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1.
PLoS One ; 17(2): e0263703, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35134096

RESUMO

BACKGROUND: On the African continent, many people live in conditions of adversity known to be associated with the onset of mental disorders, yet not all develop a mental disorder. The prevalence of common mental disorders such as depression and anxiety in the general population of Nigeria is comparatively low. Prevalence data of mental disorders in slum settings in Nigeria is sparse. There is a need to better understand the relationship between protective factors and the occurrence of common mental disorders in the Nigerian slum context. This study aimed to describe the relationship between protective factors and the occurrence of common mental disorders among female urban slum dwellers in Ibadan, Nigeria. METHODS AND FINDINGS: A cross sectional household survey of 550 women was conducted in slum settlements in Ibadan, Nigeria. Interviewer administered questionnaires were completed to elicit information on protective factors (social connectedness, self-esteem, social support, resilience) and common mental disorders (depression, anxiety and stress). The DASS-21 was used to measure common mental disorders and protective factors were measured using the Social Connectedness Scale, Multidimensional Scale of Perceived Social Support, Resilience scale and the Rosenberg Self Esteem Scale. A multivariable logistic regression model was employed to examine associations while adjusting for relevant confounders. Common mental disorders were reported by 14.0% of the respondents. Resilience and social support were found to be protective against reporting symptoms of common mental disorders. Women who reported higher levels of social support and resilience were less likely to report common mental disorders (OR:0.96, 95% CI 0.93, 0.98) and (OR:0.95, 95% CI 0.91, 0.99) respectively. Women who were 65 years and older were also less likely to report the occurrence of common mental disorders (OR:0.38, 95% CI 0.15, 0.98) compared to those aged 18-34 years. CONCLUSION: Social support and resilience appear to be protective against common mental disorders among these respondents. Further research should be conducted to explore the pathways through which protective factors reduce the likelihood of the occurrence of common mental disorders. This would be important in the development of mental health interventions.


Assuntos
Transtornos Mentais/epidemiologia , Fatores de Proteção , Resiliência Psicológica/fisiologia , Adulto , Ansiedade/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Transtornos Mentais/economia , Transtornos Mentais/etiologia , Saúde Mental/estatística & dados numéricos , Saúde Mental/tendências , Pessoa de Meia-Idade , Nigéria/epidemiologia , Áreas de Pobreza , Prevalência , Apoio Social/psicologia , Fatores Socioeconômicos
2.
PLoS One ; 17(1): e0262091, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35061766

RESUMO

BACKGROUND: A comprehensive, comparable assessment of the economic disease burden and the value of relevant care forms a major challenge in the case of mental diseases. This study aimed to inform the development of a resource use measurement (RUM) instrument and harmonized reference unit costs valid for multi-sectoral and multi-national cost assessments for mental health diseases as part of the European PECUNIA project. METHODS: An iterative, multi-methods approach was applied. Systematic literature reviews appended with national grey literature searches in six European countries were conducted to generate preliminary, literature-based, international, mental health-related service and resource use lists for all investigated sectors in 2018. As part of a multi-national expert survey, these lists were reviewed by 18 Austrian sector-specific experts regarding the clarity, relevance, comprehensiveness and availability in the Austrian context. RESULTS: Out of 295 items included in the preliminary, international, sector-specific lists (health and social care-201 items, criminal justice-35 items, education-39 items; patient, family and informal care-20 items), a total of 261 items and descriptions (88%) were considered clear by all experts. 42 items (14%) were considered not existing in Austria, and 111 items (38%) were prioritized regarding their relevance in the national context. Thirteen additional items (4%) were suggested to be added to accommodate for Austria-specific features of the individual sectors. Major typological difficulties based on item names were observed. CONCLUSIONS: The identified country-specific variations and general typological bias and their potential contributions to service and resource use cost variations across countries and sectors call for further systematic investigation. Next, PECUNIA will develop internationally harmonized and comparable definitions of the listed items and their units of analysis based on a new conceptual multi-sectoral costing framework. The developed lists will require consolidation and further prioritization for the development of a patient-reported RUM instrument and consequent reference unit cost valuation.


Assuntos
Transtornos Mentais/economia , Serviços de Saúde Mental/economia , Áustria , Efeitos Psicossociais da Doença , Direito Penal , Atenção à Saúde , Europa (Continente) , Humanos , Transtornos Mentais/prevenção & controle , Apoio Social , Inquéritos e Questionários
3.
J Correct Health Care ; 28(1): 54-58, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34788552

RESUMO

Crisis stabilization units (CSUs) are one type of "alternative to arrest" program used for jail diversion. We aimed to estimate the economic costs of starting and operating a CSU in Arkansas. We estimated the economic costs of the Pulaski County Regional CSU (PCRCSU) located in Little Rock, Arkansas, from September 1, 2018, to August 31, 2019. We collected data through interviews about start-up and ongoing management costs. We calculated total annual economic cost, average admission cost, and average 24 hr admission cost. There were 536 admissions to the CSU during the study period. The average length of stay was 60.27 hr. The total annual cost of the PCRCSU was $1,636,831 and average per admission cost was $3,054. Our results provide valuable economic data to government stakeholders who are considering establishing a CSU.


