1
|
Heider D, Rezvani F, Matschinger H, Dirmaier J, Härter M, Herbarth L, Steinisch P, Böbinger H, Schuhmann F, Krack G, Korth T, Thomsen L, Chase DP, Schreiber R, Alscher MD, Finger B, König HH. The effect of telephone health coaching and remote exercise monitoring for peripheral artery disease (TeGeCoach) on health care cost and utilization: results of a randomized controlled trial. Eur J Health Econ 2023:10.1007/s10198-023-01616-4. [PMID: 37428355 DOI: 10.1007/s10198-023-01616-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Peripheral artery disease (PAD) is the third most prevalent atherosclerotic cardiovascular disease. In 2016, costs per patient associated with PAD exceeded even the health-economic burden of coronary heart disease. Although affecting over 200 million people worldwide, a clear consensus on the most beneficial components to be included in home-based exercise programs for patients with peripheral artery disease is lacking. The aim of the study was to examine the health care use and costs caused by the 12-month patient-centered 'Telephone Health Coaching and Remote Exercise Monitoring for Peripheral Artery Disease' (TeGeCoach) program in a randomized controlled trial. METHODS This is a two-arm, parallel-group, open-label, pragmatic, randomized, controlled clinical trial (TeGeCoach) at three German statutory health insurance funds with follow-up assessments after 12 and 24-months. Study outcomes were medication use (daily defined doses), days in hospital, sick pay days and health care costs, from the health insurers' perspective. Claims data from the participating health insurers were used for analyses. The main analytic approach was an intention-to-treat (ITT) analysis. Other approaches (modified ITT, per protocol, and as treated) were executed additionally as sensitivity analysis. Random-effects regression models were calculated to determine difference-in-difference (DD) estimators for the first- and the second year of follow-up. Additionally, existing differences at baseline between both groups were treated with entropy balancing to check for the stability of the calculated estimators. RESULTS One thousand six hundred eighty-five patients (Intervention group (IG) = 806; Control group (CG) = 879) were finally included in ITT analyses. The analyses showed non-significant effects of the intervention on savings (first year: - 352€; second year: - 215€). Sensitivity analyses confirmed primary results and showed even larger savings. CONCLUSION Based on health insurance claims data, a significant reduction due to the home-based TeGeCoach program could not be found for health care use and costs in patients with PAD. Nevertheless, in all sensitivity analysis a tendency became apparent for a non-significant cost reducing effect. TRIAL REGISTRATION NCT03496948 (www. CLINICALTRIALS gov), initial release on 23 March 2018.
Collapse
Affiliation(s)
- Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Farhad Rezvani
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Herbarth
- KKH Kaufmännische Krankenkasse Statutory Health Insurance, Hannover, Germany
| | - Patrick Steinisch
- KKH Kaufmännische Krankenkasse Statutory Health Insurance, Hannover, Germany
| | - Hannes Böbinger
- TK Techniker Krankenkasse Statutory Health Insurance, Hamburg, Germany
| | | | - Gundula Krack
- mhplus Krankenkasse Statutory Health Insurance, Ludwigsburg, Germany
| | | | | | | | | | - Mark-Dominik Alscher
- Robert Bosch Gesellschaft Für Medizinische Forschung mbH, Bosch-Institute of Clinical Pharmacology, Dr. Margarete Fischer, Stuttgart, Germany
| | - Benjamin Finger
- Robert Bosch Gesellschaft Für Medizinische Forschung mbH, Bosch-Institute of Clinical Pharmacology, Dr. Margarete Fischer, Stuttgart, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| |
Collapse
|
2
|
Zwar L, Angermeyer MC, Matschinger H, Riedel-Heller SG, König HH, Hajek A. Are informal family caregivers stigmatized differently based on their gender or employment status?: a German study on public stigma towards informal long-term caregivers of older individuals. BMC Public Health 2021; 21:1868. [PMID: 34656105 PMCID: PMC8520205 DOI: 10.1186/s12889-021-11955-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Stigma and informal caregiving are determinants for health and wellbeing, but few studies have examined stigma towards informal caregiving. Public stigma may be expressed differently towards caregivers depending on their gender and employment status due to societal norms. Therefore, this study analyzes if there is a difference in public stigma shown by the general population toward informal caregivers of care recipients aged 65 years or older based on the observed caregiver’s gender or working status. Methods A cross-sectional study was conducted in Germany. Data from 1038 adult participants from the general population in Germany were assessed with an Online-Survey. They were recruited with a quota-system based on the German micro census. Participants were randomly assigned to one of 16 vignettes describing a caregiving situation, which varied in the caregiver’s gender and working status, and care recipient’s gender and type of impairment. After reading the vignette, they were asked to provide sociodemographic information and complete three questionnaires on public stigma assessing their emotional (Emotional Reactions), behavioral (Social Distance) and cognitive reaction (Statements on informal caregivers) to the caregiver described in the vignette. Regression analyses, adjusted for sociodemographic data of the participants, were conducted. Results Findings indicated an association between reading about male caregivers and increased social distance, compared with reading about female caregivers. Reading about working caregivers was associated with decreased social distance and increased appreciative statements, compared to reading about non-working caregivers. Analyses after stratifying by gender of the caregiver in the vignette indicated an association between reading about female working caregivers and increased appreciative statements, compared to reading about female non-working caregivers. When stratifying by working status, an association was found between reading about male working caregivers and increased social distance, when compared to reading about female working caregivers. Conclusions This study’s findings indicate that gender and working status of the perceived informal caregivers are of relevance to the public stigma directed towards these caregivers. Male and non-working informal caregivers were shown more public stigma than female and working informal caregivers. Thus, interventions to reduce public stigma, in particular towards male and non-working caregivers, are recommended.
Collapse
Affiliation(s)
- Larissa Zwar
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
| | | | - Herbert Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.,Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| |
Collapse
|
3
|
Abstract
OBJECTIVES This study aims to investigate the public stigma towards informal caregivers of individuals aged 65 years and older in the German population. METHOD In an Online-Survey 1038 participants (18 years and older and living in Germany) were sampled using a quota-system based on the German micro census data. To assess public stigma towards informal caregiving for individuals aged 65 years and older, three aspects of stigma were assessed: 1) emotional reactions (adapted Emotional Reaction to Mental Illness Scale), 2) behavioral reactions (adapted Social Distance Scale), and 3) cognitive reactions (newly developed List of Cognitions regarding informal caregiving). Exploratory and confirmatory factor analyses were conducted for the development and adaptation of the three instruments, and their composite reliability is provided. RESULTS Emotional reactions in terms of devaluing feelings and feelings of misery were low, while appreciative feelings were neither low nor high. Reported social distance was low. Agreement with cognitions towards informal care in terms of devaluing and accusative cognitions was on average low, but high regarding appreciative cognitions. CONCLUSION The results show that there is stigma towards informal caregiving for older individuals (65 years and older) in terms of emotional reactions, cognitions and social distance, although the magnitude of this stigma seems to be small. Knowledge regarding the occurrence and magnitude of stigma, as well as the processes that underlie this, is needed to prevent stigmatization and its negative outcomes, or at the very least, to enable the development of support for the affected individuals.
Collapse
Affiliation(s)
- L Zwar
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M C Angermeyer
- Center for Public Mental Health, Gösing am Wagram, Austria
| | - H Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - S G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - H-H König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
4
|
Zwar L, Angermeyer MC, Matschinger H, Riedel-Heller SG, König HH, Hajek A. The importance of familiarity with caregiving for public caregiver stigma: Evidence from a cross-sectional study in Germany. Arch Gerontol Geriatr 2020; 93:104301. [PMID: 33260047 DOI: 10.1016/j.archger.2020.104301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to investigate the association between familiarity with caregiving and public stigma towards informal caregivers of older individuals. MATERIAL AND METHODS The sample for this Online-Survey was identified using a quota-system based on German micro census data (N=1037; aged 18 years and older, living in Germany). Familiarity with caregiving was assessed by asking whether the participant has experience in or has friends or relatives with experience in informal or professional caregiving for individuals aged 65 years or older. Public caregiver stigma was assessed by analyzing the emotional, behavioral and cognitive reactions towards caregivers as described in a vignette. RESULTS Adjusted regressions analyses indicated that experience in providing informal care was associated with increased appreciative feelings and statements, and decreased social distance. Experience in providing professional care was associated with increased devaluing statements. Having friends or relatives who have experience in informal caregiving was associated with decreased social distance. Having friends or relatives who have experience in professional caregiving was associated with decreased devaluing feelings, increased appreciative feelings and decreased social distance. CONCLUSIONS Results indicate that familiarity with caregiving, through one's own informal care experience or through contact with informal or professional caregivers, reduced public stigma towards informal caregivers. Moreover, experience with informal care or contact with professional caregivers increased appreciation of informal caregivers. However, increased negative stigmatizing statements were indicated among participants with experience in professional caregiving. Fostering contact and cooperation between informal caregivers and non-caregivers, as well as with professional caregivers may help reduce stigmatizing reactions.
Collapse
Affiliation(s)
- Larissa Zwar
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | | | - Herbert Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany; Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany.
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| |
Collapse
|
5
|
Angermeyer MC, Carta MG, Ghachem R, Matschinger H, Millier A, Refai T, Schomerus G, Toumi M. Cultural Variations in Public Beliefs about Mental Disorders: A Comparison between Tunisia and Germany. Clin Pract Epidemiol Ment Health 2020; 16:70-81. [PMID: 33029184 PMCID: PMC7536730 DOI: 10.2174/1745017902016010070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 11/22/2022]
Abstract
Background In recent years there is a growing interest in public beliefs about mental disorders. Numerous representative population-based studies have been conducted around the globe, also in European countries bordering on the Mediterranean Sea. However, relatively little is known about public beliefs in countries in Northern Africa. Objective To fill this gap by comparing public beliefs about mental disorders in Tunisia and Germany, focusing on causal beliefs, help-seeking recommendations and treatment preferences. Methods Representative national population-based surveys have been conducted in Tunisia in 2012 (N = 811) and in Germany in 2011 (N = 1852), using the same interview mode and the same fully structured interview starting with a vignette depicting a person suffering from either schizophrenia or depression. Results In Tunisia, the public was more likely to adopt psychosocial and to reject biogenetic explanations than in Germany. Correspondingly, psychological treatments were more frequently recommended and biological ones more frequently advised against. There was also a strong inclination to share religious beliefs and to recommend seeking religious advice. Tunisians tended much more than Germans to hold moralistic views and to blame the afflicted person for his or her illness. In Tunisia, the public tended less to differentiate between schizophrenia and depression than in Germany. Conclusion Marked differences between Tunisia and Germany exist in public beliefs about the causes of mental disorders and their treatment, which correspond to differences in cultural orientations prevailing in these countries. Mental health professionals need to be sensitive to the particular cultural context in which they operate, in order to be able to reach those they intend to care for.
Collapse
Affiliation(s)
- Matthias C Angermeyer
- Center for Public Mental Health, Gösing am Wagram, Austria.,Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Mauro G Carta
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | | | - Herbert Matschinger
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.,Institute of Health Economics and Health Services Research, University of Hamburg, Hamburg, Germany
| | | | - Tarek Refai
- Tarek Refaï, Creativ-Ceutical, Les Berges du Lac, Tunisia
| | - Georg Schomerus
- Department of Psychiatry, University of Greifswald, Greifswald, Germany
| | - Mondher Toumi
- Aurélie Millier, Creativ-Ceutical, Paris, France.,Department of Public Health, Aix-Marseille University, Marseille, France
| |
Collapse
|
6
|
Abstract
Depressive disorders are among the most widespread mental disorders in old age, with negative consequences for quality of life (QOL). Understanding QOL as a multidimensional construct, in this article we have a closer look on what specific aspects are affected by depression. We used a representative sample of the German population (n = 805) and one of individuals diagnosed with depression (n = 106) to compare QOL using the WHOQOL-BREF and the WHOQOL-OLD. Multivariate analysis showed that individuals diagnosed with depression exhibited lower QOL with regard to WHOQOL-BREF-dimensions physical health, psychological, social relationships and global QOL and with regard to WHOQOL-OLD-facets sensory abilities, past, present, and future activities and social participation. In addition, in the regression analysis, there were no significant differences between individuals with and without depression with regard to environment (WHOQOL-BREF), autonomy, death and dying, intimacy and overall (WHOQOL-OLD). Associations between depression and QOL in older age are selective in terms of which aspects of QOL are affected. From a methodological perspective, a multidimensional approach to QOL is recommended. From a clinical perspective, our research highlights those areas of QOL that are relevant for health professionals working with older people and that could be the focus of interventions.
