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Vasiliadis HM, Lamoureux-Lamarche C, Chapdelaine A, Provencher MD, Norton PJ, Berbiche D, Roberge P. Cost-Effectiveness of Group Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders in Primary Care Settings: Economic Evaluation From the Healthcare System Perspective Over a 1-Year Time Horizon. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:43-53. [PMID: 37461378 PMCID: PMC10867409 DOI: 10.1177/07067437231187459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
AIM To assess the incremental cost-effectiveness ratio (ICER) of group transdiagnostic cognitive-behavioural therapy (tCBT) added to treatment as usual (TAU) for anxiety disorders compared to TAU only from the healthcare system perspective over a 1-year time horizon. METHODS Data from a pragmatic multisite randomized controlled trial where adults (18-65 years) with an anxiety disorder were randomized to tCBT + TAU (n = 117) or TAU (n = 114). Group tCBT is a 12-week (2h weekly sessions) community-based intervention. Health service utilization and related costs were captured from medico-administrative data and included those for the intervention, ambulatory visits, hospitalizations and medications. Effectiveness was based on quality-adjusted life years (QALYs). The study included measures at baseline, 4, 8, and 12 months. Intention-to-treat and complete case analyses were carried out. Missing data were imputed using multiple imputation analyses. Seemingly unrelated regression analyses were used to assess the effect of the intervention on total costs and QALYs while also adjusting for baseline confounders. The probability of cost-effectiveness of the intervention was assessed according to different willingness-to-pay (WTP) thresholds using the net benefit regression method. RESULTS The ICER of tCBT + TAU as compared to TAU in the intention-to-treat analysis was $6,581/QALY. Complete case analyses showed a similar ICER of $6,642/QALY. The probability at a WTP threshold of $20,000 and $40,000 that tCBT + TAU as compared to TAU is cost-effective is 93.0% and 99.9%. CONCLUSION tCBT added to TAU appears to be cost-effective from the healthcare system perspective for treating adult patients with anxiety disorders. Larger trials including young and older adults as well as a range of anxiety disorders are needed to further investigate the cost-effectiveness of tCBT in different patient populations.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Catherine Lamoureux-Lamarche
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Alexandra Chapdelaine
- PRIMUS Research Group, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | - Djamal Berbiche
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Pasquale Roberge
- Département de médecine familiale et d’urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
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Cressman S, Ghanbarian S, Edwards L, Peterson S, Bunka M, Hoens AM, Riches L, Austin J, Vijh R, McGrail K, Bryan S. Costs of major depression covered / not covered in British Columbia, Canada. BMC Health Serv Res 2023; 23:1446. [PMID: 38124043 PMCID: PMC10734183 DOI: 10.1186/s12913-023-10474-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is one of the world's leading causes of disability. Our purpose was to characterize the total costs of MDD and evaluate the degree to which the British Columbia provincial health system meets its objective to protect people from the financial impact of illness. METHODS We performed a population-based cohort study of adults newly diagnosed with MDD between 2015 and 2020 and followed their health system costs over two years. The expenditure proportion of MDD-related, patient paid costs relative to non-subsistence income was estimated, incidences of financial hardship were identified and the slope index of inequality (SII) between the highest and lowest income groups compared across regions. RESULTS There were 250,855 individuals diagnosed with MDD in British Columbia over the observation period. Costs to the health system totalled >$1.5 billion (2020 CDN), averaging $138/week for the first 12 weeks following a new diagnosis and $65/week to week 52 and $55/week for weeks 53-104 unless MDD was refractory to treatment ($125/week between week 12-52 and $101/week over weeks 53-104). The proportion of MDD-attributable costs not covered by the health system was 2-15x greater than costs covered by the health system, exceeding $700/week for patients with severe MDD or MDD that was refractory to treatment. Population members in lower-income groups and urban homeowners had disadvantages in the distribution of financial protection received by the health system (SII reached - 8.47 and 15.25, respectively); however, financial hardship and inequities were mitigated province-wide if MDD went into remission (SII - 0.07 to 0.6). CONCLUSIONS MDD-attributable costs to health systems and patients are highest in the first 12 weeks after a new diagnosis. During this time, lower income groups and homeowners in urban areas run the risk of financial hardship.
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Affiliation(s)
- Sonya Cressman
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Shahzad Ghanbarian
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| | - Louisa Edwards
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Mary Bunka
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Linda Riches
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
- Patient Partner, University of British Columbia, Vancouver, BC, Canada
| | - Jehannine Austin
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Rohit Vijh
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Stirling Bryan
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
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Shefler G, Abargil M, Yonatan-Leus R, Finkenberg R, Amir I. Empirical examination of long-term and intensive psychodynamic psychotherapy for severely disturbed patients. Psychother Res 2023:1-16. [PMID: 37774371 DOI: 10.1080/10503307.2023.2263810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/07/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVES This study examines the effectiveness and efficiency of intensive psychodynamic psychotherapy for severely impaired patients. METHOD 104 patients in four public mental health centers underwent intensive psychodynamic psychotherapy. The number and duration of psychiatric hospitalizations were monitored for these patients from one year before therapy to eight years after. Several outcome variables were measured every six months, six times in total over two and a half years, using a longitudinal design. A multi-level analytic approach was applied to account for repeated measurements and missing data. RESULTS Significant improvement was found in all three symptomatic outcome measures (SCL-90, OQ-45, BDI) throughout treatment. The numbers of psychiatric hospitalizations and psychiatric hospitalization days decreased significantly from the level they were in the year before the start of psychodynamic treatment to three years after the start of treatment. These results were maintained for at least up to eight years. After capitalization, the overall cumulative 127.47-day decrease in hospitalization days equals savings of 115,850 NIS. The average cost of treatment after capitalization was 26,770 NIS. The insurer's estimated direct savings is 89,080 NIS (24,054 $). CONCLUSION These findings support the hypothesis that psychodynamic psychotherapy is clinically effective and economically efficient for severely impaired patients.
