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1.
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
2.
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
/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
3.
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
/economia , 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 , Inquéritos e Questionários , Estados Unidos
4.
J Nerv Ment Dis ; 209(1): 85-87, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33323794

RESUMO

In the last half of the 20th century, psychiatry lost many of the conditions needed for unhindered practice. I compiled from searches of the literature the 20th century changes in the arenas of psychiatric practice and the sources of these changes. I determined how these changes are shaping 21st century health and well-being. The neglect of the severely mentally ill, first in Bedlams and now on Boulevards, reflects a wide loss of resources. Psychiatry's patients have lost a past of community-based mental health services, interdisciplinary care teams, preventive consultation with social agencies, and, with reimbursements targeted for 15-minute visits, time adequate with the physician to individualize diagnosis and treatment. With the Covid-19 and other epidemics, economic inequalities, an economic crisis, unrest over police violence, and racism, psychiatry can find in its past the resources to engage 21st century psychiatric and other problems.


Assuntos
Transtornos Mentais/terapia , Serviços de Saúde Mental/história , Psiquiatria/história , /história , História do Século XX , História do Século XXI , Humanos , Transtornos Mentais/economia , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/tendências , Psiquiatria/economia , Psiquiatria/tendências
5.
Eur Psychiatry ; 64(1): e3, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-33342450

RESUMO

BACKGROUND: Administrators and policymakers are increasingly interested in individual placement and support (IPS) as a way of helping people with severe mental illness (SMI) obtain employment or education. It is thus important to investigate the cost-effectiveness to secure that resources are being used properly. METHODS: In a randomized clinical trial, 720 people diagnosed with SMI were allocated into three groups; (a) IPS, (b) IPS supplemented with cognitive remediation a social skills training (IPSE), and (c) Service as usual (SAU). Health care costs, municipal social care costs, and labor market service costs were extracted from nationwide registers and combined with data on use of IPS services. Cost-utility and cost-effectiveness analyses were conducted with two primary outcomes: quality-adjusted life years (QALY) and hours in employment. Incremental cost-effectiveness ratios (ICER) were computed for both QALY, using participant's responses to the EQ-5D questionnaire, and for hours in employment. RESULTS: Both IPS and IPSE were less costly, and more effective than SAU. Overall, there was a statistically significant cost difference of €9,543 when comparing IPS with SAU and €7,288 when comparing IPSE with SAU. ICER's did generally not render statistically significant results. However, there was a tendency toward the IPS and IPSE interventions being dominant, that is, cheaper with greater effect in health-related quality of life and hours in employment or education compared to usual care. CONCLUSION: Individual placement support with and without a supplement of cognitive remediation tends to be cost saving and more effective compared to SAU.


Assuntos
Remediação Cognitiva/economia , Remediação Cognitiva/métodos , Transtornos Mentais/economia , Transtornos Mentais/reabilitação , Adulto , Análise Custo-Benefício , Readaptação ao Emprego , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Qualidade de Vida , Inquéritos e Questionários
7.
PLoS One ; 15(10): e0240876, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33108374

RESUMO

Many different countries have been under lockdown or extreme social distancing measures to control the spread of COVID-19. The potentially far-reaching side effects of these measures have not yet been fully understood. In this study we analyse the results of a multi-country survey conducted in Italy (N = 3,504), Spain (N = 3,524) and the United Kingdom (N = 3,523), with two separate analyses. In the first analysis, we examine the elicitation of citizens' concerns over the downplaying of the economic consequences of the lockdown during the COVID-19 pandemic. We control for Social Desirability Bias through a list experiment included in the survey. In the second analysis, we examine the data from the same survey to predict the level of stress, anxiety and depression associated with being economically vulnerable and having been affected by a negative economic shock. To accomplish this, we have used a prediction algorithm based on machine learning techniques. To quantify the size of this affected population, we compare its magnitude with the number of people affected by COVID-19 using measures of susceptibility, vulnerability and behavioural change collected in the same questionnaire. We find that the concern for the economy and for "the way out" of the lockdown is diffuse and there is evidence of minor underreporting. Additionally, we estimate that around 42.8% of the populations in the three countries are at high risk of stress, anxiety, and depression, based on their level of economic vulnerability and their exposure to a negative economic shock.