Collapse
Affiliation(s)
- Felix S. Hussenoeder
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Doreen Jentzsch
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Herbert Matschinger
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, Section of Health Economics and Mental Health Services Research, Ulm University, Ulm, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Ines Conrad
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103 Leipzig, Germany
| |
Collapse
|
7
|
Bohlken J, Schömig F, Seehagen T, Köhler S, Gehring K, Roth-Sackenheim C, Matschinger H, Riedel-Heller SG. [Experience of Practice-Based Psychiatrists and Neurologists During the COVID-19 Pandemic]. Psychiatr Prax 2020; 47:214-217. [PMID: 32340050 DOI: 10.1055/a-1159-5575] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM To date, to our knowledge there are no studies regarding attitudes and experiences of outpatient medical personnel during a pandemic. This study's aim was to evaluate the impact of the COVID-19 pandemic in March 2020 on German psychiatrists and neurologists. METHODS An e-mail and fax-based short survey of 2,072 practice-based psychiatrists and neurologists was performed including Likert-type questions on personal burden and concerns, anticipated risk of infection, practice management as well as anxiety and sleep problems. RESULTS 396 physicians returned the questionnaire (19 %). More than 60 % of the participants felt restricted strongly or very strongly, more than 30 % were strongly and very strongly concerned. They anticipated a high own risk of infection. However, 91 % did not report any contact with patients positively screened for COVID-19, which they were aware of. One third felt financially threatened and loss of business volume was anticipated. 18 % reported, that the pandemic triggers substantial anxiety. Sleep problems, which occur at least almost every night, were rarely reported (9 %). CONCLUSION Practice-based psychiatrists and neurologists are negatively affected by the COVID-19 pandemic.
Collapse
Affiliation(s)
- Jens Bohlken
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP) der Medizinischen Fakultät der Universität Leipzig.,Berufsverband Deutscher Nervenärzte (BVDN)
| | - Friederike Schömig
- Centrum für Muskuloskeletale Chirurgie (CMSC), Klinik für Orthopädie, Klinik für Unfall- und Wiederherstellungschirurgie Universitätsmedizin Berlin, Charité - Campus Berlin Mitte
| | | | | | | | | | - Herbert Matschinger
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP) der Medizinischen Fakultät der Universität Leipzig
| | - Steffi G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP) der Medizinischen Fakultät der Universität Leipzig
| |
Collapse
|
8
|
Angermeyer MC, Dietrich S, Pott D, Matschinger H. Media consumption and desire for social distance towards people with schizophrenia. Eur Psychiatry 2020; 20:246-50. [PMID: 15935424 DOI: 10.1016/j.eurpsy.2004.12.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2004] [Revised: 11/15/2004] [Accepted: 12/07/2004] [Indexed: 11/24/2022] Open
Abstract
AbstractThere is ample evidence for a distorted presentation of the mentally ill in the media. However, only little is known about its impact on attitudes towards people with mental disorders. Therefore, we investigated the relationship between watching TV and reading the newspaper on the one hand, and the desire for social distance towards people with schizophrenia on the other. In 2001, a representative population survey was conducted in Germany, using a fully structured personal interview. We found that the desire for social distance towards people with schizophrenia increases almost continuously with the amount of TV consumption. The association between reading the newspaper and social distance is less pronounced and depends on the type of newspaper people read. Since, obviously, there is a relationship between media consumption and attitudes towards people with schizophrenia, inaccurate and one-sided messages about mental disorders should be replaced by accurate and more balanced messages.
Collapse
Affiliation(s)
- M C Angermeyer
- Department of Psychiatry, University of Leipzig, Johannisallee 20, 04317 Leipzig, Germany.
| | | | | | | |
Collapse
|
9
|
Schomerus G, Matschinger H, Kenzin D, Breier P, Angermeyer MC. Public attitudes towards mental patients: a comparison between Novosibirsk, Bratislava and German cities. Eur Psychiatry 2020; 21:436-41. [PMID: 16531016 DOI: 10.1016/j.eurpsy.2006.01.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AbstractPurpose– It is commonly assumed that reforms in the sector of psychiatric care have contributed to reducing the stigma attached to mental illness. In order to examine whether a relation between the psychiatric care set-up and stigmatisation of the patients exists we compared public attitudes towards mental patients in three countries at differing stages of progress in psychiatric reform.Methods– Population surveys on public attitudes towards mental patients were conducted in Novosibirsk (Russia) and Bratislava (Slovakia). The data were compared with those from a population survey that had recently been carried out in Germany. In all three surveys the same sampling procedure and fully structured interview were used. Public attitude towards mental patients was elicited using a perceived devaluation-discrimination measure.Results– Psychiatric patients face considerable rejection in all three locations in question. Overall, the degree of perceived devaluation and discrimination was similar in all countries with a significant, but marginal tendency towards stronger devaluation of mental patients in Germany.Conclusion– Our results do not support a strong relationship between psychiatric reform and mental illness stigma.
Collapse
|
10
|
Matschinger H, Heider D, König HH. A Comparison of Matching and Weighting Methods for Causal Inference Based on Routine Health Insurance Data, or: What to do If an RCT is Impossible. Gesundheitswesen 2020; 82:S139-S150. [PMID: 32066197 DOI: 10.1055/a-1009-6634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Due to a multitude of reasons Randomized Control Trials on the basis of so-called "routine data" provided by insurance companies cannot be conducted. Therefore the estimation of "causal effects" for any kind of treatment is hampered since systematic bias due to specific selection processes must be suspected. The basic problem of counterfactual, which is to evaluate the difference between two potential outcomes for the same unit, is discussed. The focus lies on the comparison of the performance of different approaches to control for systematic differences between treatment and control group. These strategies are all based on propensity scores, namely matching or pruning, IPTW (inverse probability treatment weighting) and entropy balancing. Methods to evaluate these strategies are presented. A logit model is employed with 87 predictors to estimate the propensity score or to estimate the entropy balancing weights. All analyses are restricted to estimate the ATT (Average Treatment Effect for the Treated) Exemplary data come from a prospective controlled intervention-study with two measurement occasions. Data contain 35 857 chronically ill insurants with diabetes, congestive heart failure, arteriosclerosis, coronary heart disease or hypertension of one German sickness fund. The intervention group was offered an individual telephone coaching to improve health behavior and slow down disease progression while the control group received treatment as usual. Randomization took place before the insurants' consent to participate was obtained so assumptions of an RCT are violated. A weighted mixture model (difference-in-difference) as the causal model of interest is employed to estimate treatment effects in terms of costs distinguishing the categories outpatient costs, medication costs, and total costs. It is shown that entropy balancing performs best with respect to balancing treatment and control group at baseline for the first three moments of all 87 predictors. This will result in least biased estimates of the treatment effect.
Collapse
|
11
|
Hohls JK, König HH, Heider D, Brenner H, Böhlen F, Matschinger H, Saum KU, Schöttker B, Haefeli WE, Hajek A, Wild B. Longitudinal association between panic disorder and health care costs in older adults. Depress Anxiety 2019; 36:1135-1142. [PMID: 31609044 DOI: 10.1002/da.22959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/16/2019] [Accepted: 09/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To analyze whether probable panic disorder (PD) is associated with health care costs in older age over time. METHODS Data regarding individuals aged 65 and over were derived from two waves of the ESTHER cohort study (nt1 = 2,348, nt2 = 2,090). Probable PD was assessed using the panic screening module from the Patient Health Questionnaire. Health care costs were obtained through monetary valuation of self-reported health care use data. Fixed effects regressions analyzed the association between transitions in probable PD status and change in health care costs, while adjusting for potential confounders. RESULTS On a descriptive level, study participants with a positive PD screening displayed higher three-month health care costs compared to those without (incremental costs: € 259 for t1 , € 1,544 for t2 ). Transitions in probable PD were associated with an approximate increase of 65% in outpatient health care costs (β = 0.50, p < .05). There was no significant association between probable PD transition and change in any other cost category. CONCLUSIONS Using longitudinal data, our results highlight the economic consequences of probable PD in older adults. Future research should address whether reducing PD in older adults may reduce the associated economic burden and analyze underlying mechanisms.
Collapse
Affiliation(s)
- Johanna Katharina Hohls
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Friederike Böhlen
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
12
|
Conrad I, Alltag S, Matschinger H, Kilian R, Riedel-Heller SG. [Quality of life among older informal caregivers of people with dementia]. Nervenarzt 2019; 89:500-508. [PMID: 29637233 DOI: 10.1007/s00115-018-0510-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Germany, informal caregiving becomes an increasingly important issue especially for people with dementia. Spouses often provide nursing care due to the limited daily living skills of people with dementia. This leads to a wide range of caregiver burden and decreased quality of life (QoL). Analyses on the relation between QoL and caregiver burden of older informal caregivers in Germany are rare. OBJECTIVE The following research questions were assessed: (1) Does caregivers' QoL differ from that of the older general population?; (2) Which sociodemographic, health- and care-related characteristics affect caregivers' QoL? MATERIAL AND METHODS For this study, two samples (aged 60 years and older) were recruited: informal caregivers (n = 119) and a representative sample of older non-caregivers in the general population (n = 1133). Linear regression analyses were applied to examine the effects of sociodemographic, health and care-related variables on the QoL of older informal caregivers of people with dementia. RESULTS Older informal caregivers reported a significantly lower QoL compared to older non-caregivers in the general population. Especially the domains autonomy, activities in the past, the present and the future as well as intimacy were negatively associated with caregivers' QoL. CONCLUSION The results of the study highlighted caregivers' need for assistance. Due to demographic changes, tailored support services should be based on older caregivers' needs.
Collapse
Affiliation(s)
- I Conrad
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland
| | - S Alltag
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland.
| | - H Matschinger
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland
| | - R Kilian
- Abt. Psychiatrie II, Bezirkskrankenhaus Günzburg, Universität Ulm, Ulm, Deutschland
| | - S G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland
| |
Collapse
|
13
|
Hohls JK, Wild B, Heider D, Brenner H, Böhlen F, Saum KU, Schöttker B, Matschinger H, Haefeli WE, König HH, Hajek A. Association of generalized anxiety symptoms and panic with health care costs in older age-Results from the ESTHER cohort study. J Affect Disord 2019; 245:978-986. [PMID: 30562680 DOI: 10.1016/j.jad.2018.11.087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/16/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Little is known specifically about the association between generalized anxiety symptoms or panic and health care costs in older age. The aim of this study was to examine the association between generalized anxiety symptoms, panic and health care costs in people aged 65 and over. METHODS Cross-sectional data from the 8-year follow-up of a large, prospective cohort study, the ESTHER study, was used. Individuals aged 65 and over, who participated in the study's home assessment, were included in this analysis (n = 2348). Total and sectoral costs were analyzed as a function of either anxiety symptoms, probable panic disorder, or a panic attack, while controlling for selected covariates, using Two Part and Generalized Linear Models. Covariates were chosen based on Andersen's Behavioral Model of Health Care Use. RESULTS There was no significant association between either of the anxiety or panic measures and total health care costs. Stratified by health care sectors, only the occurrence of a panic attack was significantly associated with incurring costs for outpatient non-physician services (OR: 1.99; 95% CI: 1.15-3.45) and inpatient services (OR: 2.14; 95% CI: 1.07-4.28). Other illness-related factors, such as comorbidities and depressive symptoms, were associated with health care costs in several models. LIMITATIONS This was a cross-sectional study relying on self-reported data. CONCLUSION This study points to an association between a panic attack and sector-specific health care costs in people aged 65 and over. Further research, especially using longitudinal data, is needed.
Collapse
Affiliation(s)
- J K Hohls
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany.
| | - B Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - D Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - H Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - F Böhlen
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - K U Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - B Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - H Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany; Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany
| | - W E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Germany
| | - H-H König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - A Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| |
Collapse
|
14
|
Rodriguez FS, Matschinger H, Angermeyer MC, Luck T, Riedel-Heller SG. Compression of cognitive morbidity by higher education in individuals aged 75+ living in Germany. Int J Geriatr Psychiatry 2018; 33:1389-1396. [PMID: 30024067 DOI: 10.1002/gps.4950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/17/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Previous studies have shown that higher education may reduce dementia risk and promote a better cognitive functioning in older age. OBJECTIVE The study investigated to what extent higher education leads to compression of cognitive morbidity, and thus a shorter lifetime affected by cognitive impairment and dementia, in individuals aged 75 years and older living in Germany. METHODS Our sample included n = 742 individuals of the population-based Leipzig Longitudinal Study of the Aged (LEILA75+; 1998-2013), who were free of dementia at baseline. The impact of higher education on compression of cognitive morbidity was studied by analyzing the association between education and (1) cognitive functioning over the study period and age at dementia onset, (2) age at death, and (3) the cumulative lifetime cognitive morbidity. RESULTS Individuals with more years of education had a higher cumulative cognitive functioning over the lifetime period 75 to 100 years (weighted for survival probability), but not a later age of dementia onset nor a later age at death. CONCLUSION Our results suggest, in individuals aged 75 years and older, higher education only compresses cognitive morbidity prior to dementia onset. Findings may be specific to countries where education is not a necessary requirement for access to good quality health care services.
