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1.
Ann Agric Environ Med ; 26(4): 600-605, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31885234

RESUMO

OBJECTIVE: The aim of the study was evaluation of the relationship between severity of symptoms of climacteric syndrome, depressive disorders and sleep problems, and the self-rated work ability of peri-menopausal and post-menopausal women in non-manual employment. MATERIAL AND METHODS: The study included 287 women aged 45-60 years, employed in various institutions as non-manual workers. Work Ability Index, Greene Climacteric Scale, Beck Depression Inventory, and Athens Insomnia Scale were used. RESULTS: The examined peri-menopausal and post-menopausal women in non-manual employment obtained good work ability on the Work Ability Index. The severity of menopausal syndrome, according to the Greene Climacteric Scale, was moderate, placing the examined women between results for the general population of women and the pattern for menopausal women. Depressive disorders ranked between low mood and moderate depression. No depression was observed in 59% of the women, whereas moderate depression was observed in 39%, and severe depression in only 2%. Sleep disorders were on the border of normal range. As many as 46% of the women had no sleep problems, which was on the border of normal range in 36%. Only 19% of the examined women suffered from insomnia. Work ability correlated negatively with depression and insomnia severity, as well as with psychological and vasomotor symptoms of climacteric syndrome, but not to its somatic symptoms. CONCLUSIONS: Preventing the occurrence and treatment of menopausal symptoms, sleep and mood disorders may contribute to maintaining the work ability of women in peri- and post-menopausal age.


Assuntos
Climatério/fisiologia , Depressão/fisiopatologia , Perimenopausa/psicologia , Pós-Menopausa/psicologia , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Climatério/psicologia , Depressão/economia , Depressão/psicologia , Emprego , Feminino , Humanos , Pessoa de Meia-Idade , Perimenopausa/fisiologia , Pós-Menopausa/fisiologia , Distúrbios do Início e da Manutenção do Sono/economia , Distúrbios do Início e da Manutenção do Sono/psicologia , Avaliação da Capacidade de Trabalho
2.
Lakartidningen ; 1162019 Nov 01.
Artigo em Sueco | MEDLINE | ID: mdl-31688945

RESUMO

By strengthening accessibility and continuity and support via a care manager for primary care patients with depression corresponding to 20-30% of a nursing service, patients recovered significantly faster and to a greater extent than in primary care-as-usual. Return to work occurred significantly earlier in the first three months, and net sick leave period was significantly shorter during the following 4-6 months. To introduce a collaborative care organizational change where the care manager is the hub and coordinates care for the patient and makes it possible to adapt the care according to the patient's needs throughout the care process, is thus the individual effort shown to have the greatest efficiency in Swedish primary care to increase the quality of care of depression. This approach, where the clinic and academy work closely and continuously in the development and evaluation phases, makes it possible to rapidly develop new ways of working where consideration is given to the complexity of primary care and the complexity of care needs and care efforts.


Assuntos
Administração de Caso , Depressão/terapia , Transtorno Depressivo/terapia , Administração dos Cuidados ao Paciente , Assistência ao Convalescente , Atitude do Pessoal de Saúde , Continuidade da Assistência ao Paciente , Análise Custo-Benefício , Depressão/economia , Transtorno Depressivo/economia , Progressão da Doença , Humanos , Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Retorno ao Trabalho , Licença Médica , Suécia , Resultado do Tratamento
4.
Artigo em Inglês | MEDLINE | ID: mdl-31547207

