RESUMO
BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous condition with extensive psychiatric comorbidities. ADHD has been associated with substantial clinical and economic burden; however, little is known about the incremental burden specifically attributable to psychiatric comorbidities of ADHD in adults. OBJECTIVE: To assess the impact of psychiatric comorbidities, specifically anxiety and depression, on health care resource utilization (HRU) and costs in treated adults with ADHD in the United States. METHODS: A retrospective case-cohort study was conducted. Adults with ADHD were identified in the IQVIA PharMetrics Plus database (10/01/2015-09/30/2021). The index date was defined as the date of initiation of a randomly selected ADHD treatment. The baseline period was defined as the 6 months prior to the index date, and the study period as the 12 months following the index date. Patients with at least 1 diagnosis for anxiety and/or depression during both the baseline and study periods were classified in the ADHD+anxiety/depression cohort, whereas those without diagnoses for anxiety or depression at any time were classified in the ADHD-only cohort. Entropy balancing was used to create reweighted cohorts with similar baseline characteristics. All-cause HRU and health care costs were assessed during the study period and compared between cohorts using regression analyses. Cost analyses were also conducted in subgroups stratified by comorbid conditions. RESULTS: After reweighting, patients in the ADHD-only cohort (N = 276,906) and ADHD+anxiety/depression cohort (N = 217,944) had similar characteristics (mean age 34.1 years; 54.8% male). All-cause HRU was higher in the ADHD+anxiety/depression cohort than the ADHD-only cohort (incidence rate ratios for inpatient admissions: 4.5, emergency department visits: 1.8, outpatient visits: 2.0, and psychotherapy visits: 6.4; all P < 0.01). All-cause health care costs were more than 2 times higher in the ADHD+anxiety/depression cohort than the ADHD-only cohort (mean per-patient per-year [PPPY] costs in ADHD-only vs ADHD+anxiety/depression cohort: $5,335 vs $11,315; P < 0.01). Among the ADHD+anxiety/depression cohort, average all-cause health care costs were $9,233, $10,651, and $15,610 PPPY among subgroup of patients with ADHD and only anxiety, only depression, and both anxiety and depression, respectively. CONCLUSIONS: Comorbid anxiety and depression is associated with additional HRU and costs burden in patients with ADHD. Comanagement of these conditions is important and has the potential to alleviate the burden experienced by patients and the health care system.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Comorbidade , Custos de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Humanos , Transtorno do Deficit de Atenção com Hiperatividade/economia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Masculino , Feminino , Estudos Retrospectivos , Adulto , Custos de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estados Unidos/epidemiologia , Pessoa de Meia-Idade , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Ansiedade/epidemiologia , Ansiedade/economia , Adulto Jovem , Depressão/epidemiologia , Depressão/economia , Estudos de Coortes , AdolescenteRESUMO
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.
Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Gastos em Saúde , Humanos , Paquistão/epidemiologia , Feminino , Gravidez , Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Ansiedade/economia , Ansiedade/epidemiologia , Qualidade de Vida , Adulto , Depressão/economia , Depressão/epidemiologia , Países em Desenvolvimento , Complicações na Gravidez/economia , Complicações na Gravidez/epidemiologia , Estudos de CoortesRESUMO
Single motherhood and poverty have a significant, negative impact on mothers and their children. When their mothers experience maternal distress, adolescent children have to take up more instrumental and emotional filial responsibilities to comfort their mother and adapt to related changes. Based on 325 mother-child dyads of Chinese single-mother families experiencing economic disadvantage, this study examined the relationship between maternal distress and adolescent mental health problems (indexed by anxiety and depression) and the moderating roles of instrumental and emotional filial responsibilities. Results indicated that maternal distress was positively associated with anxiety and depression in adolescent children. In addition, instrumental filial responsibility intensified the associations of maternal distress with adolescent anxiety and depression. Moreover, the moderating role of emotional filial responsibility in the predictive relationship between maternal distress and adolescent anxiety was different in boys and girls. Adolescent girls with more emotional filial responsibility reported higher adolescent anxiety than did those who shouldered less emotional filial responsibility when their mother exhibited more distress, whereas the relationship between maternal distress and adolescent anxiety was stable in boys, regardless of emotional filial responsibility. In short, the present study showed that parentification was likely to occur in poor Chinese single-mother families, and adolescent children who took up a more caregiving role in the family exhibited poorer mental health. Family counselling and tangible support for single-mother families experiencing economic disadvantage are urged.