Assuntos
Betacoronavirus , Infecções por Coronavirus/economia , Recessão Econômica , Transtornos Mentais/etiologia , Pandemias/economia , Pneumonia Viral/economia , Adolescente , Adulto , Idoso , Ansiedade/epidemiologia , Ansiedade/etiologia , Controle de Doenças Transmissíveis/economia , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Depressão/epidemiologia , Depressão/etiologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Transtornos Mentais/economia , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Análise de Componente Principal , Quarentena/economia , Espanha/epidemiologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Inquéritos e Questionários , Reino Unido/epidemiologia , Adulto Jovem
8.
Epidemiol Psychiatr Sci ; 29: e161, 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32807256

RESUMO

AIMS: To identify and synthesise the literature on the cost of mental disorders. METHODS: Systematic literature searches were conducted in the databases PubMed, EMBASE, Web of Science, EconLit, NHS York Database and PsychInfo using key terms for cost and mental disorders. Searches were restricted to January 1980-May 2019. The inclusion criteria were: (1) cost-of-illness studies or cost-analyses; (2) diagnosis of at least one mental disorder; (3) study population based on the general population; (4) outcome in monetary units. The systematic review was preregistered on PROSPERO (ID: CRD42019127783). RESULTS: In total, 13 579 potential titles and abstracts were screened and 439 full-text articles were evaluated by two independent reviewers. Of these, 112 articles were included from the systematic searches and 31 additional articles from snowball searching, resulting in 143 included articles. Data were available from 48 countries and categorised according to nine mental disorder groups. The quality of the studies varied widely and there was a lack of studies from low- and middle-income countries and for certain types of mental disorders (e.g. intellectual disabilities and eating disorders). Our study showed that certain groups of mental disorders are more costly than others and that these rankings are relatively stable between countries. An interactive data visualisation site can be found here: https://nbepi.com/econ. CONCLUSIONS: This is the first study to provide a comprehensive overview of the cost of mental disorders worldwide.


Assuntos
Efeitos Psicossociais da Doença , Assistência à Saúde/organização & administração , Custos de Cuidados de Saúde , Transtornos Mentais/economia , Transtornos Mentais/terapia , Análise Custo-Benefício , Humanos , Transtornos Mentais/psicologia
9.
Yakugaku Zasshi ; 140(8): 1025-1033, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32741860

RESUMO

Additional fees for ward pharmacists' services have been valued for hospitals in Japan. However, the calculation period for services provided to inpatients in the psychiatric ward is limited to 8 weeks. This study aimed to reveal the need for the services of pharmacists in the hospital ward for inpatients hospitalized for >8 weeks in the psychiatric ward. Patients who were hospitalized in the psychiatric ward from September 2016 to February 2017 were analyzed retrospectively. The pharmacists suggested prescriptions for inpatients admitted for >8 weeks, similar to those admitted for <9 weeks, and this supported pharmacotherapy without exacerbating patient outcomes. Moreover, significant decreases in benzodiazepine doses were found between the prior and post prescription suggestions of the pharmacist for inpatients >8 weeks of admission. Healthcare expenditures were also reduced. These results suggest that the prescriptions suggested by pharmacists for inpatients admitted for >8 weeks in the psychiatric ward were useful. In conclusion, our findings show that ward pharmacists' services were necessary not only for the inpatients hospitalized for <9 weeks, but also for those hospitalized for >8 weeks.


Assuntos
Pacientes Internados , Transtornos Mentais/tratamento farmacológico , Farmacêuticos , Serviço de Farmácia Hospitalar , Prescrições , Sugestão , Benzodiazepinas/administração & dosagem , Benzodiazepinas/economia , Custos de Cuidados de Saúde , Japão , Transtornos Mentais/economia , Prescrições/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo
10.
Med J Aust ; 213(8): 359-363, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32720326