Collapse
Affiliation(s)
- Francisca S Rodriguez
- Center for Cognitive Science, University of Kaiserslautern, Kaiserslautern, Germany.,Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany.,LIFE-Leipzig Research Center for Civilization Diseases, Universität Leipzig, Germany
| | - Herbert Matschinger
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany.,Institute of Health Economics and Health Service Research, University of Hamburg, Germany
| | - Matthias C Angermeyer
- Center for Public Mental Health, Gösing am Wagram, Austria.,Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Tobias Luck
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany.,LIFE-Leipzig Research Center for Civilization Diseases, Universität Leipzig, Germany.,Department of Economic and Social Sciences, University of Applied Sciences Nordhausen, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| |
Collapse
|
15
|
Alltag S, Conrad I, Matschinger H, Kilian R, Riedel-Heller SG. Lebensqualität älterer pflegender Angehöriger von Demenzerkrankten in Deutschland. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S Alltag
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Leipzig, Deutschland
| | - I Conrad
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Leipzig, Deutschland
| | - H Matschinger
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Leipzig, Deutschland
| | - R Kilian
- Sektion Gesundheitsökonomie und Versorgungsforschung, Klinik für Psychiatrie und Psychotherapie II, Günzburg, Deutschland
| | - SG Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Leipzig, Deutschland
| |
Collapse
|
16
|
Heider D, Matschinger H, Meid AD, Quinzler R, Adler JB, Günster C, Haefeli WE, König HH. The impact of potentially inappropriate medication on the development of health care costs and its moderation by the number of prescribed substances. Results of a retrospective matched cohort study. PLoS One 2018; 13:e0198004. [PMID: 30063697 PMCID: PMC6067698 DOI: 10.1371/journal.pone.0198004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 05/12/2018] [Indexed: 11/30/2022] Open
Abstract
Background In the growing population of the elderly, drug-related problems are considered an important health care safety issue. One aspect of this is the prescription of potentially inappropriate medication (PIM) which is considered to increase health care costs. Objective Using data from the Health Economics of Potentially Inappropriate Medication (HEPIME) study, we aimed to analyze how the number of prescribed substances moderates the association of PIM use as defined by the German PRISCUS list and health care costs applying a longitudinal perspective. Methods An initial number of 6,849,622 insurants aged 65+ of a large German health insurance company were included in a retrospective matched cohort study. Based on longitudinal claims data from the four separate quarters of a 12-month pre-period, 3,860,842 individuals with no exposure to PIM in 2011 were matched to 508,212 exposed individuals. Exposure effects of PIM use on health care costs and the number of prescribed substances were measured based on longitudinal claims data from the four separate quarters of the 12-month post-period. Results After successful balancing for the development of numerous matching variables during the four quarters of the pre-period, exposed individuals consumed 2.1 additional prescribed substances and had higher total health care costs of 1,237 € when compared to non-exposed individuals in the 1st quarter of the post-period. Controlling for the number of prescribed substances, the difference in total health care costs between both study groups was 401 €. The average effect of one additionally prescribed substance (other than PIM) on total health care costs was increased by an amount of 137 € for those being exposed to a PIM. In quarters 2–4 of the post-period, the differences between both study groups tended to decrease sequentially. Conclusions PIM use has an increasing effect on the development of health care costs. This cost-increasing effect of PIM use is moderated by the number of prescribed substances.
Collapse
Affiliation(s)
- Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas D. Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Renate Quinzler
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | | | | | - Walter E. Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
17
|
Hajek A, Bock JO, Saum KU, Matschinger H, Brenner H, Holleczek B, Haefeli WE, Heider D, König HH. Frailty and healthcare costs-longitudinal results of a prospective cohort study. Age Ageing 2018; 47:233-241. [PMID: 29036424 DOI: 10.1093/ageing/afx157] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 08/22/2017] [Indexed: 12/16/2022] Open
Abstract
Objective to investigate how frailty and frailty symptoms affect healthcare costs in older age longitudinally. Methods data were gathered from a prospective cohort study in Saarland, Germany (two waves with 3-year interval, n = 1,636 aged 57-84 years at baseline). Frailty was assessed by the five Fried frailty criteria. Frailty was defined as having at least three criteria, the presence of 1-2 criteria as 'pre-frail'. Healthcare costs were quantified based on self-reported healthcare use in the sectors of inpatient treatment, outpatient treatment, professional nursing care and informal care as well as the provision of pharmaceuticals, medical supplies and dental prostheses. Results while the onset of pre-frailty did not increase (log) total healthcare costs after adjusting for potential confounders including comorbidity, progression from non-frailty to frailty was associated with an increase in total healthcare costs (for example, costs increased by ~54 and 101% if 3 and 4 or 5 symptoms were present, respectively). This association of frailty onset with increased healthcare costs was in particular observed in the inpatient sector and for informal nursing care. Among the frailty symptoms, the onset of exhaustion was associated with an increase in total healthcare costs, whereas changes in slowness, weakness, weight loss and low-physical activity were not significantly associated with an increase in total healthcare costs. Conclusions our data stress the economic relevance of frailty in late life. Postponing or reducing frailty might be fruitful in order to reduce healthcare costs.
Collapse
Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Bernd Holleczek
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Saarland Cancer Registry, Saarbrücken, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
18
|
Angermeyer MC, Carta MG, Holzinger A, Matschinger H. The diffusion of the diagnostic term bipolar disorder among the German public. Psychiatry Res 2018; 260:75-77. [PMID: 29175502 DOI: 10.1016/j.psychres.2017.11.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/19/2017] [Accepted: 11/17/2017] [Indexed: 11/18/2022]
Abstract
In 2005, 15 years after the introduction of the diagnosis in DSM-III, a telephone survey in Germany revealed that the public was still unfamiliar with the term bipolar disorder. Only 5.3% of those questioned knew at the time that it denotes a mental illness. In the meantime, efforts have been made to spread the concept among the public. In the media there has been increasing mention of the disorder. Another telephone survey in 2017 showed that familiarity with the diagnostic term has grown substantially. 54.0% of respondents now connected the term bipolar disorder with a mental illness.
Collapse
Affiliation(s)
| | - Mauro G Carta
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy
| | | | - Herbert Matschinger
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany; Department of Health Economics and Health Services Research, University of Hamburg, Germany
| |
Collapse
|
19
|
Speerforck S, Schomerus G, Matschinger H, Angermeyer MC. Treatment recommendations for schizophrenia, major depression and alcohol dependence and stigmatizing attitudes of the public: results from a German population survey. Eur Arch Psychiatry Clin Neurosci 2017; 267:341-350. [PMID: 28032255 DOI: 10.1007/s00406-016-0755-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/13/2016] [Indexed: 10/20/2022]
Abstract
In addition to mental health literacy, several potentially conflicting emotions and attitudes among the public are hypothesized to guide their recommendations for specific mental health treatments. It is unclear whether evidence-based treatment strategies are guided by pro-social or stigmatizing attitudes and emotions. In a representative population survey in Germany (n = 3642), we asked respondents to what extent they would recommend psychotropic medication, psychotherapy and relaxation techniques for a person with mental illness described in an unlabelled vignette. For each treatment recommendation, we used multinomial logistic regression analyses to obtain predicted probabilities. Predictors comprised illness recognition, vignette condition, causal beliefs (current stress, childhood adversities, biogenetic), emotions (fear, anger, pro-social reactions), social distance, age, gender and education. Fear predicted greater probability for recommending psychotropic drugs in all investigated illnesses (p < 0.001), whereas associations of fear with recommending psychotherapy were generally lower and no associations with the recommendation for relaxation techniques were found. Anger was related to fewer recommendations for psychotherapy in all illnesses (p < 0.01). Pro-social reactions were predominantly related to the recommendation of relaxation techniques for a person with schizophrenia or major depression (p < 0.001). Higher desire for social distance predicted fewer recommendations for relaxation techniques in all three vignette conditions (p < 0.05). Our study corroborates findings that treatment recommendations are not necessarily linked to pro-social reactions or mental health literacy. The recommendation for a treatment modality like psychotropic medication or psychotherapy can be linked to underlying fear, possibly reflecting a public desire for protection against people with mental illness.
Collapse
Affiliation(s)
- Sven Speerforck
- Department of Psychiatry and Psychotherapy, University Medicine, Greifswald University, Ellernholzstraße 1-2, 17475, Greifswald, Germany.
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University Medicine, Greifswald University, Ellernholzstraße 1-2, 17475, Greifswald, Germany
| | - Herbert Matschinger
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.,Institute of Medical Sociology and Health Economics, University of Hamburg, Hamburg, Germany
| | - Matthias C Angermeyer
- Department of Public Health, Clinical and Molecular Psychiatry, University of Cagliari, Cagliari, Italy.,Center for Public Mental Health, Gösing Am Wagram, Austria
| |
Collapse
|
20
|
Abstract
Objective Analysis of the development of psychiatric attitude research in Germany over the past 50 years. Methods Historical overview based on systematic reviews of population-based studies. Results In the beginning, public attitudes towards people with mental disorders and towards psychiatry were studied from a sociological perspective, later on research was guided by a social psychological or individual psychological approach. This provided important insights into processes underlying the stigma of mental illness (e. g., role of labeling, causal attributions, beliefs into a continuum between mental health and illness, prevalence estimates etc.). Substantial contributions have also been made as regards the study of time trends in public attitudes and beliefs about mental illness, the investigation of the impact of the media on public attitudes, and the evaluation of the effectiveness of anti-stigma and awareness programs. Conclusion Despite these undisputable advancements it is about time to compliment the individual by a societal perspective. This appears particularly necessary in view of current trends in Germany towards sociopolitical radicalization.
Collapse
Affiliation(s)
- Matthias C Angermeyer
- Center for Public Mental Health, Gösing am Wagram, Österreich.,Dipartimento di Sanità Pubblica e Medicina Clinica e Moleculare, Università degli Studi di Cagliari, Cagliari, Italien
| | - Herbert Matschinger
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Universität Leipzig, Deutschland
| | - Georg Schomerus
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Greifswald, Greifswald, Deutschland
| |
Collapse
|
21
|
Heider D, Matschinger H, Meid AD, Quinzler R, Adler JB, Günster C, Haefeli WE, König HH. Health Service Use, Costs, and Adverse Events Associated with Potentially Inappropriate Medication in Old Age in Germany: Retrospective Matched Cohort Study. Drugs Aging 2017; 34:289-301. [DOI: 10.1007/s40266-017-0441-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
22
|
Moro MF, Angermeyer MC, Matschinger H, Holzinger A, Piras AP, Cutrano F, Mura G, Carta MG. Whom to Ask for Professional Help in Case of Major Depression? Help-Seeking Recommendations of the Sardinian Public. Adm Policy Ment Health 2016; 42:704-13. [PMID: 25344847 DOI: 10.1007/s10488-014-0604-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose of the study is to investigate help-seeking preferences of the Sardinian public in case of depression. A telephone survey was conducted among the adult population, using quota sampling (N = 1,200). Respondents were presented with a vignette depicting a person with symptoms of major depressive disorder, followed by a fully structured interview. Psychologists were most frequently selected as source of professional help, followed by psychiatrists and G.P.s. Residents of small towns more frequently recommended mental health professionals than city residents. Public help-seeking preferences reflect the availability of services, beliefs about the appropriate treatment of depression and attitudes towards those providing it.
Collapse
Affiliation(s)
- Maria Francesca Moro
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Via Ospedale 117, 09100, Cagliari, Italy.
| | - Matthias C Angermeyer
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Via Ospedale 117, 09100, Cagliari, Italy. .,Center for Public Mental Health, Gösing Am Wagram, Austria.
| | - Herbert Matschinger
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany. .,Institute of Medical Sociology, Social Medicine and Health Economics, University of Hamburg, Hamburg, Germany.
| | - Anita Holzinger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
| | - Anna Paola Piras
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy.
| | - Francesca Cutrano
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy.
| | - Gioia Mura
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy.
| | - Mauro Giovanni Carta
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy.
| |
Collapse
|
23
|
Barbaglia G, Adroher ND, Vilagut G, Bruffaerts R, Bunting B, Caldas de Almeida JM, Florescu S, de Girolamo G, de Graaf R, Haro JM, Hinkov H, Kovess-Masfety V, Matschinger H, Alonso J. Health conditions and role limitation in three European Regions: a public-health perspective. Gac Sanit 2016; 31:2-10. [PMID: 27765441 DOI: 10.1016/j.gaceta.2016.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 07/18/2016] [Accepted: 07/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe the distribution of role limitation in the European population aged 18-64 years and to examine the contribution of health conditions to role limitation using a public-health approach. METHODS Representative samples of the adult general population (n=13,666) aged 18-64 years from 10 European countries of the World Mental Health (WMH) Surveys Initiative, grouped into three regions: Central-Western, Southern and Central-Eastern. The Composite International Diagnostic Interview (CIDI 3.0) was used to assess six mental disorders and standard checklists for seven physical conditions. Days with full and with partial role limitation in the month previous to the interview were reported (WMH-WHODAS). Population Attributable Fraction (PAFs) of full and partial role limitation were estimated. RESULTS Health conditions explained a large proportion of full role limitation (PAF=62.6%) and somewhat less of partial role limitation (46.6%). Chronic pain was the single condition that consistently contributed to explain both disability measures in all European Regions. Mental disorders were the most important contributors to full and partial role limitation in Central-Western and Southern Europe. In Central-Eastern Europe, where mental disorders were less prevalent, physical conditions, especially cardiovascular diseases, were the highest contributors to disability. CONCLUSION The contribution of health conditions to role limitation in the three European regions studied is high. Mental disorders are associated with the largest impact in most of the regions. There is a need for mainstreaming disability in the public health agenda to reduce the role limitation associated with health conditions. The cross-regional differences found require further investigation.