Assuntos
Direito Penal , Intervenção na Crise , Arkansas , Custos e Análise de Custo , Direito Penal/economia , Direito Penal/organização & administração , Humanos , Transtornos Mentais/economia , Transtornos Mentais/terapia , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/organização & administração
4.
Lancet Psychiatry ; 9(1): 59-71, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34921796

RESUMO

BACKGROUND: There have been no trials of task-shared care (TSC) using WHO's mental health Gap Action Programme for people with severe mental disorders (psychosis or affective disorder) in low-income or middle-income countries. We aimed to evaluate the efficacy and cost-effectiveness of TSC compared with enhanced specialist mental health care in rural Ethiopia. METHODS: In this single-blind, phase 3, randomised, controlled, non-inferiority trial, participants had a confirmed diagnosis of a severe mental disorder, recruited from either the community or a local outpatient psychiatric clinic. The intervention was TSC, delivered by supervised, non-physician primary health care workers trained in the mental health Gap Action Programme and working with community health workers. The active comparison group was outpatient psychiatric nurse care augmented with community lay workers (PSY). Our primary endpoint was whether TSC would be non-inferior to PSY at 12 months for the primary outcome of clinical symptom severity using the Brief Psychiatric Rating Scale, Expanded version (BPRS-E; non-inferiority margin of 6 points). Randomisation was stratified by health facility using random permuted blocks. Independent clinicians allocated groups using sealed envelopes with concealment and outcome assessors and investigators were masked. We analysed the primary outcome in the modified intention-to-treat group and safety in the per-protocol group. This trial is registered with ClinicalTrials.gov, number NCT02308956. FINDINGS: We recruited participants between March 13, 2015 and May 21, 2016. We randomly assigned 329 participants (111 female and 218 male) who were aged 25-72 years and were predominantly of Gurage (198 [60%]), Silte (58 [18%]), and Mareko (53 [16%]) ethnicity. Five participants were found to be ineligible after randomisation, giving a modified intention-to-treat sample of 324. Of these, 12-month assessments were completed in 155 (98%) of 158 in the TSC group and in 158 (95%) of 166 in the PSY group. For the primary outcome, there was no evidence of inferiority of TSC compared with PSY. The mean BPRS-E score was 27·7 (SD 4·7) for TSC and 27·8 (SD 4·6) for PSY, with an adjusted mean difference of 0·06 (90% CI -0·80 to 0·89). Per-protocol analyses (n=291) were similar. There were 47 serious adverse events (18 in the TSC group, 29 in the PSY group), affecting 28 participants. These included 17 episodes of perpetrated violence and seven episodes of violent victimisation leading to injury, ten suicide attempts, six hospital admissions for physical health conditions, four psychiatric admissions, and three deaths (one in the TSC group, two in the PSY group). The incremental cost-effectiveness ratio for TSC indicated lower cost of -US$299·82 (95% CI -454·95 to -144·69) per unit increase in BPRS-E scores from a health care sector perspective at 12 months. INTERPRETATION: WHO's mental health Gap Action Programme for people with severe mental disorders is as cost-effective as existing specialist models of care and can be implemented effectively and safely by supervised non-specialists in resource-poor settings. FUNDING: US National Institute of Mental Health.


Assuntos
Transtornos Mentais/economia , Transtornos Mentais/terapia , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/organização & administração , Avaliação de Resultados em Cuidados de Saúde , Adulto , Idoso , Análise Custo-Benefício , Etiópia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenvolvimento de Programas , População Rural , Método Simples-Cego , Organização Mundial da Saúde
5.
PLoS One ; 16(12): e0260726, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34855850

