Impact of depressive symptoms on direct medical cost among medicare recipients with knee osteoarthritis.

OBJECTIVE: Depressive symptoms are prevalent among knee osteoarthritis (KOA) patients and may lead to additional medical costs. We compared medical costs in Medicare Current Beneficiary Survey (MCBS) respondents with KOA with and without self-reported depressive symptoms. METHODS: We identified a KOA cohort using ICD-9/10 diagnostic codes in both Part A and Part B claims among community-dwelling MCBS respondents from 2003 to 2019. We determined the presence of depressive symptoms using self-reported data on sadness or anhedonia. We considered three groups: 1) without depressive symptoms, 2) with depressive symptoms, no billable services, and 3) with depressive symptoms and billable services. We used a generalized linear model with log-transformed outcomes to compare annual total direct medical costs among the three groups, adjusting for age, gender, race, history of fall, Total Joint Replacement, comorbidities, and calendar year. RESULTS: The analysis included 4118 MCBS respondents with KOA. Of them, 27% had self-reported depressive symptoms, and 6% reported depressive symptoms and received depression-related billable services. The adjusted mean direct medical costs were $8598/year for those without depressive symptoms, $9239/year for those who reported depressive symptoms and received no billable services, and $14,229/year for those who reported depressive symptoms and received billable services. CONCLUSION: While over one quarter of Medicare beneficiaries with KOA self-reported depressive symptoms, only 6% received billable medical services. The presence of depressive symptoms led to higher direct medical costs, even among those who did not receive depression-related billable services.

Financial strain and social support as moderators of the relationship between living alone and depressive symptoms in older people.

This study investigated the moderating effect of financial strain or social support on depressive symptoms among older people living alone in Taiwan. Data were collected from the "Taiwan Longitudinal Study on Aging (TLSA)," which included 1513 participants aged 65 and over, among them, 153 (10.1%) were living alone, while 1360 (89.9%) were living with others. Measurement tools included the Depression scale (CES-D), financial stress scale, social support scale, ADL scale, IADL scale, and stress scale, with Cronbach's α coefficients were 0.85, 0.78, 0.67, 0.91, 0.90, and 0.70 respectively. Hierarchical multiple regression was used to examine the moderator effect. The findings revealed that (1) Financial strain was found to moderate the relationship between living alone and depressive symptoms, acting as a promotive moderator among older men living alone. For older women, financial stress does not moderate the relationship between living alone and depressive symptoms. However, financial strain was also identified as a significant factor associated with depressive symptoms among older women living alone. (2) Social support does not moderate effect on the relationship between living alone and depressive symptoms in older men or older women. These results underscore the importance of considering financial stress in mental health policy development by government agencies. It is imperative to address the unique challenges faced by older individuals living alone, particularly in relation to financial strain, in order to promote their mental well-being.

Decision tree-Markov model of perinatal depression screening: a cost-utility analysis.

Background: Perinatal depression affects the physical and mental health of pregnant women. It also has a negative effect on children, families, and society, and the incidence is high. We constructed a cost-utility analysis model for perinatal depression screening in China and evaluated the model from the perspective of health economics. Methods: We constructed a Markov model that was consistent with the screening strategy for perinatal depression in China, and two screening strategies (screening and non-screening) were constructed. Each strategy was set as a cycle of 3 months, corresponding to the first trimester, second trimester, third trimester, and postpartum. The state outcome parameters required for the model were obtained based on data from the National Prospective Cohort Study on the Mental Health of Chinese Pregnant Women from August 2015 to October 2016. The cost parameters were obtained from a field investigation on costs and screening effects conducted in maternal and child health care institutions in 2020. The cost-utility ratio and incremental cost-utility ratio of different screening strategies were obtained by multiplicative analysis to evaluate the health economic value of the two screening strategies. Finally, deterministic and probabilistic sensitivity analyses were conducted on the uncertain parameters in the model to explore the sensitivity factors that affected the selection of screening strategies. Results: The cost-utility analysis showed that the per capita cost of the screening strategy was 129.54 yuan, 0.85 quality-adjusted life years (QALYs) could be obtained, and the average cost per QALY gained was 152.17 yuan. In the non-screening (routine health care) group, the average cost was 171.80 CNY per person, 0.84 QALYs could be obtained, and the average cost per QALY gained was 205.05 CNY. Using one gross domestic product per capita in 2021 as the willingness to pay threshold, the incremental cost-utility ratio of screening versus no screening (routine health care) was about -3,126.77 yuan, which was lower than one gross domestic product per capita. Therefore, the screening strategy was more cost-effective than no screening (routine health care). Sensitivity analysis was performed by adjusting the parameters in the model, and the results were stable and consistent, which did not affect the choice of the optimal strategy. Conclusion: Compared with no screening (routine health care), the recommended perinatal depression screening strategy in China is cost-effective. In the future, it is necessary to continue to standardize screening and explore different screening modalities and tools suitable for specific regions.