Assuntos
População do Leste Asiático , Saúde Mental , Relações Mãe-Filho , Mães , Pobreza , Família Monoparental , Adolescente , Feminino , Humanos , Masculino , População do Leste Asiático/psicologia , Emoções , Saúde Mental/economia , Relações Mãe-Filho/psicologia , Mães/psicologia , Família Monoparental/psicologia , Pobreza/economia , Pobreza/psicologia , Pobreza Infantil/economia , Pobreza Infantil/psicologia , China , Ansiedade/economia , Ansiedade/psicologia , Depressão/economia , Depressão/psicologia , Saúde do Adolescente/economia , Sobrecarga do Cuidador/economia , Sobrecarga do Cuidador/psicologiaAssuntos
Análise Custo-Benefício/métodos , Atenção Plena/métodos , Cuidados Pré-Operatórios/métodos , Telemedicina/métodos , Ansiedade/diagnóstico , Ansiedade/economia , Ansiedade/terapia , Humanos , Atenção Plena/economia , Cuidados Pré-Operatórios/economia , Telemedicina/economia , Resultado do TratamentoRESUMO
Nonpharmaceutical interventions (NPI) such as stay-at-home orders aim at curbing the spread of the novel coronavirus, SARS-COV-2. In March 2020, a large proportion of the German population supported such interventions. In this article, we analyse whether the support for NPI dwindle with economic worries superimposing virus-related worries in the months to follow. We test seven pre-registered1 hypotheses using data from the German COSMO survey (Betsch, Wieler, Habersaat, et al. 2020), which regularly monitors behavioural and psychological factors related to the pandemic. The present article covers the period from March 24, 2020 to July 7, 2020 (Ntotal = 13,094), and, in addition, includes a validation study providing evidence for the reliability and validity of the corresponding COSMO measures (N = 612). Results revealed that virus-related worries decreased over time, whereas economic worries remained largely constant. Moreover, the acceptance of NPIs considerably decreased over time. Virus-related worries were positively associated with acceptance of NPIs, whereas this relationship was negative regarding economic worries (albeit smaller and less consistent). Unexpectedly, no interactions between virus-related worries and economic worries were found. We conclude that individual differences in virus-related and economic threat perceptions related to COVID-19 play an important role in the acceptance of NPIs.
Assuntos
COVID-19/economia , COVID-19/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Fatores Socioeconômicos , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/economia , Ansiedade/epidemiologia , Ansiedade/psicologia , Ansiedade/terapia , COVID-19/epidemiologia , COVID-19/terapia , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Máscaras/economia , Máscaras/tendências , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto JovemRESUMO
People living with HIV (PLWH) may be at higher risk for adverse outcomes indirectly associated with the severe acute respiratory syndrome coronavirus (SARS-CoV-2). When comparing responses to questionnaires administered when social distancing and quarantine guidelines were first implemented, we found that PLWH were more likely to have restricted access to medical care, increased financial stress, increased symptoms of anxiety and depression, and increased substance use compared to demographically-similar people without HIV.
Assuntos
Ansiedade/epidemiologia , COVID-19/epidemiologia , Depressão/epidemiologia , Infecções por HIV/epidemiologia , Pandemias , Estresse Psicológico/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Idoso , Ansiedade/economia , Ansiedade/psicologia , Ansiedade/virologia , COVID-19/economia , COVID-19/psicologia , COVID-19/virologia , Comorbidade , Depressão/economia , Depressão/psicologia , Depressão/virologia , Feminino , Infecções por HIV/economia , Infecções por HIV/psicologia , Infecções por HIV/virologia , HIV-1/patogenicidade , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/ética , Humanos , Masculino , Pessoa de Meia-Idade , Missouri/epidemiologia , Distanciamento Físico , Quarentena/economia , Quarentena/psicologia , SARS-CoV-2/patogenicidade , Estresse Psicológico/economia , Estresse Psicológico/virologia , Transtornos Relacionados ao Uso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/virologia , Inquéritos e QuestionáriosRESUMO
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].