Collapse
Affiliation(s)
- Gabriela Barbaglia
- Agency for Health and Quality Assessment of Catalonia (AQuAS), Barcelona, Spain; Universitat Pompeu Fabra, Department of Experimental Sciences and Health, Faculty of Public Health and Education in Health Sciences, Barcelona, Spain
| | - Núria D Adroher
- University of Lucerne, Faculty of Humanities and Social Sciences, Department of Health Science and Health Policy, Lucerne, Switzerland
| | - Gemma Vilagut
- Universitat Pompeu Fabra, Department of Experimental Sciences and Health, Faculty of Public Health and Education in Health Sciences, Barcelona, Spain; Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum, KU Leuven (UPC-KUL), Leuven, Belgium
| | - Brentan Bunting
- University of Ulster, School of Psychology, Research Institute of Psychology, Northern Ireland, United Kingdom
| | | | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | | | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat (Barcelona), España; CIBER en Salud Mental (CIBERSAM), Spain
| | - Hristo Hinkov
- National Center for Public Health Protection, Department of Mental Health, Sofia, Bulgaria
| | - Vivianne Kovess-Masfety
- Université Paris Descartes, Department of Epidemiology, Evaluation and Health policies, Paris, France
| | - Herbert Matschinger
- University of Leizpig, Department of Social Medicine, Occupational Health and Public Health, Leipzig, Germany
| | - Jordi Alonso
- Universitat Pompeu Fabra, Department of Experimental Sciences and Health, Faculty of Public Health and Education in Health Sciences, Barcelona, Spain; Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
| |
Collapse
|
24
|
Härter M, Dirmaier J, Dwinger S, Kriston L, Herbarth L, Siegmund-Schultze E, Bermejo I, Matschinger H, Heider D, König HH. Effectiveness of Telephone-Based Health Coaching for Patients with Chronic Conditions: A Randomised Controlled Trial. PLoS One 2016; 11:e0161269. [PMID: 27632360 PMCID: PMC5025178 DOI: 10.1371/journal.pone.0161269] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 08/02/2016] [Indexed: 01/09/2023] Open
Abstract
Background Chronic diseases, like diabetes mellitus, heart disease and cancer are leading causes of death and disability. These conditions are at least partially preventable or modifiable, e.g. by enhancing patients’ self-management. We aimed to examine the effectiveness of telephone-based health coaching (TBHC) in chronically ill patients. Methods and Findings This prospective, pragmatic randomized controlled trial compares an intervention group (IG) of participants in TBHC to a control group (CG) without TBHC. Endpoints were assessed two years after enrolment. Three different groups of insurees with 1) multiple conditions (chronic campaign), 2) heart failure (heart failure campaign), or 3) chronic mental illness conditions (mental health campaign) were targeted. The telephone coaching included evidence-based information and was based on the concepts of motivational interviewing, shared decision-making, and collaborative goal setting. Patients received an average of 12.9 calls. Primary outcome was time from enrolment until hospital readmission within a two-year follow-up period. Secondary outcomes comprised the probability of hospital readmission, number of daily defined medication doses (DDD), frequency and duration of inability to work, and mortality within two years. All outcomes were collected from routine data provided by the statutory health insurance. As informed consent was obtained after randomization, propensity score matching (PSM) was used to minimize selection bias introduced by decliners. For the analysis of hospital readmission and mortality, we calculated Kaplan-Meier curves and estimated hazard ratios (HR). Probability of hospital readmission and probability of death were analysed by calculating odds ratios (OR). Quantity of health service use and inability to work were analysed by linear random effects regression models. PSM resulted in patient samples of 5,309 (IG: 2,713; CG: 2,596) in the chronic campaign, of 660 (IG: 338; CG: 322) in the heart failure campaign, and of 239 (IG: 101; KG: 138) in the mental health campaign. In none of the three campaigns, there were significant differences between IG and CG in time until hospital readmission. In the chronic campaign, the probability of hospital readmission was higher in the IG than in the CG (OR = 1.13; p = 0.045); no significant differences could be found for the other two campaigns. In the heart failure campaign, the IG showed a significantly reduced number of hospital admissions (-0.41; p = 0.012), although the corresponding reduction in the number of hospital days was not significant. In the chronic campaign, the IG showed significantly increased number of DDDs. Most striking, there were significant differences in mortality between IG and CG in the chronic campaign (OR = 0.64; p = 0.005) as well as in the heart failure campaign (OR = 0.44; p = 0.001). Conclusions While TBHC seems to reduce hospitalization only in specific patient groups, it may reduce mortality in patients with chronic somatic conditions. Further research should examine intervention effects in various subgroups of patients, for example for different diagnostic groups within the chronic campaign, or duration of coaching. Trial Registration German Clinical Trials Register DRKS00000584
Collapse
Affiliation(s)
- Martin Härter
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Dwinger
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Isaac Bermejo
- University Medical Centre Freiburg, Freiburg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
25
|
Bock JO, Hajek A, Brenner H, Saum KU, Matschinger H, Haefeli WE, Schöttker B, Quinzler R, Heider D, König HH. A Longitudinal Investigation of Willingness to Pay for Health Insurance in Germany. Health Serv Res 2016; 52:1099-1117. [PMID: 27324300 DOI: 10.1111/1475-6773.12522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To investigate factors affecting willingness to pay (WTP) for health insurance of older adults in a longitudinal setting in Germany. DATA SOURCES Survey data from a cohort study in Saarland, Germany, from 2008-2010 and 2011-2014 (n1 = 3,124; n2 = 2,761) were used. STUDY DESIGN Panel data were taken at two points from an observational, prospective cohort study. DATA COLLECTION WTP estimates were derived using a contingent valuation method with a payment card. Participants provided data on sociodemographics, lifestyle factors, morbidity, and health care utilization. PRINCIPAL FINDINGS Fixed effects regression models showed higher individual health care costs to increase WTP, which in particular could be found for members of private health insurance. Changes in income and morbidity did not affect WTP among members of social health insurance, whereas these predictors affected WTP among members of private health insurance. CONCLUSIONS The fact that individual health care costs affected WTP positively might indicate that demanding (expensive) health care services raises the awareness of the benefits of health insurance. Thus, measures to increase WTP in old age should target at improving transparency of the value of health insurances at the moment when individual health care utilization and corresponding costs are still relatively low.
Collapse
Affiliation(s)
- Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Renate Quinzler
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
26
|
Bock JO, König HH, Brenner H, Haefeli WE, Quinzler R, Matschinger H, Saum KU, Schöttker B, Heider D. Associations of frailty with health care costs--results of the ESTHER cohort study. BMC Health Serv Res 2016; 16:128. [PMID: 27074800 PMCID: PMC4831082 DOI: 10.1186/s12913-016-1360-3] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/23/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The concept of frailty is rapidly gaining attention as an independent syndrome with high prevalence in older adults. Thereby, frailty is often related to certain adverse outcomes like mortality or disability. Another adverse outcome discussed is increased health care utilization. However, only few studies examined the impact of frailty on health care utilization and corresponding costs. The aim of this study was therefore to investigate comprehensively the relationship between frailty, health care utilization and costs. METHODS Cross sectional data from 2598 older participants (57-84 years) recruited in the Saarland, Germany, between 2008 and 2010 was used. Participants passed geriatric assessments that included Fried's five frailty criteria: weakness, slowness, exhaustion, unintentional weight loss, and physical inactivity. Health care utilization was recorded in the sectors of inpatient treatment, outpatient treatment, pharmaceuticals, and nursing care. RESULTS Prevalence of frailty (≥3 symptoms) was 8.0%. Mean total 3-month costs of frail participants were €3659 (4 or 5 symptoms) and €1616 (3 symptoms) as compared to €642 of nonfrail participants (no symptom). Controlling for comorbidity and general socio-demographic characteristics in multiple regression models, the difference in total costs between frail and non-frail participants still amounted to €1917; p < .05 (4 or 5 symptoms) and €680; p < .05 (3 symptoms). Among the 5 symptoms of frailty, weight loss and exhaustion were significantly associated with total costs after controlling for comorbidity. CONCLUSIONS The study provides evidence that frailty is associated with increased health care costs. The analyses furthermore indicate that frailty is an important factor for health care costs independent from pure age and comorbidity. Costs were rather attributable to frailty (and comorbidity) than to age. This stresses that the overlapping concepts of multimorbidity and frailty are both necessary to explain health care use and corresponding costs among older adults.
Collapse
Affiliation(s)
- Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, Heidelberg, 69120, Germany.,Network Aging Research, University of Heidelberg, Bergheimer Straße 20, Heidelberg, 69115, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Renate Quinzler
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany.,Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Strasse 55, Leipzig, 04103, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, Heidelberg, 69120, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, Heidelberg, 69120, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| |
Collapse
|
27
|
Angermeyer MC, Carta MG, Matschinger H, Millier A, Refaï T, Schomerus G, Toumi M. Cultural differences in stigma surrounding schizophrenia: comparison between Central Europe and North Africa. Br J Psychiatry 2016; 208:389-97. [PMID: 26585098 DOI: 10.1192/bjp.bp.114.154260] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 04/05/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Exploring cultural differences may improve understanding about the social processes underlying the stigmatisation of people with mental illness. AIMS To compare public beliefs and attitudes about schizophrenia in Central Europe and North Africa. METHOD Representative national population surveys conducted in Germany (2011) and in Tunisia (2012), using the same interview mode (face to face) and the same fully structured interview. RESULTS In Tunisia, respondents showed a stronger tendency to hold the person with schizophrenia responsible for the condition. At the same time they expressed more prosocial reactions and less fear than their German counterparts. In Germany, the desire for social distance was greater for more distant relationships, whereas in Tunisia this was the case for close, family-related relationships. CONCLUSIONS Stigma differs between Tunisia and Germany more in form than in magnitude. It manifests particularly in those social roles which 'matter most' to people within a given culture.
Collapse
Affiliation(s)
- Matthias C Angermeyer
- Matthias C. Angermeyer, MD, Center for Public Mental Health, Gösing am Wagram, Austria and Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy; Mauro G. Carta, MD, Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy; Herbert Matschinger, PhD, Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany and Institute of Health Economics and Health Services Research, University of Hamburg, Hamburg, Germany; Aurélie Millier, PhD, Creativ-Ceutical, Paris, France; Tarek Refaï, PhD, Creativ-Ceutical, Les Berges du lac, Tunisia; Georg Schomerus, MD, Department of Psychiatry, Ernst Moritz Arndt University Greifswald and HELIOS Hanseklinikum Stralsund, Stralsund, Germany; Mondher Toumi, PhD, University of Lyon I, Villeurbane, France
| | - Mauro G Carta
- Matthias C. Angermeyer, MD, Center for Public Mental Health, Gösing am Wagram, Austria and Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy; Mauro G. Carta, MD, Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy; Herbert Matschinger, PhD, Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany and Institute of Health Economics and Health Services Research, University of Hamburg, Hamburg, Germany; Aurélie Millier, PhD, Creativ-Ceutical, Paris, France; Tarek Refaï, PhD, Creativ-Ceutical, Les Berges du lac, Tunisia; Georg Schomerus, MD, Department of Psychiatry, Ernst Moritz Arndt University Greifswald and HELIOS Hanseklinikum Stralsund, Stralsund, Germany; Mondher Toumi, PhD, University of Lyon I, Villeurbane, France
| | - Herbert Matschinger
- Matthias C. Angermeyer, MD, Center for Public Mental Health, Gösing am Wagram, Austria and Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy; Mauro G. Carta, MD, Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy; Herbert Matschinger, PhD, Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany and Institute of Health Economics and Health Services Research, University of Hamburg, Hamburg, Germany; Aurélie Millier, PhD, Creativ-Ceutical, Paris, France; Tarek Refaï, PhD, Creativ-Ceutical, Les Berges du lac, Tunisia; Georg Schomerus, MD, Department of Psychiatry, Ernst Moritz Arndt University Greifswald and HELIOS Hanseklinikum Stralsund, Stralsund, Germany; Mondher Toumi, PhD, University of Lyon I, Villeurbane, France
| | - Aurélie Millier
- Matthias C. Angermeyer, MD, Center for Public Mental Health, Gösing am Wagram, Austria and Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy; Mauro G. Carta, MD, Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy; Herbert Matschinger, PhD, Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany and Institute of Health Economics and Health Services Research, University of Hamburg, Hamburg, Germany; Aurélie Millier, PhD, Creativ-Ceutical, Paris, France; Tarek Refaï, PhD, Creativ-Ceutical, Les Berges du lac, Tunisia; Georg Schomerus, MD, Department of Psychiatry, Ernst Moritz Arndt University Greifswald and HELIOS Hanseklinikum Stralsund, Stralsund, Germany; Mondher Toumi, PhD, University of Lyon I, Villeurbane, France
| | - Tarek Refaï
- Matthias C. Angermeyer, MD, Center for Public Mental Health, Gösing am Wagram, Austria and Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy; Mauro G. Carta, MD, Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy; Herbert Matschinger, PhD, Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany and Institute of Health Economics and Health Services Research, University of Hamburg, Hamburg, Germany; Aurélie Millier, PhD, Creativ-Ceutical, Paris, France; Tarek Refaï, PhD, Creativ-Ceutical, Les Berges du lac, Tunisia; Georg Schomerus, MD, Department of Psychiatry, Ernst Moritz Arndt University Greifswald and HELIOS Hanseklinikum Stralsund, Stralsund, Germany; Mondher Toumi, PhD, University of Lyon I, Villeurbane, France
| | - Georg Schomerus
- Matthias C. Angermeyer, MD, Center for Public Mental Health, Gösing am Wagram, Austria and Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy; Mauro G. Carta, MD, Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy; Herbert Matschinger, PhD, Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany and Institute of Health Economics and Health Services Research, University of Hamburg, Hamburg, Germany; Aurélie Millier, PhD, Creativ-Ceutical, Paris, France; Tarek Refaï, PhD, Creativ-Ceutical, Les Berges du lac, Tunisia; Georg Schomerus, MD, Department of Psychiatry, Ernst Moritz Arndt University Greifswald and HELIOS Hanseklinikum Stralsund, Stralsund, Germany; Mondher Toumi, PhD, University of Lyon I, Villeurbane, France
| | - Mondher Toumi
- Matthias C. Angermeyer, MD, Center for Public Mental Health, Gösing am Wagram, Austria and Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy; Mauro G. Carta, MD, Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy; Herbert Matschinger, PhD, Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany and Institute of Health Economics and Health Services Research, University of Hamburg, Hamburg, Germany; Aurélie Millier, PhD, Creativ-Ceutical, Paris, France; Tarek Refaï, PhD, Creativ-Ceutical, Les Berges du lac, Tunisia; Georg Schomerus, MD, Department of Psychiatry, Ernst Moritz Arndt University Greifswald and HELIOS Hanseklinikum Stralsund, Stralsund, Germany; Mondher Toumi, PhD, University of Lyon I, Villeurbane, France
| |
Collapse
|
28
|
Angermeyer MC, Van der Auwera S, Matschinger H, Carta MG, Baumeister SE, Schomerus G. The public debate on psychotropic medication and changes in attitudes 1990-2011. Eur Arch Psychiatry Clin Neurosci 2016; 266:165-72. [PMID: 26615405 DOI: 10.1007/s00406-015-0660-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 11/17/2015] [Indexed: 11/28/2022]
Abstract
Over the last 25 years, the appraisal of psychotropic drugs within the scientific community and their representation in the media has changed considerably. The initial optimism in the wake of the introduction of second-generation drugs has increasingly made room for a more critical evaluation of alleged advantages of these drugs. The question arises as to what extent this is reflected in similar changes in the public's attitudes towards psychiatric medication. Three representative population surveys on attitudes towards psychotropic medication were carried out in Germany in 1990 (N = 3075), 2001 (N = 2610) and 2011 (N = 1223), using the same sampling procedure, interview mode and instrument for assessing attitudes. In order to disentangle time-related effects, an age-period-cohort analysis was performed. Over the time period of 21 years, the German public's evaluation of psychotropic medication has become markedly more favourable. This change was mostly due to a period effect, i.e. concurrent influences of the social environment people are exposed to. Changes were much more pronounced in the 1990s, while over the following decade only a small, although statistically significant, increase in the favourable appraisal of medication was found. Age and birth cohort had only a minor effect on public attitudes. Our findings suggest that changes in the evaluation of the effects of psychotropic drugs within the psychiatric community and their representation in the media also affect public opinion. Given the ongoing debate about side effects and efficacy of psychiatric medication, future changes of public opinion can be expected.