Occult, undiagnosed obstructive sleep apnea is associated with increased health care resource utilization and costs among older adults with comorbid depression: a retrospective cohort study among Medicare beneficiaries.

Obstructive sleep apnea and depression are highly comorbid among older adults, and each is associated with increased economic costs and health care resource utilization. The purpose of this study was to determine the economic burden of comorbid occult obstructive sleep apnea among a random sample of older adult Medicare beneficiaries in the United States. Among 41,500 participants with preexisting depression and meeting inclusion criteria, 4,573 (11%) had occult OSA. In fully adjusted models, beneficiaries with occult OSA were heavier users of inpatient (rate ratio: 1.53; 95% CI: 1.39, 1.67), outpatient (rate ratio: 1.18; 95% CI: 1.10, 1.27), emergency department (rate ratio: 1.48; 95% CI: 1.35, 1.63), and prescription (rate ratio: 1.09; 95% CI: 1.05, 1.14) services. Mean total costs were also significantly higher among beneficiaries with occult OSA ($44,390; 95% CI: $32,076, $56,703). CITATION: Wickwire EM, Albrecht JS. Occult, undiagnosed obstructive sleep apnea is associated with increased health care resource utilization and costs among older adults with comorbid depression: a retrospective cohort study among Medicare beneficiaries. J Clin Sleep Med. 2024;20(5):817-819.

Health care resource utilization and costs associated with psychiatric comorbidities in adult patients with attention-deficit/hyperactivity disorder.

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.

Financial burden and physical and emotional quality of life in COPD, heart failure, and kidney failure.

Patients with chronic and serious illnesses experience significant quality of life concerns. More research is needed to understand the impact of financial burden on patients with COPD, heart failure, and kidney failure. Patients with COPD, heart failure, or kidney failure completed a cross-sectional online survey using validated measures of financial burden (general financial strain as well as financial toxicity attributable to treatment), physical quality of life (symptom burden and perceived health), and emotional quality of life (anxiety, depression, and suicidal ideation). ANCOVA was used to examine whether financial strain and financial toxicity were associated with physical and emotional quality of life, while accounting for key covariates. Among 225 participants with COPD (n = 137), heart failure (n = 48), or kidney failure (n = 40), 62.2% reported general financial strain, with 34.7% experiencing financial toxicity attributable to treatments. Additionally, 68.9% rated their health as fair or poor, experiencing significant symptom burden including fatigue, dyspnea, and chest pain. Participants also reported clinically relevant levels of anxiety (55.1%), depression (52.0%), and suicidal ideation (21.8%). In the total sample, financial strain was associated with worse physical and emotional quality of life on all measures (all Ps < .001). Financial toxicity attributable to treatment was not associated with quality of life in the total sample or subsamples. Patients with COPD, heart failure, and kidney failure face significant financial, physical, and emotional burdens. Financial strain appears to undermine physical and emotional quality of life. Our study highlights the demand for interventions aimed at mitigating financial strain and toxicity experienced by individuals with chronic illnesses.

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.

Economic Evaluation of Videoconference Group Acceptance and Commitment Therapy and Behavioral Activation Therapy for Depression Versus Usual Care Among Adults With Chronic Low Back Pain Plus Comorbid Depressive Symptoms.