Assuntos
Ansiedade/terapia , Reabilitação Cardíaca , Terapia Cognitivo-Comportamental , Depressão/terapia , Intervenção Baseada em Internet , Isquemia Miocárdica/reabilitação , Telemedicina , Ansiedade/diagnóstico , Ansiedade/economia , Ansiedade/psicologia , Reabilitação Cardíaca/economia , Análise Custo-Benefício , Dinamarca , Depressão/diagnóstico , Depressão/economia , Depressão/psicologia , Custos de Cuidados de Saúde , Nível de Saúde , Humanos , Intervenção Baseada em Internet/economia , Saúde Mental , Estudos Multicêntricos como Assunto , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/economia , Isquemia Miocárdica/psicologia , Pacientes Desistentes do Tratamento , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Telemedicina/economia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Young women with breast cancer tend to report lower quality of life and higher levels of stress than older women with breast cancer, and this may have implications for other psychosocial factors including finances. We sought to determine if stress, anxiety, and depression at diagnosis were associated with changes in household income over 12-months in young women with breast cancer in the United States. METHODS: This study was a prospective, longitudinal cohort study comprised of women enrolled in the Young and Strong trial. Of the 467 women aged 18-45 newly diagnosed with early-stage breast cancer enrolled in the Young and Strong trial from 2012 to 2013, 356 (76%) answered income questions. Change in household income from baseline to 12 months was assessed and women were categorized as having lost, gained, maintained the same household income <$100,000, or maintained household income ≥$100,000. Patient-reported stress, anxiety, and depression were assessed close to diagnosis at trial enrollment. Adjusted multinomial logistic regression models were used to compare women who lost, gained, or maintained household income ≥$100,000 to women who maintained the same household income <$100,000. RESULTS: Although most women maintained household income ≥$100,000 (37.1%) or the same household income <$100,000 (32.3%), 15.4% lost household income and 15.2% gained household income. Stress, anxiety, and depression were not associated with gaining or losing household income compared to women maintaining household incomes <$100,000. Women with household incomes <$50,000 had a higher risk of losing household income compared to women with household incomes ≥$50,000. Women who maintained household incomes ≥$100,000 were less likely to report financial or insurance problems. Among women who lost household income, 56% reported financial problems and 20% reported insurance problems at 12 months. CONCLUSIONS: Baseline stress, anxiety, and depression were not associated with household income changes for young women with breast cancer. However, lower baseline household income was associated with losing household income. Some young survivors encounter financial and insurance problems in the first year after diagnosis, and further support for these women should be considered. TRIAL REGISTRATION: Clinicaltrials.gov , NCT01647607 ; date registered: July 23, 2012.
Assuntos
Ansiedade/economia , Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Depressão/economia , Renda/estatística & dados numéricos , Estresse Psicológico/economia , Adolescente , Adulto , Ansiedade/etiologia , Neoplasias da Mama/economia , Ensaios Clínicos como Assunto , Depressão/etiologia , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida/psicologia , Estresse Psicológico/etiologia , Estados Unidos , Adulto JovemRESUMO
RATIONALE: Asthma is one of the most common chronic disorders of childhood and is associated with significant healthcare utilization and costs. Comorbid psychiatric illnesses, specifically depression and anxiety, are more prevalent in patients with asthma and associated with worse asthma control, more emergency department visits, and increased hospitalization rates. OBJECTIVES: We aimed to compare hospital outcomes and charges for children with severe asthma with and without comorbid depression and anxiety, hypothesizing that those with depression and anxiety would have longer hospitalizations and higher charges. METHODS: Retrospective review of the 2000-2012 Healthcare Cost and Utilization Project's Kids' Inpatient Databases for admissions of patients aged 10-21 years with an ICD-9 code severe asthma (status asthmaticus or any asthma diagnosis with a procedure code for endotracheal intubation). Depression and Anxiety subgroups were created based on ICD-9 codes. Data collected included demographics, hospital outcomes and charges and comparisons made between groups. RESULTS: There were 52,485 admissions for severe asthma: 45,094 (86%) with No Comorbid Psychiatric Illnesses, 1284 (2.4%) with depression, and 1297 (2.5%) with anxiety. Patients with depression or anxiety were older, had longer hospitalizations, and higher hospital charges (p < .001 for all). CONCLUSIONS: Comorbid depression or anxiety is associated with significantly longer hospitalizations and higher charges for children with severe asthma. These findings add to prior reports of worse outcomes for children with asthma and comorbid depression or anxiety and suggest that improved screening for and management of these conditions in children with asthma could improve hospital outcomes and reduce costs.