RESUMO

BACKGROUND: Depression, one of the most frequent mental disorders, affects more than 350 million people of all ages worldwide, with China facing an increased prevalence of depression. Childhood depression is on the rise; globally, and in China. This study estimates the hospitalization costs and the financial burden on families with children suffering from depression and recommends strategies both to improve the health care of children with depression and to reduce their families' financial burden. METHODS: The data were obtained from the hospitalization information system of 297 general hospitals in six regions of Shandong Province, China. We identified 488 children with depression. The information on demographics, comorbidities, medical insurance, hospitalization costs and insurance reimbursements were extracted from the hospital's information systems. Descriptive statistics were presented, and regression analyses were conducted to explore the factors associated with hospitalization costs. STATA14 software was used for analysis. RESULTS: The mean age of children with depression was 13.46 ± 0.13 years old. The availability of medical insurance directly affected the hospitalization costs of children with depression. The children with medical insurance had average total hospitalization expenses of RMB14528.05RMB (US$2111.91) and length of stay in hospital of 38.87 days compared with the children without medical insurance of hospital with expenses of RMB10825.55 (US$1573.69) and hospital stays of 26.54 days. Insured children's mean out-of-pocket expenses (6517.38RMB) was lower than the those of uninsured children (RMB10825.55 or US$1573.69), significant at 0.01 level. Insured children incurred higher treatment costs, drug costs, bed fees, check-up fees, test costs and nursing fees than uninsured patients (p < 0.01). CONCLUSIONS: Children suffering from depression with medical insurance had higher hospitalization costs and longer hospitalization stays than children without medical insurance. While uninsured inpatients experienced larger out-of-pocket costs than insured patients, out-of-pocket hospital expenses strained all family budgets, pushing many, especially low-income, families into poverty-insured or uninsured. The different hospital cost structures for drugs, treatment, bed fees, nursing and other costs, between insured and uninsured children with depression, suggest the need for further investigations of treatment regimes, including over-demand by parents for treatment of their children, over-supply of treatment by medical staff and under-treatment of uninsured patients. We recommend more careful attention paid to diagnosing depression in girls and further reform to China's health insurance schemes-especially to allow migrant families to gain basic medical insurance.


Assuntos
Efeitos Psicossociais da Doença , Depressão/economia , Transtorno Depressivo/economia , Gastos em Saúde/estatística & dados numéricos , Hospitalização/economia , Adolescente , Criança , China/epidemiologia , Estudos Transversais , Feminino , Custos de Cuidados de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados , Seguro Saúde/economia , Tempo de Internação , Masculino , Pessoas sem Cobertura de Seguro de Saúde , Pobreza
5.
Artigo em Inglês | MEDLINE | ID: mdl-30897747

RESUMO

In recent years, migrant workers, defined as people who move from Chinese rural areas to cities in other parts of the country to find work, have experienced slowed wage growth. An important question that has emerged is whether depressive symptoms have a significant relationship with migrant worker wages. This paper uses a nationally representative panel dataset to examine the overall association of depressive symptoms and migrant worker wages in China and explores the indirect mechanisms through which these impacts occur. Using the Coarsened Exact Matching method, our results show that depressive symptoms have a significant direct negative relationship with migrant worker wages, and that this relationship is consistent. Furthermore, we also find that depressive symptoms can reduce migrant worker wages indirectly by increasing the frequency of job conversion or by shortening work duration.


Assuntos
Depressão/economia , Salários e Benefícios , Migrantes/psicologia , Grupo com Ancestrais do Continente Asiático , Estudos de Casos e Controles , China , Cidades , Humanos , Modelos Estatísticos
7.
PLoS One ; 14(2): e0211357, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30759173

RESUMO

AIMS: Research demonstrates a negative relationship between alcohol use and affect, but the value of deprecation is unknown and thus cannot be included in estimates of the cost of alcohol to society. This paper aims to examine this relationship and develop econometric techniques to value the loss in affect attributable to alcohol consumption. METHODS: Cross-sectional (n = 129,437) and longitudinal (n = 11,352) analyses of alcohol consumers in UK Biobank data were undertaken, with depression and neuroticism as proxies of negative affect. The cross-sectional relationship between household income, negative affect and alcohol consumption were analysed using regression models, controlling for confounding variables, and using within-between random models that are robust to unobserved heterogeneity. The differential in household income required to offset alcohol's detriment to affect was derived. RESULTS: A consistent relationship between depression and alcohol consumption (ß = 0.001, z = 7.64) and neuroticism and alcohol consumption (ß = 0.001, z = 9.24) was observed in cross-sectional analyses, replicated in within-between models (depression ß = 0.001, z = 2.32; neuroticism ß = 0.001, z = 2.33). Significant associations were found between household income and depression (cross sectional ß = -0.157, z = -23.86, within-between ß = -0.146, z = -9.51) and household income and neuroticism (cross sectional ß = -0.166, z = -32.02, within-between ß = -0.158, z = -7.44). The value of reducing alcohol consumption by one gram/day was pooled and estimated to be £209.06 (95% CI £171.84 to £246.27). CONCLUSIONS: There was a robust relationship between alcohol consumption and negative affect. Econometric methods can value the intangible effects of alcohol use and may, therefore, facilitate the fiscal determination of benefit.