Chronic pain and depression are frequently comorbid conditions associated with significant health care and social costs. This study examined the cost-utility and cost-effectiveness of videoconference-based group forms of Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD), as a complement to treatment-as-usual (TAU), for patients with chronic low back pain (CLBP) plus depressive symptoms, compared to TAU alone. A trial-based economic evaluation (n = 234) was conducted from a governmental and health care perspective with a time horizon of 12 months. Primary outcomes were the Brief Pain Inventory-Interference Scale (BPI-IS) and Quality Adjusted Life Year. Compared to TAU, ACT achieved a significant reduction in total costs (d = .47), and BATD achieved significant reductions in indirect (d = .61) and total costs (d = .63). Significant improvements in BPI-IS (d = .73 and d = .66, respectively) and Quality Adjusted Life Year scores (d = .46 and d = .28, respectively) were found in ACT and BATD compared to TAU. No significant differences in costs and outcomes were found between ACT and BATD. In the intention-to-treat analyses, from the governmental and health care perspective, no significant differences in cost reduction and incremental effects were identified in the comparison between ACT, BATD, and TAU. However, in the complete case analysis, significant incremental effects of ACT (∆BPI-IS = -1.57 and -1.39, respectively) and BATD (∆BPI-IS = -1.08 and -1.04, respectively) compared with TAU were observed. In the per-protocol analysis, only the significant incremental effects of ACT (∆BPI-IS = -1.68 and -1.43, respectively) compared to TAU were detected. In conclusion, ACT and BATD might be efficient options in the management of CLBP plus comorbid depression symptoms as compared to usual care. However, no clear difference was found in the comparison between the 2 active therapies regarding cost-effectiveness or cost-utility. PERSPECTIVE: The economic evaluation of psychological therapies for the management of complex conditions can be used in decision-making and resource allocation. This study provides evidence that ACT and BATD are more effective and involve a greater reduction in costs than usual care in the management of CLBP plus comorbid depressive symptoms. TRIAL NUMBER: NCT04140838.

Análisis de costos de atención médica para esquizofrenia y depresión en México para el periodo 2005-2013 / Cost analyses of medical care for schizophrenia and depression in México, 2005-2013 / Análises de custos da atenção médica para esquizofrenia e depressão no México no período de 2005-2013

El objetivo fue identificar los costos de la atención para enfermedades de salud mental en el sistema de salud de México. Se trata de una investigación evaluativa de tipo transversal retrospectivo. Se seleccionaron como trazadores del problema dos de las principales demandas de salud mental en los últimos años: depresión y esquizofrenia. La incidencia acumulada anual se identificó a partir del reporte epidemiológico por tipo de institución para el periodo 2005-2013. El costo del manejo anual de caso promedio se determinó a partir de la técnica de instrumentación y consenso, identificando las funciones de producción, el tipo de insumos, los costos y cantidad de insumos requeridos, concentrados en la matriz de caso promedio. Finalmente, se aplicó un factor de ajuste econométrico para controlar efecto inflacionario para cada año del periodo de estudio. El costo promedio del manejo anual de un caso en dólares americanos para esquizofrenia fue de 2.216,00 y para depresión 2.456,00. Para todas las instituciones del sistema de salud se observan tendencias epidemiológicas y económicas crecientes y constantes. El costo total para ambas enfermedades para el último año del periodo (2013) fue de USD 39.081.234,00, USD 18.119.877,00 para esquizofrenia y USD 20.961.357,00 para depresión. El mayor impacto para ambas enfermedades está en las instituciones para población no asegurada (USD 24.852.321,00) vs. población asegurada (USD 12.891.977,00). El costo de satisfacer la demanda de servicios para ambas enfermedades difiere considerablemente entre las instituciones que se ocupan de la población asegurada vs. población no asegurada, siendo mayor el de las segundas. Los indicadores epidemiológicos y económicos de este estudio contribuyen a la generación de evidencias para tomar decisiones en el uso y asignación de recursos para los servicios de salud que demandarán ambas enfermedades en los próximos años.