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Affiliation(s)
- Gaby Shefler
- Department of Psychology, Achva Academic College and Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maayan Abargil
- Department of Psychology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Refael Yonatan-Leus
- Department of Psychology, The College of Management Academic Studies, Rishon Lezion, Israel
| | | | - Ilan Amir
- Lechol Nefesh Organization, Jerusalem, Israel
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Sun FK, Long A, Chiang CY, Yang CJ, Yao Y. Four psychological processes navigated by patients during their journey of healing and recovering from depression: a grounded theory study. Arch Psychiatr Nurs 2023; 45:36-43. [PMID: 37544700 DOI: 10.1016/j.apnu.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/04/2023] [Accepted: 04/30/2023] [Indexed: 08/08/2023]
Abstract
This study explored the psychological processes that patients navigated when healing and recovering from depression. A grounded theory approach was used. Twenty patients who had recovered from depression participated. Four categories emerged depicting the psychological processes navigated by the participants during the recovery process: (1) acceptance: acceptance of depression and agreement to treatment; (2) transformation: change of mindsets and behaviours; (3) adaptation: stress regulation and change of focus; (4) integration: progress of depressive symptoms and moving on with 'regular' life. Each phase is related to the other phases, mental health professionals could assist patients with depression achieve the integration phase.
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Affiliation(s)
- Fan-Ko Sun
- Second Degree Bachelor of Science in Nursing, College of Medicine, National Taiwan University, No.1 Je n Ai Road section 1, Taipei 100, Taiwan, ROC; Department of Nursing, National Taiwan University Hospital Yunlin Branch, Taiwan, ROC.
| | - Ann Long
- School of Nursing, Ulster University, 41. North Parade, Ormeau Road, Belfast BT 72GH, Northern Ireland, UK
| | - Chun-Ying Chiang
- Department of Nursing, I-Shou University, No.8, Yida Rd., Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan, ROC.
| | - Ching-Ju Yang
- Surgical Intensive Care Unit, Department of Nursing, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan 704, Taiwan, ROC
| | - YuChun Yao
- Department of Nursing, I-Shou University, No.8, Yida Rd., Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan, ROC.
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Brice SN, Harper PR, Gartner D, Behrens DA. Modeling disease progression and treatment pathways for depression jointly using agent based modeling and system dynamics. Front Public Health 2023; 10:1011104. [PMID: 36817182 PMCID: PMC9932262 DOI: 10.3389/fpubh.2022.1011104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/15/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction Depression is a common mental health condition that affects millions of people worldwide. Care pathways for depression are complex and the demand across different parts of the healthcare system is often uncertain and not entirely understood. Clinical progression with depression can be equally complex and relates to whether or not a patient is seeking care, the care pathway they are on, and the ability for timely access to healthcare services. Considering both pathways and progression for depression are however rarely studied together in the literature. Methods This paper presents a hybrid simulation modeling framework that is uniquely able to capture both disease progression, using Agent Based Modeling, and related care pathways, using a System Dynamics. The two simulation paradigms within the framework are connected to run synchronously to investigate the impact of depression progression on healthcare services and, conversely, how any limitations in access to services may impact clinical progression. The use of the developed framework is illustrated by parametrising it with published clinical data and local service level data from Wales, UK. Results and discussion The framework is able to quantify demand, service capacities and costs across all care pathways for a range of different scenarios. These include those for varying service coverage and provision, such as the cost-effectiveness of treating patients more quickly in community settings to reduce patient progression to more severe states of depression, and thus reducing the costs and utilization of more expensive specialist settings.
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Affiliation(s)
| | - Paul R. Harper
- School of Mathematics, Cardiff University, Cardiff, United Kingdom
| | - Daniel Gartner
- School of Mathematics, Cardiff University, Cardiff, United Kingdom,Aneurin Bevan Continuous Improvement (ABCi), Aneurin Bevan University Health Board, Caerleon, United Kingdom,*Correspondence: Daniel Gartner ✉
| | - Doris A. Behrens
- School of Mathematics, Cardiff University, Cardiff, United Kingdom,Department of Economy and Health, University of Continuing Education Krems, Krems an der Donau, Austria,Public Health Team, Aneurin Bevan University Health Board, Caerleon, United Kingdom
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Entwistle N, Polnay A, Russ TC. Service impact: how patients use mental health and medical services before and after psychodynamic psychotherapy. PSYCHOANALYTIC PSYCHOTHERAPY 2022. [DOI: 10.1080/02668734.2022.2147580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Naomi Entwistle
- Psychotherapy Department, Royal Edinburgh Hospital, Edinburgh, UK
| | - Adam Polnay
- Psychotherapy Department, Royal Edinburgh Hospital, Edinburgh, UK
- Medical Division, The State Hospital, Carstairs, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Tom C. Russ
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
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Collaton J, Barata P, Lewis SP. Understanding Discussions of Sexual Assault in Young Women on a Peer Support Mental Health App: A Content Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP22811-NP22833. [PMID: 35195468 PMCID: PMC9679558 DOI: 10.1177/08862605211073112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Trauma narratives may have been influenced by the Me Too movement, with thousands of individuals disclosing sexual violence stories online. Youth, the largest demographic of online users, may prefer the anonymity of the Internet to discuss experiences of sexual assault. Understanding the ways that young women, especially those experiencing mental health difficulties, discuss their experiences is important as they are at higher risk of revictimization and continued poor mental health. We searched for terms related to acts of sexual assault on a mental health peer-support app, TalkLife, and compared the number of posts during the initial wave of the Me Too movement (October 2017-March 2018) to the same time period in the previous year (October 2016-March 2017). We found a significant increase in posts related to sexual assault of 49.7% between the Pre and Post Me Too time periods (p < .001), controlling for a general increase in posts. A content analysis of 700 randomly selected posts found that a substantial number of young women used TalkLife to discuss their experiences of sexual assault, and these self-disclosures were mostly hopeless or depressing in tone. Additionally, neither the nature nor the number of self-disclosures varied across time points. The negative tone of the self-disclosures in the current study is worrying because the way women talk about their trauma can shape how they understand it, which could lead to negative self-appraisal and continued mental health difficulties. Online spaces have the potential to support young women and facilitate help-seeking, but we must be attentive to how they are used.
