Mental health economics: a prospective study on psychological flourishing and associations with healthcare costs and sickness benefit transfers in Denmark

Background: Escalating healthcare expenditures highlight the need to identify modifiable predictors of the use and costs of healthcare and sickness benefit transfers. We conducted a prospective analysis on Danish data to determine the costs associated with flourishing as compared to the below threshold level of flourishing. Methods: We used data from a 2016 Danish survey of 3508 adults, which was linked to Danish register data. Flourishing was assessed with a validated psychological well-being scale. A two-part regression model was used to predict 2017 costs while adjusting for 2016 costs, demographic variables, and health status, including psychiatric morbidity and health behaviours. Costs are expressed in USD PPP. Results: Applying criteria from prior literature, the prevalence of flourishing in Denmark (measured in 2016) was 34.7%. Flourishing was associated with significantly lower healthcare costs ($-687.7, 95$-1295.0, $-80.4) and sickness benefit transfers ($-297.8, 95% CI = $-551.5,$-44.0) per person in 2017, as compared to the below threshold level of flourishing. Extrapolated to the Danish population (4.1 M people aged 16+ years), flourishing was associated with lower healthcare costs and sickness benefit transfers amounting to $-1.2bn (95$-2.3 bn, $-149.0 M). Conclusions: Flourishing is associated with considerably lower health-related government expenditure. Substantial reductions could potentially be achieved by increasing the number of people who are flourishing in the population

Economics of mental wellbeing: a prospective study estimating associated productivity costs due to sickness absence from the workplace in Denmark

Background Few studies have assessed associations between mental wellbeing (MWB) and productivity loss using nationally-representative longitudinal data. The objective of the study was to determine how different levels of MWB are associated with future productivity loss due to sickness absence. Methods Data stem from a Danish nationally representative panel study of 1,959 employed adults (aged 16-64 years old) conducted in 2019 and 2020, which was linked to Danish register data. The validated Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) was used to assess MWB in 2019. The outcome was days absent from work due to sickness in 2020. Linear regression models were used to predict sickness absence in 2020 while adjusting for sickness absence in 2019, sociodemographics and health status, including psychiatric morbidity. Productivity costs were estimated using the human capital approach (HCA) and friction cost approach (FCA). Results Each point increase in MWB was significantly associated with fewer sick days and, by extension, lower productivity loss (reported in the order HCA/FCA). As compared to low MWB, moderate MWB was associated with $-1,614/$-1,271 per person, while high MWB was associated with $-2,351/$-1,779 per person. Extrapolated to the Danish population (2.7M employed adults aged 16-64), moderate MWB (67.3% of the population) was associated with lower productivity costs amounting to $-2.9bn/$-2.3bn, while high MWB (20.4% of the population) was associated with lower costs amounting to $-1.3bn/$-0.9bn. Conclusions Higher levels of MWB are associated with considerably less productivity loss. Substantial reductions in productivity loss could potentially be achieved by promoting higher levels of MWB in the population workforce

Social disconnectedness, loneliness, and mental health among adolescents in Danish high schools : a nationwide cross-sectional study

Background: Previous research has suggested that social disconnectedness experienced at school is linked to mental health problems, however, more research is needed to investigate (1) whether the accumulation of various types of social disconnectedness is associated with risk for mental health problems, and (2) whether loneliness is a mechanism that explains these associations. Methods: Using data from the Danish National Youth Study 2019 (UNG19), nation-wide cross-sectional data from 29,086 high school students in Denmark were analyzed to assess associations between social disconnectedness experienced at school (lack of classmate support, lack of teacher support, lack of class social cohesion, and not being part of the school community) and various mental health outcomes, as well as the mediating role of loneliness for each type of disconnectedness. Multilevel regression analyses were conducted to assess the associations. Results: Descriptive analyses suggest that 27.5% of Danish high school students experience at least one type of social disconnectedness at school. Each type of social disconnectedness was positively associated with mental health problems (depression symptoms, anxiety symptoms, stress, sleep problems, suicidal ideation, non-suicidal self-injury, eating disorder, body dissatisfaction, and low self-esteem) and negatively associated with mental well-being. In all cases, loneliness significantly mediated the associations. We found a clear dose-response pattern, where each addition in types of social disconnectedness was associated with (1) stronger negative coefficients with mental well-being and (2) stronger positive coefficients with mental health problems. Conclusion: Our results add to a large evidence-base suggesting that mental health problems among adolescents may be prevented by promoting social connectedness at school. More specifically, fostering social connectedness at school may prevent loneliness, which in turn may promote mental well-being and prevent mental health problems during the developmental stages of adolescence. It is important to note that focusing on single indicators of school social connectedness/disconnectedness would appear to be insufficient. Implications for practices within school settings to enhance social connectedness are discussed