RESUMO

OBJECTIVE: To develop a casemix classification to underpin a new funding model for residential aged care in Australia. DESIGN, SETTING: Cross-sectional study of resident characteristics in thirty non-government residential aged care facilities in Melbourne, the Hunter region of New South Wales, and northern Queensland, March 2018 - June 2018. PARTICIPANTS: 1877 aged care residents and 1600 residential aged care staff. MAIN OUTCOME MEASURES: The Australian National Aged Care Classification (AN-ACC), a casemix classification for residential aged care based on the attributes of aged care residents that best predict their need for care: frailty, mobility, motor function, cognition, behaviour, and technical nursing needs. RESULTS: The AN-ACC comprises 13 aged care resident classes reflecting differences in resource use. Apart from the class that included palliative care patients, the primary branches were defined by the capacity for mobility; further classification is based on physical capacity, cognitive function, mental health problems, and behaviour. The statistical performance of the AN-ACC was good, as measured by the reduction in variation statistic (RIV; 0.52) and class-specific coefficients of variation. The statistical performance and clinical acceptability of AN-ACC compare favourably with overseas casemix models, and it is better than the current Australian aged care funding model, the Aged Care Funding Instrument (64 classes; RIV, 0.20). CONCLUSIONS: The care burden associated with frailty, mobility, function, cognition, behaviour and technical nursing needs drives residential aged care resource use. The AN-ACC is sufficiently robust for estimating the funding and staffing requirements of residential aged care facilities in Australia.


Assuntos
Grupos Diagnósticos Relacionados/classificação , Serviços de Saúde para Idosos/economia , Instituição de Longa Permanência para Idosos , Casas de Saúde , Atividades Cotidianas , Austrália , Disfunção Cognitiva/economia , Disfunção Cognitiva/enfermagem , Fragilidade/economia , Fragilidade/enfermagem , Necessidades e Demandas de Serviços de Saúde , Financiamento da Assistência à Saúde , Humanos , Transtornos Mentais/economia , Transtornos Mentais/enfermagem , Limitação da Mobilidade , New South Wales , Serviços de Enfermagem/economia , Queensland , Vitória
12.
BMC Public Health ; 20(1): 436, 2020 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-32245377

RESUMO

BACKGROUND: Mental health and poverty are strongly interlinked. There is a gap in the literature on the effects of poverty alleviation programmes on mental health. We aim to fill this gap by studying the effect of an exogenous income shock generated by the Child Support Grant, South Africa's largest Unconditional Cash Transfer (UCT) programme, on mental health. METHODS: We use biennial data on 10,925 individuals from the National Income Dynamics Study between 2008 and 2014. We exploit the programme's eligibility criteria to estimate instrumental variable Fixed Effects models. RESULTS: We find that receiving the Child Support Grant improves adult mental health by 0.822 points (on a 0-30 scale), 4.1% of the sample mean. CONCLUSION: Our findings show that UCT programmes have strong mental health benefits for the poor adult population.


Assuntos
Organização do Financiamento/economia , Transtornos Mentais/economia , Saúde Mental/economia , Pobreza/psicologia , Assistência Pública/economia , Adulto , Criança , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pobreza/economia , África do Sul/epidemiologia
13.
Soc Psychiatry Psychiatr Epidemiol ; 55(6): 715-721, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32140739

RESUMO

PURPOSE: When housing is insufficient, or poor quality, or unaffordable there are well established health effects. Despite the pervasiveness of housing affordability problems (widely referred to as Housing Affordability Stress-HAS), little quantitative work has analysed long-term mental health effects. We examine the mental health effects of (prolonged and intermittent) patterns of exposure to housing affordability problems. METHODS: We analysed a large, nationally representative longitudinal population sample of individuals, following them over five-year periods to assess the relative mental health effects of different patterns of exposure to housing affordability problems. To maximise the number of observations and the robustness of findings, we used 15 years (2002-2016) of data, across three pooled exposure windows. Longitudinal regression analysis with Mundlak adjustment was used to estimate the association between prolonged (constant over a 5-year period) and intermittent exposure to HAS, and mental health (as measured using the SF-36 MCS). RESULTS: We found that, on average, both prolonged and intermittent exposure were associated with lower mental health (Beta = - 1.338 (95% CI - 2.178-0.488) and Beta = - 0.516 (95% CI - 0.868-0.164), respectively). When we additionally adjusted for baseline mental health, thereby accounting for initial mental health status, coefficients were attenuated but remained significant. CONCLUSIONS: Both prolonged and intermittent exposure to HAS negatively impact mental health, irrespective of baseline mental health. Interventions that target affordable housing would benefit population mental health. Mental health interventions should be designed with people's housing context in mind.