Assuntos
Ansiedade , Asma , Depressão , Preços Hospitalares/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Adolescente , Adulto , Ansiedade/economia , Ansiedade/terapia , Asma/economia , Asma/terapia , Criança , Bases de Dados Factuais , Depressão/economia , Depressão/terapia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: With the development of evidence-based interventions for treatment of priority mental health conditions in humanitarian settings, it is important to establish the cost-effectiveness of such interventions to enable their scale-up. AIMS: To evaluate the cost-effectiveness of the Problem Management Plus (PM+) intervention compared with enhanced usual care (EUC) for common mental disorders in primary healthcare in Peshawar, Pakistan. Trial registration ACTRN12614001235695 (anzctr.org.au). METHOD: We randomly allocated 346 participants to either PM+ (n = 172) or EUC (n = 174). Effectiveness was measured using the Hospital Anxiety and Depression Scale (HADS) at 3 months post-intervention. Cost-effectiveness analysis was performed as incremental costs (measured in Pakistani rupees, PKR) per unit change in anxiety, depression and functioning scores. RESULTS: The total cost of delivering PM+ per participant was estimated at PKR 16 967 (US$163.14) using an international trainer and supervisor, and PKR 3645 (US$35.04) employing a local trainer. The mean cost per unit score improvement in anxiety and depression symptoms on the HADS was PKR 2957 (95% CI 2262-4029) (US$28) with an international trainer/supervisor and PKR 588 (95% CI 434-820) (US$6) with a local trainer/supervisor. The mean incremental cost-effectiveness ratio (ICER) to successfully treat a case of depression (PHQ-9 ≥ 10) using an international supervisor was PKR 53 770 (95% CI 39 394-77 399) (US$517), compared with PKR 10 705 (95% CI 7731-15 627) (US$102.93) using a local supervisor. CONCLUSIONS: The PM+ intervention was more effective but also more costly than EUC in reducing symptoms of anxiety, depression and improving functioning in adults impaired by psychological distress in a post-conflict setting of Pakistan.
Assuntos
Transtornos de Ansiedade/economia , Transtornos de Ansiedade/terapia , Análise Custo-Benefício , Depressão/economia , Depressão/terapia , Organização Mundial da Saúde/economia , Organização Mundial da Saúde/organização & administração , Adulto , Ansiedade/economia , Ansiedade/terapia , Humanos , Paquistão , Resultado do TratamentoRESUMO
PURPOSE: To (1) quantify the prevalence of mood disorders in patients undergoing arthroscopic rotator cuff repair (RCR) by use of a large claims database and (2) compare opioid use and medical costs in the year before and the year after RCR between patients with and without comorbid mood disorders. METHODS: A large claims database was queried to identify patients who underwent arthroscopic RCR (Current Procedural Terminology code 29827) between October 2010 and December 2015. All patients were then screened for insurance claims relating to either anxiety or depression. We compared net costs and opioid use both 1 year preoperatively and 1 year postoperatively between patients with and without mood disorders by use of an analysis of covariance. RESULTS: A total of 170,329 patients (97,427 male patients [57.2%] and 72,902 female patients [42.8%]) undergoing arthroscopic RCR were identified. Of the 170,329 patients, 46,737 (27.4%) had comorbid anxiety or depression, and after adjustment for preoperative cost, sex, age, and both preoperative and postoperative opioid use, the 1-year postoperative cost was 7.05% higher for those with a preoperative mood disorder than for those without a mood disorder. In addition, opioid use both in the 180 days prior to surgery (36.7% vs 26.9%) and more than 90 days after surgery (33.0% vs 27.2%) was substantially greater in the group with comorbid depression or anxiety. CONCLUSIONS: In patients with comorbid mood disorders, opioid use and health care costs were increased both preoperatively and postoperatively. The increased cost in this patient population is estimated at $62.3 million annually. In an effort to provide high-quality, value-based care, treatment strategies should be developed to identify these patients preoperatively and provide the appropriate resources needed to improve the probability of a successful surgical outcome. LEVEL OF EVIDENCE: Level III, retrospective, comparative therapeutic study.
