Randomized controlled trial of computerized cognitive behavioural therapy for depressive symptoms: effectiveness and costs of a workplace intervention

Background Depression and anxiety are major causes of absence from work and underperformance in the workplace. Cognitive behavioural therapy (CBT) can be effective in treating such problems and online versions offer many practical advantages. The aim of the study was to investigate the effectiveness of a computerized CBT intervention (MoodGYM) in a workplace context.Method The study was a phase III two-arm, parallel randomized controlled trial whose main outcome was total score on the Work and Social Adjustment Scale (WSAS). Depression, anxiety, psychological functioning, costs and acceptability of the online process were also measured. Most data were collected online for 637 participants at baseline, 359 at 6 weeks marking the end of the intervention and 251 participants at 12 weeks post-baseline.Results In both experimental and control groups depression scores improved over 6 weeks but attrition was high. There was no evidence for a difference in the average treatment effect of MoodGYM on the WSAS, nor for a difference in any of the secondary outcomes.Conclusions This study found no evidence that MoodGYM was superior to informational websites in terms of psychological outcomes or service use, although improvement to subthreshold levels of depression was seen in nearly half the patients in both groups

Effectiveness and Cost-Effectiveness of Dialectical Behaviour Therapy for Self-Harming Patients with Personality Disorder: A Pragmatic Randomised Controlled Trial

Background: A primary goal of dialectical behaviour therapy (DBT) is to reduce self-harm, but findings from empirical studies are inconclusive. The aim of this study was to assess the effectiveness and cost-effectiveness of DBT in reducing self-harm in patients with personality disorder. Methods: Participants with a personality disorder and at least 5 days of self-harm in the previous year were randomised to receive 12 months of either DBT or treatment as usual (TAU). The primary outcome was the frequency of days with self-harm; secondary outcomes included borderline personality disorder symptoms, general psychiatric symptoms, subjective quality of life, and costs of care. Results: Forty patients each were randomised to DBT and TAU. In an intention-to-treat analysis, there was a statistically significant treatment by time interaction for self-harm (incidence rate ratio 0.91, 95% CI 0.89-0.92, p < 0.001). For every 2 months spent in DBT, the risk of self-harm decreased by 9% relative to TAU. There was no evidence of differences on any secondary outcomes. The economic analysis revealed a total cost of a mean of 5,685 GBP (6,786 EUR) in DBT compared to a mean of 3,754 GBP (4,481 EUR) in TAU, but the difference was not significant (95% CI -603 to 4,599 GBP). Forty-eight per cent of patients completed DBT. They had a greater reduction in self-harm compared to dropouts (incidence rate ratio 0.78, 95% CI 0.76-0.80, p < 0.001). Conclusions: DBT can be effective in reducing self-harm in patients with personality disorder, possibly incurring higher total treatment costs. The effect is stronger in those who complete treatment. Future research should explore how to improve treatment adherence

Examining the cost effectiveness of interventions to promote the physical health of people with mental health problems: a systematic review

Recently attention has begun to focus not only on assessing the effectiveness of interventions to tackle mental health problems, but also on measures to prevent physical co-morbidity. Individuals with mental health problems are at significantly increased risk of chronic physical health problems, such as cardiovascular disease or diabetes, as well as reduced life expectancy. The excess costs of co-morbid physical and mental health problems are substantial. Potentially, measures to reduce the risk of co-morbid physical health problems may represent excellent value for money

Financing mental health in low and middle-income countries: making an economic case to support investment

The main objective of this work is to provide a book with high quality content that becomes a reference and support for graduate course (Mental Health, Public Health and Epidemiology) and for research in the domain of health economics applied to mental health. Also this book might be useful for policymakers on formulating mental health policies. Key messages of this book are based on: a) mental illness represent a huge cost for society and for health care; b) health economics applied to mental health could help in the optimization of resource allocation for mental health care and for better decision making in terms of balancing costs and benefits; c) interventions and treatment should be also chosen in general medical practice and in public decision-policy according to cost-effectiveness, burden of disease and equity principles; d) quality of care is related with better outcomes, higher quality of life for clients, and with lower costs for society and health system (best value for money); e) it is possible to decrease the burden of mental disorders with cost-effective treatments. The book is divided in four main topics: 1. Introduction to Health Economics applied to Mental Health – this section is an overview of basic principles, concepts and methods used in Economics and Health Economics to enable students to make critical appraisal of Health Economics texts and also to design research studies in this topic. 2. Health Economics applied to the evaluation of quality and costs of Mental Health Services – this section presents results of Brazilian studies on the costs of mental health care (hospital, outpatient care, residential care, informal care), methods on the measurement of costs and it discusses issues related with public policies decisions and quality of mental health car in the low and middle income countries context. There is also an overview of quality indicators of mental health care and instruments to evaluate mental health services and costs.3. Health Economics applied to evaluate treatment of mental disorders - This section presents a review of cost-effectiveness of pharmacological treatments and other interventions applied for treating the most burdensome mental disorders such as depressive and anxiety disorders, bipolar disorders, psychosis, alcohol and drug disorders, dementia, and hyper attention deficit disorders. 4. Health Economics, burden and indirect costs of mental disorders - This section highlights the social and economic burden caused by mental illness under societal perspective focusing on stigma, unemployment, indirect costs in the workplace (absenteeism and presenteeism), the relationship between poverty and mental disorders, global health and social determinants of mental health and on the costs of mental disorders (depression, anxiety, psychosis, alcohol and drug disorders). We present some instruments to measure indirect costs of mental disorders