Assuntos
Custos e Análise de Custo/estatística & dados numéricos , Habitação/economia , Transtornos Mentais/epidemiologia , Adulto , Austrália/epidemiologia , Feminino , Humanos , Renda/estatística & dados numéricos , Estudos Longitudinais , Masculino , Transtornos Mentais/economia , Transtornos Mentais/psicologia , Saúde Mental , Pessoa de Meia-Idade , Análise de Regressão
14.
BMC Health Serv Res ; 20(1): 230, 2020 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-32188440

RESUMO

BACKGROUND: The decreased life expectancy and care costs of mental disorders could be enormous. However, research that compares mortality and utilization concurrently across the major category of mental disorders is absent. This study investigated all-cause mortality and medical utilization among patients with and without mental disorders, with an emphasis on identifying the psychiatric category of high mortality and low medical utilization. METHODS: A total of 570,250 individuals identified from the 2002-2013 Taiwan National Health Insurance Reearch Database consistuted 285,125 psychiatric patients and 285,125 non-psychiatric peers through 1:1 dual propensity score matching (PSM). The expenditure survival ratio (ESR) was proposed to indicate potential utilization shortage. The category of mental disorders and 13 covariates were analyzed using the Cox proportional hazard model and general linear model (GLM) through SAS 9.4. RESULTS: PSM analyses indicated that mortality and total medical expenditures per capita were both significantly higher in psychiatric patients than those in non-psychiatric patients (all P <.0.0001). Patients with substance use disorders were reported having the youngest ages at diagnosis and at death, with the highest 25.64 of potential years of life loss (YPLL) and relevant 2904.89 of ESR. Adjusted Cox model and GLM results indicated that, compared with anxiety disorders, affective disorders and substance use disorders were significantly associated with higher mortality (HR = 1.246 and 1.064, respectively; all P < 0.05); schizophrenia was significantly associated with higher total medical expenditures per capita (P < 0.0001). Thirteen additional factors were significantly associated with mortality or utilization (all P < 0.05). CONCLUSION: Substance use disorders are the category of highest YPLL but notably in insufficient utilization. Health care utilization in patients with substance use disorders should be augmented timely after the diagnosis, especially toward home and community care. The factors related to mortality and utilization identified by this study merit clinical attention.


Assuntos
Transtornos Mentais/mortalidade , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Adulto , Idoso , Bases de Dados Factuais , Feminino , Gastos em Saúde , Humanos , Masculino , Transtornos Mentais/economia , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Esquizofrenia/economia , Transtornos Relacionados ao Uso de Substâncias , Taiwan/epidemiologia , Adulto Jovem
15.
JAMA Netw Open ; 3(3): e201210, 2020 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-32191329