Collapse
Affiliation(s)
- Matthias C Angermeyer
- Center for Public Mental Health, Untere Zeile 13, 3482, Gösing am Wagram, Austria. .,Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cittadella, Universitaria asse didattica E, Monserrato, CA, Italy.
| | - Sandra Van der Auwera
- Department of Psychiatry, University Medicine Greifswald, Ellernholzstr. 1-2, 17475, Greifswald, Germany
| | - Herbert Matschinger
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany.,Institute of Health Economics and Health Services Research, University of Hamburg, Martinistr. 52, 20246, Hamburg, Germany
| | - Mauro G Carta
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cittadella, Universitaria asse didattica E, Monserrato, CA, Italy
| | - Sebastian E Baumeister
- Institute of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Georg Schomerus
- Department of Psychiatry, University Medicine Greifswald, Ellernholzstr. 1-2, 17475, Greifswald, Germany.,HELIOS Hanseklinikum Stralsund, Große Parower Str. 47, 18435, Stralsund, Germany
| |
Collapse
|
29
|
Bock JO, Heider D, Matschinger H, Brenner H, Saum KU, Haefeli WE, König HH. Willingness to pay for health insurance among the elderly population in Germany. Eur J Health Econ 2016; 17:149-158. [PMID: 25526928 DOI: 10.1007/s10198-014-0663-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 11/27/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION All elderly Germans are legally obliged to have health insurance. About 90 % of this population are members of social health insurances (SHI) whose premiums are generally income-related and independent of health status. For most of these members, holding social health insurance is mandatory. As a consequence, genuine information about preferences for health insurance is not available. The aim of this study was therefore to determine and analyze the willingness to pay (WTP) for health insurance among elderly Germans. METHODS Data from a population-based 8-year follow-up of a large cohort study conducted in the Saarland, Germany was used. Participants aged 57-84 years passed a geriatric assessment and responded to a health economic questionnaire. Individuals' WTP was elicited based on a contingent valuation method with a payment card. RESULTS Mean monthly WTP per capita for health insurance amounted to €260. This corresponded to about 20% of individual disposable income. Regression analyses showed that WTP increased significantly with higher income, male gender, higher educational level, and privately insured status. In contrast, neither increasing morbidity level nor higher individual health care costs influenced WTP significantly. DISCUSSION The relatively large extent of average WTP for health insurance indicates that the elderly would probably accept higher contributions to SHI rather than policy efforts to reduce contributions. The identified determinants of WTP might indicate that elderly generally approve the principle of solidarity of the SHI with contributions depending on income rather than morbidity.
Collapse
Affiliation(s)
- Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Straβe 55, 04103, Leipzig, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| |
Collapse
|
30
|
Hajek A, Bock JO, Brenner H, Saum KU, Matschinger H, Haefeli WE, Quinzler R, Heider D, König HH. [Which Factors Affect Out-of-pocket Payments for Health Care Services Among Elderly Germans? Results of a Longitudinal Study]. Gesundheitswesen 2015; 79:e18-e25. [PMID: 26551845 DOI: 10.1055/s-0035-1564247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: In Germany, out-of-pocket payments (OOPP) account for a large proportion of total health expenditure. However, there are only few investigations on how morbidity-related, sociodemographic and lifestyle factors affect OOPP particularly in the older population. The aim of this study was to identify factors affecting OOPP for health care services among elderly Germans in a longitudinal setting. Methods: This longitudinal study used data from 2 follow-up waves (3-year interval) from a population-based prospective cohort study (ESTHER study) collected in Saarland, Germany. At the first follow-up wave, subjects were between 57 and 84 years old. Participants provided comprehensive data including individual OOPP for the preceding 3 months. Fixed effects (FE) regressions were used to determine factors affecting OOPP. Results: Mean individual OOPP (3-month period) rose from € 119 (first wave) to € 136 (second wave). Longitudinal regressions showed that higher morbidity did not affect OOPP. Moreover, changes in sociodemographic as well as lifestyle factors were not related to changes in OOPP. Solely, exemption of OOPP reduced the dependent variable significantly. Conclusion: In contrast to cross-sectional findings for Germany, OOPP are not related to morbidity and income in this study. This underlines the complex nature of OOPP in old age and the need for longitudinal studies to gain some insight into the underlying causal factors.
Collapse
Affiliation(s)
- A Hajek
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - J-O Bock
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - H Brenner
- Klinische Epidemiologie und Alternsforschung, Deutsches Krebsforschungszentrum, Heidelberg
| | - K-U Saum
- Klinische Epidemiologie und Alternsforschung, Deutsches Krebsforschungszentrum, Heidelberg
| | - H Matschinger
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - W E Haefeli
- Klinische Pharmakologie und Pharmakoepidemiologie, Universität Heidelberg, Heidelberg
| | - R Quinzler
- Klinische Pharmakologie und Pharmakoepidemiologie, Universität Heidelberg, Heidelberg
| | - D Heider
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - H-H König
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| |
Collapse
|
31
|
Schomerus G, Van der Auwera S, Matschinger H, Baumeister SE, Angermeyer MC. Do attitudes towards persons with mental illness worsen during the course of life? An age-period-cohort analysis. Acta Psychiatr Scand 2015; 132:357-64. [PMID: 25676686 DOI: 10.1111/acps.12401] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Cross-sectional studies frequently find higher age associated with negative attitudes towards persons with mental illness. We explore whether attitudes worsen over the life span, or follow a cohort pattern. METHOD Using data from three identical population surveys in Germany from 1990, 2001 and 2011 (combined sample n = 7835), we performed age-period-cohort analyses determining the association of age, time period and birth-cohort with social distance from a person with either depression (n = 3910) or schizophrenia (n = 3925), using linear and nonlinear partial least squares regression models. RESULTS Social distance increases with age, independent from cohort and period effects, cumulating to an increase of 2.4 (schizophrenia) and 2.3 (depression) on the 28 point social distance scale over the life span (youngest to oldest participant). We found a cohort effect in depression, but not schizophrenia, with decreasing social distance until 1970 and a slight increase in younger cohorts. Period effects were visible particularly in schizophrenia, with growing social distance over time. CONCLUSION Considering demographic change and the vulnerability of older persons to severe outcomes of mental illness such as suicide, the observed increase of negative attitudes over the life span seems highly relevant. We discuss the role of conservatism and preferences for agreeable social contacts in older age.
Collapse
Affiliation(s)
- G Schomerus
- Department of Psychiatry, University of Greifswald, Greifswald, Germany.,HELIOS Hanseklinikum Stralsund, Stralsund, Germany
| | - S Van der Auwera
- Institute of Community Medicine, University of Greifswald, Greifswald, Germany
| | - H Matschinger
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.,Institute of Health Economics and Health Services Research, University of Hamburg, Hamburg, Germany
| | - S E Baumeister
- Institute of Community Medicine, University of Greifswald, Greifswald, Germany
| | - M C Angermeyer
- Department of Public Health, University of Cagliari, Cagliari, Italy.,Center for Public Mental Health, Gösing am Wagram, Austria
| |
Collapse
|
32
|
König HH, Lehnert T, Brenner H, Schöttker B, Quinzler R, Haefeli WE, Matschinger H, Heider D. Health service use and costs associated with excess weight in older adults in Germany. Age Ageing 2015; 44:616-23. [PMID: 25829392 DOI: 10.1093/ageing/afu120] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/11/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND excess weight is a risk factor for numerous co-morbidities that predominantly occur in later life. This study's purpose was to analyse the association between excess weight and health service use/costs in the older population in Germany. METHODS this cross-sectional analysis used data of n = 3,108 individuals aged 58-82 from a population-based prospective cohort study. Body mass index (BMI) and waist-to-height ratio (WHtR) were calculated based on clinical examinations. Health service use was measured by a questionnaire for a 3-month period. Corresponding costs were calculated applying a societal perspective. RESULTS 21.8% of the sample were normal weight, 43.0% overweight, 25.5% obese class 1 and 9.6% obese class ≥2 according to BMI. In 42.6%, WHtR was ≥0.6. For normal weight, overweight, obese class 1 and obese class ≥2 individuals, mean costs (3-month period) of outpatient care were 384€, 435€, 475€ and 525€ (P < 0.001), mean costs of inpatient care were 284€, 408€, 333€ and 652€ (P = 0.070) and mean total costs 716€, 891€, 852€ and 1,244€ (P = 0.013). For individuals with WHtR <0.6 versus ≥0.6, outpatient costs were 401€ versus 499€ (P < 0.001), inpatient costs 315€ versus 480€ (P = 0.016) and total costs 755€ versus 1,041€ (P < 0.001). Multiple regression analyses controlling for sociodemographic variables showed a significant effect of obesity on costs of outpatient care (class 1: +72€; class ≥2: +153€) and total costs (class ≥2: +361€) while the effect of overweight was not significant. WHtR ≥0.6 significantly increased outpatient costs by +79€ and total costs by +189€. CONCLUSIONS excess weight is associated with increased service use and cost in elderly individuals, in particular in obese class ≥2 individuals.
Collapse
Affiliation(s)
- Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Lehnert
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Renate Quinzler
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
33
|
Hardt J, Bernert S, Matschinger H, Angermeier MC, Vilagut G, Bruffaerts R, de Girolamo G, de Graaf R, Haro JM, Kovess V, Alonso J. Suicidality and its relationship with depression, alcohol disorders and childhood experiences of violence: results from the ESEMeD study. J Affect Disord 2015; 175:168-74. [PMID: 25618003 DOI: 10.1016/j.jad.2014.12.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/16/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Suicidality constitutes a major health concern in many countries. The aim of the present paper was to analyse 10 of its risk factors and their interdependence. METHODS Data on suicidality, mental disorders and experience of childhood violence was collected from 8796 respondents in the European Study of the Epidemiology of Mental Disorders (ESEMeD). The CIDI was used to assess mental disorders. Individuals were randomly divided into two subgroups. In one, a Graphical Markov model to predict suicidality was constructed, in the second, predictors were cross-validated. RESULTS Lifetime suicidality was predicted mainly by lifetime depression and early experiences of violence, with a pseudo R-square of 12.8%. In addition, alcohol disorders predicted suicidality, but played a minor role compared with the other risk factors in this sample. CONCLUSION In addition to depression, early experience of violence constitutes an important risk factor of suicidality. LIMITATIONS This is a cross-sectional and retrospective study assessing risk factors for suicidality, not for suicide itself.