Assuntos
Consumo de Bebidas Alcoólicas/economia , Consumo de Bebidas Alcoólicas/epidemiologia , Depressão/economia , Depressão/epidemiologia , Neuroticismo , Adulto , Afeto , Idoso , Consumo de Bebidas Alcoólicas/psicologia , Bancos de Espécimes Biológicos , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos Econométricos , Classe Social , Reino Unido/epidemiologia
8.
Eur Psychiatry ; 57: 10-18, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30658275

RESUMO

BACKGROUND: Late-life depression is a highly prevalent disorder that causes a large economic burden. A stepped collaborative care program was set up in order to improve care for patients with late-life depression in primary care in Germany: GermanIMPACT is the adaption of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) program that has already been established in primary care in the USA. The aim of this study was to determine the cost-effectiveness of GermanIMPACT compared with treatment as usual from a societal perspective. METHODS: This study is part of a 12-month bi-centric cluster-randomized controlled trial aiming to assess the effectiveness of GermanIMPACT compared with treatment as usual among patients with late-life depression. A cost-effectiveness analysis using depression-free days (DFDs) was performed. Net-monetary benefit (NMB) regressions adjusted for baseline differences for different willingness-to-pay (WTP) thresholds were conducted and cost-effectiveness acceptability curves were constructed. RESULTS: In total, n = 246 patients (intervention group: n = 139; control group: n = 107) with a mean age of 71 from 71 primary care practices were included in the analysis. After 12 months, adjusted mean differences in costs and DFDs between intervention group and control group were +€354 and +21.4, respectively. Only the difference in DFDs was significant (p = 0.022). According to the unadjusted incremental cost-effectiveness ratio, GermanIMPACT was dominant compared with treatment as usual. The probability of GermanIMPACT being cost-effective was 80%, 90% or 95% if societal WTP per DFD was ≥€70, ≥€110 or ≥€180, respectively. CONCLUSION: Evidence for cost-effectiveness of GermanIMPACT relative to treatment as usual is not clear. Only if societal WTP was ≥€180 for an additional DFD, GermanIMPACT could be considered cost-effective with certainty.


Assuntos
Depressão/economia , Depressão/terapia , Educação de Pacientes como Assunto/economia , Atenção Primária à Saúde/economia , Idoso , Análise Custo-Benefício , Transtorno Depressivo/economia , Transtorno Depressivo/terapia , Feminino , Alemanha , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Resultado do Tratamento
9.
Trials ; 20(1): 53, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30646944