RESUMO

Importance: The degree to which the presence of mental health disorders is associated with additional medical spending on non-mental health conditions is largely unknown. Objective: To determine the proportion and degree of total spending directly associated with mental health conditions vs spending on other non-mental health conditions. Design, Setting, and Participants: This retrospective cohort study of 4 358 975 fee-for-service Medicare beneficiaries in the US in 2015 compared spending and health care utilization among Medicare patients with serious mental illness (SMI; defined as bipolar disease, schizophrenia or related psychotic disorders, and major depressive disorder), patients with other common mental health disorders (defined as anxiety disorders, personality disorders, and posttraumatic stress disorder), and patients with no known mental health disorders. Data analysis was conducted from February to October 2019. Exposure: Diagnosis of an SMI or other common mental health disorder. Main Outcomes and Measures: Risk-adjusted, standardized spending and health care utilization. Multivariable linear regression models were used to adjust for patient characteristics, including demographic characteristics and other medical comorbidities, using hospital referral region fixed effects. Results: Of 4 358 975 Medicare beneficiaries, 987 379 (22.7%) had an SMI, 326 991 (7.5%) had another common mental health disorder, and 3 044 587 (69.8%) had no known mental illness. Compared with patients with no known mental illness, patients with an SMI were younger (mean [SD] age, 72.3 [11.6] years vs 67.4 [15.7] years; P < .001) and more likely to have dual eligibility (633 274 [20.8%] vs 434 447 [44.0%]; P < .001). Patients with an SMI incurred more mean (SE) spending on mental health services than those with other common mental health disorders or no known mental illness ($2024 [3.9] vs $343 [6.2] vs $189 [2.1], respectively; P < .001). Patients with an SMI also had substantially higher mean (SE) spending on medical services for physical conditions than those with other common mental health disorders or no known mental illness ($17 651 [23.6] vs $15 253 [38.2] vs $12 883 [12.8], respectively; P < .001), reflecting $4768 (95% CI, $4713-$4823; 37% increase) more in costs for patients with an SMI and $2370 (95% CI, $2290-$2449; 18.4% increase) more in costs for patients with other common mental health disorders. Among Medicare beneficiaries, $2 686 016 110 of $64 326 262 104 total Medicare spending (4.2%) went to mental health services and an additional $5 482 791 747 (8.5%) went to additional medical spending associated with mental illness, representing a total of 12.7% of spending associated with mental health disorders. Conclusions and Relevance: In this study, having a mental health disorder was associated with spending substantially more on other medical conditions. These findings quantify the extent of additional spending in the Medicare fee-for-service population associated with a diagnosis of a mental health disorder.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Medicare/estatística & dados numéricos , Transtornos Mentais/economia , Serviços de Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estados Unidos
16.
Occup Environ Med ; 77(7): 470-477, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32220918

RESUMO

OBJECTIVE: To determine whether step-downs, which cut the rate of compensation paid to injured workers after they have been on benefits for several months, are effective as a return to work incentive. METHODS: We aggregated administrative claims data from seven Australian workers' compensation systems to calculate weekly scheme exit rates, a proxy for return to work. Jurisdictions were further subdivided into four injury subgroups: fractures, musculoskeletal, mental health and other trauma. The effect of step-downs on scheme exit was tested using a regression discontinuity design. Results were pooled into meta-analyses to calculate combined effects and the proportion of variance attributable to heterogeneity. RESULTS: The combined effect of step-downs was a 0.86 percentage point (95% CI -1.45 to -0.27) reduction in the exit rate, with significant heterogeneity between jurisdictions (I 2=68%, p=0.003). Neither timing nor magnitude of step-downs was a significant moderator of effects. Within injury subgroups, only fractures had a significant combined effect (-0.84, 95% CI -1.61 to -0.07). Sensitivity analysis indicated potential effects within mental health and musculoskeletal conditions as well. CONCLUSIONS: The results suggest some workers' compensation recipients anticipate step-downs and exit the system early to avoid the reduction in income. However, the effects were small and suggest step-downs have marginal practical significance. We conclude that step-downs are generally ineffective as a return to work policy initiative.Postprint link: https://www.medrxiv.org/content/10.1101/19012286.


Assuntos
Doenças Profissionais/economia , Traumatismos Ocupacionais/economia , Retorno ao Trabalho/economia , Indenização aos Trabalhadores/economia , Austrália , Fraturas Ósseas/economia , Humanos , Transtornos Mentais/economia , Motivação , Doenças Musculoesqueléticas/economia , Retorno ao Trabalho/psicologia , Ferimentos e Lesões/economia
17.
South Med J ; 113(2): 51-54, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32016432

