcare providers should recognise these problems and related factors in order to refer patients to appropriate care in a timely manner. Outcomes on the usability and feasibility of E‐PsEYE are promising as a prelude to performing a randomised controlled trial, which will shed more light on its (cost‐)effectiveness.
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Affiliation(s)
- Hilde Pa van der Aa
- Ophthalmology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ger Hmb van Rens
- Ophthalmology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Ophthalmology, Elkerliek Hospital, Helmond, The Netherlands
| | - Frank D Verbraak
- Ophthalmology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Machteld Bosscha
- Ophthalmology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hannie C Comijs
- Psychiatry, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ruth Ma van Nispen
- Ophthalmology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Łyszczarz B. Production losses attributable to suicide deaths in European Union. BMC Public Health 2021; 21:950. [PMID: 34011334 PMCID: PMC8136218 DOI: 10.1186/s12889-021-11010-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/06/2021] [Indexed: 04/03/2024] Open
Abstract
BACKGROUND Suicide is an important public health problem with multidimensional consequences for societies. One of the under-researched areas of suicide consequences are cross-country analyses of production losses associated with these deaths. The aim of this study was to estimate the production losses (indirect cost) of suicide deaths in 28 European Union states (EU-28) in 2015. METHODS The study used societal perspective and human capital approach to investigate production losses due to suicide mortality at working age. Eurostat's data on the number of deaths was used to identify suicide mortality burden in terms of years of potential productive life lost. Labour and economic indicators were applied to proxy the discounted value of potential economic output lost. A one-way deterministic sensitivity analysis was conducted to test the robustness of the estimates. RESULTS The production losses attributable to suicide deaths in EU-28 in 2015 were €9.07 billion. The per suicide indirect cost of these deaths was €231,088 for the whole EU-28 population; Luxembourg experienced the highest per suicide burden of €649,148. The per capita production losses of suicides in EU-28 was €17.80 and Ireland experienced the highest per capita burden of €48.57. The losses constituted an economic burden of 0.061% of EU-28's GDP and this share ranged from 0.018% in Cyprus to 0.161% in Latvia. Most of the losses (71-91%) were due to men's deaths. The results of the sensitivity analysis exhibit a large variation of losses; the highest (lowest) cost was identified with no adjustment for lower employment rates among those dying by suicide (adjustment for minimum productivity) and was 92.3% higher (59.7% lower) on average than in the base scenario. CONCLUSION Public health actions aimed at prevention of suicides might reduce their health burden but also contribute to the economic welfare of European societies.
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Affiliation(s)
- Błażej Łyszczarz
- Department of Health Economics, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, ul. Sandomierska 16, 85-830, Bydgoszcz, Poland.
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Zemedikun DT, Kigozi J, Wynne-Jones G, Guariglia A, Roberts T. Methodological considerations in the assessment of direct and indirect costs of back pain: A systematic scoping review. PLoS One 2021; 16:e0251406. [PMID: 33974661 PMCID: PMC8112645 DOI: 10.1371/journal.pone.0251406] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 04/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Back pain is a common and costly health problem worldwide. There is yet a lack of consistent methodologies to estimate the economic burden of back pain to society. Objective To systematically evaluate the methodologies used in the published cost of illness (COI) literature for estimating the direct and indirect costs attributed to back pain, and to present a summary of the estimated cost burden. Methods Six electronic databases were searched to identify COI studies of back pain published in English up to February 2021. A total of 1,588 abstracts were screened, and 55 full-text studies were subsequently reviewed. After applying the inclusion criteria, 45 studies pertaining to the direct and indirect costs of back pain were analysed. Results The studies reported data on 15 industrialised countries. The national cost estimates of back pain in 2015 USD ranged from $259 million ($29.1 per capita) in Sweden to $71.6 billion ($868.4 per capita) in Germany. There was high heterogeneity among the studies in terms of the methodologies used for analysis and the resulting costs reported. Most of the studies assessed costs from a societal perspective (n = 29). The magnitude and accuracy of the reported costs were influenced by the case definition of back pain, the source of data used, the cost components included and the analysis method. Among the studies that provided both direct and indirect cost estimates (n = 15), indirect costs resulting from lost or reduced work productivity far outweighed the direct costs. Conclusion Back pain imposes substantial economic burden on society. This review demonstrated that existing published COI studies of back pain used heterogeneous approaches reflecting a lack of consensus on methodology. A standardised methodological approach is required to increase credibility of the findings of COI studies and improve comparison of estimates across studies.
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Affiliation(s)
- Dawit T. Zemedikun
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom
- * E-mail:
| | - Jesse Kigozi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom
| | - Gwenllian Wynne-Jones
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, Keele, England, United Kingdom
| | - Alessandra Guariglia
- Department of Economics, University of Birmingham, Birmingham, England, United Kingdom
| | - Tracy Roberts
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom
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Nelson BD, Jarcho JM. Neural Response to Monetary and Social Feedback Demonstrate Differential Associations with Depression and Social Anxiety. Soc Cogn Affect Neurosci 2021; 16:1048-1056. [PMID: 33942882 PMCID: PMC8483280 DOI: 10.1093/scan/nsab055] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/01/2021] [Accepted: 05/03/2021] [Indexed: 01/23/2023] Open
Abstract
An aberrant neural response to rewards has been linked to both depression and social anxiety. Most studies have focused on the neural response to monetary rewards, and few have tested different modalities of reward (e.g. social) that are more salient to particular forms of psychopathology. In addition, most studies contain critical confounds, including contrasting positive and negative feedback and failing to disentangle being correct from obtaining positive feedback. In the present study, 204 participants underwent electroencephalography during monetary and social feedback tasks that were matched in trial structure, timing and feedback stimuli. The reward positivity (RewP) was measured in response to correctly identifying stimuli that resulted in monetary win, monetary loss, social like or social dislike feedback. All monetary and social tasks elicited a RewP, which were positively correlated. Across all tasks, the RewP was negatively associated with depression and positively associated with social anxiety. The RewP to social dislike feedback, independent of monetary and social like feedback, was also associated with social anxiety. The present study suggests that a domain-general neural response to correct feedback demonstrates a differential association with depression and social anxiety, but a domain-specific neural response to social dislike feedback is uniquely associated with social anxiety.
