Journal of Mental Health Policy and Economics最新文献

Introduction: The relationship between economic downturns and substance use has been studied in numerous economic crises occurring worldwide, but the precise relationship between the two remains unclear.

Aims: The aim of the present study was to undertake a survey on behaviour and perspectives related to the latest European economic crisis among illegal drug users attending substance treatment services.

Design and methods: We conducted a questionnaire-based survey in drug dependence treatment settings, in three geographically different jurisdictions (England, Catalonia and Poland), including 180 drug users.

Results: Most of the participants of the survey (58.3%) reported an increase in drug use during the crisis, compared with only 25.6% of the sample who reported a decrease in drug use. The main reason given for increasing drug use was greater amount of free time available. Other important reasons were greater substance availability during this period, more stress at work and seeking comfort in response to the loss of a stable source of income, social status and/or family. Those who reported cutting down on the amount of drug use during the economic recession, reported economic difficulties as the main reason. Other important factors were family and friends' economic problems and the fear of losing their job. Illegal drug use reduction was compensated by increased smoking in 46.3% of the patients, and increased alcohol use in 39.4%.

Discussion and conclusions: While this result has potential interest for those developing policies and interventions to reduce drug-related harm, longitudinal studies and future research involving a broader population of drug-users (including those not in treatment) could shed further light on these behavioural mechanisms linking changes in drug use with economic recessions.

Background: Bipolar Type I Disorder (BID) is a disabling mental disorder among young adults that places enormous psychological, social, and economic burdens on patients, their families, and health care systems and decreases quality of life (QOL). Few studies have investigated the quality-adjusted life-years (QALY), health state preferences, and utilities in patients with BID.

Aim of study: The aim of this study was to elicit health state utilities for current health among a sample of individuals with BID irrespective of their clinical conditions at the time of evaluation.

Methods: One hundred individuals with BID were consecutively enrolled in this cross-sectional study. Preferences were elicited from patients with visual analogous scale (VAS) and time trade-off (TTO). To assess quality of life, the Farsi version of the World Health Organization's QOL Instrument-Short Version (WHOQOL-BREF) was used. In addition, health state was assessed with the Short Form-36 (SF-36) health survey, and then a specially- derived reduced version of the SF-36 (the `SF-6D') was calculated as an alternative to existing preference-based measures of health for conducting economic evaluation of various interventions. Moreover, several clinical measures were administered to participants.

Results: The mean (S.D.) VAS, TTO, and SF-6D utility scores were 0.59 (0.21), 0.44 (0.33), and 0.61 (0.11), respectively. There were significant associations of most selected clinical characteristics with VAS and TTO scores. Additionally, there were strong correlations between all domains of WHOQOL-BREF and VAS scores as well as moderate to strong correlations with TTO scores. Furthermore, there were strong correlations between all scales of SF-36 scores and VAS scores as well as moderate to strong correlations between the scales of SF-36 scores and TTO scores.

Discussion: The current study showed that even unstable patients could evaluate their own health states. Furthermore, the present study showed substantial decrements in health-related life preferences among persons with BID. Additionally, the patients with most recent depressive or mixed episodes reported lower VAS scores than those with most recent manic episodes.

Limitations: This study was performed on a group of patients with BID in a referral psychiatric center. This sample can potentially make a selection bias. Furthermore, this study was cross-sectional.

Implications for health care provision and use: Generally, clinical features could explain more than half of the variances in VAS utility scores. Among all clinical features, severity of symptoms and duration of disease were among the main factors significantly associated with the utility decreases.

Implication for health policies: The present study data provide health state preferences useful fo

Background: The MindSpot Clinic (MindSpot) offers internet-delivered cognitive behavior therapy (iCBT) courses for people with anxiety and depressive disorders in Australia. The efficacy credentials of the courses offered at MindSpot are now well established but not the credentials of cost-effectiveness. The current study is aimed to evaluate the cost-effectiveness of the Wellbeing Course offered in MindSpot in comparison with the routine/usual care (defined as care in the absence of MindSpot) for people with symptoms of depression or/and anxiety from the perspective of Australian Department of Health.