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Affiliation(s)
- Joanna Collaton
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | - Paula Barata
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | - Stephen P. Lewis
- Department of Psychology, University of Guelph, Guelph, ON, Canada
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Munder T, Geisshüsler A, Krieger T, Zimmermann J, Wolf M, Berger T, Watzke B. Intensity of Treatment as Usual and Its Impact on the Effects of Face-to-Face and Internet-Based Psychotherapy for Depression: A Preregistered Meta-Analysis of Randomized Controlled Trials. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:200-209. [PMID: 35158363 DOI: 10.1159/000521951] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/06/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Treatment as usual (TAU) is the most frequently used control group in randomized trials of psychotherapy for depression. Concerns have been raised that the heterogeneity of treatments in TAU leads to biased estimates of psychotherapy efficacy and to an unclear difference between TAU and control groups like waiting list (WL). OBJECTIVE We investigated the impact of control group intensity (i.e., amount and degree to which elements of common depression treatments are provided) on the effects of face-to-face and internet-based psychotherapy for depression. METHODS We conducted a preregistered meta-analysis (www.osf.io/4mzyd). We included trials comparing psychotherapy with TAU or WL in patients with symptoms of unipolar depression. Six indicators were used to assess control group intensity. PRIMARY OUTCOME Standardized mean difference (SMD) of psychotherapy and control in depressive symptoms at treatment termination. RESULTS We included 89 trials randomizing 14,474 patients to 113 psychotherapy conditions and 89 control groups (TAU in 42 trials, WL in 47 trials). Control group intensity predicted trial results in preregistered (one-sided ps < 0.042) and exploratory analyses. Psychotherapy effects were significantly smaller (one-sided p = 0.002) in trials with higher intensity TAU (SMD = 0.324, CI 0.209 to 0.439) than in trials with lower intensity TAU (SMD = 0.628, CI 0.455 to 0.801). Psychotherapy effects against lower intensity TAU did not differ from effects against WL (two-sided p = 0.663). CONCLUSIONS Our results suggest that variation in TAU intensity impacts the outcome of trials. More scrutiny in the design of control groups for clinical trials is recommended.
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Affiliation(s)
- Thomas Munder
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | | | - Tobias Krieger
- Institute of Psychology, University of Bern, Bern, Switzerland
| | | | - Markus Wolf
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Thomas Berger
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - Birgit Watzke
- Department of Psychology, University of Zurich, Zurich, Switzerland
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Yonatan-Leus R, Abargil M, Cooper-Kazaz R. The combined effect of psychodynamic psychotherapy and pharmacotherapy on healthcare cost. Psychother Res 2022; 32:874-885. [PMID: 35118912 DOI: 10.1080/10503307.2022.2032861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Previous studies have established a connection between therapy and healthcare cost: an increase in cost prior to therapy and a maintained decrease post therapy. There is, however, a lack of studies examining the combined effects of psychotherapy and pharmacotherapy on healthcare cost. METHOD Healthcare cost was examined quarterly in 1,213 patients (28,776 observations) in a naturalistic longitudinal design. Psychotherapy only was compared to combined treatment and to an addition of psychotherapy to preexisting pharmacotherapy. The comparisons were conducted with a multilevel piecewise model (LMLM) computed for three phases: pre-, during-, and post-therapy. RESULTS Significant interactions were found between the contrast comparing preexisting pharmacotherapy to the during-psychotherapy and no-pharmacotherapy groups and the three piecewise variables. The pre-therapy increase was larger for the preexisting-pharmacotherapy group than for the other groups. The during-therapy decrease was larger for the preexisting-pharmacotherapy group than for the other groups. In the post-therapy period, the increase was significant only for the prior-psychiatric-medication group. CONCLUSIONS Preexisting psychotropic treatment along with an increase in healthcare expenditure may serve as an indication of the need for additional psychotherapy treatment.
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Affiliation(s)
- Refael Yonatan-Leus
- Department of Psychology the College of Management Academic Studies- Rishon Lezion, Israel.,Clalit Health Services - Jerusalem, Israel
| | - Maayan Abargil
- Department of Psychology, Hebrew University of Jerusalem, Israel
| | - Rena Cooper-Kazaz
- Clalit Health Services -Jerusalem. Affiliated with The Faculty of Medicine at The Hebrew University Jerusalem, Israel
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Zifkin C, Montreuil M, Beauséjour MÈ, Picard S, Gendron-Cloutier L, Carnevale FA. An exploration of youth and parents' experiences of child mental health service access. Arch Psychiatr Nurs 2021; 35:549-555. [PMID: 34561072 DOI: 10.1016/j.apnu.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/12/2021] [Accepted: 06/12/2021] [Indexed: 11/28/2022]
Abstract
Youth experience an increased prevalence of mental health issues, while access to timely and quality services remains problematic. This study examined the experiences of adolescents and their parents surrounding mental health care access. A 4-month focused ethnography was conducted at a mental health clinic for adolescents experiencing difficulties with emotional regulation. Findings revealed major barriers to service access, including a lack of knowledge, information, and guidance, long wait times, and stigma. Facilitators to access included social support, having a contact person, and good rapport with healthcare providers. The study highlights the importance of timely mental health service access for adolescents and provides insights for the improvement of service accessibility.
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Affiliation(s)
- Cleo Zifkin
- Ingram School of Nursing, McGill University, 680, rue Sherbrooke Ouest, Montreal, Quebec H3A 2M7, Canada
| | - Marjorie Montreuil
- Ingram School of Nursing, McGill University, 680, rue Sherbrooke Ouest, Montreal, Quebec H3A 2M7, Canada; Douglas Hospital Research Centre, 6875 boul. LaSalle, Verdun, Québec H4H 1R3, Canada.