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Affiliation(s)
- Brady D Nelson
- Correspondence should be addressed to Brady D. Nelson, Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA. E-mail:
| | - Johanna M Jarcho
- Department of Psychology, Temple University, 1701 N 13th St, Philadelphia, PA 19122, USA
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Kristensen K, König HH, Hajek A. The empty nest, depressive symptoms and loneliness of older parents: Prospective findings from the German Ageing Survey. Arch Gerontol Geriatr 2021; 95:104425. [PMID: 33979713 DOI: 10.1016/j.archger.2021.104425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 04/11/2021] [Accepted: 04/22/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to analyse the longitudinal association between the transition to an empty nest and depressive symptoms and loneliness, respectively. METHOD Longitudinal data was used from the German Ageing Survey, a representative sample of community-dwelling adults aged 40 and over. The indication of children living outside the respondent's household was defined as an empty nest. A 6-item version of the validated De Jong Gierveld Loneliness scale was used to assess perceived loneliness. The 15 item version of the Center for Epidemiological Studies Depression Scale was used to measure depressive symptoms. Fixed-effects regression analyses adjusted for time-varying socio-demographic and health-related variables were applied. RESULTS The unadjusted regression yielded that transitioning to an empty nest led to decreased loneliness in men (b = -0.05; p < 0.05) and increased depressive symptoms in women (b = 0.48; p = 0.05). However, when controlling for potential confounders, the transition was no longer associated with a change in loneliness or depressive symptom scores. CONCLUSION The empty nest is an expected phase of the family life cycle that most parents will experience. In this longitudinal study, this phase of the family life cycle was shown not to be associated with parents' psychosocial health in terms of loneliness and depressive symptoms. Our study suggests that the consequences of an empty nest have been overestimated in the past. Future longitudinal studies with panel regression models in different cultural settings are needed to confirm our findings.
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Affiliation(s)
- Kaja Kristensen
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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35
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García-Pérez L, Linertová R, Valcárcel-Nazco C, Posada M, Gorostiza I, Serrano-Aguilar P. Cost-of-illness studies in rare diseases: a scoping review. Orphanet J Rare Dis 2021; 16:178. [PMID: 33849613 PMCID: PMC8045199 DOI: 10.1186/s13023-021-01815-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 04/06/2021] [Indexed: 12/30/2022] Open
Abstract
Objective The aim of this scoping review was to overview the cost-of-illness studies conducted in rare diseases.
Methods We searched papers published in English in PubMed from January 2007 to December 2018. We selected cost-of-illness studies on rare diseases defined as those with prevalence lower than 5 per 10,000 cases. Studies were selected by one researcher and verified by a second researcher. Methodological characteristics were extracted to develop a narrative synthesis.
Results We included 63 cost-of-illness studies on 42 rare diseases conducted in 25 countries, and 9 systematic reviews. Most studies (94%) adopted a prevalence-based estimation, where the predominant design was cross-sectional with a bottom-up approach. Only four studies adopted an incidence-based estimation. Most studies used questionnaires to patients or caregivers to collect resource utilisation data (67%) although an important number of studies used databases or registries as a source of data (48%). Costs of lost productivity, non-medical costs and informal care costs were included in 68%, 60% and 43% of studies, respectively. Conclusion This review found a paucity of cost-of-illness studies in rare diseases. However, the analysis shows that the cost-of-illness studies of rare diseases are feasible, although the main issue is the lack of primary and/or aggregated data that often prevents a reliable estimation of the economic burden. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01815-3.
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Affiliation(s)
- Lidia García-Pérez
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain. .,Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. .,Instituto Universitario de Desarrollo Regional (IUDR), Universidad de La Laguna, Campus de Guajara, Camino de la Hornera, s/n, 38071, La Laguna, Santa Cruz de Tenerife, Spain. .,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain.