The study aimed to analyze the costs of medical care for mental disorders in the Mexican health system. This was a retrospective cross-sectional evaluation study. As markers for the problem, the study selected two of the principal psychological processes in mental disorders in recent years: depression and schizophrenia. Annual accumulated incidence was identified based on epidemiological reporting by type of institution in 2005-2013. The mean annual case management cost was determined with the instrumentation and consensus technique, identifying the production functions, types of inputs, costs, and amounts of inputs ordered, concentrated in the mean case matrix. Finally, an econometric adjustment factor was applied to control the inflationary effect for each year in the study period. Mean annual case management cost was USD 2,216.00 for schizophrenia and USD 2,456.00 for depression. All the institutions in the Mexican health system showed upward and constant epidemiological and economic trends. The total cost for the two disorders in the last year of the period (2013) was USD 39,081,234.00 (USD 18,119,877.00 for schizophrenia and USD 20,961,357.00 for depression). The largest impact for the two disorders combined was in institutions serving the population without health insurance (USD 24,852,321.00) versus the population with private insurance (USD 12,891,977.00). The cost of meeting the demand for services for the two disorders differs considerably between institutions that treat the population with private health service versus the population without, and is higher in the latter. The study's epidemiological and economic indicators provide evidence for decision-making in the use and allocation of healthcare resources for these two disorders in the coming years.

O trabalho teve como objetivo identificar os custos na atenção médica para doenças mentais no sistema de saúde no México. Trata-se de uma pesquisa de avaliação de tipo transversal retrospectiva. Foram selecionados como marcadores do problema dois dos principais processos psíquicos de doenças mentais nos últimos anos: depressão e esquizofrenia. A incidência acumulada anualmente foi identificada a partir do relatório epidemiológico por tipo de instituição no período de 2005-2013. O custo médio da gestão anual de caso foi determinado a partir da técnica de instrumentação e consenso, identificando-se as funções de produção, o tipo de insumos, os custos e quantidade de insumos solicitados, concentrados na matriz de caso médio. Por fim, foi aplicado um fator de ajuste econométrico para controlar o efeito inflacionário para cada ano do período de estudo. O custo médio da gestão anual de um caso em dólares americanos para esquizofrenia foi de 2.216,00 e para depressão 2.456,00. Para todas as instituições do sistema de saúde observam-se tendências epidemiológicas e econômicas crescentes e constantes. O custo total para ambas as doenças no último ano do período (2013) foi de USD 39.081.234,00 - USD 18.119.877,00 para esquizofrenia e USD 20.961.357,00 para depressão. O maior impacto para ambas as doenças encontra-se nas instituições para população sem seguro médico (USD 24.852.321,00) vs. população com seguro privado (USD 12.891.977,00). O custo a fim de poder satisfazer a demanda dos serviços para as duas doenças é diferente consideravelmente entre as instituições que se ocupam da população com seguro médico privado vs. população sem seguro médico, sendo maior o das segundas. Os indicadores epidemiológicos e econômicos deste estudo contribuem para a geração de evidências para a tomada de decisões no uso e atribuição dos recursos orientados aos serviços de saúde que vão ser demandados por causa das duas doenças nos próximos anos.

Evaluación económica de la desvenlafaxina en el tratamiento de la depresión mayor en España / Economic evaluation of desvenlafaxine in the treatment of major depressive disorder in Spain

INTRODUCCIÓN: El objetivo del análisis fue evaluar el valor clínico y económico del uso de desvenlafaxina-50 mg comparado con la práctica médica (pool de pacientes tratados con duloxetina o venlafaxina) tras el fracaso del tratamiento de primera línea de la depresión mayor en España. MATERIALES Y MÉTODOS: Modelo Markov que sigue una cohorte de pacientes diagnosticados con depresión mayor, tras el fracaso del tratamiento de primera línea con inhibidores selectivos de la recaptación de serotonina y estima la respuesta al tratamiento (porcentaje de remisión y días libres de depresión) y los costes directos incurridos durante el tratamiento. Los datos de eficacia considerados en el análisis fueron obtenidos de ensayos clínicos a partir de una revisión de la literatura. Los principales supuestos del modelo, así como el uso de recursos, fueron validados por expertos clínicos. El análisis de realizó en el año 2014 desde la perspectiva del Sistema Nacional de Salud. RESULTADOS: Debido al menor número de discontinuaciones, iniciar el tratamiento de segunda línea con desvenlafaxina se asoció a un mayor número de días libres de depresión (+1,7) y un mayor porcentaje de pacientes en remisión (+0,5%). Esto se tradujo en un menor coste farmacológico y del manejo de los eventos y en un ahorro total para el Sistema Nacional de Salud de 108 €. CONCLUSIONES: En pacientes no respondedores al tratamiento con inhibidores selectivos de la recaptación de serotonina en primera línea de la depresión mayor, desvenlafaxina-50 mg mostró una efectividad clínicamente similar a los otros tratamientos usados en la práctica médica, pero con un menor coste para el Sistema Nacional de Salud