| | - Marie-Ève Beauséjour
- Douglas Mental Health University Institute, 6875 boul. LaSalle, Verdun, Québec H4H 1R3, Canada
| | - Stéphane Picard
- Douglas Mental Health University Institute, 6875 boul. LaSalle, Verdun, Québec H4H 1R3, Canada
| | - Lauranne Gendron-Cloutier
- Ingram School of Nursing, McGill University, 680, rue Sherbrooke Ouest, Montreal, Quebec H3A 2M7, Canada
| | - Franco A Carnevale
- Ingram School of Nursing, McGill University, 680, rue Sherbrooke Ouest, Montreal, Quebec H3A 2M7, Canada; Douglas Mental Health University Institute, 6875 boul. LaSalle, Verdun, Québec H4H 1R3, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada; Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada; Counselling Psychology, McGill University, Montreal, Quebec, Canada
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Naeem F, Tuck A, Mutta B, Dhillon P, Thandi G, Kassam A, Farah N, Ashraf A, Husain MI, Husain MO, Vasiliadis HM, Sanches M, Munshi T, Abbott M, Watters N, Kidd SA, Ayub M, McKenzie K. Protocol for a multi-phase, mixed methods study to develop and evaluate culturally adapted CBT to improve community mental health services for Canadians of south Asian origin. Trials 2021; 22:600. [PMID: 34488853 PMCID: PMC8419942 DOI: 10.1186/s13063-021-05547-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Canadians of South Asian (SA) origin comprise the largest racialized group in Canada, representing 25.6% of what Statistics Canada terms “visible minority populations”. South Asian Canadians are disproportionately impacted by the social determinants of health, and this can result in high rates of mood and anxiety disorders. These factors can negatively impact mental health and decrease access to care, thereby increasing mental health inequities. Cognitive Behavioural Therapy (CBT) in its current form is not suitable for persons from the non-western cultural backgrounds. Culturally adapted Cognitive Behavioural Therapy (CaCBT) is an evidence-based practice. CaCBT is more effective than standard CBT and can reduce dropouts from therapy compared with standard CBT. Thus, CaCBT can increase access to mental health services and improve outcomes for immigrant, refugee and ethno-cultural and racialized populations. Adapting CBT for growing SA populations in Canada will ensure equitable access to effective and culturally appropriate interventions. Methods The primary aim of the study is to develop and evaluate CaCBT for Canadian South Asian persons with depression and anxiety and to gather data from stakeholders to develop guidelines to culturally adapt CBT. This mixed methods study will use three phases: (1) cultural adaptation of CBT, (2) pilot feasibility of CaCBT and (3) implementation and evaluation of CaCBT. Phase 1 will use purposive sampling to recruit individuals from four different groups: (1) SA patients with depression and anxiety, (b) caregivers and family members of individuals affected by anxiety and depression, (c) mental health professionals and (d) SA community opinion leaders. Semi-structured interviews will be conducted virtually and analysis of interviews will be informed by an ethnographic approach. Phase 2 will pilot test the newly developed CaCBT for feasibility, acceptability and effectiveness via quantitative methodology and a randomized controlled trial, including an economic analysis. Phase 3 will recruit therapists to train and evaluate them in the new CaCBT. Discussion The outcome of this trial will benefit health services in Canada, in terms of helping to reduce the burden of depression and anxiety and provide better care for South Asians. We expect the results to help guide the development of better services and tailor existing services to the needs of other vulnerable groups. Trial registration ClinicalTrials.gov NCT04010890. Registered on July 8, 2019
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Affiliation(s)
- Farooq Naeem
- Department of Psychiatry, University of Toronto, Toronto, Canada. .,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada.
| | - Andrew Tuck
- Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - Baldev Mutta
- Punjabi Community Health Services, Toronto, Canada
| | | | - Gary Thandi
- Moving Forward Family Services, Vancouver, Canada
| | | | - Nimo Farah
- Somerset West Community Health Centre, Ottawa, Canada
| | - Aamna Ashraf
- Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - M Omair Husain
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Faculty of Medicine and Health Science, Université de Sherbrooke, Research Center Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Montreal, Canada
| | - Marcos Sanches
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - Tariq Munshi
- Department of Psychiatry, University of Toronto, Toronto, Canada.,St Michael's Hospital, Toronto, Canada
| | | | | | - Sean A Kidd
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | | | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada.,Wellesley Institute, Toronto, Canada
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Premji S, McDonald SW, McNeil DA, Spackman E. Maximizing maternal health and value for money in postpartum depression screening: a cost-effectiveness analysis using the All Our Families cohort and administrative data in Alberta, Canada. J Affect Disord 2021; 281:839-846. [PMID: 33239243 DOI: 10.1016/j.jad.2020.11.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/08/2020] [Accepted: 11/08/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Postpartum depression (PPD) affects 10-15% of women, is costly and debilitating, yet often remains undiagnosed. Within Alberta, Canada, screening is conducted at public health well child clinics using the Edinburgh Postnatal Depression Scale. If screened high-risk, women are offered referral to their family physicians for follow up diagnosis and treatment. METHODS We developed a decision tree to estimate the cost-effectiveness of PPD screening versus not screening in Alberta over a two-year time horizon using a public healthcare payer perspective. Both the current practice (51% attending referral) and a scenario analysis (100% attending referral) are presented. RESULTS Current practice results suggest screening leads to an incremental cost-effectiveness ratio (ICER) of $17,644 USD per quality adjusted life year (QALY). At a population-level, this resulted in an annual 813 (11%) additional cases diagnosed, 120 additional QALYs gained, and an additional cost of $2.1 million relative to not screening. With 100% attending referral, the ICER fell to $13,908 per QALY, resulting in an annual 1997 (27%) additional cases diagnosed, 249 additional QALYs gained, and an additional cost of $3.5 million relative to not screening. LIMITATIONS We were unable to explore the cost-effectiveness of PPD screening versus not screening for secondary populations, including children. CONCLUSIONS The results suggest screening may be most valuable when participation and compliance are maximized, where all women screened high-risk attend referral. This leads to greater value for money and increased maternal health gains across the population. Collaboration among public health and primary care services is encouraged to improve outcomes.
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Affiliation(s)
- Shainur Premji
- Population, Public and Indigenous Health, Alberta Health Services; Community Health Sciences, Cumming School of Medicine, University of Calgary.
| | - Sheila W McDonald
- Population, Public and Indigenous Health, Alberta Health Services; Community Health Sciences, Cumming School of Medicine, University of Calgary; Paediatrics, Cumming School of Medicine, University of Calgary
| | - Deborah A McNeil
- Population, Public and Indigenous Health, Alberta Health Services; Community Health Sciences, Cumming School of Medicine, University of Calgary; Faculty of Nursing, University of Calgary
| | - Eldon Spackman
- Community Health Sciences, Cumming School of Medicine, University of Calgary
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13
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Vasiliadis HM, Spagnolo J, Lesage A. Public Funding of Evidence-Based Psychotherapy for Common Mental Disorders: Increasing Calls for Action in Canadian Provinces. Healthc Policy 2021; 16:16-25. [PMID: 33720820 PMCID: PMC7957359 DOI: 10.12927/hcpol.2021.26437] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Canada's provinces are without a publicly funded psychotherapy program for common mental disorders despite evidence that psychological services help reduce the length and number of depressive episodes, symptoms of post-traumatic stress and associated negative outcomes (hospitalizations and suicide attempts). Studies also show that including psychological services as part of the service package offered under the public health plan for those without access pays for itself. We posit that a publicly funded psychotherapy program in Canada, including digitized self-guided psychotherapy platforms for common mental disorders, will lead to improved population health useful in the COVID-19 context and beyond.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Full Professor, Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Longueuil, QC
| | - Jessica Spagnolo
- Postdoctoral Fellow, Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Longueuil, QC
| | - Alain Lesage
- Full Professor, Departement of Psychiatry, University of Montreal, Centre de Recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC
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Yonatan-Leus R, Strauss AY, Cooper-Kazaz R. Psychodynamic psychotherapy is associated with sustained reduction in health care utilization and cost. Clin Psychol Psychother 2020; 28:642-655. [PMID: 33142005 DOI: 10.1002/cpp.2527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 11/10/2022]
Abstract
Our objective was to examine the effectiveness and efficiency of psychodynamic psychotherapy on the reduction in health care utilization and cost while controlling for age, gender, and year. Health care utilization and cost were examined yearly in 1,675 patients from 2 years before outpatient psychotherapy (i.e., baseline) to three consecutive years after psychotherapy in a naturalistic longitudinal design. A multilevel analytic approach (LMLM) was applied to account for repeated measures effect and missing data. In the year prior to psychotherapy, there was a significant increase in total cost compared with baseline (14.8%) and in use of health care services (primary and specialist doctors' visits and outsourced referrals). In the first year following therapy, there was a significant decrease in total cost (10%) and in use of health care services (all doctors' visits, imaging, and outsourced referrals). The decrease was to baseline levels or lower and was maintained for two additional years. Psychiatric medication usage increased significantly after psychotherapy and remained so. The overall cumulative decrease in total cost per patient over 3 years after therapy was 3,665.92 NIS, equalling a 69% average cost of psychotherapy. Further cost saving can be expected due to the reduction in sick leave, disability, and psychiatric hospitalization. These findings support the notion that providing outpatient psychodynamic psychotherapy can be financially beneficial to health care systems, although further research is required for causal inferences. Also, an increase in health care utilization along with scarce physical findings may indicate unaddressed psychological distress and warrant referral for mental assessment and possible psychotherapy.