Assuntos
Analgésicos Opioides/uso terapêutico , Ansiedade/complicações , Depressão/complicações , Custos de Cuidados de Saúde , Lesões do Manguito Rotador/psicologia , Lesões do Manguito Rotador/cirurgia , Adulto , Analgésicos Opioides/economia , Ansiedade/economia , Artroplastia/efeitos adversos , Artroscopia/efeitos adversos , Bases de Dados Factuais , Depressão/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prevalência , Estudos Retrospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/complicaçõesAssuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Psoríase/psicologia , Exacerbação dos Sintomas , Desemprego/psicologia , Adulto , Ansiedade/economia , Ansiedade/epidemiologia , Ansiedade/psicologia , Betacoronavirus/patogenicidade , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Depressão/economia , Depressão/epidemiologia , Depressão/psicologia , Feminino , Humanos , Renda/estatística & dados numéricos , Internet , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Psoríase/terapia , Quarentena/economia , Quarentena/psicologia , SARS-CoV-2 , Estresse Psicológico/economia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Inquéritos e Questionários , Desemprego/estatística & dados numéricos , Adulto JovemRESUMO
PURPOSE: To determine if opioid use and health care costs in the year before and following hip arthroscopy for femoroacetabular impingement (FAI) differ between those with or without depression or anxiety. METHODS: Using the Truven Health Marketscan database, FAI patients who underwent hip arthroscopy between October 2010 and December 2015 were identified (Current Procedural Terminology codes 29914 [femoroplasty], 29915 [acetabuloplasty], and/or 29916 [labral repair]). Patients were excluded if they had incomplete coverage for 1 year either before or following surgery. The number of patients with 1 or more claims related to depression or anxiety during the year before surgery was quantified (International Statistical Classification Diseases and Related Health-9 codes 296, 298, 300, 309, 311). Health care costs in the year before and following hip arthroscopy were compared between those with or without depression or anxiety. We also compared the number of patients in each group who filled a narcotic pain prescription within 180 days before surgery as well as >60 or >90 days after hip arthroscopy. RESULTS: Depression or anxiety claims were seen in 5,208/14,830 patients (35.1%) before surgery. A significantly greater proportion of those with preoperative depression or anxiety filled opioid-related prescriptions in the 6 months before surgery (36.2% vs 25.6%, P < .0001) and both >60 days (31.3% vs 24.7%, P < .0001) and >90 days after surgery (29.5% vs 23.4%, P < .0001). The group with preoperative depression or anxiety had significantly greater health care costs both before ($8,775 vs $5,674, P < .0001) and following surgery ($5,287 vs $3,908, P < .0001). CONCLUSIONS: Both before and following hip arthroscopy, opioid use and health care costs were significantly greater for FAI patients with comorbid depression or anxiety. LEVEL OF EVIDENCE: Level III, retrospective comparative therapeutic study.
Assuntos
Analgésicos Opioides/uso terapêutico , Ansiedade/economia , Artroscopia/métodos , Bases de Dados Factuais , Depressão/economia , Impacto Femoroacetabular/cirurgia , Custos de Cuidados de Saúde , Acetabuloplastia , Adulto , Ansiedade/complicações , Artroscopia/economia , Comorbidade , Depressão/complicações , Feminino , Impacto Femoroacetabular/economia , Impacto Femoroacetabular/psicologia , Quadril/cirurgia , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Dor/cirurgia , Estudos Retrospectivos , Adulto JovemRESUMO
STUDY DESIGN: Epidemiological study based on cross-sectional data of a representative sample. OBJECTIVE: To determine whether financial worries are associated with chronic spinal pain in the US adult population. SUMMARY OF BACKGROUND DATA: This study used data from the US 2015 National Health Interview Survey. The sample size was 33,672 and the study population is defined as aged 18 to 85 years. METHODS: To account for the complex sampling design, the Taylor linearized variance estimation method was used. Spinal pain was defined in two ways: chronic low back pain and neck pain, chronic low back pain and/or neck pain. Eight types of financial worries were assessed: paying monthly bills, maintaining standard of living, credit card payments, paying rent/mortgage/housing costs, medical costs for healthcare, money for retirement, medical costs of illness/accident, and paying for children's college. RESULTS: Different types of financial worries were significantly associated with chronic spinal pain, controlling for demographic characteristics and socioeconomic status. These worries included paying monthly bills (odds ratio [OR] 2.5), maintaining standard of living (OR 2.5), credit card payments (OR 2.2), paying rent/mortgage/housing costs (OR 2.2), medical costs for healthcare (OR 2.2), money for retirement, (OR 2.3), medical costs of illness/accident (OR 2.2), and paying for children's college (OR 1.4). CONCLUSION: This study shows that financial worries were significantly associated with chronic spinal pain. Financial worries may be important to be taken into consideration by clinicians managing patients with spinal pain. More future research is needed to explore the association between financial worries and spinal pain. LEVEL OF EVIDENCE: 3.