| | - Renata Linertová
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain.,Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain
| | - Cristina Valcárcel-Nazco
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain.,Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain
| | - Manuel Posada
- Institute of Rare Diseases Research, Institute of Health Carlos III, Monforte de Lemos, 5, 28029, Madrid, Spain.,CIBER of Rare Diseases (CIBERER), Madrid, Spain
| | - Inigo Gorostiza
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Osakidetza Basque Health Service, Basurto University Hospital, Avenida de Montevideo Nº 18, 48013, Bilbao, Spain
| | - Pedro Serrano-Aguilar
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain
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36
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García-Pérez L, Linertová R, Valcárcel-Nazco C, Posada M, Gorostiza I, Serrano-Aguilar P. Cost-of-illness studies in rare diseases: a scoping review. Orphanet J Rare Dis 2021. [PMID: 33849613 DOI: 10.1186/s13023-021-01815-] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
OBJECTIVE The aim of this scoping review was to overview the cost-of-illness studies conducted in rare diseases. METHODS We searched papers published in English in PubMed from January 2007 to December 2018. We selected cost-of-illness studies on rare diseases defined as those with prevalence lower than 5 per 10,000 cases. Studies were selected by one researcher and verified by a second researcher. Methodological characteristics were extracted to develop a narrative synthesis. RESULTS We included 63 cost-of-illness studies on 42 rare diseases conducted in 25 countries, and 9 systematic reviews. Most studies (94%) adopted a prevalence-based estimation, where the predominant design was cross-sectional with a bottom-up approach. Only four studies adopted an incidence-based estimation. Most studies used questionnaires to patients or caregivers to collect resource utilisation data (67%) although an important number of studies used databases or registries as a source of data (48%). Costs of lost productivity, non-medical costs and informal care costs were included in 68%, 60% and 43% of studies, respectively. CONCLUSION This review found a paucity of cost-of-illness studies in rare diseases. However, the analysis shows that the cost-of-illness studies of rare diseases are feasible, although the main issue is the lack of primary and/or aggregated data that often prevents a reliable estimation of the economic burden.
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Affiliation(s)
- Lidia García-Pérez
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain.
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain.
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
- Instituto Universitario de Desarrollo Regional (IUDR), Universidad de La Laguna, Campus de Guajara, Camino de la Hornera, s/n, 38071, La Laguna, Santa Cruz de Tenerife, Spain.
- Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain.
| | - Renata Linertová
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain
| | - Cristina Valcárcel-Nazco
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain
| | - Manuel Posada
- Institute of Rare Diseases Research, Institute of Health Carlos III, Monforte de Lemos, 5, 28029, Madrid, Spain
- CIBER of Rare Diseases (CIBERER), Madrid, Spain
| | - Inigo Gorostiza
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Osakidetza Basque Health Service, Basurto University Hospital, Avenida de Montevideo Nº 18, 48013, Bilbao, Spain
| | - Pedro Serrano-Aguilar
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain
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Sampaio F, Ssegonja R, Thiblin I, Nystrand C. A model for evaluating the economic value of prevention programs for illicit use of anabolic androgenic steroids. Health Policy 2021; 125:807-813. [PMID: 33838934 DOI: 10.1016/j.healthpol.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/27/2020] [Accepted: 03/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The illicit use of anabolic androgenic steroids (AAS) has become a societal concern. We developed a decision-analytic model for assessing the cost-effectiveness of preventive interventions targeting AAS-use. We used scenario analyses to demonstrate: a) the potential health economic consequences of AAS use in Sweden, and b) the cost-effectiveness of a hypothetical preventive intervention. METHODS A population-based cohort model compared a hypothetical preventive intervention targeting AAS with a 'no intervention' scenario, from a limited societal perspective. The model simulated how a cohort of 18 year-old males transitioned between different states and predicted their health status and complications until the age of 41. Health outcomes were estimated as quality-adjusted life-years (QALY). Costs included intervention costs, drug costs, and costs of complications. RESULTS Total yearly costs related to AAS use amounted to nearly half a million US$, with the largest cost borne by the healthcare sector. Results suggest that AAS prevention could entail large costs and benefits with a mean incremental cost-effectiveness ratio of $550 per QALY, in a scenario where the intervention would decrease the probability of initiating AAS use by 5%. CONCLUSION Results show large AAS related costs, and suggest that the implementation of a preventive intervention could offer good value for money given different effectiveness scenarios. This model can be used to estimate the value of interventions targeting AAS use.
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Affiliation(s)
- Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, P.O Box 564, 751 22 Uppsala, Sweden.
| | - Richard Ssegonja
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, P.O Box 564, 751 22 Uppsala, Sweden
| | - Ingemar Thiblin
- Forensic Medicine, Department of Surgical Sciences Uppsala University, Uppsala, Sweden
| | - Camilla Nystrand
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, P.O Box 564, 751 22 Uppsala, Sweden
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38
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Eden JL, Konnopka A, König HH. [Costs of Depression in Germany - Systematic Review]. PSYCHIATRISCHE PRAXIS 2021; 48:290-300. [PMID: 33773504 DOI: 10.1055/a-1399-4430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Depression is a common mental disorder associated with a high economic burden. Aim of this study was to review cost-of-illness studies of depression in Germany. METHODS We conducted a systematic literature search of bottom-up cost-of-illness-studies of depression in adults in Germany. Included studies were classified into three groups depending on their costing approach (total health care cost studies, disease-specific health care cost studies, excess cost studies). RESULTS Depending on the type of cost calculation the average total costs per patient and year varied between 400-3,300 € for disease-specific costs, 3,000 € for excess costs and 3,000-5,000 € for total health care costs. There were no results for indirect costs in most studies. CONCLUSION Depression in Germany is associated with high costs, but especially indirect costs are missing in the current literature and should be examined more intensively.
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Affiliation(s)
- Jan-Luca Eden
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf
| | - Alexander Konnopka
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf
| | - Hans-Helmut König
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf
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Huang SS, Veitz-Keenan A, McGowan R, Niederman R. What is the societal economic cost of poor oral health among older adults in the United States? A scoping review. Gerodontology 2021; 38:252-258. [PMID: 33719086 PMCID: PMC8451791 DOI: 10.1111/ger.12548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 11/27/2022]
Abstract
Objective To assess the state of the literature in the United States quantifying the societal economic cost of poor oral health among older adults. Background Proponents of a Medicare dental benefit have argued that addressing the growing need for dental care among the US older adult population will decrease costs from systemic disease and other economic costs due to oral disease. However, it is unclear what the current economic burden of poor oral health among older adults is in the United States. Methods We conducted a scoping review examining the cost of poor oral health among older adults and identified cost components that were included in relevant studies. Results Other than oral cancer, no studies were found examining the economic costs of poor oral health among older adults (untreated tooth decay, gum disease, tooth loss and chronic disease/s). Only two studies examining the costs of oral cancer were found, but these studies did not assess the full economic cost of oral cancer from patient, insurer and societal perspectives. Conclusions Future work is needed to assess the full economic burden of poor oral health among older adults in the United States, and should leverage novel linkages between medical claims data, dental claims data and oral health outcomes data.