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Affiliation(s)
- Refael Yonatan-Leus
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel.,Mental Health Services (Talbiya), Clalit Health Services-Jerusalem, Affiliated with The Faculty of Medicine at The Hebrew University Jerusalem, Jerusalem, Israel
| | - Asher Y Strauss
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rena Cooper-Kazaz
- Mental Health Services (Talbiya), Clalit Health Services-Jerusalem, Affiliated with The Faculty of Medicine at The Hebrew University Jerusalem, Jerusalem, Israel
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15
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Vu T, Anderson KK, Devlin RA, Somé NH, Sarma S. Physician remuneration schemes, psychiatric hospitalizations and follow-up care: Evidence from blended fee-for-service and capitation models. Soc Sci Med 2020; 268:113465. [PMID: 33128977 DOI: 10.1016/j.socscimed.2020.113465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/28/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022]
Abstract
Psychiatric hospitalizations could be reduced if mental illnesses were detected and treated earlier in the primary care setting, leading to the World Health Organization recommendation that mental health services be integrated into primary care. The mental health services provided in primary care settings may vary based on how physicians are incentivized. Little is known about the link between physician remuneration and psychiatric hospitalizations. We contribute to this literature by studying the relationship between physician remuneration and psychiatric hospitalizations in Canada's most populous province, Ontario. Specifically, we study family physicians (FPs) who switched from blended fee-for-service (FFS) to blended capitation remuneration model, relative to those who remained in the blended FFS model, on psychiatric hospitalizations. Outcomes included psychiatric hospitalizations by enrolled patients and the proportion of hospitalized patients who had a follow-up visit with the FP within 14 days of discharge. We used longitudinal health administrative data from a cohort of practicing physicians from 2006 through 2016. Because physicians practicing in these two models are likely to be different, we employed inverse probability weighting based on estimated propensity scores to ensure that switchers and non-switchers were comparable at the baseline. Using inverse probability weighted fixed-effects regressions controlling for relevant confounders, we found that switching from blended FFS to blended capitation was associated with a 6.2% decrease in the number of psychiatric hospitalizations and a 4.7% decrease in the number of patients with a psychiatric hospitalization. No significant effect of remuneration on follow-up visits within 14 days of discharge was observed. Our results suggest that the blended capitation model is associated with fewer psychiatric hospitalizations relative to blended FFS.
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Affiliation(s)
- Thyna Vu
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; ICES, Toronto, ON, Canada.
| | - Rose Anne Devlin
- Department of Economics, University of Ottawa, Ottawa, ON, Canada.
| | - Nibene H Somé
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; ICES, Toronto, ON, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Sisira Sarma
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; ICES, Toronto, ON, Canada.
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16
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Tremblay D, Poder TG, Vasiliadis HM, Touati N, Fortin B, Lévesque L, Longo C. Translation and Cultural Adaptation of the Patient Self-Administered Financial Effects (P-SAFE) Questionnaire to Assess the Financial Burden of Cancer in French-Speaking Patients. Healthcare (Basel) 2020; 8:E366. [PMID: 32992780 PMCID: PMC7712971 DOI: 10.3390/healthcare8040366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 12/23/2022] Open
Abstract
People living with and beyond cancer (PLC) experience financial hardship associated with the disease and its treatment. Research demonstrates that the "economic toxicity" of cancer can cause distress and impair well-being, health-related quality of life and, ultimately, survival. The Patient Self-Administered Financial Effects (P-SAFE) questionnaire was created in Canada and tested in English. The objective of this study is to describe the processes of translation and cultural adaptation of the P-SAFE for use with French speaking PLC in Canada. The Canadian P-SAFE questionnaire was translated from English to French in collaboration with the developer of the initial version, according to the 12-step process recommended by the Patient-Reported Outcome (PRO) Consortium. These steps include forward and backward translation, a multidisciplinary expert committee, and cross-cultural validation using think-aloud, probing techniques, and clarity scoring during cognitive interviewing. Translation and validation of the P-SAFE questionnaire were performed without major difficulties. Minor changes were made to better fit with the vocabulary used in the public healthcare system in Quebec. The mean score for clarity of questions was 6.4 out of a possible 7 (totally clear) Cognitive interviewing revealed that lengthy questionnaire instructions could be confusing. Our team produced a Canadian-French version of the P-SAFE. After minor rewording in the instructions, the P-SAFE questionnaire appears culturally appropriate for use with French-speaking PLC in Canada. Further testing of the French version will require evaluation of psychometric properties of validity and reliability.
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Affiliation(s)
- Dominique Tremblay
- Centre de Recherche Charles-Le Moyne–Saguenay–Lac-Saint-Jean sur les Innovations en Santé, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (H.-M.V.); (B.F.); (L.L.)
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Campus de Longueuil, Longueuil, QC J4K 0A8, Canada
| | - Thomas G. Poder
- Département de Gestion, Évaluation et Politique de Santé, École de Santé Publique de l’Université de Montréal (ESPUM), Université de Montréal, Montréal, QC H3N 1X9, Canada;
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, CIUSSS de l’Est de l’Île de Montréal, Montréal, QC H1N 3M5, Canada
| | - Helen-Maria Vasiliadis
- Centre de Recherche Charles-Le Moyne–Saguenay–Lac-Saint-Jean sur les Innovations en Santé, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (H.-M.V.); (B.F.); (L.L.)