INTRODUCTION: The objective of this analysis was to evaluate the clinical and economic value of the use of 50 mg-desvenlafaxine compared to the usual care (mix of duloxetine and venlafaxine) in the outpatient treatment of major depressive disorder after first line treatment failure (relapse) in Spain. MATERIALS AND METHODS: A Markov model was used to follow up a cohort of major depressive disorder patients for one year after failure of first-line treatment with a serotonin-specific reuptake inhibitor and estimate outcome measures (percentage remission and depression-free days) and accrued and direct costs incurred during outpatient treatment of major depressive disorder. In order to obtain the efficacy data related to the treatment alternatives, a literature review of clinical trials was performed. A panel of clinical experts validated the use of clinical resources employed in the estimation of economic outcomes together with model assumptions. The analysis was performed in 2014 from the perspective of the National Health System. RESULTS: Due to fewer discontinuations, initiating second line treatment with desvenlafaxine was associated with more depression-free days and a higher percentage of patients in remission versus usual care: 1.7 days and 0.5%, respectively. This was translated into lower drug and events management costs, and an overall cost reduction of € 108 for the National Health System. CONCLUSIONS: In patients who have not responded to a first-line serotonin-specific reuptake inhibitor therapy, desvenlafaxine-50 mg was clinically similar in effectiveness, but a less costly option, compared with a weighted average of duloxetine and venlafaxine for the second-line treatment of major depressive disorder patients from a payer (National Health System) perspective in Spain

Perfil sociodemográfico, econômico e de saúde de idosos rurais segundo o indicativo de depressão / Sociodemographic, economic and health profile of the rural elderly, according to depression indicators / Perfil sociodemográfico, económico y de salud de ancianos rurales según el indicativo de depresión

Objetivou-se comparar as variáveis sociodemográficas, econômicas e percepção de saúde de 374 idosos residentes na zona rural, divididos em dois grupos: 187 com indicativo de depressão e 187 sem indicativo. Utilizaram-se: Mini Exame(o nome é assim registrado? o correto seria: Miniexame) de Estado Mental, parte do Older Americans Resources and Services e a Escala de Depressão Geriátrica Abreviada. Para tanto, procedeu-se à análise estatística descritiva. Em ambos os grupos, predominaram: sexo feminino, 60├70 anos, casados, 4├8 anos de escolaridade e renda de um salário mínimo. A proporção de idosos com indicativo de depressão, que referiu ter se aposentado por motivo de saúde, satisfazer mal suas necessidades básicas, residir em casa cedida, situação de saúde péssima, piora na saúde comparada com 12 meses anteriores e saúde pior que de outros da mesma idade, foi significativamente superior àqueles sem indicativo. Este estudo pode contribuir para o conhecimento das peculiaridades de saúde de idosos rurais, com isso, auxiliando em políticas públicas, especialmente quanto à depressão.

The goal of the present study is to compare sociodemographic, economic and health perception variables among 374 elderly individuals inhabitants of a rural area, divided in two groups: 187 displaying depression indicators and 187 without. The study used: Mini Mental State Exam, part of the Older Americans Resources and Services, and the Abbreviated Geriatric Depression Scale. Analysis was carried out using descriptive statistics. Both groups displayed a prevalence of: female sex, 60├70 years of age, married, 4├8 years of schooling and income of one monthly minimum wage. The present study can contribute towards knowledge of the peculiarities of the health of the elderly in rural areas, assisting with public policy, especially with regards to depression

Se objetivó comparar variables sociodemográficas, económicas y percepción de salud de 374 ancianos residentes en zona rural, divididos en dos grupos: 187 con indicativo de depresión y 187 sin indicativo. Se utilizaron: Mini Examen de Estado Mental, parte del Older Americans Resources and Services y Escala de Depresión Geriátrica Abreviada. Se aplicó análisis estadístico descriptivo. En ambos grupos predominaron: sexo femenino, 60├70 años, casados, 4├8 años de escolarización, ingresos de un salario mínimo. La proporción de ancianos con indicativo de depresión que informó haberse jubilado por razones de salud, satisfacción insuficiente de necesidades básicas, residencia en domicilio cedido, refirieron situación de salud pésima, empeoramiento de salud comparada con 12 meses anteriores y salud peor que la de otros de la misma edad, fue significativamente superior a aquellos sin indicativo. Este estudio puede contribuir al conocimiento de particularidades sanitarias de ancianos rurales, colaborando con políticas públicas, en particular referidas a depresión