RESUMO

BACKGROUND: Depression is a serious mental health problem and is common in children and adolescents. Online interventions are promising in overcoming the widespread undertreatment of depression and in improving the help-seeking behavior in children and adolescents. METHODS: The multicentre, randomized controlled E.motion trial is part of the German ProHEAD consortium (Promoting Help-seeking using E-technology for ADolescents). The objective of the trial is to investigate the efficacy and cost-effectiveness of two online interventions to reduce depressive symptomatology in high-risk children and adolescents with subsyndromal symptoms of depression in comparison to an active control group. Participants will be randomized to one of three conditions: (1) Intervention 1, a clinician-guided self-management program (iFightDepression®); (2) Intervention 2, a clinician-guided group chat intervention; and (3) Control intervention, a psycho-educational website on depressive symptoms. Interventions last six weeks. In total, N = 363 children and adolescents aged ≥ 12 years with Patient Health Questionnaire-9 modified for Adolescents (PHQ-A) scores in the range of 5-9 will be recruited at five study sites across Germany. Online questionnaires will be administered before onset of the intervention, at the end of the intervention, and at the six-month follow-up. Further, children and adolescents will participate in the baseline screening and the one- and two-year school-based follow-up assessments integrated in the ProHEAD consortium. The primary endpoint is depression symptomatology at the end of intervention as measured by the PHQ-A score. Secondary outcomes include depression symptomatology at all follow-ups, help-seeking attitudes, and actual face-to-face help-seeking, adherence to and satisfaction with the interventions, depression stigma, and utilization and cost of interventions. DISCUSSION: This study represents the first randomized controlled trial (RCT) investigating efficacy and cost-effectiveness of two online interventions in children and adolescents aged ≥ 12 years at risk for depression. It aims to provide a better understanding of the help-seeking behavior of children and adolescents, potential benefits of E-mental health interventions for this age group, and new insights into so far understudied aspects of E-mental health programs, such as potential negative effects of online interventions. This knowledge will be used to tailor and improve future help offers and programs for children and adolescents and ways of treatment allocation. TRIAL REGISTRATION: German Register for Clinical Trials (DRKS), DRKS00014668 . Registered on 4 May 2018. International trial registration took place through the "international clinical trials registry platform" with the secondary ID S-086/2018.


Assuntos
Comportamento do Adolescente , Afeto , Comportamento Infantil , Depressão/terapia , Internet , Telemedicina/métodos , Terapia Assistida por Computador/métodos , Adolescente , Fatores Etários , Criança , Análise Custo-Benefício , Depressão/diagnóstico , Depressão/economia , Depressão/psicologia , Alemanha , Custos de Cuidados de Saúde , Humanos , Internet/economia , Estudos Multicêntricos como Assunto , Questionário de Saúde do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Autocuidado , Telemedicina/economia , Terapia Assistida por Computador/economia , Fatores de Tempo , Resultado do Tratamento
10.
J Med Econ ; 22(4): 372-378, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30663460

RESUMO

AIMS: Depression is the most frequent comorbidity reported among patients with rheumatoid arthritis (RA). Comorbid depression negatively impacts RA patients' health-related quality-of-life, physical function, mental function, mortality, and experience of pain and symptom severity. The objective of this study was to assess healthcare utilization, expenditures, and work productivity among patients with RA with or without depression. MATERIALS AND METHODS: Data from adult patients who had at least two visits each related to RA and depression over a 1-year period were extracted from the Truven Health MarketScan research databases. Outcomes comprised healthcare resource utilization, work productivity loss, and direct healthcare costs comparing patients with RA with depression (n = 3,478) vs patients with RA without depression (n = 43,222). RESULTS: Patients with RA and depression had a significantly greater relative risk of hospitalization and number of all-cause and RA-related hospitalizations, utilization of emergency services, days spent in the hospital, physician visits, and RA-related surgeries compared with RA patients without depression. Patients with RA and depression had a higher risk of and experienced more events and days of short-term disability compared with patients without depression. The incremental adjusted annual all-cause and RA-related direct costs were $8,488 (95% CI = $6,793-$10,223) and $578 (95% CI = -$98-$1,243), respectively, when comparing patients with RA and depression vs RA only. LIMITATIONS: The current analysis is subject to the known limitations of retrospective studies based on administrative claims data. CONCLUSIONS: This study suggested increased healthcare utilization, work productivity loss, and economic burden among RA patients due to comorbid depression. These findings emphasize the importance of managing depression and including depression as a factor when devising treatment algorithms for patients with RA.