RESUMO

Mental health disorders represent an enormous cost to society, are related to economic outcomes, and have increased markedly since the COVID-19 outbreak. Economic activity contracted dramatically on a global scale in 2020, representing the worst crisis since the Great Depression. This study used the COVID Impact Survey to provide insights on the interactions of mental illness and economic uncertainty during COVID-19. We used a probability-based panel survey, COVID Impact Survey, conducted in the U.S. over three waves in the period April-June 2020. The survey covered individual information on employment, economic and financial uncertainty, mental and physical health, as well as other demographic information. The prevalence of moderate mental distress was measured using a Psychological Distress Scale, a 5-item scale that is scored on a 4-point scale (total range: 0-15). The mental distress effect of employment, economic, and financial uncertainty, was assessed in a logit regression analysis conditioning for demographic and health information. It is found that employment, health coverage, social security, and food provision uncertainty are additional stressors for mental health. These economic factors work in addition to demographic effects, where groups who display increased risk for psychological distress include: women, Hispanics, and those in poor physical health. A decrease in employment and increases in economic uncertainty are associated with a doubling of common mental disorders. The population-representative survey evidence presented strongly suggests that economic policies which support employment (e.g., job keeping, job search support, stimulus spending) provide not only economic security but also constitute a major health intervention. Moving forward, the economic uncertainty effect ought to be reflected in community level intervention and prevention efforts, which should include strengthening economic support to reduce financial and economic strain.


Assuntos
COVID-19/psicologia , Recessão Econômica , Transtornos Mentais/etiologia , Adolescente , Adulto , Fatores Etários , Idoso , Emprego/economia , Emprego/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/economia , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Angústia Psicológica , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Incerteza , Estados Unidos/epidemiologia , Adulto Jovem
6.
J Alzheimers Dis ; 83(4): 1563-1601, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34487051

RESUMO

Neurological disorders significantly impact the world's economy due to their often chronic and life-threatening nature afflicting individuals which, in turn, creates a global disease burden. The Group of Twenty (G20) member nations, which represent the largest economies globally, should come together to formulate a plan on how to overcome this burden. The Neuroscience-20 (N20) initiative of the Society for Brain Mapping and Therapeutics (SBMT) is at the vanguard of this global collaboration to comprehensively raise awareness about brain, spine, and mental disorders worldwide. This paper aims to provide a comprehensive review of the various brain initiatives worldwide and highlight the need for cooperation and recommend ways to bring down costs associated with the discovery and treatment of neurological disorders. Our systematic search revealed that the cost of neurological and psychiatric disorders to the world economy by 2030 is roughly $16T. The cost to the economy of the United States is $1.5T annually and growing given the impact of COVID-19. We also discovered there is a shortfall of effective collaboration between nations and a lack of resources in developing countries. Current statistical analyses on the cost of neurological disorders to the world economy strongly suggest that there is a great need for investment in neurotechnology and innovation or fast-tracking therapeutics and diagnostics to curb these costs. During the current COVID-19 pandemic, SBMT, through this paper, intends to showcase the importance of worldwide collaborations to reduce the population's economic and health burden, specifically regarding neurological/brain, spine, and mental disorders.


Assuntos
Carga Global da Doença , Cooperação Internacional , Transtornos Mentais , Doenças do Sistema Nervoso , COVID-19/epidemiologia , Carga Global da Doença/organização & administração , Carga Global da Doença/tendências , Saúde Global/economia , Saúde Global/tendências , Humanos , Transtornos Mentais/economia , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Doenças do Sistema Nervoso/economia , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/terapia , Neurociências/métodos , Neurociências/tendências , SARS-CoV-2
7.
J Psychiatr Pract ; 27(4): 254-264, 2021 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-34398575

RESUMO

The Coronavirus Disease 2019 (COVID-19) pandemic has led to an exponential rise in mental health issues. Studies have shown that, in times of increased unemployment rates and economic downturn, rates of mental health issues, suicide, substance use, and domestic violence tend to increase. Barriers to care, including stigma and decreased access to providers, contribute to morbidity and mortality. Telehealth services are being utilized to help increase access to care, and economic stimulus packages have been created to help with the financial burden that is often associated with increased mental health stressors. Efforts to prevent burnout and other policy recommendations can help decrease mental health issues in first responders and health care professionals, who are at an increased risk for these problems. Increasing the ability to provide wellness screenings to the general population, to educate the public about preventive measures and practices, and to provide mental health and substance use treatment, such as medication management and therapy services, are among top priorities to further reduce the socioeconomic impact of COVID-19 on mental illness.


Assuntos
COVID-19/epidemiologia , Transtornos Mentais/epidemiologia , Saúde Mental/estatística & dados numéricos , COVID-19/economia , Humanos , Transtornos Mentais/economia , Transtornos Mentais/prevenção & controle , Transtornos Mentais/terapia , Pandemias , SARS-CoV-2 , Fatores Socioeconômicos
8.
Pharmacogenomics J ; 21(4): 533-541, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34215853

