Societal costs of untreated perinatal mood and anxiety disorders in Vermont.

PURPOSE: To estimate the societal costs of untreated perinatal mood and anxiety disorders (PMADs) in Vermont for the 2018-2020 average annual birth cohort from conception through five years postpartum. METHODS: We developed a cost analysis model to calculate the excess cases of outcomes attributed to PMADs in the state of Vermont. Then, we modeled the associated costs of each outcome incurred by birthing parents and their children, projected five years for birthing parents who do not achieve remission by the end of the first year postpartum. RESULTS: We estimated that the total societal cost of untreated PMADs in Vermont could reach $48 million for an annual birth cohort from conception to five years postpartum, amounting to $35,910 in excess societal costs per birthing parent with an untreated PMAD and their child. CONCLUSION: Our model provides evidence of the high costs of untreated PMADs for birthing parents and their children in Vermont. Our estimates for Vermont are slightly higher but comparable to national estimates, which are $35,500 per birthing parent-child pair, adjusted to 2021 US dollars. Investing in perinatal mental health prevention and treatment could improve health outcomes and reduce economic burden of PMADs on individuals, families, employers, and the state.

Health service and medication costs associated with common mental disorders and subthreshold symptoms in women: Findings from the Geelong Osteoporosis Study in Australia.

OBJECTIVE: This analysis estimated 2013 annual healthcare costs associated with the common mental disorders of mood and anxiety disorders and psychological symptoms within a representative sample of Australian women. METHODS: Data from the 15-year follow-up of women in the Geelong Osteoporosis Study were linked to 12-month Medicare Benefits Schedule and Pharmaceutical Benefits Scheme data. A Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Non-patient edition identified common mental disorders and the General Health Questionnaire 12 assessed psychological symptoms. Participants were categorised into mutually exclusive groups: (1) common mental disorder (past 12 months), (2) subthreshold (no common mental disorder and General Health Questionnaire 12 score ⩾4) or (3) no common mental disorder and General Health Questionnaire 12 score <4. Two-part and hurdle models estimated differences in service use, and adjusted generalised linear models estimated mean differences in costs between groups. RESULTS: Compared to no common mental disorder, women with common mental disorders utilised more Medicare Benefits Schedule services (mean 26.9 vs 20.0, p < 0.001), had higher total Medicare Benefits Schedule cost ($1889 vs $1305, p < 0.01), received more Pharmaceutical Benefits Scheme prescriptions (35.8 vs 20.6, p < 0.001), had higher total Pharmaceutical Benefits Scheme cost ($1226 vs $740, p < 0.05) and had significantly higher annual out-of-pocket costs for Pharmaceutical Benefits Scheme prescriptions ($249 vs $162, p < 0.001). Compared to no common mental disorder, subthreshold women were less likely to use any Medicare Benefits Schedule service (89.6% vs 97.0%, p < 0.01), but more likely to use mental health services (11.4% vs 2.9%, p < 0.01). The subthreshold group received more Pharmaceutical Benefits Scheme prescriptions (mean 43.3 vs 20.6, p < 0.001) and incurred higher total Pharmaceutical Benefits Scheme cost ($1268 vs $740, p < .05) compared to no common mental disorder. CONCLUSIONS: Common mental disorders and subthreshold psychological symptoms place a substantial economic burden on Australian healthcare services and consumers.

Financial Toll of Untreated Perinatal Mood and Anxiety Disorders Among 2017 Births in the United States.

Objectives. To estimate the economic burden of untreated perinatal mood and anxiety disorders (PMADs) among 2017 births in the United States.Methods. We developed a mathematical model based on a cost-of-illness approach to estimate the impacts of exposure to untreated PMADs on mothers and children. Our model estimated the costs incurred by mothers and their babies born in 2017, projected from conception through the first 5 years of the birth cohort's lives. We determined model inputs from secondary data sources and a literature review.Results. We estimated PMADs to cost $14 billion for the 2017 birth cohort from conception to 5 years postpartum. The average cost per affected mother-child dyad was about $31 800. Mothers incurred 65% of the costs; children incurred 35%. The largest costs were attributable to reduced economic productivity among affected mothers, more preterm births, and increases in other maternal health expenditures.Conclusions. The US economic burden of PMADs is high. Efforts to lower the prevalence of untreated PMADs could lead to substantial economic savings for employers, insurers, the government, and society.

A national study for regional variation of inpatient ECT utilization from 4,411 hospitals across the United States.

