[Impacts of a brief contact intervention in suicide prevention on medical care consumptions]. / Impacts d'un système de veille en prévention du suicide sur les consommations de soins.

INTRODUCTION: Suicide prevention is a major objective in public health. The development of alternative approaches to the prevention of suicide, such as monitoring systems, is growing quickly. The results are encouraging, but the analysis of the effectiveness remains complex. The objective of this study is to evaluate the medico-economic impact of the ALGOS brief contact intervention (BCI) on the consumption of medical care. METHOD: ALGOS is a prospective, comparative, multicentre, single-blind, randomized, controlled trial, which compared two groups after a suicide attempt (SA). The ALGOS algorithm assigned each BCI to the subgroup of participants. The medico-economic impact of each intervention was evaluated at 6 and 13 months after inclusion. RESULTS: In all, 987 patients were included. There was no significant difference between the two groups at 6 months and at 13 months after SA in the total number of patients who had been hospitalized in psychiatry or other care services. However, the average number of rheumatology visits was significantly higher in the control group (P=0.01) at 13 months. The total number of rheumatologist and physiotherapist visits was significantly higher in the control group at 6 and 13 months. CONCLUSION: Our results suggest that the use of a BCI after SA does not lead to increased consumption of medical care.

Target groups for the prevention of late-life anxiety.

BACKGROUND: Anxiety disorders in older people are highly prevalent, yet there is little evidence to guide targeted prevention strategies. AIMS: To identify subgroups at increased risk of developing anxiety in later life. METHOD: Anxiety was measured with the Hospital Anxiety and Depression anxiety sub-scale in 1931 people aged 55-85 years followed over 3 years. Risk factors were identified that had a high combined attributable fraction, indicative of substantial health gains when the adverse effect of the risk factors can be contained. RESULTS: Factors significantly associated with increased risk of developing anxiety included sub-threshold anxiety, depression, two or more chronic illnesses, poor sense of mastery, poor self-rated health and low educational level. CONCLUSIONS: The identified risk groups are small, thus providing prevention with a narrow focus, and health gains are likely to be more substantial than in groups not exposed to these risk factors. Nevertheless, more research is needed to produce evidence on target groups where prevention has optimal impacts.

Opportunities for cost-effective prevention of late-life depression: an epidemiological approach.

CONTEXT: Clinically relevant late-life depression has a prevalence of 16% and is associated with substantial societal costs through its disease burden and unfavorable prognosis. From the public health perspective, depression prevention may be an attractive, if not imperative, means to generate health gains and reduce future costs. OBJECTIVE: To target high-risk groups for depression prevention such that maximum health gains are generated against the lowest cost. DESIGN: Population-based cohort study over 3 years. SETTING: General population in the Netherlands. PARTICIPANTS: Twenty-two hundred community residents aged 55 to 85 years. Of these, 1925 were not depressed at baseline. MAIN OUTCOME MEASURE: The onset of clinically relevant depression was measured with the Center for Epidemiological Studies Depression Scale. For each of the risk factors (and their combinations), we calculated indices of potential health gain and the effort (costs) required to generate those health gains. RESULTS: One in every 5 cases of clinically relevant late-life depression is a new case. Consequently, depression prevention has to play a key role in reducing the influx of new cases. This is best done by directing prevention efforts toward elderly people who have depressive symptoms, experience functional impairment, and have a small social network, in particular women, as well as people who have attained only a low educational level or who suffer from chronic diseases. CONCLUSIONS: Directing prevention efforts toward selected high-risk groups could help reduce the incidence of depression and is likely to be more cost-effective than alternative approaches. This article further shows that we have the methodology at our disposal to conduct ante hoc cost-benefit analysis in preventive psychiatry. This helps set a rational research and development agenda before testing the cost-effectiveness of interventions in time-consuming and expensive trials.