RESUMO

Nowadays, many relevant drug-gene associations have been discovered, but pharmacogenomics (PGx)-guided treatment needs to be cost-effective as well as clinically beneficial to be incorporated into standard health care. To address current challenges, this systematic review provides an update regarding previously published studies, which assessed the cost-effectiveness of PGx testing for the prescription of antidepressants and antipsychotics. From a total of 1159 studies initially identified by literature database querying, and after manual assessment and curation of all of them, a mere 18 studies met our inclusion criteria. Of the 18 studies evaluations, 16 studies (88.89%) drew conclusions in favor of PGx testing, of which 9 (50%) genome-guided interventions were cost-effective and 7 (38.9%) were less costly compared to standard treatment based on cost analysis. More precisely, supportive evidence exists for CYP2D6 and CYP2C19 drug-gene associations and for combinatorial PGx panels, but evidence is limited for many other drug-gene combinations. Amongst the limitations of the field are the unclear explanation of perspective and cost inputs, as well as the underreporting of study design elements, which can influence though the economic evaluation. Overall, the findings of this article demonstrate that although there is growing evidence on the cost-effectiveness of genome-guided interventions in psychiatric diseases, there is still a need for performing additional research on economic evaluations of PGx implementation with an emphasis on psychiatric disorders.


Assuntos
Antipsicóticos/economia , Transtornos Mentais/economia , Transtornos Mentais/genética , Farmacogenética/economia , Antipsicóticos/uso terapêutico , Análise Custo-Benefício/economia , Humanos , Transtornos Mentais/tratamento farmacológico , Farmacogenética/métodos
9.
Nutrients ; 13(5)2021 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-34067617

RESUMO

BACKGROUND: Adolescence is a critical transition period in the course of human development. Although food insecurity (FI) has been shown to be associated with adverse mental health and sleep outcomes in US adolescents, there is a paucity of research examining the relationships between FI, mental health, and sleep outcomes in Taiwanese adolescents. Furthermore, it is unknown how the change of FI over time (i.e., the trajectory of FI) is related to health outcomes. METHODS: The data come from the Taiwan Database of Children and Youth in Poverty, which is a national longitudinal project measuring FI in five survey waves (2009-2017). We employed group-based trajectory modeling to classify various FI trends over the five waves using STATA. Furthermore, a generalized estimating equation analysis was conducted with FI trajectories as the independent variable to see how FI trajectory is related to mental health and sleep outcomes. RESULTS: In total, 1921 participants aged 12-18 years in the first wave were deemed valid for the analysis. We classified the participants into four FI trajectory groups: persistently low FI (24.8%), persistently moderate FI (64.7%), declining from high to low FI (4.1%), and food-secure groups (6.4%). As compared to food-secure adolescents, the persistently moderate FI group was more likely to have mental problems (ß = 0.30, [95% confidence interval 0.21-0.38]), while the other FI groups were only marginally associated with mental health problems. Moreover, adolescents in the persistently low FI group (ß = 0.13, [0.02-0.23]) and persistently moderate FI group (ß = 0.39, [0.29-0.48]) were found to have more sleep problems than those in the food-secure group. CONCLUSIONS: Our study describes the FI profile of adolescents from economically disadvantaged families and the difficulties they might encounter. With this information, healthcare providers can aid adolescents in the early stages of mental health problems and provide guidance when appropriate.


Assuntos
Insegurança Alimentar/economia , Transtornos Mentais/economia , Pobreza/psicologia , Transtornos do Sono-Vigília/economia , Populações Vulneráveis/psicologia , Adolescente , Criança , Bases de Dados Factuais , Feminino , Humanos , Estudos Longitudinais , Masculino , Transtornos Mentais/epidemiologia , Saúde Mental/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Sono , Transtornos do Sono-Vigília/epidemiologia , Taiwan/epidemiologia
10.
Alcohol Clin Exp Res ; 45(7): 1448-1457, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34081349

RESUMO

BACKGROUND: There are significant concerns that the COVID-19 pandemic may have negative effects on substance use and mental health, but most studies to date are cross-sectional. In a sample of emerging adults, over a two-week period during the pandemic, the current study examined: (1) changes in drinking-related outcomes, depression, anxiety, and posttraumatic stress disorder and (2) differences in changes by sex and income loss. The intra-pandemic measures were compared to pre-pandemic measures. METHODS: Participants were 473 emerging adults (Mage  = 23.84; 41.7% male) in an existing longitudinal study on alcohol misuse who were assessed from June 17 to July 1, 2020, during acute public health restrictions in Ontario, Canada. These intra-pandemic data were matched to participant pre-pandemic reports, collected an average of 5 months earlier. Assessments included validated measures of drinking, alcohol-related consequences, and mental health indicators. RESULTS: Longitudinal analyses revealed significant decreases in heavy drinking and adverse alcohol consequences, with no moderation by sex or income loss, but with substantial heterogeneity in changes. Significant increases in continuous measures of depression and anxiety were present, both of which were moderated by sex. Females reported significantly larger increases in depression and anxiety. Income loss >50% was significantly associated with increases in depression. CONCLUSIONS: During the initial phase of the pandemic, reductions in heavy drinking and alcohol consequences were present in this sample of emerging adults, perhaps due to restrictions on socializing. In contrast, there was an increase in internalizing symptoms , especially in females, highlighting disparities in the mental health impacts of the pandemic.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/psicologia , COVID-19/psicologia , Saúde Mental/tendências , Caracteres Sexuais , Classe Social , Consumo de Bebidas Alcoólicas/economia , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/economia , Alcoolismo/epidemiologia , COVID-19/economia , COVID-19/epidemiologia , Estudos de Coortes , Estudos Transversais/métodos , Feminino , Humanos , Estudos Longitudinais , Masculino , Transtornos Mentais/economia , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Saúde Mental/economia , Ontário/epidemiologia , Adulto Jovem
11.
PLoS Med ; 18(5): e1003606, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33974641

