The lifetime costs of perinatal depression and anxiety in Brazil

Health economic evaluation evidence of interventions for peripartum depression: A scoping review

This scoping review provides a broad overview of the existing literature on economic evaluations of preventive, screening, and treatment programmes for peripartum depression (PPD). PPD is one of the leading causes of disease-related disability among women. However, PPD often goes undiagnosed and untreated, with as many as half of cases not being identified. We followed the PICO-P (publication type) structure. Databases were searched from inception until 30 June 2023. The intervention stage in the studies was classified as prevention, screening, treatment, screening and treatment, and prevention and treatment. The health economics methods of the studies were divided into cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis, cost-minimisation analysis, return of investment, and multiple. Ultimately, 38 studies were included for extraction and evaluation. Several interventions for PPD may be cost effective, including peer support, psychological therapies, and screening strategies using tools like the Edinburgh Postnatal Depression Scale (EPDS). However, study limitations include heterogeneity across studies, methodological limitations, and limited generalisability to diverse populations. The cost-effectiveness results of PPD interventions may differ across different health systems, partly due to differences in the amount and distribution of resources available. By implementing suggested policy recommendations, policymakers can significantly improve the identification, treatment, and prevention of PPD, ultimately improving the health and well-being of mothers, children, and families.

Short-term attributable risk and economic burden of hospital admissions for anxiety disorders due to air pollution: a multicity time-stratified case-crossover study

BACKGROUND

Anxiety disorders are a leading cause of severe quality of life impairment and are among the most common mental disorders globally. However, few studies have investigated the association between exposure to high levels of air pollution and an increased risk of developing anxiety disorders. This study aimed to investigate the relationship between air pollutants and hospitalisation for anxiety disorders and the associated economic burden of these hospitalisations in Sichuan, China.

METHODS

We collected 7,282 records of anxiety disorder hospitalisation from medical institutions across nine cities between January 1, 2017, and December 31, 2018. Concurrent meteorological and air pollution data, including temperature, humidity, PM2.5, PM10, SO2, and CO, were obtained from 183 monitoring stations in Sichuan Province. After controlling for long-term trends, day of the week, and meteorological factors, we employed a time-stratified case-crossover design based on conditional logistic regression to assess the association between concentrations of the four pollutants (PM2.5, PM10, SO2, and CO) and hospital admissions for anxiety disorders, with stratified analysis by age, sex, and season. The cost of hospitalisation was evaluated using the cost-of-illness method.

RESULTS

The finding indicated a positive correlation between short-term exposure to air pollutants and hospitalization rates of anxiety disorders. The effect of each 10 µg/m3 increase in airborne particulate matter (PM) and SO2 on hospital admissions for people with anxiety disorders peaked with a lag of 5 days, and each 1 mg/m3 increase in CO had the greatest effect on the 0-7 day moving average lag, with OR values of PM2.5:1.002 (95% CI: 1.001,1.004), PM10:1.001 (95% CI: 1.000,1.002), SO2:1.034 (95% CI: 1.020,1.047), and CO: 1.614 (95% CI: 1.247, 2.089). Air pollution increases the chances of anxiety disorders during the cold season. Furthermore, the elderly are particularly susceptible to these pollutants, which may contribute to an increased hospitalization rates of anxiety disorders (P < 0.05). The total economic cost of hospitalisation for anxiety disorders due to particulate matter pollution was ¥ 966,319 during the study period.

CONCLUSION

Short-term exposure to PM2.5, PM10, SO2, and CO may increase the risk of hospital admissions for anxiety disorders and impose significant financial burdens.

Effectiveness of smartphone-based music intervention on perinatal depression: protocol for a randomized controlled trial

BACKGROUND

Perinatal depression has become a global public health issue with a high prevalence rate. Multiple studies have confirmed the effectiveness of music intervention. Still, the current form of offline intervention ignores issues such as convenient transportation and the stigma of diseases that pregnant women are concerned about, resulting in poor adherence. This randomized controlled study will evaluate the impact of music intervention on depression, anxiety, and stress in perinatal women through the WeChat application. In addition, the usability of the WeChat application and the adherence of PND women will also be evaluated.

METHODS

This randomized, open, single-center parallel controlled trial randomly divided 110 women with perinatal depression who met the inclusion criteria into a smartphone-based music intervention group and usual care group in a 1:1 ratio. The main outcome measures will consist of EPDS and WeChat application usability score. The secondary outcome measures will consist of GAD-7, CPSS, and Knowledge-Attitude-Practice questionnaire scores.