RESUMO

OBJECTIVES: The primary objective of this study was to determine whether there was a change in the rate and types of patients with psychiatric illnesses being seen in the emergency department (ED) from 2012 to 2015 using the National Ambulatory Care Survey. A secondary objective was to determine what if any changes occurred in the resources available to care for these patients. METHODS: Our study used 2012-2015 data from the National Hospital Ambulatory Medical Care Survey and the State Mental Health Agency Per Capita Mental Health Services Expenditures, and expenditures data from 2012-2015 to examine whether there was a significant change in the rate and type of mental illness ED visits. Additional data on the number of beds per region from the National Mental Health Services Survey, 2012-2015 were used. A t test was used to look for significant (P = 0.05) changes in the rate and types of patients, ED dispositions, ED reimbursement types, region and community level income, sex, age, state mental health funding, and psychiatric beds from 2012 to 2015. RESULTS: There was an 8% increase in the rate of patients who presented with a diagnosed mental health disorder (P = 0.03, 95% confidence interval [CI] 5.32-5.96) and substance use disorders (P = 0.03, 95% CI 0.564-0.122). The reimbursement for these visits did change (P = 0.01, 95% CI 0.245-0.685); however, there was no significant increase (P = 0.07, 95% CI-214 to 101) in state mental health budgets and the number of psychiatric and detox hospital beds from 2012 to 2015. CONCLUSIONS: The rate and types of mental health patients coming to the ED are still on the rise. This is coupled with a lack of mental health infrastructure to address the needs and diagnoses that continue to be seen in the ED. States may need increased, targeted funding for mental health outside the increase in coverage via the Patient Protection and Affordable Care Act to slow the rate of mental health patients seen in the ED.


Assuntos
Serviço Hospitalar de Emergência/tendências , Gastos em Saúde/tendências , Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/tendências , Serviço Hospitalar de Emergência/economia , Pesquisas sobre Serviços de Saúde , Humanos , Transtornos Mentais/economia , Transtornos Relacionados ao Uso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia
18.
BMC Psychiatry ; 20(1): 10, 2020 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914959

RESUMO

BACKGROUND: The mental health treatment gap-the difference between those with mental health need and those who receive treatment-is high in low- and middle-income countries. Task-shifting has been used to address the shortage of mental health professionals, with a growing body of research demonstrating the effectiveness of mental health interventions delivered through task-shifting. However, very little research has focused on how to embed, support, and sustain task-shifting in government-funded systems with potential for scale up. The goal of the Building and Sustaining Interventions for Children (BASIC) study is to examine implementation policies and practices that predict adoption, fidelity, and sustainment of a mental health intervention in the education sector via teacher delivery and the health sector via community health volunteer delivery. METHODS: BASIC is a Hybrid Type II Implementation-Effectiveness trial. The study design is a stepped wedge, cluster randomized trial involving 7 sequences of 40 schools and 40 communities surrounding the schools. Enrollment consists of 120 teachers, 120 community health volunteers, up to 80 site leaders, and up to 1280 youth and one of their primary guardians. The evidence-based mental health intervention is a locally adapted version of Trauma-focused Cognitive Behavioral Therapy, called Pamoja Tunaweza. Lay counselors are trained and supervised in Pamoja Tunaweza by local trainers who are experienced in delivering the intervention and who participated in a Train-the-Trainer model of skills transfer. After the first sequence completes implementation, in-depth interviews are conducted with initial implementing sites' counselors and leaders. Findings are used to inform delivery of implementation facilitation for subsequent sequences' sites. We use a mixed methods approach including qualitative comparative analysis to identify necessary and sufficient implementation policies and practices that predict 3 implementation outcomes of interest: adoption, fidelity, and sustainment. We also examine child mental health outcomes and cost of the intervention in both the education and health sectors. DISCUSSION: The BASIC study will provide knowledge about how implementation of task-shifted mental health care can be supported in government systems that already serve children and adolescents. Knowledge about implementation policies and practices from BASIC can advance the science of implementation in low-resource contexts. TRIAL REGISTRATION: Trial Registration: ClinicalTrials.gov Identifier: NCT03243396. Registered 9th August 2017, https://clinicaltrials.gov/ct2/show/NCT03243396.


Assuntos
Terapia Cognitivo-Comportamental/tendências , Recursos em Saúde/tendências , Transtornos Mentais/terapia , Serviços de Saúde Mental/tendências , Saúde Mental/tendências , Adolescente , Criança , Análise por Conglomerados , Terapia Cognitivo-Comportamental/economia , Terapia Cognitivo-Comportamental/métodos , Feminino , Recursos em Saúde/economia , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/economia , Serviços de Saúde Mental/economia , Psicoterapia/economia , Psicoterapia/métodos , Psicoterapia/tendências
19.
PLoS One ; 15(1): e0227565, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31935266