Collapse
Affiliation(s)
- J Hardt
- Medizinische Psychologie und Medizinische Soziologie, Klinik für Psycho-somatische Medizin und Psychotherapie, Universitätsmedizin Mainz, Germany.
| | - S Bernert
- Institute of Medical Sociology, Department of Rehabilitation Research, Charité - University Medicine Berlin
| | - H Matschinger
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig
| | - M C Angermeier
- Center for Public Mental Health, Gösing am Wagram, Austria; Department of Public Health, University of Cagliari, Italy
| | - G Vilagut
- Health Services Research Unit, IMIM- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - R Bruffaerts
- Department of Psychiatry, University Hospital Gasthuisberg; Leuven, Belgium
| | - G de Girolamo
- IRCCS St John of God Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, Italy
| | - R de Graaf
- Netherlands Institute of Mental Health and Addiction (Trimbos-Instituut), Utrecht, Nl; Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - J M Haro
- CIBER en Salud Mental (CIBERSAM), Spain
| | - V Kovess
- EA4069, Paris Descartes University, Ecole des Hautes Etudes en Santé Publique (EHESP), Paris, France
| | - J Alonso
- Health Services Research Unit, IMIM- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| |
Collapse
|
34
|
Luck T, Luppa M, Matschinger H, Jessen F, Angermeyer MC, Riedel-Heller SG. Incident subjective memory complaints and the risk of subsequent dementia. Acta Psychiatr Scand 2015; 131:290-6. [PMID: 25201166 DOI: 10.1111/acps.12328] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE In this study, we aimed to analyze the association between new-incident-subjective memory complaints (SMC) and risk of subsequent dementia in a general population sample aged 75+ years. METHOD Data were derived from follow-up (FUP) waves I-V of the population-based Leipzig Longitudinal Study of the Aged (LEILA75+). We used the Kaplan-Meier survival method to estimate dementia-free survival times of individuals with and without incident SMC and multivariable Cox proportional hazards regression to assess the association between incident SMC and risk of subsequent dementia, controlled for covariates. RESULTS Of 443 non-demented individuals, 58 (13.1%) developed dementia during a subsequent 5.4-year follow-up period. Participants with incident SMC showed a significantly higher progression to dementia (18.5% vs. 10.0%; P=0.010) and a significantly shorter mean dementia-free survival time than those without (6.2 vs. 6.8 years; P=0.008). The association between incident SMC and risk of subsequent dementia remained significant in the multivariable Cox analysis (adjusted hazard ratio=1.8; P=0.028). CONCLUSION Our findings suggest higher progression to dementia and shorter dementia-free survival in older individuals with incident SMC. These findings support the notion that such subjective complaints should be taken seriously in clinical practice as possible early indicators of incipient dementia.
Collapse
Affiliation(s)
- T Luck
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany; LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | | | | | | | | | | |
Collapse
|
35
|
Bruffaerts R, Posada-Villa J, Al-Hamzawi AO, Gureje O, Huang Y, Hu C, Bromet EJ, Viana MC, Hinkov HR, Karam EG, Borges G, Florescu SE, Williams DR, Demyttenaere K, Kovess-Masfety V, Matschinger H, Levinson D, de Girolamo G, Ono Y, de Graaf R, Browne MO, Bunting B, Xavier M, Haro JM, Kessler RC. Proportion of patients without mental disorders being treated in mental health services worldwide. Br J Psychiatry 2015; 206:101-9. [PMID: 25395690 PMCID: PMC4312965 DOI: 10.1192/bjp.bp.113.141424] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Previous research suggests that many people receiving mental health treatment do not meet criteria for a mental disorder but are rather 'the worried well'. AIMS To examine the association of past-year mental health treatment with DSM-IV disorders. METHOD The World Health Organization's World Mental Health (WMH) Surveys interviewed community samples of adults in 23 countries (n = 62 305) about DSM-IV disorders and treatment in the past 12 months for problems with emotions, alcohol or drugs. RESULTS Roughly half (52%) of people who received treatment met criteria for a past-year DSM-IV disorder, an additional 18% for a lifetime disorder and an additional 13% for other indicators of need (multiple subthreshold disorders, recent stressors or suicidal behaviours). Dose-response associations were found between number of indicators of need and treatment. CONCLUSIONS The vast majority of treatment in the WMH countries goes to patients with mental disorders or other problems expected to benefit from treatment.
Collapse
|
36
|
Carta MG, Angermeyer MC, Matschinger H, Holzinger A, Pintus E, Pintus M, Moro MF. Recommendations of the Sardinian public for the treatment of depression. Int J Soc Psychiatry 2014; 60:619-26. [PMID: 24221099 DOI: 10.1177/0020764013509077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Public beliefs about appropriate treatment impact, help-seeking and treatment adherence. AIM To determine the recommendations of the Sardinian public for the treatment of depression. METHODS In 2012, a population-based survey was conducted by phone in Sardinia (N = 1,200). In the context of a fully structured interview, respondents were presented with a vignette depicting a case of depression. Subsequently, they were asked about their treatment recommendations. The results are contrasted with findings from a similar survey which had been conducted in Vienna 3 years before. RESULTS In Sardinia as in Vienna, psychotherapy was the uncontested favorite, while antidepressant medication was recommended by relatively few respondents. In Sardinia, there were also no marked differences between urban and rural areas with regard to these two treatments. However, between Sardinia and Vienna, as well as within Sardinia, great differences were found with regard to autogenic training and 'alternative' methods like homeopathic medicines and acupuncture. CONCLUSION Cross-cultural comparisons may help better understand treatment preferences of the public. In Sardinia, as in Vienna, there seems to be a need for improving the public's knowledge about the appropriate treatment of depression.
Collapse
Affiliation(s)
- Mauro G Carta
- Department of Public Health, Centro di Psichiatria di Consultazione e Psicosomatica, University of Cagliari, Italy
| | - Matthias C Angermeyer
- Department of Public Health, Centro di Psichiatria di Consultazione e Psicosomatica, University of Cagliari, Italy Center for Public Mental Health, Gösing am Wagram, Austria
| | - Herbert Matschinger
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany Institute of Medical Sociology, Social Medicine and Health Economics, University of Hamburg, Germany
| | - Anita Holzinger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Elisa Pintus
- Department of Public Health, Centro di Psichiatria di Consultazione e Psicosomatica, University of Cagliari, Italy
| | - Mirra Pintus
- Department of Public Health, Centro di Psichiatria di Consultazione e Psicosomatica, University of Cagliari, Italy
| | - Maria F Moro
- Department of Public Health, Centro di Psichiatria di Consultazione e Psicosomatica, University of Cagliari, Italy
| |
Collapse
|
37
|
Schomerus G, Matschinger H, Lucht MJ, Angermeyer MC. Changes in the perception of alcohol-related stigma in Germany over the last two decades. Drug Alcohol Depend 2014; 143:225-31. [PMID: 25156226 DOI: 10.1016/j.drugalcdep.2014.07.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 07/26/2014] [Accepted: 07/27/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Alcohol dependence is a severely stigmatized disorder. Perceived stigma may deter help-seeking and is associated with higher co-morbidity and self-stigma in persons with alcohol dependence. We assess changes in the perception of alcohol-related stigma over 21 years in the general population. METHODS Two representative population surveys using identical methodology were conducted in Germany in 1990 and 2011 (n=1022 and n=967), eliciting the perceived discrimination and devaluation of someone with a history of alcohol problems as measured with an adoption of Link's Perceived Discrimination and Devaluation Scale (aPDDS), and perceived negative stereotypes of an "alcoholic." RESULTS Both on item level and using factor scores, attitudes changed significantly between 1990 and 2011. Perceived discrimination and devaluation of someone with a history of alcohol dependence decreased considerably by 0.44 standard deviations (SD). Perceived negative stereotypes related to unpredictability of an "alcoholic" increased slightly by 0.15 SD, while perceived stereotypes related to strangeness decreased (-0.23 SD). CONCLUSIONS Our findings suggest that particularly the image of someone who has received treatment for alcohol dependence has improved in Germany. This parallels increasing acceptance of professional treatment for alcohol dependence among the general population over the last twenty years, and contrasts with overall unchanged negative attitudes toward persons who actually suffer from alcohol problems.
Collapse
Affiliation(s)
- Georg Schomerus
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany; HELIOS Hanseklinikum Stralsund, Germany.
| | - Herbert Matschinger
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany; Institute of Medical Sociology, Social Medicine and Health Economics, University of Hamburg, Germany
| | - Michael J Lucht
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany; HELIOS Hanseklinikum Stralsund, Germany
| | - Matthias C Angermeyer
- Center for Public Mental Health, Gösing am Wagram, Austria; Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy
| |
Collapse
|
38
|
Schomerus G, Matschinger H, Baumeister SE, Mojtabai R, Angermeyer MC. Public attitudes towards psychiatric medication: a comparison between United States and Germany. World Psychiatry 2014; 13:320-1. [PMID: 25273308 PMCID: PMC4219076 DOI: 10.1002/wps.20169] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Georg Schomerus
- Department of Psychiatry, University of GreifswaldGreifswald, Germany,HELIOS Hanseklinikum StralsundStralsund, Germany
| | - Herbert Matschinger
- Institute of Social Medicine, Occupational Health and Public Health, University of LeipzigLeipzig, Germany,Institute of Health Economics and Health Services ResearchGermany
| | | | | | - Matthias C Angermeyer
- Department of Public Health and Clinical and Molecular Medicine, University of CagliariCagliari, Italy,Center for Public Mental HealthGösing am Wagram, Austria
| |
Collapse
|
39
|
Troost JP, Barondess DA, Storr CL, Wells JE, Obaid Al-Hamzawi A, Andrade LH, Bromet E, Bruffaerts R, Florescu S, de Girolamo G, de Graaf R, Gureje O, Haro JM, Hu C, Huang Y, Karam AN, Kessler RC, Lepine JP, Matschinger H, Medina-Mora ME, O'Neill S, Posada-Villa J, Sagar R, Takeshima T, Tomov T, Williams DR, Anthony JC. An updated global picture of cigarette smoking persistence among adults. J Epidemiol Glob Health 2014; 2:135-44. [PMID: 23626929 PMCID: PMC3635135 DOI: 10.1016/j.jegh.2012.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Cross-national variance in smoking prevalence is relatively well documented. The aim of this study is to estimate levels of smoking persistence across 21 countries with a hypothesized inverse relationship between country income level and smoking persistence. Methods: Data from the World Health Organization World Mental Health Survey Initiative were used to estimate cross-national differences in smoking persistence—the proportion of adults who started to smoke and persisted in smoking by the date of the survey. Results: There is large variation in smoking persistence from 25% (Nigeria) to 85% (China), with a random-effects meta-analytic summary estimate of 55% with considerable cross-national variation. (Cochran’s heterogeneity Q statistic = 6845; p < 0.001). Meta-regressions indicated that observed differences are not attributable to differences in country’s income level, age distribution of smokers, or how recent the onset of smoking began within each country. Conclusion: While smoking should remain an important public health issue in any country where smokers are present, this report identifies several countries with higher levels of smoking persistence (namely, China and India).
Collapse
Affiliation(s)
- Jonathan P Troost
- Department of Epidemiology, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Stein DJ, McLaughlin KA, Koenen KC, Atwoli L, Friedman MJ, Hill ED, Maercker A, Petukhova M, Shahly V, van Ommeren M, Alonso J, Borges G, de Girolamo G, de Jonge P, Demyttenaere K, Florescu S, Karam EG, Kawakami N, Matschinger H, Okoliyski M, Posada-Villa J, Scott KM, Viana MC, Kessler RC. DSM-5 and ICD-11 definitions of posttraumatic stress disorder: investigating "narrow" and "broad" approaches. Depress Anxiety 2014; 31:494-505. [PMID: 24894802 PMCID: PMC4211431 DOI: 10.1002/da.22279] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 04/22/2014] [Accepted: 04/26/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The development of the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) and ICD-11 has led to reconsideration of diagnostic criteria for posttraumatic stress disorder (PTSD). The World Mental Health (WMH) Surveys allow investigation of the implications of the changing criteria compared to DSM-IV and ICD-10. METHODS WMH Surveys in 13 countries asked respondents to enumerate all their lifetime traumatic events (TEs) and randomly selected one TE per respondent for PTSD assessment. DSM-IV and ICD-10 PTSD were assessed for the 23,936 respondents who reported lifetime TEs in these surveys with the fully structured Composite International Diagnostic Interview (CIDI). DSM-5 and proposed ICD-11 criteria were approximated. Associations of the different criteria sets with indicators of clinical severity (distress-impairment, suicidality, comorbid fear-distress disorders, PTSD symptom duration) were examined to investigate the implications of using the different systems. RESULTS A total of 5.6% of respondents met criteria for "broadly defined" PTSD (i.e., full criteria in at least one diagnostic system), with prevalence ranging from 3.0% with DSM-5 to 4.4% with ICD-10. Only one-third of broadly defined cases met criteria in all four systems and another one third in only one system (narrowly defined cases). Between-system differences in indicators of clinical severity suggest that ICD-10 criteria are least strict and DSM-IV criteria most strict. The more striking result, though, is that significantly elevated indicators of clinical significance were found even for narrowly defined cases for each of the four diagnostic systems. CONCLUSIONS These results argue for a broad definition of PTSD defined by any one of the different systems to capture all clinically significant cases of PTSD in future studies.