BACKGROUND: We conducted a study to examine regional variation in the utilization of inpatient electroconvulsive therapy (ECT) across the United States, and its impact on length of hospital stay and cost. METHODS: Analysis of the Nationwide Inpatient Sample databases to compare patient and hospital characteristics, and regional variation of ECT administration across different regions of the United States. RESULTS: The study included 41,055 inpatients who had ECT from 4,411 hospitals. Electroconvulsive therapy use is significantly higher in the Midwest. A higher proportion of females (65.2%) than males received ECT across the United States. Medicaid beneficiaries were less likely to undergo ECT compared with patients with Medicare (52.2%) or private insurance (32%). Electroconvulsive therapy was used mainly for mood disorders (84.3%). There were marked reductions of inpatient costs ($25,298 to $38,244) and average hospital stay (16 days) when ECT was initiated within the first 5 days of admission compared with later during the hospitalization. CONCLUSIONS: There is a wide variability of utilization of ECT, depending on the region, type of hospital, and type of insurance carrier. The utilization of ECT services is reduced across the United States. Appropriate utilization of this effective treatment can greatly help patients who are not responding to standard therapeutics, reduce overall health care cost and length of stay, and, most importantly, alleviate suffering.

Neighborhood affluence is not associated with positive and negative valence processing in adults with mood and anxiety disorders: A Bayesian inference approach.

Survey-based studies show that neighborhood disadvantage is associated with community reported mental health problems. However, fewer studies have examined whether neighborhood characteristics have measurable impact on mental health status of individuals in general and whether neighborhood characteristics impact positive/negative valence processing at both behavioral and brain levels. This study addressed these questions by investigating effects of census-based neighborhood affluence on self-reported symptoms, brain functions, and structures associated with positive/negative valence processing in a sample of individuals with mood and anxiety disorders (n = 262). Employing a Bayesian inference approach, our investigation demonstrates that neighborhood affluence fails to be associated with positive/negative valence processing measured across multiple modalities, with the only effects of neighborhood affluence identified in trait anxiety scores. These findings highlight that while community-based relationships between neighborhood characteristics and mental health problems are strong, it is much less clear that these characteristics have a measurable impact on the individual.

Healthcare utilization costs of emerging adults with mood and anxiety disorders in an early intervention treatment program compared to a matched cohort.

AIM: The First Episode Mood and Anxiety Disorder Program (FEMAP) provides treatment to emerging adults with mood and anxiety disorders in an accessible, youth-friendly environment. We sought to investigate FEMAP's impact on the costs of care. METHODS: We conducted a retrospective observational study of one-year health service costs using linked administrative datasets to compare emerging adults treated at FEMAP (FEMAP users) to propensity-score matched controls (non-users). Costs from the perspective of the Ontario Ministry of Health and Long-Term Care, included drug benefit claims, inpatient, physician and ambulatory care services. We used bootstrapping to perform unadjusted comparisons between FEMAP users and non-users, by cost category and overall. We performed risk-adjusted comparison of overall costs using generalized estimating equations. RESULTS: FEMAP users (n = 366) incurred significantly lower costs compared to non-users (n = 660), for inpatient services (-$784, 95% confidence interval [CI] -$1765, -$28), ambulatory care services (-$90, 95% CI -$175, -$14) and drug benefit claims (-$47, 95% CI -$115,-$4) and significantly higher physician services costs ($435, 95% CI $276, $581) over 1 year. The unadjusted difference in overall costs was not significant (-$853, 95% CI -$2048, $142). Following adjustment for age, sex and age at first mental health diagnosis, the difference of -$914 (95% CI (-$2747, $919)) was also not significant. CONCLUSIONS: FEMAP was associated with significantly lower costs of inpatient and ambulatory care services, and higher costs of physician services, however we are unable to conclude that FEMAP is cost-saving overall.

Association between continuity of care and subsequent hospitalization and mortality in patients with mood disorders: Results from the Korea National Health Insurance cohort.