RESUMO

BACKGROUND: Because of the rapid increase of non-communicable diseases (NCDs) and high burden of healthcare-related financial issues in Bangladesh, there is a concern that out-of-pocket (OOP) payments related to illnesses may become a major burden on household. It is crucial to understand what are the major illnesses responsible for high OPP at the household level to help policymakers prioritize key areas of actions to protect the household from 100% financial hardship for seeking health care as part of universal health coverage. OBJECTIVES: We first estimated the costs of illnesses among a population in urban Bangladesh, and then assessed the household financial burden associated with these illnesses. METHOD: A cross-sectional survey of 1593 randomly selected households was carried out in Bangladesh (urban area of Rajshahi city), in 2011. Catastrophic expenditure was estimated at 40% threshold of household capacity to pay. We employed the Bayesian two-stage hurdle model and Bayesian logistic regression model to estimate age-adjusted average cost and the incidence of household financial catastrophe for each illness, respectively. RESULTS: Overall, approximately 45% of the population of Bangladesh had at least one episode of illness. The age-sex-adjusted average medical expenses and catastrophic health care expenditure among the households were TK 621 and 8%, respectively. Households spent the highest amount of money 7676.9 on paralysis followed by liver disease (TK 2695.4), injury (TK 2440.0), mental disease (TK 2258.0), and tumor (TK 2231.2). These diseases were also responsible for higher incidence of financial catastrophe. Our study showed that 24% of individuals who suffered typhoid incurred catastrophic expenditure followed by liver disease (12.3%), tumor (12.1%), heart disease (8.4%), injury (7.9%), mental disease (7.9%), cataract (7.1%), and paralysis (6.5%). CONCLUSION: The study findings suggest that chronic illnesses were responsible for high costs and high catastrophic expenditures in Bangladesh. Effective risk pooling mechanism might reduce household financial burden related to illnesses. Chronic illness related to NCDs is the major cause of OOP. It is also important to consider prioritizing vulnerable population by subsidizing the high health care cost for some of the chronic illnesses.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Hepatopatias/economia , Transtornos Mentais/economia , Ferimentos e Lesões/economia , Adulto , Bangladesh , Teorema de Bayes , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Humanos , Entrevistas como Assunto , Hepatopatias/patologia , Masculino , Transtornos Mentais/patologia , Pessoa de Meia-Idade , População Urbana , Ferimentos e Lesões/patologia
20.
Nord J Psychiatry ; 74(4): 301-306, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31889460

RESUMO

Purpose: While the pivotal role of pharmacotherapy in psychiatry is universal, significant regional differences exist in drug use patterns. Herewith we compare the use of ATC psychotropic drugs (N05, psycholeptics and N06A, antidepressants) in 2010-2015 in the three Baltic Countries with reference to the Nordic Countries.Methods: Data were obtained from the national authorities on medicines as expressed in DDD per 1000 inhabitants per day. A semi-structured questionnaire was used for expert statements on the rationale of current use of medicines.Results: During the observation period the use of antipsychotics, anxiolytics, hypnotics and sedatives, and antidepressants steadily increased, while the growth in use of anxiolytics stagnated in the more recent years. Antipsychotic use was the largest in Lithuania and the lowest in Estonia. The use on anxiolytics in Lithuania was more than twice of that in Estonia and Latvia. Conversely, the use of hypnotics and sedatives was about three times higher in Estonia than in Latvia or Lithuania. Antidepressant use was dominated by the selective serotonin reuptake inhibitors in all three countries, but overall was much lower in Latvia as compared to Lithuania and Estonia. As compared to the Nordic Countries in 2015, antidepressants are used at much lower level throughout Baltics, probably reflecting underdiagnostics of depression and anxiety disorders.Conclusion: While the health-care expenditures in Estonia, Latvia and Lithuania are largely similar, as is the cultural and recent political background of these EU member countries, the extent and the pattern of psychotropic drug use is remarkably variable.


Assuntos
Transtornos Mentais/tratamento farmacológico , Psicotrópicos/uso terapêutico , Inquéritos e Questionários , Estônia/epidemiologia , Humanos , Letônia/epidemiologia , Lituânia/epidemiologia , Masculino , Transtornos Mentais/economia , Transtornos Mentais/epidemiologia , Psicotrópicos/economia , Países Escandinavos e Nórdicos/epidemiologia
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