DISCUSSION

This study will test the effectiveness of music intervention based on the WeChat application for perinatal depression and the usability of the WeChat application, to provide practical guidance for perinatal mental health care.

TRIAL REGISTRATION

This protocol was registered at the Chinese Clinical Trials.gov (Identifier: ChiCTR2400088924) on August 29, 2024.

Stakeholders and their perspectives on perinatal depression screening: a systematic review

BACKGROUND

Untreated perinatal depression significantly affects the health outcomes of both mothers and infants and increases the economic burden on families and society. Early depression screening to identify at-risk women is essential, and involving key stakeholders ensures the successful integration of best practices within healthcare settings.

OBJECTIVES

This study aims are: 1) to identify stakeholders from guidelines and studies that influence the implementation of perinatal depression screening; and 2) to provide a thematic summary of stakeholders' perspectives on the opportunities and challenges for scaling perinatal depression screening.

METHODS

A total of 10 databases were comprehensively searched from their inception until July 28 in 2024, encompassing both Chinese and English literature. Websites of academic organizations were also explored to obtain guidelines pertaining to perinatal depression screening. This study followed the PRISMA guidelines for systematic reviews. Stakeholders' perspectives were analyzed using second-order thematic qualitative analysis.

RESULTS

A total of 3268 original articles and 104 guidelines were retrieved. Titles, abstracts, and full texts were screened, resulting in the inclusion of 57 original studies and 9 guidelines for data analysis. The most commonly mentioned stakeholders in perinatal depression screening were health care workers (n = 48) and perinatal women (n = 32), followed by healthcare leaders/managers (n = 16) and policymakers (n = 15). A total 23 articles reported stakeholders' perspectives, from which 291 quotes were extracted. Thematic synthesis identified 12 initial codes, which were summarized into three themes: perinatal depression screening practices, challenges in implementing screening, facilitating factors and opportunities for screening services.

CONCLUSIONS

This study identified 17 types of stakeholders, with health care workers and perinatal women being the primary groups. Additionally, key challenges in perinatal depression screening were identified, highlighting the need for future research to focus cost, quality, and reimbursement structures to ensure the sustainable and scalable implementation of screening initiatives.

Efficacy of a Standalone Smartphone Application to Treat Postnatal Depression: A Randomized Controlled Trial

INTRODUCTION

Smartphone app interventions based on cognitive-behavioral therapy (CBT) are promising scalable alternatives for treating mental disorders, but the evidence of their efficacy for postpartum depression is limited. We assessed the efficacy of Motherly, a standalone CBT-based smartphone app, in reducing symptoms of postpartum depression.

METHODS

Women aged 18-40 with symptoms of postpartum depression were randomized either to intervention (Motherly app) or active control (COMVC app). The primary outcome was symptoms of depression measured by the Edinburgh Postnatal Depression Scale (EPDS) at post-treatment. Secondary outcomes were anxiety symptoms, parental stress, quality of sleep, behavioral activation, availability of response-contingent positive reinforcement, and clinical improvement at post-treatment and 1-month follow-up. Exploratory analyses were performed to investigate if app engagement was associated with treatment response.

RESULTS

From November 2021 to August 2022, 1,751 women volunteered, of which 264 were randomized, and 215 provided primary outcome data. No statistically significant differences were found between groups at post-treatment: intervention: mean (SD): 12.75 (5.52); active control: 13.28 (5.32); p = 0.604. There was a statistically significant effect of the intervention on some of the secondary outcomes. Exploratory analyses suggest a dose-response relationship between Motherly app engagement and outcomes.

CONCLUSION

Our standalone app intervention did not significantly reduce postnatal depression symptoms when compared to active control. Exploratory findings suggest that negative findings might be associated with insufficient app engagement. Consistent with current literature, our findings suggest that standalone app interventions for postpartum depression are not ready to be implemented in clinical practice.

The effect of music intervention on depression in perinatal women: A systematic review

Objective

Perinatal depression has become a global public health problem, which not only harms the health of mothers and their offspring, but also increases the socio-economic burden, so early intervention is urgent. Music intervention is a low-cost and safe intervention method. This study endeavored to systematically integrate and quantitatively evaluate the effectiveness of music intervention for perinatal depression.