Assuntos
Artrite Reumatoide/epidemiologia , Depressão/economia , Depressão/epidemiologia , Adulto , Idoso , Comorbidade , Efeitos Psicossociais da Doença , Eficiência , Feminino , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Qualidade de Vida , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Socioeconômicos , Estados Unidos/epidemiologia
11.
Soc Psychiatry Psychiatr Epidemiol ; 54(2): 255-276, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29947863

RESUMO

PURPOSE: We determined the prevalence of untreated depression in patients with hypertension (HT) and/or diabetes (DM) and estimated the extra health care use and expenditures associated with this comorbidity in a rural Hungarian adult population. We also assessed the potential workload of systematic screening for depression in this patient group. METHODS: General health check database from a primary care programme containing survey data of 2027 patients with HT and/or DM was linked to the outpatient secondary care use database of National Institute of Health Insurance Fund Management. Depression was ascertained by Beck Depression Inventory score and antidepressant drug use. The association between untreated depression and secondary healthcare utilization indicated by number of visits and expenses was evaluated by multiple logistic regression analysis controlled for socioeconomic/lifestyle factors and comorbidity. The age-, sex- and education-specific observations were used to estimate the screening workload for an average general medical practice. RESULTS: The frequency of untreated depression was 27.08%. The untreated severe depression (7.45%) was associated with increased number of visits (OR 1.60, 95% CI 1.11-2.31) and related expenses (OR 2.20, 95% CI 1.50-3.22) in a socioeconomic status-independent manner. To identify untreated depression cases among patients with HT and/or DM, an average GP has to screen 42 subjects a month. CONCLUSION: It seems to be reasonable and feasible to screen for depression in patients with HT and/or DM in the primary care, in order to detect cases without treatment (which may be associated with increase of secondary care visits and expenditures) and to initiate the adequate treatment of them.


Assuntos
Depressão/epidemiologia , Diabetes Mellitus/psicologia , Hipertensão/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Secundária à Saúde/estatística & dados numéricos , Adulto , Idoso , Assistência Ambulatorial/estatística & dados numéricos , Antidepressivos/uso terapêutico , Comorbidade , Bases de Dados Factuais , Depressão/economia , Depressão/etiologia , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Feminino , Gastos em Saúde , Humanos , Hungria , Hipertensão/economia , Hipertensão/epidemiologia , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Secundária à Saúde/economia , Fatores Socioeconômicos
12.
Perspect Psychiatr Care ; 55(3): 372, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30019468

RESUMO

PURPOSE: To advocate an economic way to release inner stress for patients with depression. CONCLUSIONS: Setting off firecrackers has psychological value. It is not merely for fun, but is more an economic and easy behavioral therapy in psychiatric care, even risking a little bit noise and air pollution, especially for patients with depression. PRACTICE IMPLICATIONS: In routine psychiatric care practice, patient with depression were encouraged to set off firecrackers to release their stress.


Assuntos
Terapia Comportamental , Depressão/terapia , Estresse Psicológico/terapia , China , Cultura , Depressão/economia , Explosões , Humanos , Som , Estresse Psicológico/economia
13.
Arthritis Care Res (Hoboken) ; 71(6): 748-757, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30067892

RESUMO

OBJECTIVE: To examine independent and combined effects of pain with concurrent insomnia and depression symptoms on the use of health care services in older adults with osteoarthritis (OA). METHODS: Patients were Group Health Cooperative (GHC) patients with a primary diagnosis of OA (n = 2,976). We used survey data on pain (Graded Chronic Pain Scale), insomnia (Insomnia Severity Index), and depression (Patient Health Questionnaire-8), and health care use extracted from GHC electronic health records (office visits, length of stay, outpatient and inpatient costs, and hip or knee replacement) for 3 years after the survey. Negative binomial, logistic, and generalized linear models were used to assess predictors of health care use. RESULTS: Approximately 34% and 29% of patients displayed at least subclinical insomnia and at least subclinical depression symptoms, respectively, in addition to moderate-to-severe pain. Pain had the greatest independent effects on increasing all types of health care use, followed by depression (moderate effects) on increased office visits, length of stay, outpatient and inpatient costs, and insomnia (mild effects) on decreased length of stay. No synergistic effects of the 3 symptoms on use of health care services were observed. The combined effects of pain plus insomnia and pain plus depression were significant for all types of health care use and increased greatly with increasing severity of insomnia and depression, except for hip/knee replacement. CONCLUSION: Pain is the main driver for health care use in patients with OA. In addition to pain, insomnia plus depression jointly increased diverse types of health care use, and these combined effects increased greatly with increasing severity of insomnia and depression. These findings indicate the important role that concurrent symptomatic conditions may play in increasing use of health care services.