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Affiliation(s)
- Shulamite S Huang
- Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York, NY, USA
| | - Analia Veitz-Keenan
- Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York, NY, USA.,Department of Oral and Maxillofacial Pathology, Radiology and Medicine, New York University, New York, NY, USA
| | - Richard McGowan
- Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York, NY, USA
| | - Richard Niederman
- Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York, NY, USA
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Afkar A, Jalilian H, Pourreza A, Mir H, Sigaroudi AE, Heydari S. Cost analysis of breast cancer: a comparison between private and public hospitals in Iran. BMC Health Serv Res 2021; 21:219. [PMID: 33706762 PMCID: PMC7953682 DOI: 10.1186/s12913-021-06136-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS Breast cancer is the most prevalent cancer among women. Breast cancer imposes a considerable economic burden on the health system. This study aimed to compare the cost of breast cancer among patients who referred to private and public hospitals in Iran (2017). METHODS This was a prevalence-based cost of illness study. A total of 179 patients were selected from private and public hospitals using the census method. The researcher-constructed checklist was used for data collection. Data were analyzed using SPSS software version 22. RESULTS The estimated total mean (SD) direct cost of patients who referred to the private hospital and the public hospital was $10,050 (19,480) and $3960 (6780), respectively. Further, the total mean indirect cost of patients who referred to the private hospital was lower than those referring to the public hospital at $1870 (15 % of total costs) and $22,350 (85 % of total costs), respectively. These differences were statistically significant (P < 0.05). CONCLUSIONS Breast cancer imposes a substantial cost on patients, health insurance organizations and the whole society in Iran. Therefore, the adoption of effective measures for the prevention and early diagnosis of breast cancer is urgently needed.
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Affiliation(s)
- Abolhasan Afkar
- Social Determinants of Health Research Center, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Habib Jalilian
- Assistant Professor, Department of Health Services Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Social Determinants of Health Research Center, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran
| | - Abolghasem Pourreza
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Habibeh Mir
- Student Research Committee, School of Management and Medical Informatics, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolhosein Emami Sigaroudi
- Cardiovascular Diseases Research Center, Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Somayeh Heydari
- School of Public Health, Guilan University of Medical Science, PO Box: 3391, Rasht, Iran.
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Bilbao A, Martín-Fernández J, García-Pérez L, Mendezona JI, Arrasate M, Candela R, Acosta FJ, Estebanez S, Retolaza A. Psychometric properties of the EQ-5D-5L in patients with major depression: factor analysis and Rasch analysis. J Ment Health 2021; 31:506-516. [PMID: 33522336 DOI: 10.1080/09638237.2021.1875422] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The EQ-5D is one of the most recommended questionnaires for cost-effectiveness studies. AIMS To study the psychometric properties of the EQ-5D-5L in patients with major depression. METHODS This prospective observational study included 433 patients with major depression who completed the EQ-5D-5L and Patient Health Questionnaire-9 (PHQ-9) questionnaires at baseline, of whom 310 also did six months later. The structural validity was assessed by confirmatory factor analysis, the item functioning by item response analysis, and reliability by Cronbach's alpha. Convergent validity and known-groups validity was studied using the PHQ-9 and a general health question. To assess responsiveness effect sizes were calculated. RESULTS The results supported the unidimensionality and showed adequate item functioning, with somewhat age-related item differential functioning for the mobility dimension. Cronbach's alpha was 0.77. The EQ-5D-5L showed a high correlation with the PHQ-9 and general health. The more severe the depression level and the poorer the general health, the lower the EQ-5D-5L scores (p < 0.001). Responsiveness parameters showed moderate changes among "improved" patients. CONCLUSIONS These findings support the adequate psychometric properties of the EQ-5D-5L in patients with major depression. It could be very useful for clinicians and researchers as an outcome measure and for use in economic evaluation.