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Campus de Longueuil, Longueuil, QC J4K 0A8, Canada
| | - Nassera Touati
- École Nationale D’administration Publique, Montréal, QC H2T 2C8, Canada;
| | - Béatrice Fortin
- Centre de Recherche Charles-Le Moyne–Saguenay–Lac-Saint-Jean sur les Innovations en Santé, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (H.-M.V.); (B.F.); (L.L.)
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Campus de Longueuil, Longueuil, QC J4K 0A8, Canada
| | - Lise Lévesque
- Centre de Recherche Charles-Le Moyne–Saguenay–Lac-Saint-Jean sur les Innovations en Santé, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (H.-M.V.); (B.F.); (L.L.)
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Campus de Longueuil, Longueuil, QC J4K 0A8, Canada
| | - Christopher Longo
- DeGroote School of Business, McMaster University, Hamilton, ON L8S 4L8, Canada;
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17
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Duevel JA, Hasemann L, Peña-Longobardo LM, Rodríguez-Sánchez B, Aranda-Reneo I, Oliva-Moreno J, López-Bastida J, Greiner W. Considering the societal perspective in economic evaluations: a systematic review in the case of depression. HEALTH ECONOMICS REVIEW 2020; 10:32. [PMID: 32964372 PMCID: PMC7510122 DOI: 10.1186/s13561-020-00288-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/07/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Depressive disorders are associated with a high burden of disease. However, due to the burden posed by the disease on not only the sufferers, but also on their relatives, there is an ongoing debate about which costs to include and, hence, which perspective should be applied. Therefore, the aim of this paper was to examine whether the change between healthcare payer and societal perspective leads to different conclusions of cost-utility analyses in the case of depression. METHODS A systematic literature search was conducted to identify economic evaluations of interventions in depression, launched on Medline and the Cost-Effectiveness Registry of the Tufts University using a ten-year time horizon (2008-2018). In a two-stepped screening process, cost-utility studies were selected by means of specified inclusion and exclusion criteria. Subsequently, relevant findings was extracted and, if not fully stated, calculated by the authors of this work. RESULTS Overall, 53 articles with 92 complete economic evaluations, reporting costs from healthcare payer/provider and societal perspective, were identified. More precisely, 22 estimations (24%) changed their results regarding the cost-effectiveness quadrant when the societal perspective was included. Furthermore, 5% of the ICURs resulted in cost-effectiveness regarding the chosen threshold (2% of them became dominant) when societal costs were included. However, another four estimations (4%) showed the opposite result: these interventions were no longer cost-effective after the inclusion of societal costs. CONCLUSIONS Summarising the disparities in results and applied methods, the results show that societal costs might alter the conclusions in cost-utility analyses. Hence, the relevance of the perspectives chosen should be taken into account when carrying out an economic evaluation. This systematic review demonstrates that the results of economic evaluations can be affected by different methods available for estimating non-healthcare costs.
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Affiliation(s)
- Juliane Andrea Duevel
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany.
| | - Lena Hasemann
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany
| | - Luz María Peña-Longobardo
- Faculty of Law and Social Sciences, Economic Analysis Department, Research Group in Economics and Health, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
| | - Beatriz Rodríguez-Sánchez
- Faculty of Law and Social Sciences, Economic Analysis Department, Research Group in Economics and Health, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
- Faculty of Technology and Science, University Camilo José Cela, Urb. Villafranca del Castillo, Calle Castillo de Alarcón, 49, 28692 Villanueva de la Cañada, Madrid, Spain
| | - Isaac Aranda-Reneo
- Faculty of Social Science, Economic Analysis and Finance Department, Research Group in Economics and Health, University of Castilla-La Mancha, Avda. Real Fábrica s/n, Talavera de la Reina, 45600, Toledo, Spain
| | - Juan Oliva-Moreno
- Faculty of Law and Social Sciences, Economic Analysis Department, Research Group in Economics and Health, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
| | - Julio López-Bastida
- Faculty of Health Science, Research Group in Economics and Health, University of Castilla-La Mancha, Av. Real Fábrica de Sedas, s/n, Talavera de la Reina, 45600, Toledo, Spain
| | - Wolfgang Greiner
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany
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18
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Villarreal-Zegarra D, Cabrera-Alva M, Carrillo-Larco RM, Bernabe-Ortiz A. Trends in the prevalence and treatment of depressive symptoms in Peru: a population-based study. BMJ Open 2020; 10:e036777. [PMID: 32690526 PMCID: PMC7371215 DOI: 10.1136/bmjopen-2020-036777] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aimed to estimate the trends in the prevalence and treatment of depressive symptoms using nationally representative surveys in Peru from 2014 to 2018. DESIGN A secondary analysis was conducted using five nationally representative surveys carried out consecutively in the years between 2014 and 2018. SETTING The study was conducted in Peru. PARTICIPANTS Individuals, men and women, aged ≥15 years who participated in the selected surveys. Sampling was probabilistic using a two-stage approach. MAIN OUTCOME MEASURES Two versions of the Patient Health Questionnaire (PHQ-9) that focused on the presence of depressive symptoms were administered (one in the last 2 weeks and other in the last year). Scores ≥15 were used as the cut-off point in both versions of the PHQ-9 to define the presence of depressive symptoms. Also, the treatment rate was based on the proportion of individuals who had experienced depressive symptoms in the last year and who had self-reported having received specific treatment for these symptoms. The age-standardised prevalence was estimated. RESULTS A total of 161 061 participants were included. There was no evidence of a change in age-standardised prevalence rates of depressive symptoms at the 2 weeks prior to the point of data collection (2.6% in 2014 to 2.3% in 2018), or in the last year (6.3% in 2014 to 6.2% in 2018). Furthermore, no change was found in the proportion of depressive cases treated in the last year (14.6% in 2014 to 14.4% in 2018). Rural areas and individuals with low-level of wealth had lower proportion of depressive cases treated. CONCLUSIONS No changes in trends of rates of depressive symptoms or in the proportion of depressive cases treated were observed. This suggests the need to reduce the treatment gap considering social determinants associated with inequality in access to adequate therapy.