El abordaje de la depresión en el ámbito del trabajo: recomendaciones clave / Management of depression in the work setting: key recommendations

La depresión en el ámbito del trabajo representa una de las primeras causas de pérdida de productividad, absentismo laboral, incremento de accidentes laborales, utilización de los servicios de salud y jubilación anticipada. Los costes totales atribuibles a la depresión constituyen más del 1% del PIB, por lo que su correcto abordaje repercutirá no solo en el bienestar emocional de los trabajadores sino también en la productividad de las empresas y la sostenibilidad del Sistema Nacional de Salud. La depresión no solo es un problema estrictamente sanitario, sino que hay que enmarcarlo en un contexto mucho más amplio vinculado al bienestar social. El presente documento es el resultado de un proceso de consulta y reuniones entre un grupo multidisciplinar de expertos y ofrece una serie de recomendaciones sobre la definición, detección y opciones de tratamiento de la depresión, con especial interés en el ámbito del trabajo. Entre otras medidas, se propone promover programas que permitan concienciar y ayudar a los empleados y empleadores a reconocer y manejar la depresión en los lugares de trabajo, así como mejorar las políticas y la legislación que les protegen. Esta estrategia multidimensional y efectiva, basada en un acercamiento holístico al problema, debe situar la depresión como un problema clave en las empresas, cuyo abordaje debe ser un objetivo estratégico prioritario (AU)

Depression in the work setting is one of the leading causes of lost productivity, absenteeism, increased accidents, use of health services, and early retirement. As the total costs attributable to depression are more than 1% of GDP, the correct approach will impact not only on the emotional welfare of workers but also on business productivity and sustainability of the National Health System. Depression is not just a health problem, but should be framed it in a much broader context linked to social welfare. This document is the result of a process of consultation and meetings between a multidisciplinary group of experts, and offers a series of recommendations on the definition, detection and treatment options of depression, with special interest in the occupational setting. Among other measures, it intends to promote programs that should raise awareness and help employees and employers to recognise and manage depression in the workplace, and to improve policies and legislation that protect them. This multidimensional and effective strategy, based on a holistic approach to the problem, places depression as a key problem in companies, for which the approach should be a priority strategic objective (AU)

Variables moduladoras de la discapacidad asociada al trastorno depresivo / Modulating variables of work disability in depressive disorders

Objetivos. Describir la duración de la incapacidad temporal asociada a los trastornos depresivos unipolares y determinar su asociación con variables demográficas laborales y clínicas. Métodos. Estudio observacional prospectivo. Selección secuencial sistemática de una muestra de 1.292 sujetos con diagnóstico de trastorno depresivo (CIE-9-MC) en situación de incapacidad temporal en una mutua de accidentes de trabajo y enfermedades profesionales. Se realizó un análisis descriptivo de la duración de la incapacidad temporal y análisis bivariados (contraste de la mediana) y multivariados (regresión logística) para encontrar asociaciones con variables demográficas, laborales y clínicas. Resultados. La mediana de duración de la incapacidad temporal por trastorno depresivo fue de 120 días. Ser mujer (p<0,01), una mayor edad (p<0,01), menor nivel educativo (p<0,01), las modalidades de pago directo durante la baja (trabajadores autónomos y que quedaran en desempleo durante la misma) (p<0,01) y la derivación conjunta a un psiquiatra y un psicólogo (p<0,01) se asociaron con un riesgo mayor de cronicidad en el análisis multivariante. Conclusiones. Los resultados confirman el papel de la depresión como importante generador de incapacidad laboral y señalan la necesidad de introducir mejoras en la evaluación y promoción de la capacidad funcional del enfermo, en el tratamiento del trastorno, así como en el itinerario asistencial del paciente depresivo(AU)