Economics of mental well-being: a prospective study estimating associated health care costs and sickness benefit transfers in Denmark

Background: Previous literature has examined the societal costs of mental illness, but few studies have estimated the costs associated with mental well-being. In this study, a prospective analysis was conducted on Danish data to determine 1) the association between mental well-being (measured in 2016) and government expenditure in 2017, specifially healthcare costs and sickness benefit transfers. Methods: Data stem from a Danish population-based survey of 3,508 adults (aged 16 + years) in 2016, which was linked to Danish registry data. A validated scale (WEMWBS) was used for the assessment of mental well-being. Costs are expressed in USD PPP. A two-part model was applied to predict costs in 2017, adjusting for sociodemographics, health status (including psychiatric morbidity and health behaviour), as well as costs in the previous year (2016). Results: Each point increase in mental well-being (measured in 2016) was associated with lower healthcare costs ($− 42.5, 95$− 78.7, $− 6.3) and lower costs in terms of sickness benefit transfers ($− 23.1, 95% CI = $− 41.9,$− 4.3) per person in 2017. Conclusions: Estimated reductions in costs related to mental well-being add to what is already known about potential savings related to the prevention of mental illness. It does so by illustrating the savings that could be made by moving from lower to higher levels of mental well-being both within and beyond the clinical range. Our estimates pertain to costs associated with those health-related outcomes that were included in the study, but excluding other social and economic outcomes and benefits. They cover immediate cost estimates (costs generated the year following mental well-being measurement) and not those that could follow improved mental well-being over the longer term. They may therefore be considered conservative from a societal perspective. Population approaches to mental health promotion are necessary, not only to potentiate disease prevention strategies, but also to reduce costs related to lower levels of mental well-being in the non-mental illness population. Our results suggest that useful reductions in both health care resource use and costs, as well as in costs due to sick leave from the workplace, could be achieved from investment in mental well-being promotion within a year

Higher levels of mental wellbeing predict lower risk of common mental disorders in the Danish general population

Background: Few studies have investigated the protective role of higher levels of wellbeing in relation to common mental disorders (CMDs). The objective of this study was to explore the protective role of mental wellbeing at baseline on CMDs during a 12–16 months follow-up period in the Danish general population. Methods: Data stem from a Danish nationally-representative panel study of 6629 adults (aged 15+ years) conducted in 2019 and 2020, which was linked to Danish register data. A validated scale (SWEMWBS) was used to assess mental wellbeing, along with pre-defined cut-points for low/moderate/high mental wellbeing. Register-based outcomes were 1) onset of ICD-10 CMDs, and 2) onset or recurrence of antidepressant use. The survey-based outcome was case depression based on a screening tool (PHQ-8 score≥10). Register-based analyses (N = 6624) were conducted with Cox regression, and the survey-based analysis (N = 5000) was conducted with logistic regression. Results: Mental wellbeing was negatively associated with all outcomes, both continuously and dose-dependently. Notably, as compared to low mental wellbeing, moderate mental wellbeing was associated with a 55–68% reduction in risk for all outcomes (onset of ICD-10 CMDs; onset or recurrence of antidepressant use; onset or recurrence of case depression based on the PHQ-8), while high mental wellbeing was associated with a 69–90% reduction in the same outcomes. Conclusions: Higher levels of mental wellbeing are protective against onset or recurrence of CMDs. Future studies are warranted to investigate the effectiveness of universal and targeted approaches to promote mental wellbeing and prevent CMDs