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Affiliation(s)
- David Villarreal-Zegarra
- Instituto Peruano de Orientación Psicológica, Lima, Peru
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Rodrigo M Carrillo-Larco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Universidad Científica del Sur, Miraflores, Peru
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Moroz N, Moroz I, D'Angelo MS. Mental health services in Canada: Barriers and cost-effective solutions to increase access. Healthc Manage Forum 2020; 33:282-287. [PMID: 32613867 DOI: 10.1177/0840470420933911] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article, an overview of the barriers to accessing mental health services in Canada is provided and the recent federal funding commitments toward increasing the availability of evidence-based and cost-effective solutions to improve access to mental health services are highlighted. Barriers pertain mainly to costs, not knowing where to get help, excessive wait times, and insufficient funding. Through the Common Statement of Principles on Shared Health Priorities agreement, action is being taken by all jurisdictions in Canada to increase community-based mental health promotion programs and early interventions, especially those targeting children and youth. A growing body of evidence is demonstrating how specific community and primary care-based interventions are both effective and cost-effective. These integrated community solutions, shown to be effective for increasing access to appropriate services for patients while saving costs to the healthcare system, would benefit from the recent funding investments put in place by the federal government.
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Affiliation(s)
- Nicholas Moroz
- 33498The Conference Board of Canada, Ottawa, Ontario, Canada
| | - Isabella Moroz
- 33498The Conference Board of Canada, Ottawa, Ontario, Canada
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20
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Wiktorowicz ME, Di Pierdomenico K, Buckley NJ, Lurie S, Czukar G. Governance of mental healthcare: Fragmented accountability. Soc Sci Med 2020; 256:113007. [PMID: 32464418 DOI: 10.1016/j.socscimed.2020.113007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/31/2020] [Accepted: 04/18/2020] [Indexed: 12/01/2022]
Abstract
Within international healthcare systems the neglect of mental health and challenge in shifting from institutional to community care have been recurrent themes. In analysing the challenges, we focus on the case study of Canada by exploring the manner in which health law and policy evolved to inhibit community-based mental healthcare, and compare the resulting funding landscape from an international perspective. The historical institutionalist analysis draws on the literature and healthcare finance data. As a spending statute, the Canada Health Act defines the terms on which the federal government finances publicly insured provincial healthcare. Despite the goal to support physical and mental well-being by removing financial barriers to access health services, exclusion of community care offered by non-physicians (such as psychotherapy) from the terms of the Act inhibited its fulfilment. Diminished federal transfers deepened the disincentive for provinces to establish community care: mental health declined from 11 to 7 percent of provincial healthcare spending from 1979 to 2014. Governance oversight was passed to provinces whose competing demands on diminished resources limited their capacity to extend care. Accountability was found fragmented as neither government stepped-in to ensure the continuum of care, even as federal transfers were restored and evidence of cost-effectiveness grew. Although American and Canadian funding patterns are similar, other OECD countries invest between 13 and 18 percent of healthcare expenditures on mental health. Lessons from the Canadian case are the manner in which its federal structure and intergovernmental dynamics shaped health policy, and the importance of ensuring representation from a range of perspectives in policy development. Federal financial incentives were also found to profoundly impact the expansion of community-based mental healthcare. Evidence shows that public insurance for community supports would reduce healthcare expenditures and employer productivity loss, resulting in savings of $255 billion over 30 years.
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Affiliation(s)
- Mary E Wiktorowicz
- York University, School of Health Policy and Management, Toronto, Canada; Dahdaleh Institute for Global Health Research, York University, Canada.
| | | | - Neil J Buckley
- York University, Department of Economics, Toronto, Ontario, Canada
| | - Steve Lurie
- Canadian Mental Health Association, Toronto, Canada
| | - Gail Czukar
- Addictions and Mental Health Ontario, Toronto, Canada
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21
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Gontijo Guerra S, Berbiche D, Vasiliadis HM. Changes in instrumental activities of daily living functioning associated with concurrent common mental disorders and physical multimorbidity in older adults. Disabil Rehabil 2020; 43:3663-3671. [PMID: 32255362 DOI: 10.1080/09638288.2020.1745303] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction: Instrumental activities of daily living (IADL) are key indicators of general functional status that are frequently used to assess the autonomy of older adults living in the community.Aims: To evaluate the changes in IADL in community-living older adults and the role of common mental disorders and physical multimorbidity in predicting these changes.Method: A secondary analysis including participants from the Longitudinal Survey on Senior's Health and Health Services. Self-reported sociodemographic and clinical information on chronic conditions were obtained at baseline interview (n = 1615). Measures of IADL were obtained at two time points, 3 years apart. Administrative data on physician diagnoses of chronic diseases were linked to self-reported information. Logistic and multinomial regression models were used to study the outcomes of interest.Results: More than one-third of participants reported disability. Significant increase in global and specific IADL tasks disability were observed over time. Concurrent mental and physical chronic conditions predicted persistent and future incidence of disability.Conclusions: We draw attention to the synergistic effect of mental and physical co-morbidities on IADL functioning and to the importance of the simultaneous management of these conditions in order to prevent disability, future decline and the associated health and societal burden.Implications for RehabilitationBy establishing the prevalence of global and specific IADL disability, we can better recognize the needs of older adults and inform health and social care planning.Influenced by the morbidity profile, older adults may experience decline, improvement or maintenance of autonomy in IADL over time.The presence of synergistic effect of physical and mental chronic conditions on functioning suggests that their simultaneous management is crucial in delaying or preventing disability.Reports of significant impairment in tasks such as taking medication calls attention to the need for increased accessibility to programs on medication management.The progressive loss of ability to take medication among multimorbid patients emphasize the need for therapeutic plans that circumvent polypharmacy.
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Affiliation(s)
- Samantha Gontijo Guerra
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Longueuil, QC, Canada.,Faculty of Medicine and Health Sciences, Université de Sherbrooke, Campus Longueuil, Longueuil, QC, Canada
| | - Djamal Berbiche
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Longueuil, QC, Canada.,Faculty of Medicine and Health Sciences, Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
| | - Helen-Maria Vasiliadis
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Longueuil, QC, Canada.,Faculty of Medicine and Health Sciences, Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
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22
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Let’s Distinguish Relative and Absolute Efficacy to Move Psychotherapy Research Forward. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2020; 65:178-182. [PMID: 31154927 DOI: 10.13109/zptm.2019.65.2.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective: Background regarding a recent debate between Cuijpers et al. (2019a, b) and the authors (Munder et al. 2019) about the efficacy of psychotherapy for depression is given. Method: A main reason for the discrepancy in Cuijpers et al.'s and our conclusions is discussed. Results: In our view the discrepancy is due, among other things, to a blurred distinction between questions of relative and absolute efficacy of psychotherapy. Although the efficacy of psychotherapy vis-à-vis alternative treatments may be ambiguous, there can be little doubt about the benefits of psychotherapy relative to no treatment. Conclusion: We do not think that raising fundamental concerns about the value of psychotherapy is a service to the field. We argue that moving the field forward requires a focus on how psychotherapy works and how the access to psychotherapy can be increased.