Collapse
Affiliation(s)
- Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa,Correspondence to: Dan J. Stein, Department of Psychiatry, University of Cape Town, Groote Schuur Hospital J2, Anzio Road, Observatory 7925, Cape Town , South Africa.
| | | | - Karestan C. Koenen
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Lukoye Atwoli
- Department of Psychiatry, Moi University, Eldoret, Kenya
| | - Matthew J. Friedman
- National Center for PTSD, US Department of Veteran Affairs, VA Medical Center, White River Junction, Vermont
| | - Eric D. Hill
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Andreas Maercker
- Division of Psychopathology, Department of Psychology, University of Zurich, Switzerland
| | - Maria Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Victoria Shahly
- Division of Psychopathology, Department of Psychology, University of Zurich, Switzerland
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Jordi Alonso
- Health Services Research Unit, Institut Municipal d Investigacio Medica (IMIM-Hospital del Mar), Barcelona, Spain,CIBER en Epidemologıa y Salud Publica (CIBERESP), Barcelona, Spain
| | - Guilherme Borges
- Division of Epidemiological and Psychosocial Research, Department of Epidemiological Research, National Institute of Psychiatry (Mexico) & Metropolitan Autonomous University, Mexico City, Mexico
| | | | - Peter de Jonge
- Department of Psychiatry (PdJ), University Medical Center Groningen, Groningen, The Netherlands
| | - Koen Demyttenaere
- Department of Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium
| | - Silvia Florescu
- Health Services Research and Evaluation Center, National School of Public Health Management and Professional Development, Bucharest, Romania
| | - Elie G. Karam
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Medical Institute for Neuropsychological Disorders (MIND), St. George Hospital University Medical Center, Faculty of Medicine, Balamand University, Beirut, Lebanon
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Herbert Matschinger
- Public Health Research Unit (HM), Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Michail Okoliyski
- Department of Mental Health, National Centre of Public Health and Analyses, Ministry of Health, Sofia, Bulgaria
| | - Jose Posada-Villa
- Instituto Colombiano del Sistema Nervioso, Pontificia Universidad Javeriana, Bogota D.C., Colombia
| | - Kate M. Scott
- Department of Psychological Medicine, Otago University, Dunedin, New Zealand
| | - Maria Carmen Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitória, Brazil
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
41
|
Andrade LH, Alonso J, Mneimneh Z, Wells JE, Al-Hamzawi A, Borges G, Bromet E, Bruffaerts R, de Girolamo G, de Graaf R, Florescu S, Gureje O, Hinkov HR, Hu C, Huang Y, Hwang I, Jin R, Karam EG, Kovess-Masfety V, Levinson D, Matschinger H, O'Neill S, Posada-Villa J, Sagar R, Sampson NA, Sasu C, Stein DJ, Takeshima T, Viana MC, Xavier M, Kessler RC. Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychol Med 2014; 44:1303-1317. [PMID: 23931656 DOI: 10.1017/s003329171300194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders. METHOD Data were from the World Health Organization (WHO) World Mental Health (WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n = 63,678) and analyzed at different levels of clinical severity. RESULTS Among those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders). CONCLUSIONS Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.
Collapse
Affiliation(s)
- L H Andrade
- Section of Psychiatric Epidemiology-LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - J Alonso
- Health Services Research Unit, IMIM (Hospital del Mar Research Institute), and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Z Mneimneh
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), St George Hospital University Medical Center, Beirut, Lebanon
| | - J E Wells
- Department of Public Health and General Practice, University of Otago, Christchurch, New Zealand
| | - A Al-Hamzawi
- Al-Qadisia University College of Medicine, Diwania Teaching Hospital, Diwania, Iraq
| | - G Borges
- Instituto Nacional de Psiquatria Ramon de la Fuente and Universidad Autonoma Metropolitana, Mexico DF, Mexico
| | - E Bromet
- Department of Psychiatry, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - R Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Leuven, Belgium
| | - G de Girolamo
- IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - R de Graaf
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - S Florescu
- National School of Public Health Management and Professional Development, Bucharest, Romania
| | - O Gureje
- Department of Psychiatry, University of Ibadan, College of Medicine, Ibadan, Nigeria
| | - H R Hinkov
- National Center for Public Health and Analyses, Sofia, Bulgaria
| | - C Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Shenzhen, P. R. China
| | - Y Huang
- Institute of Mental Health, Peking University, Beijing, P. R. China
| | - I Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - R Jin
- Harvard Pilgrim Health Care, Boston, MA, USA
| | - E G Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), St George Hospital University Medical Center, Beirut, Lebanon
| | - V Kovess-Masfety
- EA 4069 Université Paris Descartes and Department of Epidemiology, EHESP School for Public Health, Paris, France
| | - D Levinson
- Research and Planning, Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - H Matschinger
- Institute of Social Medicine, Occupational Health and Public Health, Public Health Research Unit, University of Leipzig, Germany
| | - S O'Neill
- Psychology Research Institute, University of Ulster, Londonderry, UK
| | - J Posada-Villa
- Pontificia Universidad Javeriana, Instituto Colombiano del Sistema Nervioso, Bogota, Colombia
| | - R Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - N A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - C Sasu
- Scoala Nationala de Sanatate Publica, Management si Perfectionare in Domeniul Sanitar (SNSPMPDSB), Bucharest, Romania
| | - D J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Cape Town, South Africa
| | - T Takeshima
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan
| | - M C Viana
- Department of Social Medicine, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - M Xavier
- Mental Health Department, Faculdade Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - R C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
42
|
de Jonge P, Alonso J, Stein DJ, Kiejna A, Aguilar-Gaxiola S, Viana MC, Liu Z, O'Neill S, Bruffaerts R, Caldas-de-Almeida JM, Lepine JP, Matschinger H, Levinson D, de Girolamo G, Fukao A, Bunting B, Haro JM, Posada-Villa JA, Al-Hamzawi AO, Medina-Mora ME, Piazza M, Hu C, Sasu C, Lim CCW, Kessler RC, Scott KM. Associations between DSM-IV mental disorders and diabetes mellitus: a role for impulse control disorders and depression. Diabetologia 2014; 57:699-709. [PMID: 24488082 PMCID: PMC4124905 DOI: 10.1007/s00125-013-3157-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS No studies have evaluated whether the frequently observed associations between depression and diabetes could reflect the presence of comorbid psychiatric conditions and their associations with diabetes. We therefore examined the associations between a wide range of pre-existing Diagnostic Statistical Manual, 4th edition (DSM-IV) mental disorders with self-reported diagnosis of diabetes. METHODS We performed a series of cross-sectional face-to-face household surveys of community-dwelling adults (n = 52,095) in 19 countries. The World Health Organization Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Diabetes was indicated by self-report of physician's diagnosis together with its timing. We analysed the associations between all mental disorders and diabetes, without and with comorbidity adjustment. RESULTS We identified 2,580 cases of adult-onset diabetes mellitus (21 years +). Although all 16 DSM-IV disorders were associated with diabetes diagnosis in bivariate models, only depression (OR 1.3; 95% CI 1.1, 1.5), intermittent explosive disorder (OR 1.6; 95% CI 1.1, 2.1), binge eating disorder (OR 2.6; 95% CI 1.7, 4.0) and bulimia nervosa (OR 2.1; 95% CI 1.3, 3.4) remained after comorbidity adjustment. CONCLUSIONS/INTERPRETATION Depression and impulse control disorders (eating disorders in particular) were significantly associated with diabetes diagnosis after comorbidity adjustment. These findings support the focus on depression as having a role in diabetes onset, but suggest that this focus may be extended towards impulse control disorders. Acknowledging the comorbidity of mental disorders is important in determining the associations between mental disorders and subsequent diabetes.
Collapse
Affiliation(s)
- Peter de Jonge
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, PO 9700 MB, Groningen, The Netherlands,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Andrade LH, Alonso J, Mneimneh Z, Wells JE, Al-Hamzawi A, Borges G, Bromet E, Bruffaerts R, de Girolamo G, de Graaf R, Florescu S, Gureje O, Hinkov HR, Hu C, Huang Y, Hwang I, Jin R, Karam EG, Kovess-Masfety V, Levinson D, Matschinger H, O’Neill S, Posada-Villa J, Sagar R, Sampson NA, Sasu C, Stein D, Takeshima T, Viana MC, Xavier M, Kessler RC. Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychol Med 2014; 44:1303-1317. [PMID: 23931656 PMCID: PMC4100460 DOI: 10.1017/s0033291713001943] [Citation(s) in RCA: 609] [Impact Index Per Article: 60.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders. METHOD Data were from the World Health Organization (WHO) World Mental Health (WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n = 63,678) and analyzed at different levels of clinical severity. RESULTS Among those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders). CONCLUSIONS Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.
Collapse
Affiliation(s)
- L. H. Andrade
- Section of Psychiatric Epidemiology-LIM 23, Department/Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - J. Alonso
- Health Services Research Unit, IMIM (Hospital del Mar Research Institute), and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Z. Mneimneh
- Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Survey Methodology Program, Institute for Social Research, University of Michigan, USA
| | - J. E. Wells
- Department of Public Health and General Practice, University of Otago, Christchurch. Christchurch, New Zealand
| | - A. Al-Hamzawi
- Al-Qadisia University College of Medicine, Diwania Teaching Hospital, Diwania, Iraq
| | - G. Borges
- Instituto Nacional de Psiquatria Ramon de la Fuente & Universidad Autonoma Metropolitana, Mexico DF, Mexico
| | - E. Bromet
- State University of New York at Stony Brook Department of Psychiatry, Stony Brook, NY
| | - R. Bruffaerts
- Universitair Psychiatrisch Centrum –Katholieke Universiteit Leuven (UPC-KUL), Leuven, Belgium
| | - G. de Girolamo
- IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - R. de Graaf
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - S. Florescu
- National School of Public Health Management and Professional Development, Bucharest, Romania
| | - O. Gureje
- Department of Psychiatry, University of Ibadan, College of Medicine, Ibadan, Nigeria
| | - H. R. Hinkov
- National Center for Public Health and Analyses, Sofia, Bulgaria
| | - C. Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, People’s Republic of China
| | - Y. Huang
- Institute of Mental Health, Peking University, Beijing, P. R. China
| | - I. Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - R. Jin
- Harvard Pilgrim Health Care, Boston, MA
| | - E. G. Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), St. George Hospital University Medical Center, Beirut, Lebanon
| | - V. Kovess-Masfety
- EA 4069 Université Paris Descartes & EHESP School for Public Health, Department of Epidemiology, Paris, France
| | - D. Levinson
- Research and Planning, Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - H. Matschinger
- Institute of Social Medicine, Occupational Health and Public Health, Public Health Research Unit, University of Leipzig, Germany
| | - S. O’Neill
- Psychology Research Institute, University of Ulster, Londonderry, UK
| | - J. Posada-Villa
- Pontificia Universidad Javeriana, Instituto Colombiano del Sistema Nervioso, Bogota, Colombia
| | - R. Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - N. A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - C. Sasu
- Scoala Nationala de Sanatate Publica, Management si Perfectionare in Domeniul Sanitar (SNSPMPDSB), Bucharest, Romania
| | - D. Stein
- University of Cape Town, Department of Psychiatry and Mental Health, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - T. Takeshima
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan
| | - M. C. Viana
- Department of Social Medicine, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - M. Xavier
- Mental Health Department, Faculdade Ciências Médicas - Universidade Nova de Lisboa Lisbon, Portugal
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
44
|
McDowell RD, Ryan A, Bunting BP, O'Neill SM, Alonso J, Bruffaerts R, de Graaf R, Florescu S, Vilagut G, de Almeida JMC, de Girolamo G, Haro JM, Hinkov H, Kovess-Masfety V, Matschinger H, Tomov T. Mood and anxiety disorders across the adult lifespan: a European perspective. Psychol Med 2014; 44:707-722. [PMID: 23721650 DOI: 10.1017/s0033291713001116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The World Mental Health Survey Initiative (WMHSI) has advanced our understanding of mental disorders by providing data suitable for analysis across many countries. However, these data have not yet been fully explored from a cross-national lifespan perspective. In particular, there is a shortage of research on the relationship between mood and anxiety disorders and age across countries. In this study we used multigroup methods to model the distribution of 12-month DSM-IV/CIDI mood and anxiety disorders across the adult lifespan in relation to determinants of mental health in 10 European Union (EU) countries. METHOD Logistic regression was used to model the odds of any mood or any anxiety disorder as a function of age, gender, marital status, urbanicity and employment using a multigroup approach (n = 35500). This allowed for the testing of specific lifespan hypotheses across participating countries. RESULTS No simple geographical pattern exists with which to describe the relationship between 12-month prevalence of mood and anxiety disorders and age. Of the adults sampled, very few aged ≥ 80 years met DSM-IV diagnostic criteria for these disorders. The associations between these disorders and key sociodemographic variables were relatively homogeneous across countries after adjusting for age. CONCLUSIONS Further research is required to confirm that there are indeed stages in the lifespan where the reported prevalence of mental disorders is low, such as among younger adults in the East and older adults in the West. This project illustrates the difficulties in conducting research among different age groups simultaneously.