RESUMO

BACKGROUND: The prevention of mental disorders and promotion of mental health and well-being are growing fields. Whether mental health promotion and prevention interventions provide value for money in children, adolescents, adults, and older adults is unclear. The aim of the current study is to update 2 existing reviews of cost-effectiveness studies in this field in order to determine whether such interventions are cost-effective. METHODS AND FINDINGS: Electronic databases (including MEDLINE, PsycINFO, CINAHL, and EconLit through EBSCO and Embase) were searched for published cost-effectiveness studies of prevention of mental disorders and promotion of mental health and well-being from 2008 to 2020. The quality of studies was assessed using the Quality of Health Economic Studies Instrument (QHES). The protocol was registered with PROSPERO (# CRD42019127778). The primary outcomes were incremental cost-effectiveness ratio (ICER) or return on investment (ROI) ratio across all studies. A total of 65 studies met the inclusion criteria of a full economic evaluation, of which, 23 targeted children and adolescents, 35 targeted adults, while the remaining targeted older adults. A large number of studies focused on prevention of depression and/or anxiety disorders, followed by promotion of mental health and well-being and other mental disorders. Although there was high heterogeneity in terms of the design among included economic evaluations, most studies consistently found that interventions for mental health prevention and promotion were cost-effective or cost saving. The review found that targeted prevention was likely to be cost-effective compared to universal prevention. Screening plus psychological interventions (e.g., cognitive behavioural therapy [CBT]) at school were the most cost-effective interventions for prevention of mental disorders in children and adolescents, while parenting interventions and workplace interventions had good evidence in mental health promotion. There is inconclusive evidence for preventive interventions for mental disorders or mental health promotion in older adults. While studies were of general high quality, there was limited evidence available from low- and middle-income countries. The review was limited to studies where mental health was the primary outcome and may have missed general health promoting strategies that could also prevent mental disorder or promote mental health. Some ROI studies might not be included given that these studies are commonly published in grey literature rather than in the academic literature. CONCLUSIONS: Our review found a significant growth of economic evaluations in prevention of mental disorders or promotion of mental health and well-being over the last 10 years. Although several interventions for mental health prevention and promotion provide good value for money, the varied quality as well as methodologies used in economic evaluations limit the generalisability of conclusions about cost-effectiveness. However, the finding that the majority of studies especially in children, adolescents, and adults demonstrated good value for money is promising. Research on cost-effectiveness in low-middle income settings is required. TRIAL REGISTRATION: PROSPERO registration number: CRD42019127778.


Assuntos
Análise Custo-Benefício/estatística & dados numéricos , Promoção da Saúde/economia , Transtornos Mentais/economia , Saúde Mental/economia , Promoção da Saúde/estatística & dados numéricos , Humanos , Transtornos Mentais/terapia
12.
Lancet Psychiatry ; 8(7): 630-638, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33826925

RESUMO

Mental disorders (including substance use disorders, dementia, and self-harm) account for a substantial burden of disease and economic costs in low-income and middle-income countries (LMICs), yet they attract little funding. External resources are urgently needed but evidence on investments is scarce. This Health Policy paper uses 35 elite interviews and documentary analyses to examine how and why external organisations have invested in mental health in LMICs over the past three decades, and how this investment has changed over time. Four levels are examined: organisations, source countries, recipient countries, and global landscape. Organisations have invested in numerous internal and external activities. Among the various factors shaping organisational decisions, actors (ie, individuals and organisations concerned with mental health) were the most salient at all four levels. To increase external organisation investments in mental health in LMICs, organisational leadership and understanding are crucial, along with increased political support in source and recipient countries, and a stronger governance structure at the global level.