Methods: An economic model using a one-year decision-tree framework was constructed. The four health states in the model included: fully recovered; partially recovered; no improvement; and deteriorated. The probabilities between the four health states in the model were derived from a series of individual client datasets and from the Australian National Survey of Mental Health and Wellbeing. The EuroQol Five Dimension -- Five Level was used to derive the utilities, and costs were expressed in 2014 Australian dollars. Sensitivity analyses were conducted to examine the robustness of results to key model parameters.

Results: In the base case analysis, for people seeking treatment, care offered at Mindspot cost less and achieved greater benefits compared to the comparator. By adopting MindSpot, an additional 505 of fully recovered and 223 of partially recovered clients can be achieved per annum compared to routine/usual care. The result of the sensitivity analyses indicated the result of the analysis were robust.

Conclusions: This study found that the iCBT treatments provided by MindSpot were highly cost-effective in comparison with current routine/usual care in the Australia setting. However, future research using a prospective matched comparator that comprehensively assesses all the respective costs is required to verify the current study findings.

Background: Treating youth with serious emotional disturbances (SED) is expensive often requiring institutional care. A significant amount of recent federal and state funding has been dedicated to expanding home and community-based services for these youth as an alternative to institutional care. High Fidelity Wraparound (Wrap) is an evolving, evidence-informed practice to help sustain community-based placements for youth with an SED through the use of intensive, customized care coordination among parents, multiple child-serving agencies, and providers. While there is growing evidence on the benefits of Wrap, few studies have examined health care spending associated with Wrap participation and none have examined spending patterns after the completion of Wrap. Merging health care spending data from multiple agencies and programs allows for a more complete picture of the health care costs of treating these youth in a system-of-care framework.

Aims of study: (i) To compare overall health care spending for youth who transitioned from institutional care into Wrap (the treatment group) versus youth not receiving Wrap (the control group) and (ii) to compare changes in health care spending, overall and by category, for both groups before (the pre-period) and after (the post-period) Wrap participation.

Methods: The treatment group (N=161) is matched to the control group (N=324) temporally based on the month the youth entered institutional care. Both total health care spending and spending by category are compared for each group pre- and post-Wrap participation. The post-period includes the time in which the youth was receiving Wrap services and one year afterwards to capture long-term cost impacts.

Results: In the year before Wrap participation, the treatment group averaged USD 8,433 in monthly health care spending versus USD 4,599 for the control group. Wrap participation led to an additional reduction of USD 1,130 in monthly health care spending as compared to the control group in the post-period. For youth participating in Wrap, these spending reductions were the result of decreases in mental health inpatient spending and general outpatient spending.

Discussion: Youth participating in Wrap had much higher average monthly costs than youth in the control group for the year prior to entering Wrap, suggesting that the intervention targeted youth with the highest mental health utilization and likely more complex needs. While both groups experienced reductions in spending, the treatment group experienced larger absolute reductions, but smaller relative reductions associated with participation. These differences were driven mainly by reductions in mental health inpatient spending. Larger reductions in general outpatient spending for the treatment group suggest spillover benefits in terms of physical health care spending. Further analysis is needed t

Background: In September 2010, the Affordable Care Act (ACA) extended dependent care coverage to individuals under the age of 26, allowing young adults to remain on their parent's private insurance.

Aims of the study: This policy offers a natural experiment to examine the impact of expanded insurance coverage on mental health and substance use treatment utilization and payment composition.

Methods: Using National Survey on Drug Use and Health (NSDUH) and Medical Expenditure Panel Survey (MEPS) data between 2005 and 2014, this study employs a difference-in-differences approach with 23-25 year olds as the treatment group and 27-30 year olds as the control group to examine the impact of the expansion on insurance coverage, behavioral health treatment utilization, and treatment payment source.

Results: Results indicate that the dependent care coverage expansion is associated with an increase in insurance coverage, greater mental health treatment utilization, and an increase in payment for behavioral health treatment by private insurance.

Discussion: This study shows that insurance coverage increased and financial barriers to getting behavioral health treatment fell. Improving access to care only led to increases in mental health treatment utilization, while substance use treatment utilization remained unchanged.

Implications: The ACA succeeded in extending insurance benefits to a population that has been historically underinsured. Along with those benefits, young adults enjoyed greater access to behavioral health care and a measure of financial protection from high costs. While the evidence has yet to be presented for the full implementation of the ACA, if these results are typical of its other provisions, then the ACA will have achieved some of its most important objectives.