Concerns have been raised about the loss of treatment continuity in unipolar and bipolar depressive disorder patients as continuity of care (COC) may be associated with patient outcomes. This study aimed to examine the relationship between COC and subsequent hospitalization, all-cause mortality, and suicide mortality in individuals with unipolar and bipolar disorder. Data were from the National Health Insurance (NHI) cohort, 2002 to 2013. Study participants included individuals first diagnosed with unipolar depressive disorder or bipolar affective disorder. The independent variable was COC for the first year of outpatient visits after diagnosis, measured using the usual provider of care (UPC) index. The dependent variables were hospitalization in the year after COC measurement, all-cause mortality, and suicide mortality. Analysis was conducted using logistic regression and Cox proportional hazards survival regression. A total of 48,558 individuals were analyzed for hospitalization and 48,947 for all-cause and suicide mortality. Compared to the low COC group, the medium [odds ratio (OR) 0.30, 95 percent confidence interval (95% CI) 0.19-0.47] and the high COC group (OR 0.14, 95% CI 0.09-0.21) showed statistically significant decreased odds of hospitalization. Additionally, lower likelihoods of suicide death were found in the high (HR 0.35, 95% CI 0.16-0.74) compared to the low COC group. The results infer an association between COC after first diagnosis of unipolar or bipolar depressive disorder and hospitalization and suicide mortality, suggesting the potential importance of treatment continuity in improving patient outcomes.

Influence of socio-economic factors on emotional changes during the postnatal period.

OBJECTIVES: The aim of the study was to identify socio-economic factors that may influence the emotional changes which occur among new mothers in the first days postpartum. MATERIAL AND METHODS: A group of 541 women completed a questionnaire consisting of 30 multiple-choice questions, Edinburgh Postnatal Depression Scale (EPDS), and Hospital Anxiety and Depression Scale (HADS). Statistical calculations were performed with the use of Statistica v.10 and Cytel Studio v. 9.0.0. RESULTS: The findings revealed the presence of factors which might increase the risk of mood disorders during the postpartum period. CONCLUSIONS: Women who demonstrate warning symptoms should be screened for postnatal emotional changes and mood swings during their hospitalization after delivery. EPDS seems to be a suitable tool for early detection of emotional disturbances.

Cost-effectiveness of supported employment adapted for people with affective disorders.

OBJECTIVE: The individual enabling and support (IES) model was effective in gaining competitive employment for people with affective disorders compared with traditional vocational rehabilitation (TVR) services in a randomized controlled trial in a Swedish setting. The object of this study is to perform a cost-effectiveness analysis of IES comparing to TVR. METHODS: We considered the costs of intervention and productivity gain due to increased competitive employment. We estimated quality of life using EuroQol 5 Dimension (EQ-5D) and Manchester Short Assessment of Quality of Life (MANSA) scale. EQ-5D was translated into quality-adjusted life-years (QALY), using the UK, Danish, and Swedish tariffs. We performed the analysis from a societal perspective with a one-year timeframe. RESULTS: The cost of IES was €7247 lower per person per year (2014 prices) compared to TVR. There were no significant differences in QALY improvement within or between groups. However, quality of life measured by the MANSA scale significantly improved over the study period in IES. LIMITATIONS: Besides the small sample size, details on the intervention costs for both IES and TVR group were unavailable and had to be obtained from external sources. CONCLUSIONS: Implementation of IES for people with affective disorders is most likely cost-saving and is potentially even dominating TVR, although a larger trial is required to establish this.

Utility of functioning in predicting costs of care for patients with mood and anxiety disorders: a prospective cohort study.

Development of payment systems for mental health services has been hindered by limited evidence for the utility of diagnosis or symptoms in predicting costs of care. We investigated the utility of functioning information in predicting costs for patients with mood and anxiety disorders. This was a prospective cohort study involving 102 adult patients attending a tertiary referral specialist clinic for mood and anxiety disorders. The main outcome was total costs, calculated by applying unit costs to healthcare use data. After adjusting for covariates, a significant total costs association was yielded for functioning (e=1.02; 95% confidence interval: 1.01-1.03), but not depressive symptom severity or anxiety symptom severity. When we accounted for the correlations between the main independent variables by constructing an abridged functioning metric, a significant total costs association was again yielded for functioning (e=1.04; 95% confidence interval: 1.01-1.09), but not symptom severity. The utility of functioning in predicting costs for patients with mood and anxiety disorders was supported. Functioning information could be useful within mental health payment systems.

[What do Interpreters Cost? - A Retrospective Analysis of the Costs for Interpreters in Treatment of Refugees in a Psychiatric Outpatient Clinic in Berlin]. / Was kosten uns Dolmetscher? ­ Eine retrospektive Analyse der Dolmetscherkosten in der Behandlung von Flüchtlingen in einer Psychiatrischen Institutsambulanz in Berlin.