Assuntos
Política de Saúde , Recursos em Saúde/economia , Cooperação Internacional , Serviços de Saúde Mental , Motivação , Países em Desenvolvimento , Humanos , Transtornos Mentais/economia , Transtornos Mentais/terapia , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/provisão & distribuição , Pobreza , Pesquisa Qualitativa
13.
PLoS One ; 16(4): e0249902, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33836033

RESUMO

OBJECTIVE: To examine the health care costs associated with mental disorders and subthreshold mental disorders within a nationally representative sample of children and adolescents in Australia. METHOD: Data were derived from the Young Minds Matter Survey (N = 6,310). Mental disorders were classified using the Diagnostic Interview Schedule for Children Version IV. Participant data were linked to administrative data on health care costs. Adjusted generalized linear regression models and two-part models were used to estimate mean differences in costs between those with a mental disorder or subthreshold disorder and those without. RESULTS: Costs associated with health care attendances and medications were higher for children and adolescents with mental disorders and subthreshold mental disorders compared to those without a mental disorder. The additional population health care costs due to mental disorders amounted to AUD$234 million annually in children and adolescents, of which approximately 16% was attributed to out-of-pocket costs. Findings showed that those with subthreshold mental disorders or comorbid mental disorders have substantial additional costs of Medicare-funded medical and pharmaceutical services. CONCLUSION AND IMPLICATION: Mental disorders in children and adolescents are associated with significant health care costs. Further research is needed to ensure that this population is receiving effective and efficient care.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Transtornos Mentais/economia , Programas Nacionais de Saúde/economia , Assistência Farmacêutica/economia , Adolescente , Austrália , Criança , Pré-Escolar , Bases de Dados Factuais , Gastos em Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/tratamento farmacológico
14.
J Ment Health Policy Econ ; 24(1): 31-41, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33739934

RESUMO

BACKGROUND: Unemployment is associated with a high risk of experiencing mental illness. This can lead to stigmatisation, reduced quality of life, and long-term costs like increased healthcare expenditure and productivity losses for society as a whole. Previous research indicates evidence for an association between unemployment and higher mental health service costs, but there is insufficient information available for the German healthcare system. AIM OF THE STUDY: This study aims to identify costs and cost drivers for health and social service use among unemployed people with mental health problems in Germany. METHODS: A sample of 270 persons participated at baseline and six-month-follow-up. Healthcare and social service use was assessed using the Client Socio-Demographic and Service Receipt Inventory. Descriptive cost analysis was performed. Associations between costs and potential cost drivers were tested using structural equation modelling. RESULTS: Direct mean costs for 12 months range from EUR 1265.13 (somatic costs) to EUR 2206.38 (psychiatric costs) to EUR 3020.70 (total costs) per person. Path coefficients indicate direct positive effects from the latent variable mental health burden (MHB) on stigma stress, somatic symptoms, and sick leave. DISCUSSION: The hypothesis that unemployed people with mental health problems seek help for somatic symptoms rather than psychiatric symptoms was not supported. Associations between MHB and costs strongly mediated by sick leave indicate a central function of healthcare provision as being confirmation of the inability to work. IMPLICATIONS FOR HEALTH POLICIES: Targeted interventions to ensure early help-seeking and reduce stigma remain of key importance in reducing long-term societal costs. IMPLICATIONS FOR FURTHER RESEARCH: Future research should explore attitudes regarding effective treatment for the target group.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Transtornos Mentais/economia , Transtornos Mentais/terapia , Serviços de Saúde Mental/economia , Licença Médica/economia , Desemprego/estatística & dados numéricos , Adulto , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Transtornos Mentais/epidemiologia , Saúde Mental , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Qualidade de Vida , Estigma Social , Desemprego/psicologia , Adulto Jovem
15.
Tijdschr Psychiatr ; 63(1): 39-47, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-33537973

RESUMO

BACKGROUND: Quantification of population-level socioeconomic-demographic factors impacting onset and course of health care consumption can help health care commissioning and public health planning.
AIM: To analyse associations between mental health care, medical-specialist care and general practitioner (GP) care with regional socioeconomic-demographic factors. Two cost parameters were examined: (i) absolute costs; and (ii) relative costs, defined as the proportion of PC3-level costs attributable to outliers (defined as costs above the 80th percentile - as a proxy for care intensity).
METHOD: Analysis of Vektis data over the period 2014-2017 in the age range of 18-65 years.
RESULTS: Mental health care cost variation was for 28% reducible to (younger) age, urbanicity, PC3-level ethnic density and PC3-level socioeconomic-demographic factors. Variation in medical-specialist care and GP care costs were reducible principally to (older) age. Costs attributable to outliers ranged from 34% for GP care to 55% for mental health care. Socioeconomic-demographic factors explained a substantial part of the variation in the PC3-level proportion of outlier costs for mental health care (31%), medical-specialist care (43%) and GP-care (33%).
CONCLUSION: Analysis of the degree and pattern of socioeconomic-demographic factors impacting mental health care can inform both public mental health planning and mental health care commissioning. Tijdschrift voor psychiatrie 63(2021)1, 39-47.