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Bartram M. Expanding access to psychotherapy in Canada: Building on achievements in Australia and the United Kingdom. Healthc Manage Forum 2019; 32:63-67. [PMID: 30700162 DOI: 10.1177/0840470418818581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Australia and the United Kingdom have significantly expanded access to psychotherapy over the past decade. With this international experience to draw upon and a new $5 billion federal mental health transfer, Canada is well positioned to address long-standing gaps and inequities in access to psychotherapy. In Canada's more decentralized context, a concerted effort from health leaders at all levels of government and across multiple sectors and professions is needed to make the most of this opportunity for reform. Key priorities for health leaders include using the full range of provincial and territorial policy levers for either a grants-based or insurance-based approach; implementing a strong approach to performance monitoring, with equity targets built in from the outset; addressing gaps in workforce planning; and forming a pan-Canadian coalition for expanding access to psychotherapy.
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Affiliation(s)
- Mary Bartram
- 1 Faculty of Law, Institute for Health and Social Policy, McGill University, Montreal, Quebec, Canada
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Diminic S, Bartram M. Does Introducing Public Funding for Allied Health Psychotherapy Lead to Reductions in Private Insurance Claims? Lessons for Canada from the Australian Experience. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:68-76. [PMID: 29925270 PMCID: PMC6364136 DOI: 10.1177/0706743718784941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Provincial and territorial governments are considering how best to improve access to psychotherapy from the current patchwork of programmes. To achieve the best value for money, new funding needs to reach a wider population rather than simply replacing services funded through insurance benefits. We considered lessons for Canada from the relative uptake of private insurance and public funding for allied health psychotherapy in Australia. METHOD We analysed published administrative claims data from 2003-2004 to 2014-2015 on Australian privately insured psychologist services, publicly insured psychotherapy under the 'Better Access' initiative, and public grant funding for psychotherapy through the 'Access to Allied Psychological Services' programme. Utilisation was compared to the prevalence of mental disorders and treatment rates in the 2007 National Survey of Mental Health and Wellbeing. RESULTS The introduction of public funding for psychotherapy led to a 52.1% reduction in private insurance claims. Costs per session were more than double under private insurance and likely contributed to individuals with private coverage choosing to instead access public programmes. However, despite substantial community unmet need, we estimate just 0.4% of the population made private insurance claims in the 2006-2007 period. By contrast, from its introduction, growth in the utilisation of Better Access quickly dwarfed other programmes and led to significantly increased community access to treatment. CONCLUSIONS Although insurance in Canada is sponsored by employers, psychology claims also appear surprisingly low, and unmet need similarly high. Careful consideration will be needed in designing publicly funded psychotherapy programmes to prepare for the high demand while minimizing reductions in private insurance claims.
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Affiliation(s)
- Sandra Diminic
- 1 School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia.,3 Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada
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Altmann U, Thielemann D, Zimmermann A, Steffanowski A, Bruckmeier E, Pfaffinger I, Fembacher A, Strauß B. Outpatient Psychotherapy Improves Symptoms and Reduces Health Care Costs in Regularly and Prematurely Terminated Therapies. Front Psychol 2018; 9:748. [PMID: 29867697 PMCID: PMC5964296 DOI: 10.3389/fpsyg.2018.00748] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/30/2018] [Indexed: 11/13/2022] Open
Abstract
Background: In view of a shortage of health care costs, monetary aspects of psychotherapy become increasingly relevant. The present study examined the pre-post reduction of impairment and direct health care costs depending on therapy termination (regularly terminated, dropout with an unproblematic reason, and dropout with a quality-relevant reason) and the association of symptom and cost reduction. Methods: In a naturalistic longitudinal study, we examined a disorder heterogeneous sample of N = 584 outpatients who were either treated with cognitive-behavioral, psychodynamic, or psychoanalytic therapy. Depression, anxiety, stress, and somatization were assessed with the Patient Health Questionnaire (PHQ). Annual amounts of inpatient costs, outpatient costs, medication costs, days of hospitalization, work disability days, utilization of psychotherapy, and utilization of pharmacotherapy 1 year before therapy and 1 year after therapy were provided by health care insurances. Symptom and cost reduction were analyzed using t-tests. Associations between symptom and cost reduction were examined using partial correlations and hierarchical linear models. Results: Patients who terminated therapy regularly showed the largest symptom reduction (d = 0.981–1.22). Patients who dropped out due to an unproblematic reason and patients who terminated early due to a quality-relevant reason showed significant but small effects of symptom reductions (e.g., depression: d = 0.429 vs. d = 0.366). For patients with a regular end and those dropping out due to a quality-relevant reason, we observed a significant reduction of work disability (diff in % of pre-test value = 56.3 vs. 42.9%) and hospitalization days (52.8 vs. 35.0%). Annual inpatient costs decreased in the group with a regular therapy end (31.5%). Furthermore, reduction of symptoms on the one side and reduction of work disability days and psychotherapy utilization on the other side were significant correlated (r = 0.091–0.135). Conclusion: Health care costs and symptoms were reduced in each of the three groups. The average symptom and cost reduction of patients with a quality-relevant dropout suggested that not each dropout might be seen as therapy failure.
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Affiliation(s)
- Uwe Altmann
- Institute of Psychosocial Medicine and Psychotherapy, Universitätsklinikum Jena, Jena, Germany
| | - Désirée Thielemann
- Institute of Psychosocial Medicine and Psychotherapy, Universitätsklinikum Jena, Jena, Germany
| | - Anna Zimmermann
- Institute of Psychosocial Medicine and Psychotherapy, Universitätsklinikum Jena, Jena, Germany
| | - Andrés Steffanowski
- Faculty of Applied Psychology, SRH University Heidelberg, Heidelberg, Germany
| | | | | | - Andrea Fembacher
- Bavarian Administration of Statutory Health Care Physicians, Munich, Germany
| | - Bernhard Strauß
- Institute of Psychosocial Medicine and Psychotherapy, Universitätsklinikum Jena, Jena, Germany
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Bartram M. Making the most of the federal investment of $5 billion for mental health. CMAJ 2017; 189:E1360-E1363. [PMID: 29109209 DOI: 10.1503/cmaj.170738] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Mary Bartram
- School of Public Policy and Administration, Carleton University, Ottawa, Ont.
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