Clinical diagnostics of mental disorders especially among refugees and asylum seekers come with unique difficulties: language barriers, different forms of expression and concepts of the understanding of mental illness as well as a different cultural background. Therefore professional interpreters are needed but associated with a higher effort related to costs and time. We conducted a retrospective analysis of costs, which incurred by the use of professional interpreters in our outpatient clinic in Berlin, Germany, in the first quarter 2016 for the treatment of refugees and asylum seekers. The sample consisted of 110 refugees and asylum seekers; the highest costs in the use of interpreters incurred among Neurotic, stress-related and somatoform disorders (53.04%), especially Posttraumatic Stress Disorder (39.04%), as well as affective disorders (38.47%), especially major depressive episodes (25.23%). Our data point out the crucial need of a regulation of costs with regard to the service of professional interpreters in Germany.

Social Welfare Centers Protect Outpatients with Mood Disorders from Risk of Hospital Admission.

BACKGROUND: South Korea faces difficulties in the management of mental disorders, and those difficulties are expected to gradually worsen. Therefore, we analyzed the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders. METHODS: We used data from the National Health Insurance Service National Sample Cohort 2002-2013, which included all medical claims filed for the 50,160 patients who were newly diagnosed with a mood disorder among the 1,025,340 individuals in a nationally representative sample. We performed a logistic regression analysis using generalized estimating equation (GEE) models to examine the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders (ICD-10: F3). RESULTS: There was a 3.9% admission rate among a total of 99,533 person-years. Outpatients who lived in regions with more social welfare centers were less likely to be admitted to a hospital (per increase of five social welfare centers per 100,000 people; OR: 0.958; 95% CI: 0.919-0.999). Social welfare centers had an especially strong protective effect on patients with relatively mild mood disorders and those who were vulnerable to medical expenditures. CONCLUSIONS: Considering the protective role of social welfare centers in managing patients with mood disorders, health-policy makers need to consider strategies for activating mental healthcare.

Family caregiver burden in mental illnesses: The case of affective disorders and schizophrenia - a qualitative exploratory study.

BACKGROUND: Caregivers of people with mental illnesses often experience a wide range of burdens. Although many studies have confirmed burdens among family caregivers of mentally ill relatives in general, specific knowledge regarding the concrete everyday hassle and existential sorrows from the caregivers subjective reasoning perspective is lacking. Furthermore, there is little evidence on the possible different effects of affective disorders and schizophrenia on the quality of burden; this is also true with regard to the role of cultural traditions and lay beliefs. AIMS: The aim of this study was to explore the specific burdens experienced by caregivers of patients with schizophrenia and affective disorders. METHODS: A qualitative study was conducted by semi-structured interviews with 45 caregivers of patients with schizophrenia and affective disorders. Data were analysed by qualitative content analysis. RESULTS: Eleven encumbering themes resulted from the interviews including incertitude, unawareness, emotional burden, stigma and blame, financial burden, physical burden, restriction in routine, disruption in routine, dissatisfaction with family, relatives, and acquaintances, troubles with patients' adherence to medication, and problems with health services and governmental support. CONCLUSIONS: Caring for a person with mental illness affects caregivers emotionally, financially, physically, and it elicits some restrictions in their routine (daily hassles). Finally, it causes conflicts in family relationships. Despite some differences regarding perceived burden among caregivers of schizophrenia and affective disorders, a common pattern of burden could be identified. Thus, authorities should provide adequate financial, educational, and psychosocial supports for caregivers of mental illnesses.

Mental illness, poverty and stigma in India: a case-control study.

OBJECTIVE: To assess the effect of experienced stigma on depth of multidimensional poverty of persons with severe mental illness (PSMI) in Delhi, India, controlling for gender, age and caste. DESIGN: Matching case (hospital)-control (population) study. SETTING: University Hospital (cases) and National Capital Region (controls), India. PARTICIPANTS: A case-control study was conducted from November 2011 to June 2012. 647 cases diagnosed with schizophrenia or affective disorders were recruited and 647 individuals of same age, sex and location of residence were matched as controls at a ratio of 1:2:1. Individuals who refused consent or provided incomplete interview were excluded. MAIN OUTCOME MEASURES: Higher risk of poverty due to stigma among PSMI. RESULTS: 38.5% of PSMI compared with 22.2% of controls were found poor on six dimensions or more. The difference in multidimensional poverty index was 69% between groups with employment and income of the main contributors. Multidimensional poverty was strongly associated with stigma (OR 2.60, 95% CI 1.27 to 5.31), scheduled castes/scheduled tribes/other backward castes (2.39, 1.39 to 4.08), mental illness (2.07, 1.25 to 3.41) and female gender (1.87, 1.36 to 2.58). A significant interaction between stigma, mental illness and gender or caste indicates female PSMI or PSMI from 'lower castes' were more likely to be poor due to stigma than male controls (p<0.001) or controls from other castes (p<0.001). CONCLUSIONS: Public stigma and multidimensional poverty linked to SMI are pervasive and intertwined. In particular for low caste and women, it is a strong predictor of poverty. Exclusion from employment linked to negative attitudes and lack of income are the highest contributors to multidimensional poverty, increasing the burden for the family. Mental health professionals need to be aware of and address these issues.