Assuntos
Artralgia/terapia , Depressão/terapia , Recursos em Saúde , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia , Atenção Primária à Saúde , Distúrbios do Início e da Manutenção do Sono/terapia , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Artralgia/diagnóstico , Artralgia/economia , Artralgia/epidemiologia , Artroplastia de Quadril , Artroplastia do Joelho , Ensaios Clínicos como Assunto , Depressão/diagnóstico , Depressão/economia , Depressão/epidemiologia , Feminino , Custos de Cuidados de Saúde , Recursos em Saúde/economia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/economia , Osteoartrite do Quadril/epidemiologia , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/economia , Osteoartrite do Joelho/epidemiologia , Admissão do Paciente , Prevalência , Atenção Primária à Saúde/economia , Índice de Gravidade de Doença , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/economia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Washington/epidemiologia
14.
J Crohns Colitis ; 13(1): 19-26, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30256923

RESUMO

Background: Depression frequently co-occurs in patients with inflammatory bowel disease [IBD] and is a driver in health care costs and use. Aim: This study examined the associations between depression and total health care costs, emergency department [ED] visits, computed tomography [CT] during ED/inpatient visits, and IBD-related surgery among IBD patients. Methods: Our sample included 331772 IBD patients from a national administrative claims database [Truven Health MarketScan® Database]. Gamma and Poisson regression analyses assessed differences related to depression, controlling for key variables. Results: Approximately 16% of the IBD cohort was classified as having depression. Depression was associated with a $17,706 (95% confidence interval [CI] [$16,892, 18,521]) increase in mean annual IBD-related health care costs and an increased incidence of ED visits (adjusted incidence rate ratio [aIRR] of 1.5; 95% CI [1.5, 1.6]). Among patients who had one or more ED/inpatient visits, depression was associated with an increased probability of receiving repeated CT [one to four scans, adjusted odds ratio [aOR] of 1.6; 95% CI [1.5, 1.7]; five or more scans, aOR of 4.6; 95% CI [2.9, 7.3]) and increased odds of undergoing an IBD-related surgery (aOR of 1.2; 95% CI [1.1, 1.2]). Secondary analysis with a paediatric subsample revealed that approximately 12% of this cohort was classified as having depression, and depression was associated with increased costs and incidence rates of ED visits and CT, but not of IBD-related surgery. Conclusions: Quantifiable differences in health care costs and patterns of use exist among patients with IBD and depression. Integration of mental health services within IBD care may improve overall health outcomes and costs of care.


Assuntos
Depressão/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Doenças Inflamatórias Intestinais/economia , Doenças Inflamatórias Intestinais/cirurgia , Adolescente , Adulto , Criança , Bases de Dados Factuais , Depressão/complicações , Feminino , Humanos , Doenças Inflamatórias Intestinais/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Estados Unidos
15.
J Affect Disord ; 245: 728-743, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30447572

