The cost-effectiveness of depression treatment for co-occurring disorders: a clinical trial

Effective Prediction and Important Counseling Experience for Perceived Helpfulness of Social Question and Answering-Based Online Counseling: An Explainable Machine Learning Model

The social question answering based online counseling (SQA-OC) is easy access for people seeking professional mental health information and service, has become the crucial pre-consultation and application stage toward online counseling. However, there is a lack of efforts to evaluate and explain the counselors' service quality in such an asynchronous online questioning and answering (QA) format efficiently. This study applied the notion of perceived helpfulness as a public's perception of counselors' service quality in SQA-OC, used computational linguistic and explainable machine learning (XML) methods suited for large-scale QA discourse analysis to build an predictive model, explored how various sources and types of linguistic cues [i.e., Linguistic Inquiry and Word Count (LIWC), topic consistency, linguistic style similarity, emotional similarity] contributed to the perceived helpfulness. Results show that linguistic cues from counselees, counselors, and synchrony between them are important predictors, the linguistic cues and XML can effectively predict and explain the perceived usefulness of SQA-OC, and support operational decision-making for counselors. Five helpful counseling experiences including linguistic styles of "talkative", "empathy", "thoughtful", "concise with distance", and "friendliness and confident" were identified in the SQA-OC. The paper proposed a method to evaluate the perceived helpfulness of SQA-OC service automatically, effectively, and explainable, shedding light on the understanding of the SQA-OC service outcome and the design of a better mechanism for SQA-OC systems.

Economic Evaluation of the SOS Training to Reduce Victimization in Dual Diagnosis Patients

OBJECTIVE

Economic evaluations of interventions for dual diagnosis patients are scarce. A recent randomized controlled trial has supported the effectiveness of the Self-wise, Otherwise, Streetwise (SOS) training to reduce victimization in dual diagnosis patients. The purpose of the current study was to analyze the cost-effectiveness and cost-utility of the SOS training as an add-on to care as usual (CAU).

METHODS

We performed an economic evaluation from a societal perspective alongside the SOS trial. Participants were 250 dual diagnosis patients recruited at three locations from a large urban psychiatric service in the Netherlands. The main outcomes were treatment response for victimization and quality-adjusted life years (QALYs). Both costs and effects were measured across a 14-month follow-up.

RESULTS

There was no significant difference between CAU + SOS and CAU in total costs (mean difference €4,859; 95% CI [-€4,795 to €14,513]) and QALY gains (mean difference 0.0012; 95% CI [-0.05 to 0.05]). Significantly more participants in CAU + SOS achieved treatment response for victimization compared to CAU (68% vs. 54%; mean difference 0.14; 95% CI [0.02 to 0.26]). The cost-effectiveness analysis indicated an 83% likelihood that CAU + SOS resulted in a higher treatment response rate for victimization at higher costs compared to CAU. The cost-utility analysis indicated that adding SOS-training to CAU is probably not cost-effective at conventional willingness-to-pay levels for QALYs.

CONCLUSIONS

At a societal willingness-to-pay of €38,000 or more per extra treatment responder, adding SOS-training to usual care is probably more attractive than usual care alone with regard to cost-effectiveness. This is a considerable willingness to pay. However, the direct costs of offering the SOS training are expected to be minor. Our findings should be interpreted with caution due to the short follow-up period and absence of data on potential reductions in police and judicial costs other than prison costs.

Substance use identification and follow-up rates among commercial and Medicare health insurance members in primary care and other settings

Background

The objective of this study was to investigate factors associated with substance use disorder identification and follow-up rates among samples of members of a private health insurance plan.

Methods

In an observational study, samples of claims data for 2017 for Commercial and Medicare members from a private health insurer were accessed and analyzed using descriptive statistics, decision tree analysis, and linear regression models.

Results

Commercial and Medicare members differed in age. Medicare members had higher rates of inclusion in a measure of substance use disorder than Commercial members, lower rates of initial short term follow-up, more opioid prescriptions from primary care provides, fewer prescriptions for opioid treatment, and higher rates of selected comorbid conditions. Mental health diagnoses and substance use disorder co-occurred frequently and to a greater extent in the Medicare sample. Among commercial members, there were primarily alcohol problems that increased with age, while opioid problems at about 10% peaked in the mid-twenties. More males were included among all substance types. The overall rate for an initial short term follow-up visit indicating initiation of treatment was 30%. There were large differences in the follow-up rates across settings with a very low rate (4.6% for alcohol and 6.9% for opioid) in primary care settings.

Conclusions

These results suggest that increased attention in primary care to young adult males and to older adults, may help to reduce substance use disorder rates, especially alcohol use disorders.

A randomized controlled trial of mindfulness-based Tai Chi Chuan for subthreshold depression adolescents

PURPOSE

The incidence of subthreshold depression (StD) in adolescents is growing rapidly, which in turn is known to impair functioning and increase the risk of major depression. It is therefore important to provide effective intervention to prevent the transition from StD to major depression. As a traditional Chinese mind-body exercise, Tai Chi Chuan (TCC) may be an available selection. Researchers have shown the effectiveness of mindfulness-based therapy on depression; however, for the StD youth, there have been no studies to investigate whether mindfulness-based Tai Chi Chuan (MTCC) can be recommended as an effective exercise for improving their psychological state. The aim of present study was to evaluate the effect of MTCC on psychological outcomes of StD adolescents including the depression levels and mindfulness state in a randomized controlled trial (RCT).

PATIENTS AND METHODS

An RCT was carried out. A sample of 64 participants who meet the inclusion criteria agreed to be arranged randomly to either the MTCC group (n=32) or the control group (n=32). Participants of the MTCC group received an 8-week, 2 days per week, 90-minute MTCC intervention for each session. Usual physical curriculum was administered to the participants in the control group. The effectiveness of MTCC training was measured by blinded evaluators through validated scales, which included depressive symptoms, stress, and mindfulness level before and after the intervention.

RESULTS

Significant improvements in psychological health were observed from MTCC groups. After 8-week intervention, superior outcomes were also observed for MTCC when compared with control group for decrease in depression (F=59.482, P<0.001) and stress level (F=59.482, P<0.001) and increase in mindfulness (F=59.482, P<0.001).

CONCLUSION

The findings of this preliminary study indicated the effects of the MTCC intervention on depression level among StD youngsters. This study provides preliminary evidence that MTCC is suitable for Chinese adolescents and is effective in decreasing depression level.