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Affiliation(s)
- Amaia Bilbao
- Osakidetza Basque Health Service, Basurto University Hospital, Research Unit, Bilbao, Spain.,Health Service Research Network on Chronic Diseases (REDISSEC), Spain.,Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - Jesús Martín-Fernández
- Health Service Research Network on Chronic Diseases (REDISSEC), Spain.,Oeste Multiprofessional Teaching Unit of Primary and Community Care, Primary Healthcare Management, Madrid Health Service, Madrid, Spain.,Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Lidia García-Pérez
- Health Service Research Network on Chronic Diseases (REDISSEC), Spain.,Fundación Canaria de Investigación Sanitaria (FUNCANIS), Santa Cruz de Tenerife, Spain
| | - José Ignacio Mendezona
- Osakidetza Basque Health Service, Bizkaia Mental Health Network, Derio Mental Health Centre, Derio, Spain
| | - Marta Arrasate
- Osakidetza Basque Health Service, Bizkaia Mental Health Network, Derio Mental Health Centre, Derio, Spain.,Osakidetza Basque Health Service, Bizkaia Mental Health Network, Uribe Mental Health Centre, Getxo, Spain
| | - Ruth Candela
- Psychiatry Department, Fuenlabrada University Hospital, Madrid, Spain
| | - Francisco Javier Acosta
- Health Service Research Network on Chronic Diseases (REDISSEC), Spain.,Service of Mental Health, General Management of Healthcare Programs, Canary Islands Health Service, Canary Islands, Spain.,Insular University Hospital of Gran Canaria, Canary Islands, Spain
| | - Soraya Estebanez
- Osakidetza Basque Health Service, Basurto University Hospital, Research Unit, Bilbao, Spain
| | - Ander Retolaza
- Health Service Research Network on Chronic Diseases (REDISSEC), Spain.,Osakidetza Basque Health Service, Bizkaia Mental Health Network, Basauri Mental Health Centre, Basauri, Spain.,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
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Aminisani N, Nikbakht HA, Shojaie L, Jafari E, Shamshirgaran M. Gender Differences in Psychological Distress in Patients with Colorectal Cancer and Its Correlates in the Northeast of Iran. J Gastrointest Cancer 2021; 53:245-252. [PMID: 33417199 DOI: 10.1007/s12029-020-00558-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Colorectal cancer has a significant impact on patients' physical, psychological, and social aspects. This study aimed to examine the gender difference in anxiety and depression and its relationship with some of the characteristics of the disease and demographic in the northeast of Iran. METHODS In this cross-sectional study, patients with colorectal cancer aged over 18 years who were admitted to hospitals, without considering the disease stage and type of treatment, were enrolled during 2014-2016. The Hospital Anxiety and Depression Scale (HADS) Questionnaire was completed via interview. RESULTS A total of 303 survivors of colorectal cancer were included in the current analysis, of whom 55.1% (167) were male. The overall frequency of depression was 44.9%, and it was 38.3% and 32.9% for men and women, respectively. The overall frequency of anxiety was 53.4% (50.3% and 57.4% for men and women, respectively). The results showed that compared to men, women (52%) were more likely to report depression (OR = 0.48, 95% CI = 0.22-1.04, P = 0.065); in contrast, men (12%) were less likely than women to report anxiety (OR = 0.88, 95% CI = 0.38-2.03, P = 0.779), which was less than 12% in men. Among other variables, education and employment were identified as independent and strong predictive variables for depression and anxiety. CONCLUSIONS The frequency of anxiety and depression is high among colorectal cancer survivors, especially in women. Therefore, screening for psychological distress is recommended in clinical settings and there is a need to pay attention to women.
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Affiliation(s)
- Nayyereh Aminisani
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
| | - Layla Shojaie
- Division of GI/Liver, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Esmat Jafari
- Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Shamshirgaran
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
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Pedersen SS, Andersen CM, Ahm R, Skovbakke SJ, Kok R, Helmark C, Wiil UK, Schmidt T, Olsen KR, Hjelmborg J, Zwisler AD, Frostholm L. Efficacy and cost-effectiveness of a therapist-assisted web-based intervention for depression and anxiety in patients with ischemic heart disease attending cardiac rehabilitation [eMindYourHeart trial]: a randomised controlled trial protocol. BMC Cardiovasc Disord 2021; 21:20. [PMID: 33413109 PMCID: PMC7788554 DOI: 10.1186/s12872-020-01801-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/25/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND One in five patients with ischaemic heart disease (IHD) develop comorbid depression or anxiety. Depression is associated with risk of non-adherence to cardiac rehabilitation (CR) and dropout, inadequate risk factor management, poor quality of life (QoL), increased healthcare costs and premature death. In 2020, IHD and depression are expected to be among the top contributors to the disease-burden worldwide. Hence, it is paramount to treat both the underlying somatic disease as well as depression and anxiety. eMindYourHeart will evaluate the efficacy and cost-effectiveness of a therapist-assisted eHealth intervention targeting depression and anxiety in patients with IHD, which may help fill this gap in clinical care. METHODS eMindYourHeart is a multi-center, two-armed, unblinded randomised controlled trial that will compare a therapist-assisted eHealth intervention to treatment as usual in 188 CR patients with IHD and comorbid depression or anxiety. The primary outcome of the trial is symptoms of depression, measured with the Hospital Anxiety and Depression Scale (HADS) at 3 months. Secondary outcomes evaluated at 3, 6, and 12 months include symptoms of depression and anxiety (HADS), perceived stress, health complaints, QoL (HeartQoL), trial dropout (number of patients dropped out in either arm at 3 months) and cost-effectiveness. DISCUSSION To our knowledge, this is the first trial to evaluate both the efficacy and cost-effectiveness of a therapist-assisted eHealth intervention in patients with IHD and comorbid psychological distress as part of CR. Integrating screening for and treatment of depression and anxiety into standard CR may decrease dropout and facilitate better risk factor management, as it is presented as "one package" to patients, and they can access the eMindYourHeart program in their own time and at their own convenience. The trial holds a strong potential for improving the quality of care for an increasing population of patients with IHD and comorbid depression, anxiety or both, with likely benefits to patients, families, and society at large due to potential reductions in direct and indirect costs, if proven successful. Trial registration The trial was prospectively registered on https://clinicaltrials.gov/ct2/show/NCT04172974 on November 21, 2019 with registration number [NCT04172974].