Assuntos
Clínicos Gerais , Custos de Cuidados de Saúde/estatística & dados numéricos , Transtornos Mentais/economia , Serviços de Saúde Mental/estatística & dados numéricos , Psiquiatria , Adolescente , Adulto , Idoso , Efeitos Psicossociais da Doença , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/economia , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Fatores Socioeconômicos , Adulto Jovem
16.
Med Care ; 59(4): 362-367, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33528234

RESUMO

IMPORTANCE: Better patient management can reduce emergency department (ED) use. Performance measures should reward plans for reducing utilization by predictably high-use patients, rather than rewarding plans that shun them. OBJECTIVE: The objective of this study was to develop a quality measure for ED use for people diagnosed with serious mental illness or substance use disorder, accounting for both medical and social determinants of health (SDH) risks. DESIGN: Regression modeling to predict ED use rates using diagnosis-based and SDH-augmented models, to compare accuracy overall and for vulnerable populations. SETTING: MassHealth, Massachusetts' Medicaid and Children's Health Insurance Program. PARTICIPANTS: MassHealth members ages 18-64, continuously enrolled for the calendar year 2016, with a diagnosis of serious mental illness or substance use disorder. EXPOSURES: Diagnosis-based model predictors are diagnoses from medical encounters, age, and sex. Additional SDH predictors describe housing problems, behavioral health issues, disability, and neighborhood-level stress. MAIN OUTCOME AND MEASURES: We predicted ED use rates: (1) using age/sex and distinguishing between single or dual diagnoses; (2) adding summarized medical risk (DxCG); and (3) further adding social risk (SDH). RESULTS: Among 144,981 study subjects, 57% were women, 25% dually diagnosed, 67% White/non-Hispanic, 18% unstably housed, and 37% disabled. Utilization was higher by 77% for those dually diagnosed, 50% for members with housing problems, and 18% for members living in the highest-stress neighborhoods. SDH modeling predicted best for these high-use populations and was most accurate for plans with complex patients. CONCLUSION: To set appropriate benchmarks for comparing health plans, quality measures for ED visits should be adjusted for both medical and social risks.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Adolescente , Adulto , Fatores Etários , Feminino , Humanos , Masculino , Transtornos Mentais/economia , Pessoa de Meia-Idade , Multimorbidade , Indicadores de Qualidade em Assistência à Saúde , Fatores Sexuais , Determinantes Sociais da Saúde , Transtornos Relacionados ao Uso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos , Adulto Jovem
17.
Lancet Psychiatry ; 8(4): 340-346, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33549174

RESUMO

Social protection measures can play an important part in securing livelihoods and in mitigating short-term and long-term economic, social, and mental health impacts of the COVID-19 pandemic. In particular, cash transfer programmes are currently being adapted or expanded in various low-income and middle-income countries to support individuals and families during the pandemic. We argue that the current crisis offers an opportunity for these programmes to focus on susceptible young people (aged 15-24 years), including those with mental health conditions. Young people living in poverty and with mental health problems are at particular risk of experiencing adverse health, wellbeing, and employment outcomes with long-term consequences. They are also at risk of developing mental health conditions during this pandemic. To support this population, cash transfer programmes should not only address urgent needs around food security and survival but expand their focus to address longer-term mental health impacts of pandemics and economic crises. Such an approach could help support young people's future life chances and break the vicious cycle between mental illness and poverty that spirals many young people into both socioeconomic and mental health disadvantage.


Assuntos
COVID-19/psicologia , Transtornos Mentais/prevenção & controle , Saúde Mental , Política Pública , Adolescente , Países em Desenvolvimento , Programas Governamentais , Humanos , Transtornos Mentais/economia , Pobreza , Assistência Pública/economia , Adulto Jovem
18.
Prev Med ; 145: 106441, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33515588

RESUMO

The COVID-19 pandemic will have long-term consequences due to social and economic disruption. This study aimed to understand the contextual, media, and economic factors associated with anticipated mental health consequences from the COVID-19 pandemic among Americans. A nationally representative survey of 1001 respondents was conducted in April 2020. Chi-square tests and logistic regressions examined anticipated emotional or psychological effects on respondents or members of their households should social distancing measures continue. Specific analyses focused on: 1) COVID-19 experience - knowing someone or being infected; living in a state with a high death rate; or state social distancing policies; 2) media exposure - source of coronavirus information and time spent on coronavirus news; and 3) economics - current economic effects; and anticipated long-term financial effects. 41% of respondents anticipated mental health consequences. Living in a state with a greater COVID-19 death rate (OR 1.73; 95% CI 1.10, 2.72) and anticipating long-term financial difficulties (OR 2.98; 95% CI 1.93, 4.60) were both associated with greater likelihood of anticipated mental health consequences. Those whose primary news source was television, as opposed to print or online, were almost 50% less likely to anticipate mental health challenges (OR 0.52 CI 0.33, 0.81), while those who reported spending two or more hours daily on COVID-19 news were 90% more likely (OR 1.90; 95% CI 1.27, 2.85). Aspects of community health, media consumption, and economic impacts influence anticipated poor mental health from the COVID-19 pandemic, suggesting each domain is relevant to interventions to address the consequences.