Background: There have been claims that community mental health principles leads to the maintenance of better health and functioning in patients and can be more economical for patients with severe and chronic mental disorders. Economic evaluation studies have been used to assess the cost-effectiveness of national health programs, or to propose efficient strategies for health care delivery.

Aims of the study: The current study is intended to test the cost-effectiveness of an Aftercare Service when compared with Treatment-As-Usual for patients with severe mental disorders in Iran.

Methods: This study was a parallel group randomized controlled trial. A total of 160 post-discharge eligible patients were randomized into two equal patient groups, Aftercare Service (that includes either Home Visiting Care, or Telephone Follow-up for outpatient treatment) vs Treatment-As-Usual, using stratified balanced block randomization method. All patients were followed for 12 months after discharge. The perspective of the present study was the societal perspective. The outcome measures were the rate of readmission at the hospitals after discharge, psychotic symptoms, manic symptoms, depressive symptoms, illness severity, global functioning, quality of life, and patients' satisfaction with the services. The costs included the intervention costs and the patient and family costs in the evaluation period.

Results: There was no significant difference in effectiveness measures between the two groups. The Aftercare Service arm was about 66,000 US$ cheaper than Treatment-As-Usual arm. The average total cost per patient in the Treatment-As-Usual group was about 4651 USD, while it was reduced to 3823 US$ in the Aftercare Service group; equivalent to a cost reduction of about 800 USD per patient per year.

Discussion and limitations: Given that there was no significant difference in effectiveness measures between the two groups (slightly in favor of the intervention), the Aftercare Service was cost-effective. The most important limitation of the study was the relatively small sample size due to limited budget for the implementation of the study. A larger sample size and longer follow-ups are warranted.

Implications for health care provision, use and policies: Considering the limited resources and equity concerns for health systems, the importance of making decisions about healthcare interventions based on cost-effectiveness evidence is increasing. Our results suggest that the aftercare service can be recommended as an efficient service delivery mode, especially when psychiatric bed requirements are insufficient for a population.

Implications for further research: Further research should continue the work done with a larger sample size and longer follow-ups to further establish the cost-effectiveness analysis of an aftercar

OBJECTIVES: This study investigates the association between eating out and depressive symptoms among elderly people. Potential mediators that may link to elderly eating out and depressive symptoms are also discussed.METHODS: A unique dataset of 1,184 individuals aged 65 and older was drawn from the National Health and Nutrition Survey in 2008 in Taiwan. A bivariate probit model and an instrumental variable probit model were estimated to account for correlated, unmeasured factors that may be associated with both the decision and frequency of eating out and depressive symptoms in the elderly. An additional analysis is conducted to check whether the nutrient intakes and body weights can be seen as mediators that link the association between eating out and depressive symptoms of the elderly.RESULTS: Elderly people who eat out are 38 percent points more likely to have depressive symptoms than their counterparts who do not eat out, after controlling for socio-demographic characteristics and other factors. A positive association between the frequency of eating out and the likelihood of having depressive symptoms of the elderly is also found. It is evident that one additional meal away from home is associated with an increase of the likelihood of being depressed by 3.8 percentage points. With respect to the mediations, we find that nutrient intakes and body weight are likely to serve as mediators for the positive relationship between eating out and depressive symptoms in the elderly.CONCLUSION: Our results show that elderly who eat out have a higher chance of having depressive symptoms. To prevent depressive symptoms in the elderly, policy makers should be aware of the relationship among psychological status, physical health and nutritional health when assisting the elderly to better manage their food consumption away from home.LIMITATONS AND IMPLICATIONS FOR FUTURE RESEARCH: Our study have some caveats. First, the interpretation of our results on the causality issue calls for caution in that our analysis relies on a cross-sectional survey. Second, other measures to define elderly depression, such as the Center for Epidemiological Studies -Depression (CES-D) score, can be used to check the robustness of our findings. Finally, the availability of food outlets in the local area and family characteristics are possible associated with food away from home of the elderly. If data permit, the relationship between eating out and elderly depressive symptoms can be better identified after controlling for variables related to food facilities and family characteristics.