Assuntos
Ansiedade/economia , Dor Crônica/economia , Inquéritos Epidemiológicos/economia , Dor Lombar/economia , Cervicalgia/economia , Vigilância da População , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Ansiedade/psicologia , Dor Crônica/epidemiologia , Dor Crônica/psicologia , Estudos Transversais , Feminino , Administração Financeira/economia , Administração Financeira/tendências , Inquéritos Epidemiológicos/tendências , Humanos , Dor Lombar/epidemiologia , Dor Lombar/psicologia , Masculino , Pessoa de Meia-Idade , Cervicalgia/epidemiologia , Cervicalgia/psicologia , Classe Social , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Pediatric cancer-induced financial burden is source of stress for parents, particularly mothers, single parents, and parents with lower incomes. This financial burden has been linked to poorer family quality of life (QOL) in terms of new onset material hardships, and could also affect individual QOL in terms of parents' stress-related symptoms. Our purpose was to describe pediatric cancer-induced financial burden among parents of children with that diagnosis, its effects on their stress-related symptoms (distress, anxiety, cognition impairment, sleep impairment), and associations between select risk factors (relationship to the child, marital status, income) and the extent that financial burden affected parents' symptoms. PROCEDURE: We recruited via two parent-led groups and collected data using an online survey. We calculated frequencies of demographic characteristics, financial burden, and symptoms. We used chi-square statistics to examine bivariate associations between the risk factors and extent that cancer-related financial burden affected parents' symptoms. RESULTS: Most (63.6%) respondents reported that pediatric cancer severely affected their finances. The majority (50.23-69.86%) also reported that this burden severely affected their symptoms. Marital status, income, and, for some symptoms, relationship to the child were associated with the extent that financial burden affected the symptoms. Greater proportions of mothers (53-73.5%), divorced/single parents (69.2-90.4%), and parents in the lowest income category (77.3-95.5%) experienced severely affected symptoms compared to fathers (41.7-59.5%), married/partnered parents (41.7-59.5%), and parents in the highest income category (28.6-42.9%). CONCLUSION: Financial burden and symptoms are fitting targets for interventions to improve family and individual QOL in the context of pediatric cancer.
Assuntos
Ansiedade/etiologia , Neoplasias/economia , Pais/psicologia , Qualidade de Vida , Estresse Psicológico/etiologia , Adolescente , Ansiedade/economia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Humanos , Renda , Lactente , Recém-Nascido , Masculino , Neoplasias/psicologia , Neoplasias/terapia , Fatores Socioeconômicos , Estresse Psicológico/economia , Inquéritos e QuestionáriosRESUMO
Objective: Financial problems in cancer survivors are associated with distress and reduced quality of life. Most studies have been cross-sectional, and a longitudinal study is needed to guide clinical interventions. Method: We used data from two surveys of the National Health and Aging Trends Study (NHATS). Participants (n = 307) reported whether they experienced six indicators of financial burden. The Patient Health Questionnaire 4 assessed depressive symptoms and general anxiety. Cross-lagged panel analyses assessed whether financial burden predicted distress and health or vice versa. Results: In the total sample, financial burden at the first survey predicted depressive symptoms (p < .01), general anxiety (p < .01), and self-rated health (p < .01) at the second survey. Depressive symptoms, general anxiety, and self-rated health at the first survey did not predict later financial burden (ps > .05). Discussion: Results suggest financial problems predict later distress and poor health. This study highlights the need to address financial burden in cancer survivors.