Assuntos
COVID-19/economia , COVID-19/psicologia , Transtornos Mentais/economia , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Saúde Pública/economia , Saúde Pública/estatística & dados numéricos , Feminino , Humanos , Masculino , Pandemias/economia , Pandemias/estatística & dados numéricos , SARS-CoV-2 , Inquéritos e Questionários , Estados Unidos
19.
Psychiatr Rehabil J ; 44(2): 132-141, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33030932

RESUMO

Objective: To examine variation in employment and economic outcomes before, during, and after the great recession by disability and mental health status. Methods: Using a sample of adults in the 1999 to 2016 National Health Interview Survey (N = 419,336), we examined changes in labor force and economic outcomes by mental health and physical disability status. We employed difference-in-differences analyses to determine whether the changes in these outcomes during and after the recession for each comparison group (those with moderate mental illness, serious psychiatric disability, or physical disability) were significantly different from the changes for persons with neither a mental illness nor a disability. Findings: While the recession impacted all groups, those with mental illnesses or physical disabilities were hardest hit. Persons with disabilities were disadvantaged on all outcomes at each period, but persons with mental illnesses were the most disadvantaged. Unemployment, poverty, and use of food stamps increased for all groups, but the increase was greatest for persons with mental health problems who also saw a more substantial decline in wage income. Conclusions and Implications for Practice: The effects of the recession persist well after the recovery period. Practitioners should be aware that although most persons with mental illnesses want to work, they face significant barriers to employment. Following economic shocks such as those brought on by the current coronavirus pandemic, interventions should focus on people who are the most vulnerable, especially those with mental health problems. Renewed focus on employment for people with mental disorders is important. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
COVID-19 , Pessoas com Deficiência , Recessão Econômica/estatística & dados numéricos , Transtornos Mentais , Desemprego/estatística & dados numéricos , Adulto , COVID-19/economia , COVID-19/epidemiologia , COVID-19/psicologia , Pessoas com Deficiência/reabilitação , Pessoas com Deficiência/estatística & dados numéricos , Status Econômico/estatística & dados numéricos , Emprego/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Transtornos Mentais/economia , Transtornos Mentais/epidemiologia , Transtornos Mentais/reabilitação , Saúde Mental/economia , Pessoa de Meia-Idade , SARS-CoV-2 , Estados Unidos/epidemiologia , Populações Vulneráveis
20.
Am J Epidemiol ; 190(4): 630-641, 2021 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-33047779

RESUMO

Union members enjoy better wages and benefits and greater power than nonmembers, which can improve health. However, the longitudinal union-health relationship remains uncertain, partially because of healthy-worker bias, which cannot be addressed without high-quality data and methods that account for exposure-confounder feedback and structural nonpositivity. Applying one such method, the parametric g-formula, to US-based Panel Study of Income Dynamics data, we analyzed the longitudinal relationships between union membership, poor/fair self-rated health (SRH), and moderate mental illness (Kessler 6-item score of ≥5). The SRH analyses included 16,719 respondents followed from 1985-2017, while the mental-illness analyses included 5,813 respondents followed from 2001-2017. Using the parametric g-formula, we contrasted cumulative incidence of the outcomes under 2 scenarios, one in which we set all employed-person-years to union-member employed-person-years (union scenario), and one in which we set no employed-person-years to union-member employed-person-years (nonunion scenario). We also examined whether the contrast varied by sex, sex and race, and sex and education. Overall, the union scenario was not associated with reduced incidence of poor/fair SRH (relative risk = 1.01, 95% confidence interval (CI): 0.95, 1.09; risk difference = 0.01, 95% CI: -0.03, 0.04) or moderate mental illness (relative risk = 1.02, 95% CI: 0.92, 1.12; risk difference = 0.01, 95% CI: -0.04, 0.06) relative to the nonunion scenario. These associations largely did not vary by subgroup.


Assuntos
Nível de Saúde , Transtornos Mentais/epidemiologia , Feminino , Humanos , Incidência , Masculino , Transtornos Mentais/economia , Pessoa de Meia-Idade , Salários e Benefícios , Fatores Socioeconômicos , Estados Unidos/epidemiologia
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