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Affiliation(s)
- Susanne S. Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Christina M. Andersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Robert Ahm
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Søren J. Skovbakke
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Robin Kok
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Uffe K. Wiil
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Thomas Schmidt
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Kim Rose Olsen
- Danish Center for Health Economics (DaCHE), Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Jacob Hjelmborg
- Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Ann-Dorthe Zwisler
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Danish Knowledge Center for Rehabilitation and Palliative Care (REHPA), Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
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Engels A, König HH, Magaard JL, Härter M, Hawighorst-Knapstein S, Chaudhuri A, Brettschneider C. Depression treatment in Germany - using claims data to compare a collaborative mental health care program to the general practitioner program and usual care in terms of guideline adherence and need-oriented access to psychotherapy. BMC Psychiatry 2020; 20:591. [PMID: 33317480 PMCID: PMC7737360 DOI: 10.1186/s12888-020-02995-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/03/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Societies strive for fast-delivered, evidence-based and need-oriented depression treatment within budget constraints. To explore potential improvements, selective contracts can be implemented. Here, we evaluate if the German collaborative psychiatry-neurology-psychotherapy contract (PNP), which extends the gatekeeping-based general practitioner (GP) program, improved guideline adherence or need-oriented and timely access to psychotherapy compared to usual care (UC). METHODS We conducted a retrospective observational cohort study based on health insurance claims data. After we identified patients with depression who were on sick leave due to a mental disorder in 2015, we applied entropy balancing to adjust for selection effects and employed chi-squared tests to compare guideline adherence of the received treatment between PNP, the GP program and UC. Subsequently, we applied an extended cox regression to assess need-orientation by comparing the relationship between accumulated sick leave days and waiting times for psychotherapy across health plans. RESULTS N = 23,245 patients were included. Regarding guideline adherence, we found no significant differences for most severity subgroups; except that patients with a first moderate depressive episode received antidepressants or psychotherapy more often in UC. Regarding need-orientation, we observed that the effect of each additional month of sick leave on the likelihood of starting psychotherapy was increased by 6% in PNP compared to UC. Irrespective of the health plan, we found that within the first 12 months only between 24.3 and 39.7% (depending on depression severity) received at least 10 psychotherapy sessions or adequate pharmacotherapy. CONCLUSIONS The PNP contract strengthens the relationship between sick leave days and the delay until the beginning of psychotherapy, which suggests improvements in terms of need-oriented access to care. However, we found no indication for increased guideline adherence and - independent of the health plan - a gap in sufficient utilization of adequate treatment options.
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Affiliation(s)
- Alexander Engels
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W37, 20246, Hamburg, Germany.
| | - Hans-Helmut König
- grid.13648.380000 0001 2180 3484Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W37, 20246 Hamburg, Germany
| | - Julia Luise Magaard
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Ariane Chaudhuri
- grid.491710.a0000 0001 0339 5982AOK Baden-Württemberg, Stuttgart, Germany
| | - Christian Brettschneider
- grid.13648.380000 0001 2180 3484Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W37, 20246 Hamburg, Germany
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Increased Healthcare Resource Utilization and Direct and Indirect Costs in Patients with Depression and Comorbid Overactive Bladder: Evidence From a Retrospective, Matched Case-Control Cohort Analysis. Adv Ther 2020; 37:4599-4613. [PMID: 32910419 PMCID: PMC7547960 DOI: 10.1007/s12325-020-01485-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Indexed: 11/17/2022]
Abstract
Introduction This study sought to compare healthcare resource utilization (HCRU), costs, and workplace productivity among patients with depression, with and without overactive bladder (OAB). Methods This retrospective, case–control cohort analysis compares HCRU, costs, and workplace productivity among propensity score matched patients with depression and OAB (case cohort) and patients with depression without OAB (control cohort). Patients were aged 18 years or older, insured/on Medicare, and had diagnosed depression and an antidepressant medication claim pre index. First OAB-related event was index for cases; controls were assigned a proxy (study period 12 months). Comparisons of HCRU and costs and regression models assessed the relationship between OAB and costs. For the workplace productivity subset analyses cases and controls were balanced on baseline covariates for the short-term disability analyses but as they were unbalanced for the absentee analyses, multivariate regression analyses were used for this subset. Results The study criteria were met by 39,085 cases and 308,736 controls, from which, 37,997 patients were successfully matched 1:1 (mean age 55 years; 81% female). Most depression-related HCRU measures were similar across cohorts; however, outpatient visits, ER visits, and number of unique depression medications were significantly higher (all p < 0.05) among cases. Cases also had 13% higher total depression-related costs (p < 0.0001). Total mean (standard deviation [SD]) depression-related costs were $1796 ($4235) for cases versus $1597 ($3863) for controls (p < 0.0001). For workplace productivity (absentee data: cases [n = 686], controls [n = 642]; short-term disability data: cases [n = 4395], controls [n = 4433]) absentee outcomes were similar across cohorts. However, a higher percentage of cases used short-term disability benefits compared to controls (21.3% versus 16.9%; p < 0.0001) and cases experienced more case days (11.0 versus 8.6 mean days) and received higher mean payments than controls ($1226 versus $1033; p < 0.0001) in this subset. Conclusions OAB was associated with 13% higher depression-related costs and 4.4% more cases used short-term disability benefits. Electronic Supplementary Material The online version of this article (10.1007/s12325-020-01485-w) contains supplementary material, which is available to authorized users.