Assuntos
Ansiedade/economia , Sobreviventes de Câncer/psicologia , Depressão/economia , Estresse Financeiro , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Saúde Mental , Questionário de Saúde do Paciente , Autorrelato , Estados UnidosRESUMO
PURPOSE: Caregivers of cancer survivors may need to take time off work or make other employment changes to handle caregiving demands. Work impacts of caregiving, financial burden, and psychosocial outcomes of caregivers are not well understood. METHODS: Results include information from surveys completed by 202 employed caregivers of participants in the Detroit Research on Cancer Survivors cohort, a population-based cohort of African American survivors of breast, colorectal, lung, or prostate cancer. Relationships between work outcomes, financial burden, and anxiety and depression were assessed using logistic regression models controlling for demographic and cancer-related factors. RESULTS: Most (73.8%) caregivers made some employment change. Sixty percent changed their schedule, hours, duties, or employment status; 15.3% took at least 1 month off to provide care, and 38% reported difficulty balancing work and caregiving. Employment changes were strongly associated with difficulty balancing work and caregiving (odds ratio [OR], 5.83; 95% CI, 2.38 to 14.0) and financial burden (OR, 2.12; 95% CI, 1.05 to 4.27). Difficulty balancing work and caregiving was associated with symptoms of anxiety (OR, 1.86; 95% CI, 1.01 to 3.43) and depression (OR, 2.40; 95% CI, 1.16 to 4.96). High (v low) financial burden was associated with symptoms of anxiety (OR, 2.85; 95% CI, 1.01 to 8.06). CONCLUSION: Difficulty balancing work and caregiving is common among caregivers of African American cancer survivors and is associated with symptoms of depression and anxiety. Supports for caregivers facing employment challenges may improve their psychosocial well-being.
Assuntos
Ansiedade/economia , Sobreviventes de Câncer/psicologia , Cuidadores/economia , Custos e Análise de Custo/normas , Depressão/economia , Negro ou Afro-Americano , Cuidadores/psicologia , Emprego , Feminino , Humanos , MasculinoRESUMO
AIMS: This study evaluated the implementation costs of two group interventions, one focused on diabetes education (KnowIt) and one focused directly on diabetes distress (OnTrack), that reduced diabetes distress and HbA1C in adults with poorly controlled type 1 diabetes (T1DM) in the T1-REDEEM trial. METHODS: Resources used to provide interventions were enumerated using activity-based micro-costing methods. Costs were assigned to resources in 2017 US dollars. US median wage and benefit rates were used to calculate costs of staff time. Cost per unit change was calculated for diabetes distress and HbA1C. RESULTS: For both interventions, per participant implementation costs were approximately $250 and cost per 1.0 percentage point (11â¯mmol/mol) change in HbA1C was $1400. Cost per unit change in diabetes distress was $364 for KnowIt and $335 for OnTrack. No statistically significant differences in costs were observed. CONCLUSIONS: This is the first study to examine the costs of implementing interventions targeting diabetes distress in the context of T1DM. Both interventions had per participant implementation costs in the lower end of the range of previously examined diabetes self-management interventions ($219 to $5390). These inventions and their costs merit further attention because reducing diabetes distress may impact long term T1DM outcomes. CLINICAL TRIALS REGISTRATION: ClinicalTrials.govNCT02175732.
Assuntos
Diabetes Mellitus Tipo 1/economia , Diabetes Mellitus Tipo 1/terapia , Educação de Pacientes como Assunto , Angústia Psicológica , Psicoterapia de Grupo , Adulto , Ansiedade/economia , Ansiedade/etiologia , Ansiedade/terapia , Análise Custo-Benefício , Depressão/economia , Depressão/etiologia , Depressão/terapia , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/psicologia , Processos Grupais , Custos de Cuidados de Saúde , Humanos , Ciência da Implementação , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Educação de Pacientes como Assunto/economia , Educação de Pacientes como Assunto/métodos , Psicoterapia de Grupo/economia , Psicoterapia de Grupo/métodos , Autocuidado/economia , Autocuidado/métodos , Estresse Psicológico/economia , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Estresse Psicológico/terapiaRESUMO
It has long been recognised that given the high prevalence and considerable impact of allergic disease globally, there needs to be a focus on appropriate training for clinical professionals. The health-economic consequences of allergic disease are significant, with both direct healthcare costs (doctor, nurse and dietitian consultations, hospital admissions and prescribed medications) and indirect costs (lost school and work time, reduced productivity and over-the-counter medications). There is also a well-recognised impairment of quality of life, with less tangible costs including anxiety, distress, discomfort, disability and, occasionally, death. To help to mitigate these effects, there is a need to upskill the professional workforce at all levels, and also to equip those trained with the skills to become future healthare professional trainers. Upskilling the workforce from the grass-roots of undergraduate study in Medical, Nursing and Allied Health Professionals (AHP) through the entirety of training to senior consultant levels could have a major beneficial impact on the patient and their families, lead to a reduction in emergency use of clinical service, and help increase economic productivity.