Objectives. To describe the duration of sickness absence in unipolar depression and to determine the relationship of demographic, job-related and clinical variables with length of temporary work disability in depressive disorders. Methods. Prospective observational study. A total of 1,292 subjects with depressive disorder diagnosis (ICD-9-CM) were selected claiming sick leave in an Occupational Diseases and Accident sat Work Insurance Scheme (sampling on successive occasions). Descriptive analyses of sickness absence duration, and bivariate (median test) and multivariate analysis (logistic regression) were performed to find relationships between demographic, job-related and clinical variables. Results. Mean duration of sickness absence episodes due to a depressive disorder was 120 days. After multivariate analyses, female sex (p<0.01), higher age (p<0.01), lower educational level (p<0.01), method of payment according to whether self-employed or unemployed workers (p<0.01) and being referred to both psychiatrist and psychologist (p<0.01) remained significantly associated with sick leave length. Conclusions. These findings confirm a strong association of depression with long periods of work disability and high absenteeism, and also suggest the need for improvements in functional ability assessment and promotion, treatment and referral of depressed patients(AU)

La depresión: una hipoteca social. Últimos avances en el conocimiento del coste de la enfermedad / Depression: a social mortgage. Latest advances in knowledge of the cost of the diasease

Introducción. Tras la realización del último examen sobre la situación mundial de la salud mental, la Organización Mundial de la Salud ha estimado que la depresión produce la mayor disminución en salud en comparación con otras enfermedades crónicas y ha instado a todos los países a aumentar las inversiones y la cobertura de servicios en esta materia. Metodología. A la hora de invertir recursos en el cuidado de los pacientes con depresión, los estudios de costes de la enfermedad son complementarios a los de morbimortalidad y de gran relevancia a la hora de establecer políticas sanitarias. La finalidad de este trabajo es describir el impacto económico de la depresión en nuestro entorno a la luz de las últimas publicaciones a este respecto. Resultados. El coste total de la depresión en Europa se ha estimado en 118 billones de euros, y la mayor parte de esta cifra (61%) se debe a los costes indirectos referidos a bajas por enfermedad y pérdidas de productividad. La carga económica de la depresión en España ascendería a 5.005 millones de euros anuales, con una distribución por categoría de recursos muy parecida a la europea. Conclusiones. Los sistemas sanitarios y la sociedad tienen que hacer frente al alto coste de la depresión dado que conlleva una elevada utilización de recursos, principalmente fuera del sector sanitario. Existen diversas áreas de mejora con el objetivo de reducir la carga social de la depresión, pero la incorporación de la economía de la salud mental a las políticas sanitarias debe convertirse en una prioridad (AU)

Introduction. Following the latest examination of the worldwide mental health situation, the World Health Organization has estimated that depression produces the greatest decrement in health compared with other chronic diseases, and has encouraged to all countries to increase investment and resources in this field. Methodology. On investing resources for the care of patients with depression, cost of illness studies are a complement to morbidity-mortality studies, and are of great relevance in defining health care policies. The present study describes the economic impact of depression in our setting, in the light of the most recent publications on this subject. Results. The total cost of depression in Europe has been estimated to reach 118 billion euros, and most of this amount (61 %) is due to indirect costs associated with sick leave and productivity losses. The economic burden of depression in Spain could add up to 5.005 million euros a year, with a resource category distribution very similar to that found in Europe as a whole. Conclusions. Health care systems and society must cope with the important costs of depression, which implies intense resource utilization, fundamentally outside the health care sector as such. There are a number of areas in which improvements can be made in order to reduce this important burden associated with depression, though the incorporation of health economics to public health care policies must become a priority (AU)

Una aproximación al costo del tratamiento de las enfermedades mentales en México: depresión y esquizofrenia / Cost approximation for the treatment of mental illnesses im Mexico: depression and schizophrenia