Methods

PubMed, Embase, Web of Science and Cochrane Library were searched systematically. The search period was up to September 1, 2024. The included studies were summarized and analyzed.

Results

A total of 1375 articles were obtained through preliminary search, and 13 of them were finally included. The effect of music intervention on perinatal depression was better than that of the control group (SMD = -0.53, 95%CI (-0.81, -0.26), p ＜ 0.05). Music intervention had no significant effect on alleviating anxiety (SMD = -0.47, 95%CI (-0.63, -0.31), p ＞ 0.05). However, the heterogeneity of the included studies was significant.

Conclusions

This study indicated that music intervention had a significant effect on alleviating perinatal depression, but the effect on anxiety was not significant. However, the results were highly heterogeneous, and large-scale, multi-center, and long-term studies are needed in the future to confirm this.

Exploring the return-on-investment for scaling screening and psychosocial treatment for women with common perinatal mental health problems in Malawi: Developing a cost-benefit-calculator tool

This study sought to develop a user-friendly decision-making tool to explore country-specific estimates for costs and economic consequences of different options for scaling screening and psychosocial interventions for women with common perinatal mental health problems in Malawi. We developed a simple simulation model using a structure and parameter estimates that were established iteratively with experts, based on published trials, international databases and resources, statistical data, best practice guidance and intervention manuals. The model projects annual costs and returns to investment from 2022 to 2026. The study perspective is societal, including health expenditure and productivity losses. Outcomes in the form of health-related quality of life are measured in Disability Adjusted Life Years, which were converted into monetary values. Economic consequences include those that occur in the year in which the intervention takes place. Results suggest that the net benefit is relatively small at the beginning but increases over time as learning effects lead to a higher number of women being identified and receiving (cost‑)effective treatment. For a scenario in which screening is first provided by health professionals (such as midwives) and a second screening and the intervention are provided by trained and supervised volunteers to equal proportions in group and individual sessions, as well as in clinic versus community setting, total costs in 2022 amount to US$ 0.66 million and health benefits to US$ 0.36 million. Costs increase to US$ 1.03 million and health benefits to US$ 0.93 million in 2026. Net benefits increase from US$ 35,000 in 2022 to US$ 0.52 million in 2026, and return-on-investment ratios from 1.05 to 1.45. Results from sensitivity analysis suggest that positive net benefit results are highly sensitive to an increase in staff salaries. This study demonstrates the feasibility of developing an economic decision-making tool that can be used by local policy makers and influencers to inform investments in maternal mental health.

Economic costs of perinatal depression and anxiety in a lower middle income country: Pakistan

BACKGROUND

Women's mental health during the perinatal period is a major public health problem in Pakistan. Many challenges and competing priorities prevent progress to address the large treatment gap. Aim To quantify the long-term impacts of untreated perinatal depression and anxiety in economic terms, thus highlighting its overall burden based on country-specific evidence.

METHODS

Cost estimates were generated for a hypothetical cohort of women giving birth in 2017, and their children. Women and children experiencing adverse events linked to perinatal mental health problems were modelled over 40 years. Costs assigned to adverse events included were those linked to losses in quantity and quality-of-life, productivity, and healthcare-related expenditure. Present values were derived using a discount rate of 3 %. Data were taken from published cohort studies, as well as from sources of population, economic and health indicators.

RESULTS

The total costs were $16.5 billion for the cohort and $2680 per woman giving birth. The by far largest proportion referred to quality-of-life losses ($15.8 billion). Productivity losses and out-of-pocket expenditure made up only a small proportion of the costs, due to low wages and market prices. When the costs of maternal suicide were included, total costs increased to $16.6 billion.

LIMITATIONS

Important evidence gaps prevented the inclusion of all cost consequences linked to perinatal mental health problems.

CONCLUSIONS

Total national costs are much higher compared with those in other, higher middle-income countries, reflecting the excessive disease burden. This study is an important first step to inform resource allocations.

Effect of eHealth interventions on perinatal depression: A meta-analysis

BACKGROUND

Perinatal depression (PND) is a common mental health problem, and eHealth interventions may provide a strategy for alleviating PND.

AIM

This meta-analysis aimed to determine the effect of eHealth interventions on PND.