RESUMO

PURPOSE: Psychological interventions are labor-intensive and expensive, but e-health interventions may support them in primary care. In this study, we systematically reviewed the effectiveness and cost-effectiveness of e-health interventions for depressive and anxiety symptoms and disorders in primary care. METHODS: We searched MEDLINE, Cochrane library, Embase, and PsychINFO until January 2018, for randomized controlled trials of e-health interventions for depression or anxiety in primary care. Two reviewers independently screened the identified publications, extracted data, and assessed risk of bias using the Cochrane Collaboration's tool. RESULTS: Out of 3617 publications, we included 14 that compared 33 treatments in 4183 participants. Overall, the methodological quality was poor to fair. The pooled effect size of e-health interventions was small (standardized mean difference = -0.19, 95%CI -0.31 to -0.06) for depression compared to control groups in the short-term, but this was maintained in the long-term (standardized mean difference = -0.22, 95%CI -0.35 to -0.09). Further analysis showed that e-health for depression had a small effect compared to care as usual and a moderate effect compared to waiting lists. One trial on anxiety showed no significant results. Four trials reported on cost-effectiveness. LIMITATIONS: The trials studied different types of e-health interventions and had several risks of bias. Moreover, only one study was included for anxiety. CONCLUSIONS: E-health interventions for depression have a small effect in primary care, with a moderate effect compared to waiting lists. The approach also appeared to be cost-effective for depression. However, we found no evidence for its effectiveness for anxiety.


Assuntos
Ansiedade/terapia , Análise Custo-Benefício , Depressão/terapia , Atenção Primária à Saúde/economia , Telemedicina/economia , Ansiedade/economia , Depressão/economia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Listas de Espera
16.
Neurophysiol Clin ; 49(1): 11-18, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30502122

RESUMO

OBJECTIVES: Due to its ease of use, tolerance, and cost of acquisition, transcranial direct current stimulation (tDCS) could constitute a credible therapeutic option for non-resistant depression in primary care, when combined with drug management. This indication has yet to receive official recognition in France. The objective of this study is to evaluate the production cost of tDCS for the treatment of depression in hospitals, under realistic conditions. METHODS: The methodology adopted is based on cost accounting and was validated by a multidisciplinary working group. It includes equipment, staff, and structural costs to obtain the most realistic estimate possible. We first estimated the cost of producing a tDCS session, based on our annual activity objective, and then estimated the cost of a 15-session treatment program. This was followed up with a sensitivity analysis applying appropriate parameters. RESULTS: The hospital production cost of a tDCS depression treatment program for a single patient was estimated at €1555.60 euros: €99 in equipment costs, €1076.95 in staff costs, and €379.65 in structural costs. CONCLUSION: This cost analysis should make it possible to draw up pricing proposals in compliance with regulations and health policy choices and to develop health-economic studies. This would ultimately lead to official recognition of tDCS treatment for depression in France and pave the way for studying various scenarios of coverage by the French national health insurance system.


Assuntos
Depressão/economia , Depressão/terapia , Economia Hospitalar , Estimulação Transcraniana por Corrente Contínua/economia , Economia Hospitalar/legislação & jurisprudência , Economia Hospitalar/estatística & dados numéricos , França , Política de Saúde/economia , Hospitais , Humanos , Estimulação Transcraniana por Corrente Contínua/métodos , Resultado do Tratamento
18.
J Ment Health ; 27(6): 595-601, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30445874

RESUMO

BACKGROUND: There has been little research on whether finances affect mental health in bipolar disorder. AIMS: This study aimed to examine the relationship between finances and mental health in bipolar disorder across two time points. METHODS: Fifty-four participants with bipolar disorder in a National Health Service community mental health service completed questionnaires examining financial difficulties, compulsive buying and perceived financial well-being. Questionnaires also measured alcohol dependence, stress, depression, anxiety, past and current manic symptoms. RESULTS: Partial correlations showed correlations over time: depression, anxiety and stress predicted later compulsive buying. Compulsive buying also predicted later anxiety. Lower perceived financial wellness increased anxiety and stress over time. Being on benefits was associated with higher depression and going without items such as clothes was linked to higher depression, stress, anxiety and past hypomanic symptoms. CONCLUSIONS: Financial difficulties are related to mental health in bipolar disorder. Poor mental health leads to compulsive buying, whereas worry about finances increases anxiety and stress, with a vicious cycle for anxiety.