Negative socioeconomic changes and mental disorders: a longitudinal study.

BACKGROUND: There is increasing interest on whether the current global economic uncertainties have an influence on the population's mental health. In this paper, we examined the association of negative socioeconomic changes, job loss and household income reductions with incident mental disorders. The moderating effect of gender was assessed. METHODS: Data come from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a representative population-based, longitudinal study. Individuals with a paid job and without a 12-month mental disorder at baseline were selected and reassessed 3 years later (2007-2009/2010-2012). Substantial household income reductions and not being at a paid job anymore were self-reported at follow-up. Multivariate logistic models were utilised to investigate the association between these negative socioeconomic changes and the incidence of mood, anxiety and substance use Diagnostic and Statistical Manual-IV disorders assessed by the Composite International Diagnostic Interview 3.0. RESULTS: After 3 years, 6% had lost their job, 11% had a substantial household income reduction and 12.2% had developed a mental disorder. Household income reductions increased the risk of any mental disorder (aOR=1.77), particularly the risk of mood (aOR=2.24). Job loss increased the risk of mood disorders (aOR=2.02). Gender modified the relationship: job loss increased the risk of any mental disorder among men (aOR=3.04) and household income reductions did so among women (aOR=2.32). CONCLUSIONS: Negative socioeconomic changes occurring within a short time period significantly increased the risk of incident mental disorders, particularly of mood disorders. Effective interventions to alleviate the public mental health impact of negative socioeconomic changes on men and women are needed.

Cost analysis of the Communication and Low Mood (CALM) randomised trial of behavioural therapy for stroke patients with aphasia.

OBJECTIVE: To evaluate the cost effectiveness of a behavioural therapy intervention shown to be clinically effective in comparison with usual care for stroke patients with aphasia. DESIGN: Randomised controlled trial with comparison of costs and calculation of incremental cost effectiveness ratio. SETTING: Community. PARTICIPANTS: Participants identified as having low mood on either the Visual Analog Mood Scale sad item (≥50) or Stroke Aphasic Depression Questionnaire Hospital version 21 (SADQH21) (≥6) were recruited. INTERVENTIONS: Participants were randomly allocated to behavioural therapy or usual care using internet-based randomisation generated in advance of the study by a clinical trials unit. MAIN MEASURES: Outcomes were assessed at six months after randomisation, blind to group allocation. The costs were assessed from a service use questionnaire. Effectiveness was defined as the change in SADQH21 scores and a cost-effectiveness analysis was performed comparing the behavioural group with the usual care control group. The cost analysis was undertaken from the perspective of the UK NHS and Social Services. RESULTS: The greatest difference was in home help costs where there was a saving of £56.20 in the intervention group compared to an increase of £61.40 in the control group. At six months the SADQH21 score for the intervention group was 17.3 compared to the control group value of 20.4. This resulted in a mean increase of 0.7 in the control group, compared to a mean significant different decrease of 6 in the intervention group (P = 0.003). The Incremental Cost-Effectiveness Ratio indicated that the cost per point reduction on the SADQH21 was £263. CONCLUSION: Overall the behavioural therapy was found to improve mood and resulted in some encouraging savings in resource utilisation over the six months follow-up.

The effects of diabetes mellitus and hypertension on work productivity.