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Hakulinen C, Böckerman P, Pulkki-Råback L, Virtanen M, Elovainio M. Employment and earnings trajectories before and after sickness absence due to major depressive disorder: a nationwide case-control study. Occup Environ Med 2020; 78:oemed-2020-106660. [PMID: 33051385 DOI: 10.1136/oemed-2020-106660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine employment and earnings trajectories before and after the first sickness absence period due to major depressive disorder (MDD). METHODS All individuals (n=158 813) in Finland who had a first sickness absence period (lasting longer than 9 days) due to MDD between 2005 and 2015 were matched with one randomly selected individual of the same age and gender with no history of MDD. Employment status and earnings were measured using register-based data annually from 2005 to 2015. Generalised estimating equations were used to examine the trajectories of employment and earnings before and after MDD diagnosis in men and women separately. RESULTS Sickness absence due to MDD was associated with increased probability of non-employment during and after the year of the first sickness absence period. In men, but not in women, the probability of being employed was lower 5 years before the sickness absence period due to MDD. When compared with the individuals in the control group, men had around 34% and women 15% lower earnings 1 year, and 40% and 23%, respectively, 5 years, after the first sickness absence period due to MDD. More severe MDD and longer duration of sickness absence period were associated with lower probability of being employed. CONCLUSIONS Sickness absence due to MDD was associated with considerable reduction in employment and earnings losses. For men and individuals with more severe MDD, this reduction was before the first sickness period. This supports a reciprocal association between employment and earnings with MDD.
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Affiliation(s)
- Christian Hakulinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Service System Research Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Petri Böckerman
- Labour Institute for Economic Research, Helsinki, Finland
- School of Business and Economics, University of Jyväskylä, Jyväskylä, Finland
- IZA (Institute for the Study of Labor), Bonn, Germany
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
- Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marko Elovainio
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Service System Research Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Robinson LS, Brown T, O’Brien L. Capturing the costs of acute hand and wrist injuries: Lessons learnt from a prospective longitudinal burden of injury study. HAND THERAPY 2020. [DOI: 10.1177/1758998320952815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Given the high incidence of hand and wrist injuries, they are exceptionally costly to the economy. This prospective, longitudinal study aimed to establish methods for capturing the burden of acute hand and wrist injury from an individual and societal perspective. Methods A prospective longitudinal design with baseline measures of injury type and severity, and repeated measures of disability, cost, and activity limitations and participation restrictions at six weeks, three months, and six months was selected. Participants were recruited from two large urban Australian public health care services. We sought to establish methods for capturing the burden of acute hand and wrist injury from an individual and societal perspective and compare survey completion by the method of administration. Results A total of 206 patients consented to participate in this study, representing 54% of those invited to participate. The survey completion rates were 18% at six weeks, 2.4% at twelve weeks, and 0.004% at six months following injury. From the limited data collected at six weeks, it was noted that nearly half of the patients reported a decrease in usual financial income, 14% reported absenteeism, and 62% reported presenteeism. Participants who elected to have data collected via phone call had the highest survey completion rate ( n = 6/10; 30%) at six-week’s follow-up. Discussion The study findings highlight the difficulties of completing longitudinal survey research investigating individual and societal burden with this population. Future research should be carefully designed to encourage participation and retention by considering patient and public involvement in study design, the time burden placed on the participants within and across selected survey time points, providing participants with incentives to participate, and highlighting the relevance and real-world applications of the findings.
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Affiliation(s)
- Luke Steven Robinson
- Department of Occupational Therapy, School of Primary Health Care, Monash University – Peninsula Campus, Frankston, Victoria, Australia
- Department of Occupational Therapy, Alfred Health, Melbourne, Victoria, Australia
| | - Ted Brown
- Department of Occupational Therapy, School of Primary Health Care, Monash University – Peninsula Campus, Frankston, Victoria, Australia
| | - Lisa O’Brien
- Department of Occupational Therapy, School of Primary Health Care, Monash University – Peninsula Campus, Frankston, Victoria, Australia
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Brettschneider C, Heddaeus D, Steinmann M, Härter M, Watzke B, König HH. Cost-effectiveness of guideline-based stepped and collaborative care versus treatment as usual for patients with depression - a cluster-randomized trial. BMC Psychiatry 2020; 20:427. [PMID: 32859177 PMCID: PMC7456378 DOI: 10.1186/s12888-020-02829-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/20/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Depression is associated with major patient burden. Its treatment requires complex and collaborative approaches. A stepped care model based on the German National Clinical Practice Guideline "Unipolar Depression" has been shown to be effective. In this study we assess the cost-effectiveness of this guideline based stepped care model versus treatment as usual in depression. METHODS This prospective cluster-randomized controlled trial included 737 depressive adult patients. Primary care practices were randomized to an intervention (IG) or a control group (CG). The intervention consisted of a four-level stepped care model. The CG received treatment as usual. A cost-utility analysis from the societal perspective with a time horizon of 12 months was performed. We used quality-adjusted life years (QALY) based on the EQ-5D-3L as effect measure. Resource utilization was assessed by patient questionnaires. Missing values were imputed by 'multiple imputation using chained equations' based on predictive mean matching. We calculated adjusted group differences in costs and effects as well as incremental cost-effectiveness ratios. To describe the statistical and decision uncertainty cost-effectiveness acceptability curves were constructed based on net-benefit regressions with bootstrapped standard errors (1000 replications). The complete sample and subgroups based on depression severity were considered. RESULTS We found no statically significant differences in costs and effects between IG and CG. The incremental total societal costs (+€5016; 95%-CI: [-€259;€10,290) and effects (+ 0.008 QALY; 95%-CI: [- 0.030; 0.046]) were higher in the IG in comparison to the CG. Significantly higher costs were found in the IG for outpatient physician services and psychiatrist services in comparison to the CG. Significantly higher total costs and productivity losses in the IG in comparison to the CG were found in the group with severe depression. Incremental cost-effectiveness ratios for the IG in comparison to the CG were unfavourable (complete sample: €627.000/QALY gained; mild depression: dominated; moderately severe depression: €645.154/QALY gained; severe depression: €2082,714/QALY gained) and the probability of cost-effectiveness of the intervention was low, except for the group with moderate depression (ICER: dominance; 70% for willingness-to-pay threshold of €50,000/QALY gained). CONCLUSIONS We found no evidence for cost-effectiveness of the intervention in comparison to treatment as usual. TRIAL REGISTRATION NCT, NCT01731717 . Registered 22 November 2012 - Retrospectively registered.