Assuntos
Transtorno Bipolar/economia , Transtorno Bipolar/psicologia , Administração Financeira , Saúde Mental , Adulto , Idoso , Ansiedade/economia , Ansiedade/etiologia , Transtorno Bipolar/complicações , Depressão/economia , Depressão/etiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/economia , Estresse Psicológico/etiologia , Inquéritos e Questionários , Adulto Jovem
19.
J Ment Health ; 27(6): 529-551, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30457031

RESUMO

BACKGROUND: While social determinants of health perspective might lead to the hypothesis that higher economic achievements should be associated with better mental health, the evidence for adults is mixed and inconclusive. AIM: We test the role of wealth as a predictor of depressive symptoms controlling for a number of socio-demographic covariates, with a specific interest in gender-specific patterns. METHODS: Using a nationally representative survey from Mexico (N = 44,618), we carry out multivariate regression analysis where we jointly model linear and quadratic measures of wealth to detect non-linear relations between depression and wealth. RESULTS: The paper reports clear evidence of an inverted-U relationship between depressive symptoms and wealth for females, whereas the relationship for males tends to be linear and decreasing with wealth as expected (though weak and significant only in the upper part of the wealth distribution). Our findings are robust to alternative empirical strategies and we discuss potential explanations for this novel finding. CONCLUSION: The paper confirms that the association between standards of living and depression is complex, due to the mediating role of socio-demographic characteristics and the existence of non-linearities not fully explored in the literature.


Assuntos
Depressão/economia , Depressão/psicologia , Status Econômico , Adulto , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Análise de Regressão , Saúde da Mulher/economia
20.
Hum Resour Health ; 16(1): 59, 2018 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-30413168

RESUMO

BACKGROUND: Historically, in an effort to evaluate and manage the rising cost of healthcare employers assess the direct cost burden via medical health claims and measures that yield clear data. Health related indirect costs are harder to measure and are often left out of the comprehensive overview of health expenses to an employer. Presenteeism, which is commonly referred to as an employee at work who has impaired productivity due to health considerations, has been identified as an indirect but relevant factor influencing productivity and human capitol. The current study evaluated presenteeism among employees of a large United States health care system that operates in six locations over a four-year period and estimated loss productivity due to poor health and its potential economic burden. METHODS: The Health-Related Productivity Loss Instrument (HPLI) was included as part of an online Health Risk Appraisal (HRA) administered to employees of a large United States health care system across six locations. A total of 58 299 HRAs from 22 893 employees were completed and analyzed; 7959 employees completed the HRA each year for 4 years. The prevalence of 22 specific health conditions and their effects on productivity areas (quantity of work, quality of work, work not done, and concentration) were measured. The estimated daily productivity loss per person, annual cost per person, and annual company costs were calculated for each condition by fitting marginal models using generalized estimating equations. Intra-participant agreement in reported productivity loss across time was evaluated using κ statistics for each condition. RESULTS: The health conditions rated highest in prevalence were allergies and hypertension (high blood pressure). The conditions with the highest estimated daily productivity loss and annual cost per person were chronic back pain, mental illness, general anxiety, migraines or severe headaches, neck pain, and depression. Allergies and migraines or severe headaches had the highest estimated annual company cost. Most health conditions had at least fair intra-participant agreement (κ ≥ 0.40) on reported daily productivity loss. CONCLUSIONS: Results from the current study suggested a variety of health conditions contributed to daily productivity loss and resulted in additional annual estimated costs for the health care system. To improve the productivity and well-being of their workforce, employers should consider presenteeism data when planning comprehensive wellness initiatives to curb productivity loss and increase employee health and well-being during working hours.


Assuntos
Efeitos Psicossociais da Doença , Custos e Análise de Custo , Assistência à Saúde/economia , Mão de Obra em Saúde/economia , Saúde do Trabalhador/economia , Presenteísmo/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Depressão/economia , Depressão/epidemiologia , Eficiência , Humanos , Hipersensibilidade/economia , Hipersensibilidade/epidemiologia , Hipertensão/economia , Hipertensão/epidemiologia , Transtornos Mentais/economia , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Transtornos de Enxaqueca/economia , Transtornos de Enxaqueca/epidemiologia , Dor/economia , Dor/epidemiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
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