METHODS

Six databases were searched to retrieve published randomized controlled trials (RCTs) on the effect of eHealth interventions on PND. A meta-analysis was performed on the data of these studies using a random effects model.

RESULTS

A total of 21 RCTs were included in the meta-analysis, which revealed that eHealth interventions significantly reduced antenatal depression (WMD = -1.64, 95 % CI [-2.92, -0.35], P = .013), postpartum depression (SMD = -0.41, 95 % CI [-0.52, -0.29], P < .001), anxiety (SMD = -0.39, 95 % CI [-0.51, -0.28], P < .001), stress (WMD = -2.93, 95 % CI [-4.58, -1.27], P = .001), and improved self-efficacy (SMD = 0.42, 95 % CI [0.21, 0.63], P < .001) compared with the control group. However, eHealth interventions did not significantly improve social support (SMD = 0.27, 95 % CI [-0.01, 0.56], P = .058). For antenatal depression, significant subgroup differences were observed in the digital platform and material presentation format. In addition, for postpartum depression, significant subgroup differences were found in the type of therapy.

CONCLUSIONS

The meta-analysis results suggest that eHealth interventions can relieve depression, anxiety, and stress symptoms and improve self-efficacy in perinatal women. However, these interventions did not improve social support. Additional high-quality studies on eHealth interventions in PND are needed to validate these results.

State of perinatal mental health care in the WHO region of Europe: a scoping review

Background

Although perinatal mental disorders are the most common health complication among women in the perinatal period, there is a huge gap in the implementation of related research findings in the health care system. We mapped the state of perinatal mental health (PMH) care in the WHO Europe region with aim to identify leading countries, which can serve as models for countries with less developed perinatal mental health care.

Methods

Guidelines, policies, and documents related to screening and treatment services for PMH were searched as grey literature. Results were analysed to assess the status of PMH care in the WHO European countries and to identify gaps (absence of relevant service or documents). The state of perinatal mental health care was scored on a 0-5 scale.

Results

The grey literature search resulted in a total of 361 websites. Seven countries (Belgium, Finland, Ireland, Netherlands, Sweden, UK, Malta) received full points for the presence of relevant PMH services or documents, while five countries received zero points. Most WHO European countries (48/53) have general mental health policies, but only 25 countries have policies specifically on perinatal mental health. Ten countries offer PMH screening, and 11 countries offer PMH service (of any type). Any PMH guidelines were provided in 23/53 countries.

Conclusions

Perinatal mental health care is in its infancy in most WHO European countries. Leading countries (Belgium, Finland, Ireland, Netherlands, Sweden, UK, Malta) in PMH care can serve as conceptual models for those less developed and geopolitically close.

Association between trajectories of maternal depressive symptoms and length of hospital stay, hospitalization costs, and adverse maternal and infantile outcomes: A longitudinal observational study

This study aimed to determine the trajectories of perinatal depression and their relationship with length of hospital stay (LOS), hospitalization costs, and adverse maternal and infantile outcomes. This longitudinal observational study included 525 participants. Perinatal depressive symptoms were assessed at four waves (from the first trimester to the postpartum period). LOS, hospitalization costs, and adverse maternal (sleep, fatigue, anxiety, perceived stress, and memory problems) and infantile outcomes of participants were obtained from medical records and self-reported questionnaires. Trajectories of perinatal depressive symptoms were explored with latent class growth analysis. Associations between trajectories and adverse maternal and infant outcomes were explored with multiple linear regression and binary logistic regression models. The participants' average age was 29.6 ± 3.9 years. Five heterogeneous developmental trajectories of perinatal depressive symptoms were identified as follows: high-level (7.05%), moderate-increasing (12%), remission (15.05%), moderate-level (37.14%), and low-level (28.76%). The average LOS was 5.78 ± 2.13 days, and the average hospitalization costs were 12,695.27 ± 5457.51 yuan. Compared with the trajectory of low-level depressive symptoms, the LOS, hospitalization costs, and likelihood of adverse outcomes of women with high-level and moderate-increasing depressive symptom trajectories increased. The findings capture the heterogeneity of perinatal depression in Chinese women. Women in the moderate-increasing and high-level trajectory groups had longer LOS, more hospitalization costs, and poor birth outcomes. Elucidating the trajectories of perinatal depression and their relationship with maternal and infant health outcomes provides important insights into the development of person-centred care planning for women during pregnancy and postpartum.