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Affiliation(s)
- Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20251, Hamburg, Germany.
| | - Daniela Heddaeus
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20251 Hamburg, Germany
| | - Maya Steinmann
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20251 Hamburg, Germany
| | - Martin Härter
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20251 Hamburg, Germany
| | - Birgit Watzke
- grid.7400.30000 0004 1937 0650Institute of Psychology, Clinical Psychology and Psychotherapy Research, University of Zurich, Binzmühlestrasse 14, Box 16, CH-8050 Zürich, Switzerland
| | - Hans-Helmut König
- grid.13648.380000 0001 2180 3484Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20251 Hamburg, Germany
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Christensen MK, Lim CCW, Saha S, Plana-Ripoll O, Cannon D, Presley F, Weye N, Momen NC, Whiteford HA, Iburg KM, McGrath JJ. The cost of mental disorders: a systematic review. Epidemiol Psychiatr Sci 2020; 29:e161. [PMID: 32807256 PMCID: PMC7443800 DOI: 10.1017/s204579602000075x] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 01/05/2023] Open
Abstract
AIMS To identify and synthesise the literature on the cost of mental disorders. METHODS Systematic literature searches were conducted in the databases PubMed, EMBASE, Web of Science, EconLit, NHS York Database and PsychInfo using key terms for cost and mental disorders. Searches were restricted to January 1980-May 2019. The inclusion criteria were: (1) cost-of-illness studies or cost-analyses; (2) diagnosis of at least one mental disorder; (3) study population based on the general population; (4) outcome in monetary units. The systematic review was preregistered on PROSPERO (ID: CRD42019127783). RESULTS In total, 13 579 potential titles and abstracts were screened and 439 full-text articles were evaluated by two independent reviewers. Of these, 112 articles were included from the systematic searches and 31 additional articles from snowball searching, resulting in 143 included articles. Data were available from 48 countries and categorised according to nine mental disorder groups. The quality of the studies varied widely and there was a lack of studies from low- and middle-income countries and for certain types of mental disorders (e.g. intellectual disabilities and eating disorders). Our study showed that certain groups of mental disorders are more costly than others and that these rankings are relatively stable between countries. An interactive data visualisation site can be found here: https://nbepi.com/econ. CONCLUSIONS This is the first study to provide a comprehensive overview of the cost of mental disorders worldwide.
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Affiliation(s)
- M. K. Christensen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - C. C. W. Lim
- Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia
| | - S. Saha
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia
| | - O. Plana-Ripoll
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - D. Cannon
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia
| | - F. Presley
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia
| | - N. Weye
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - N. C. Momen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - H. A. Whiteford
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia
- School of Public Health, University of Queensland, Herston, Queensland, Australia
| | - K. M. Iburg
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - J. J. McGrath
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia
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50
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Stevens ER, Mazumdar M, Caniglia EC, Khan MR, Young KE, Edelman EJ, Gordon AJ, Fiellin DA, Maisto SA, Chichetto NE, Crystal S, Gaither JR, Justice AC, Braithwaite RS. Insights Provided by Depression Screening Regarding Pain, Anxiety, and Substance use in a Veteran Population. J Prim Care Community Health 2020; 11:2150132720949123. [PMID: 32772883 PMCID: PMC7418233 DOI: 10.1177/2150132720949123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: We sought to quantify the extent to which a depression screening instrument commonly used in primary care settings provides additional information regarding pain interference symptoms, anxiety, and substance use. Methods: Veterans Aging Cohort Study (VACS) data collected from 2003 through 2015 was used to calculate odds ratios (OR) for associations between positive depression screening result cutoffs and clustering conditions. We assessed the test performance characteristics (likelihood ratio value, positive predictive value, and the percentage of individuals correctly classified) of a positive Patient Health Questionnaire (PHQ-9 & PHQ-2) depression screen for the identification of pain interference symptoms, anxiety, and substance use. Results: A total 7731 participants were included in the analyses. The median age was 50 years. The PHQ-9 threshold of ≥20 was strongly associated with pain interference symptoms (OR 21.6, 95% CI 17.5-26.7) and anxiety (OR 72.1, 95% CI 52.8-99.0) and yielded likelihood ratio values of 7.5 for pain interference symptoms and 21.8 for anxiety and positive predictive values (PPV) of 84% and 95%, respectively. A PHQ-9 score of ≥10 still showed significant associations with pain interference symptoms (OR 6.1, 95% CI 5.4-6.9) and symptoms of anxiety (OR 11.3, 95% CI 9.7-13.1) and yet yielded lower likelihood ratio values (4.36 & 8.24, respectively). The PHQ-9 was less strongly associated with various forms of substance use. Conclusion: Depression screening provides substantial additional information regarding the likelihood of pain interference symptoms and anxiety and should trigger diagnostic assessments for these other conditions.
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