Collapse
Affiliation(s)
- R D McDowell
- Institute of Nursing & Health Research, University of Ulster, Coleraine, N. Ireland
| | - A Ryan
- Institute of Nursing & Health Research, University of Ulster, Coleraine, N. Ireland
| | - B P Bunting
- Psychology Research Institute, University of Ulster, Londonderry, N. Ireland
| | - S M O'Neill
- Psychology Research Institute, University of Ulster, Londonderry, N. Ireland
| | - J Alonso
- Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - R Bruffaerts
- Universitair Psychiatrisch Centrum - KU Leuven (UPC-KUL), KU Leuven, Leuven, Belgium
| | - R de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - S Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - G Vilagut
- Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - J M C de Almeida
- Departamento de Saúde Mental, Faculdade de Ciências Médicas, Portugal
| | - G de Girolamo
- IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Italy
| | - J M Haro
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBER en Salud Mental, Spain
| | - H Hinkov
- National Center for Public Health Protection, Bulgaria
| | | | | | - T Tomov
- Department of Psychiatry, Alexandrovsaka Hospital, Bulgaria
| |
Collapse
|
45
|
O'Neill S, Posada-Villa J, Medina-Mora ME, Al-Hamzawi AO, Piazza M, Tachimori H, Hu C, Lim C, Bruffaerts R, Lépine JP, Matschinger H, de Girolamo G, de Jonge P, Alonso J, Caldas-de-Almeida JM, Florescu S, Kiejna A, Levinson D, Kessler RC, Scott KM. Associations between DSM-IV mental disorders and subsequent self-reported diagnosis of cancer. J Psychosom Res 2014; 76:207-12. [PMID: 24529039 PMCID: PMC5129659 DOI: 10.1016/j.jpsychores.2013.12.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 12/21/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The associations between mental disorders and cancer remain unclear. It is also unknown whether any associations vary according to life stage or gender. This paper examines these research questions using data from the World Mental Health Survey Initiative. METHODS The World Health Organization Composite International Diagnostic Interview retrospectively assessed the lifetime prevalence of 16 DSM-IV mental disorders in face-to-face household population surveys in nineteen countries (n = 52,095). Cancer was indicated by self-report of diagnosis. Smoking was assessed in questions about current and past tobacco use. Survival analyses estimated associations between first onset of mental disorders and subsequently reported cancer. RESULTS After adjustment for comorbidity, panic disorder, specific phobia and alcohol abuse were associated with a subsequently self-reported diagnosis of cancer. There was an association between number of mental disorders and the likelihood of reporting a cancer diagnosis following the onset of the mental disorder. This suggests that the associations between mental disorders and cancer risk may be generalised, rather than specific to a particular disorder. Depression is more strongly associated with self-reported cancers diagnosed early in life and in women. PTSD is also associated with cancers diagnosed early in life. CONCLUSION This study reports the magnitude of the associations between mental disorders and a self-reported diagnosis of cancer and provides information about the relevance of comorbidity, gender and the impact at different stages of life. The findings point to a link between the two conditions and lend support to arguments for early identification and treatment of mental disorders.
Collapse
Affiliation(s)
- Siobhan O'Neill
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom.
| | - Jose Posada-Villa
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Maria Elena Medina-Mora
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Ali Obaid Al-Hamzawi
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Marina Piazza
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Hisateru Tachimori
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Chiyi Hu
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Carmen Lim
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Ronny Bruffaerts
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Jean-Pierre Lépine
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Herbert Matschinger
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Giovanni de Girolamo
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Peter de Jonge
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Jordi Alonso
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Jose Miguel Caldas-de-Almeida
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Silvia Florescu
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Andrzej Kiejna
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Daphna Levinson
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Ronald C Kessler
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| | - Kate M Scott
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland, United Kingdom
| |
Collapse
|
46
|
Conrad I, Uhle C, Matschinger H, Kilian R, Riedel-Heller SG. [Quality of life of individuals with mild cognitive impairment]. Psychiatr Prax 2014; 42:152-7. [PMID: 24526394 DOI: 10.1055/s-0034-1369831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Studies on quality of life in people with mild cognitive disorders are rare and show inconsistent results. METHODS A representative population survey of 997 older individuals (60 - 69 y., 70 - 79 y., 80+ y.) was conducted. Study participants were interviewed face-to-face. Core instrument for the assessment of cognitive performance was the DemTect. Quality of life (QOL) was measured with the WHOQOL-BREF in four domains (physical, psychological, social, and environment domains) and the add-on module WHOQOL-OLD, which contains 24 items in six facets. RESULTS Older people with mild cognitive impairment showed a significantly reduced QOL compared to their cognitively healthy counterparts. This holds true for the physical, psychological, social, and environment domains of the WHOQOL-BREF and in five of the six facets covered by the instrument WHOQOL-OLD (with exception of the facet which assesses worries about death and dying). Influences of socio-demographic indicators and health related aspects on QOL are assessed. CONCLUSIONS The fact, that mild cognitive disorders are associated with such a significant reduction in QOL for those affected, received little attention so far and may warrant interventions.
Collapse
Affiliation(s)
- Ines Conrad
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP)
| | - Christian Uhle
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP)
| | | | - Reinhold Kilian
- Klinik für Psychiatrie II der Universität Ulm am Bezirkskrankenhaus Günzburg
| | | |
Collapse
|
47
|
Heider D, Matschinger H, Müller H, Saum KU, Quinzler R, Haefeli WE, Wild B, Lehnert T, Brenner H, König HH. Health care costs in the elderly in Germany: an analysis applying Andersen's behavioral model of health care utilization. BMC Health Serv Res 2014; 14:71. [PMID: 24524754 PMCID: PMC3927831 DOI: 10.1186/1472-6963-14-71] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 02/12/2014] [Indexed: 11/24/2022] Open
Abstract
Background To analyze the association of health care costs with predisposing, enabling, and need factors, as defined by Andersen’s behavioral model of health care utilization, in the German elderly population. Methods Using a cross-sectional design, cost data of 3,124 participants aged 57–84 years in the 8-year-follow-up of the ESTHER cohort study were analyzed. Health care utilization in a 3-month period was assessed retrospectively through an interview conducted by trained study physicians at respondents’ homes. Unit costs were applied to calculate health care costs from the societal perspective. Socio-demographic and health-related variables were categorized as predisposing, enabling, or need factors as defined by the Andersen model. Multimorbidity was measured by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Mental health status was measured by the SF-12 mental component summary (MCS) score. Sector-specific costs were analyzed by means of multiple Tobit regression models. Results Mean total costs per respondent were 889 € for the 3-month period. The CIRS-G score and the SF-12 MCS score representing the need factor in the Andersen model were consistently associated with total, inpatient, outpatient and nursing costs. Among the predisposing factors, age was positively associated with outpatient costs, nursing costs, and total costs, and the BMI was associated with outpatient costs. Conclusions Multimorbidity and mental health status, both reflecting the need factor in the Andersen model, were the dominant predictors of health care costs. Predisposing and enabling factors had comparatively little impact on health care costs, possibly due to the characteristics of the German social health insurance system. Overall, the variables used in the Andersen model explained only little of the total variance in health care costs.
Collapse
Affiliation(s)
- Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr 52, Hamburg, 20246, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Bock JO, Matschinger H, Brenner H, Wild B, Haefeli WE, Quinzler R, Saum KU, Heider D, König HH. Inequalities in out-of-pocket payments for health care services among elderly Germans--results of a population-based cross-sectional study. Int J Equity Health 2014; 13:3. [PMID: 24397544 PMCID: PMC3893415 DOI: 10.1186/1475-9276-13-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 12/23/2013] [Indexed: 11/25/2022] Open
Abstract
Introduction In order to limit rising publicly-financed health expenditure, out-of-pocket payments for health care services (OOPP) have been raised in many industrialized countries. However, higher health-related OOPP may burden social subgroups unequally. In Germany, inequalities in OOPP have rarely been analyzed. The aim of this study was to examine OOPP of the German elderly population in the different sectors of the health care system. Socio-economic and morbidity-related determinants of inequalities in OOPP were analyzed. Methods This cross-sectional analysis used data of N = 3,124 subjects aged 57 to 84 years from a population-based prospective cohort study (ESTHER study) collected in the Saarland, Germany, from 2008 to 2010. Subjects passed a geriatric assessment, including a questionnaire for health care utilization and OOPP covering a period of three months in the following sectors: inpatient care, outpatient physician and non-physician services, medical supplies, pharmaceuticals, dental prostheses and nursing care. Determinants of OOPP were analyzed by a two-part model. The financial burden of OOPP for certain social subgroups (measured by the OOPP-income-ratio) was investigated by a generalized linear model for the binomial family. Results Mean OOPP during three months amounted to €119, with 34% for medical supplies, 22% for dental prostheses, 21% for pharmaceuticals, 17% for outpatient physician and non-physician services, 5% for inpatient care and 1% for nursing care. The two-part model showed a significant positive association between income (square root equivalence scale) and total OOPP. Increasing morbidity was associated with significantly higher total OOPP, and in particular with higher OOPP for pharmaceuticals. Total OOPP amounted to about 3% of disposable income. The generalized linear model for the binomial family showed a significantly lower financial burden for the wealthiest quintile as compared to the poorest one. Conclusions This is the first study providing evidence of inequalities in OOPP in the German elderly population. Socio-economic and morbidity-related inequalities in OOPP and the resulting financial burden could be identified. The results of this study may contribute to the discussion about the mechanisms causing the observed inequalities and can thus help decision makers to consider them when adapting future regulations on OOPP.
Collapse
Affiliation(s)
- Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Schomerus G, Matschinger H, Angermeyer MC. Attitudes towards alcohol dependence and affected individuals: persistence of negative stereotypes and illness beliefs between 1990 and 2011. Eur Addict Res 2014; 20:293-9. [PMID: 25300651 DOI: 10.1159/000362407] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/22/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Alcohol dependence is among the most severely stigmatized mental disorders. We examine whether negative stereotypes and illness beliefs related to alcohol dependence have changed between 1990 and 2011. METHODS We used data from two population surveys with identical methodology that were conducted among German citizens aged ≥18 years, living in the 'old' German states. They were conducted in 1990 and 2011, respectively. In random subsamples (1990: n = 1,022, and 2011: n = 1,167), identical questions elicited agreement with statements regarding alcohol dependence, particularly with regard to the illness definition of alcohol dependence and blame. RESULTS Overall, agreement with negative stereotypes did not change in the course of 2 decades. About 55% of the respondents agreed that alcohol dependence is an illness like any other, >40% stated that it was a weakness of character and 30% endorsed that those affected are themselves to blame for their problems. CONCLUSIONS It is apparent that promoting an illness concept of alcohol dependence has not been an easy solution to the problem of stigma. We discuss how the normative functions of alcohol dependence stigma might have prevented a reduction of negative stereotypes.
Collapse
Affiliation(s)
- Georg Schomerus
- Department of Psychiatry, University of Greifswald, Greifswald, Germany
| | | | | |
Collapse
|
50
|
Schomerus G, Matschinger H, Angermeyer MC. Causal beliefs of the public and social acceptance of persons with mental illness: a comparative analysis of schizophrenia, depression and alcohol dependence. Psychol Med 2014; 44:303-314. [PMID: 23574735 DOI: 10.1017/s003329171300072x] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is an ongoing debate whether biological illness explanations improve tolerance towards persons with mental illness or not. Several theoretical models have been proposed to predict the relationship between causal beliefs and social acceptance. This study uses path models to compare different theoretical predictions regarding attitudes towards persons with schizophrenia, depression and alcohol dependence. METHOD In a representative population survey in Germany (n = 3642), we elicited agreement with belief in biogenetic causes, current stress and childhood adversities as causes of either disorder as described in an unlabelled case vignette. We further elicited potentially mediating attitudes related to different theories about the consequences of biogenetic causal beliefs (attribution theory: onset responsibility, offset responsibility; genetic essentialism: differentness, dangerousness; genetic optimism: treatability) and social acceptance. For each vignette condition, we calculated a multiple mediator path model containing all variables. RESULTS Biogenetic beliefs were associated with lower social acceptance in schizophrenia and depression, and with higher acceptance in alcohol dependence. In schizophrenia and depression, perceived differentness and dangerousness mediated the largest indirect effects, the consequences of biogenetic causal explanations thus being in accordance with the predictions of genetic essentialism. Psychosocial causal beliefs had differential effects: belief in current stress as a cause was associated with higher acceptance in schizophrenia, while belief in childhood adversities resulted in lower acceptance of a person with depression. CONCLUSIONS Biological causal explanations seem beneficial in alcohol dependence, but harmful in schizophrenia and depression. The negative correlates of believing in childhood adversities as a cause of depression merit further exploration.
Collapse
Affiliation(s)
- G Schomerus
- Department of Psychiatry, Greifswald University, Germany
| | - H Matschinger
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany
| | - M C Angermeyer
- Department of Public Health, University of Cagliari, Italy
| |
Collapse
|