OBJECTIVE: The primary objective of this paper is to examine the impact of diabetes mellitus on the ability to work in patients with diabetes mellitus. The second objective of this paper is to examine the differences in the ability to work between patients with diabetes mellitus and patients with other chronic diseases, such as hypertension. MATERIAL AND METHODS: A study was conducted in 10 family medicine practices from two primary health care centers, Pale and East Sarajevo, in the period between July 2009 and May 2010, utilising a retrospective medical records review and a cross sectional survey. The outcomes used to portray respondent's health status included functional measures and ability to work. Functional measures were analyzed using SF-36 and a general questionnaire. Absenteeism and productivity loss were retrospectively analyzed for the past ten years from a regional sick-leave database and the administrative records of the Commission for the assessment of work capacity for the Pension and Disability Insurance Fund of the Republika Srpska respectively. RESULTS: Out of the total number of patients with diabetes, 24.6% had some form of disability. A statistically significant difference was found between the two groups; patients with diabetes mellitus were much more likely to have problems meeting the required standards at the workplace due to emotional and physical health issues compared to hypertensive patients. CONCLUSION: Diabetes mellitus appears to reduce an individual's ability to work in comparison to patients with hypertension. There is a need to set up a diabetes mellitus prevention program and to develop and implement effective targeted intervention to help workers to manage their disease better.

The mood disorders association of british columbia psychiatric urgent care program: a preliminary evaluation of a suggested alternative model of outpatient psychiatric care.

OBJECTIVE: To describe an alternative model of psychiatric outpatient care for patients with mood and anxiety disorders (the Mood Disorders Association of British Columbia Psychiatric Urgent Care Program or the MDA Program) using group medical visits (GMV) and (or) email communications in lieu of individual follow-up appointments. METHOD: Annual costs of the MDA Program were compared with average costs of private psychiatrists offering outpatient care and patients being treated in a mental health centre. In addition, questionnaires as to patient satisfaction with the MDA Program intake, GMV experience, and family physician satisfaction with the MDA Program were administered. RESULTS: The MDA Program model of care is significantly more cost effective than individual psychiatric outpatient care or health authority mental health centre care for patients with moderate or severe illness. Patients and family physicians were very satisfied with the model of care and GMVs offered. CONCLUSIONS: The MDA Program model of care appears to be efficient and cost-effective, and patients and referring physicians appear satisfied with the care offered in this program.

[Cost effectiveness of a health insurance based case management programme for patients with affective disorders]. / Kosteneffektivität eines krankenkassengestützten Case-Management-Programms für Patienten mit affektiven Störungen.

OBJECTIVE: Health economic evaluation of a health insurance based case management intervention for persons with mood to severe depressive disorders from payers' perspective. Intervention intended to raise utilization rates of outpatient health services. METHODS: Comparison of patients of one German health insurance company in two different regions/states. Cohort study consists of a control region offering treatment as usual. Patients in the experimental region were exposed to a case management programme guided by health insurance account manager who received trainings, quality circles and supervisions prior to intervention. Utilization rates of ambulatory psychiatrist and/or psychotherapist should be increased. Estimation of incremental cost effectiveness ratio (ICER) was intended. RESULTS: Intervention yielded benefits for patients at comparable costs. A conservative estimation of the ICER was 44,16 euro. Maximum willingness to pay was 378,82 euro per year. Sensitivity analyses showed that this amount of maximum willingness to pay can be reduced to 34,34 euro per year or 2,86 euro per month due to cost degression effects. CONCLUSIONS: The intervention gains increasing cost effectiveness by the number of included patients and case managers. Cooperation between health insurances is suggested in order to minimize intervention cost and to maximize patient benefits. Results should be confirmed by individual longitudinal data (bottom-up approach) first.

Influence of psychiatric disorders on surgical outcomes and care resource use in Japan.

OBJECTIVE: The aim of this study was to quantify the effects of psychiatric disorders on major surgery outcomes and care resource use. METHODS: This study adopted a retrospective cohort study design. The samples consisted of hospital stays. Subjects were patients who had undergone major surgery. We used multilevel regression analysis to quantify the influence of psychiatric disorders on major surgery outcomes and care resource use. RESULTS: The total number of hospital stays included in the study was 5569, of which 250 were patients with psychiatric disorders. Compared with those without psychiatric disorders, those with schizophrenia had a significantly higher risk of complications, and those with neurotic disorder tended to have fewer complications. Total cost was significantly higher for those with schizophrenia and mood disorder and significantly lower in those with neurotic disorder. Lengths of stay were significantly longer for those with schizophrenia and mood disorder but not for those with neurotic disorder. Post-surgical mortality was equivalent among those with any psychiatric disorder and among those without a psychiatric disorder. CONCLUSION: The study revealed that surgical outcomes and care resource use are differentiated by psychiatric disorders.