En el contexto de las reformas del sector, se plantea la necesidad de distribuir los recursos financieros eficientemente, mediante el establecimiento de patrones de asignación para las demandas específicas de salud (9,13) teniendo como hilo conductor la incorporación de las perspectivas económica y epidemiológica. Tenemos antecedentes en torno de este tipo de evaluación sobre las diversas demandas de salud. Sin embargo, la evaluación económica de la producción de servicios para la salud mental, objeto de este estudio se ha abordado en escasas investigaciones. Más aún, dicha evaluación se plantea de manera aislada, como una demanda más de salud que debe satisfacerse sin entrar en detalles sobre las implicaciones económicas que tienen tanto la producción como el financiamiento, y sobre todo, el desequilibrio del mercado de la atención médica. Este trabajo incluye los resultados de una investigación evaluativa hecha en México, en la que se determinaron el costo promedio del manejo de los casos de depresión y esquizofrenia, los recursos finacieros requeridos para satisfacer la demanda en cada tipo de institución durante 1994, y el gasto per capita de acuerdo con el tipo de institución de que se trate. El costo promedio del manejo de un caso de esquizofrenia fue de $1230.00, y de depresión, $1292.00. La demanda más importante por ambas enfermedades, (96 por ciento del total nacional de depresión y 94 por ciento del total nacional por esquizofrenia) se presentó en tres instituciones: en el IMSS, en la SSA y en el ISSSTE, en ese orden. El costo del manejo de los casos de hipertensión y diabetes ocupa el rango superior, seguido del de las enfermedades mentales y en tercer lugar, el de la neumonía y la diarrea. El costo económico de satisfacer la demanda de servicios difiere considerablemente entre las instituciones que se ocupan de la población asegurada y las instituciones destinadas a la población no asegurada, siendo mayor el de las primeras. Independientemente de las diferencias encontradas, estos resultados permiten identificar indicadores de evaluación económica que pueden utilizarse para diseñar mecanismos de asignación de recursos a cada una de las instituciones estudiadas

Valoración del componente funcional que subyace al uso reiterado de un servicio de urgencias hospitalario y de sus repercusiones económicas / Psychosocial characteristics of non-organic frequent emergency department users and generated costs

Fundamento: Analizar las características psicosociales de los pacientes con un componente funcional relevante que utilizan reiteradamente nuestro servicio de urgencias hospitalario (SUH) y estimar los costes generados por su atención sanitaria. Métodos: Estudio descriptivo retrospectivo (enero 1996-junio 1997) de los pacientes hiperfrecuentadores (HF) del SUH definidos como 3 ó más visitas/semestre durante al menos dos semestres. Revisando sus historias y realizando una entrevista psiquiátrica identificamos a los HF funcionales (HFF). Posteriormente estimamos el coste generado por los episodios con destino alta durante el primer semestre de 1997. Resultados: De 220 HF identificados 66 fueron considerados HFF. La media de consultas fue 11,3ñ9,4. Clínicos y psiquiatras coincidieron en la existencia de funcionalidad en 40/55 (72,7 porciento). Los diagnósticos más frecuentes fueron: trastorno de personalidad (37,5 porciento) y ansiedad-depresión (35 porciento). Los HF psiquiátricos eran más jóvenes (51,7 vs 62,9 años) y consultaban más veces (17,6 vs 9,9). Las 240 asistencias a HFF en el semestre estudiado causaron un único ingreso. Coste promedio del episodio altado fue 8.682,9ñ6.633,8 ptas. El 25,06 porciento se atribuyó a coste variable. El coste del minuto de permanencia en urgencias se estimó en 19,26 ptas. El coste global de atención a HFF durante el semestre estudiado fue 1.903.775 ptas. (0,36 porciento del coste total). Conclusiones: Los HFF suponen proporcionalmente mayor carga en el SUH que el resto de población. Los pacientes con trastorno mental son más jóvenes y acuden más reiteradamente que el resto de HF al Servicio de Urgencias. Sólo un 25 porciento del coste por consulta se debe a material, tratamiento, pruebas o dietas (AU)

Vida a crédito: conversas com Citlali Rovirosa-Madrazo / Life credit: conversations with Citlali Rovirosa-Madrazo

Neste livro, Bauman analisa algumas questões morais e políticas. Instigado pelas perguntas da jornalista e pesquisadora Citlali Rovirosa-Madrazo, o sociólogo fala, entre outros temas, da crise financeira mundial, do fundamentalismo religioso, e até de fenômenos como a engenharia genética e a clonagem humana. O autor desenha o cenário do mundo e explica como se passa de uma sociedade de produtores para uma de consumidores. Nesse panorama, homens e mulheres, velhos ou jovens, se transformam numa verdadeira raça de devedores.