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

Social network typologies and mortality risk among older people in China, India, and Latin America: A 10/66 Dementia Research Group population-based cohort study

BACKGROUND: Restricted social networks have been associated with higher mortality in several developed countries but there are no studies on this topic from developing countries. This gap exists despite potentially greater dependence on social networks for support and survival due to various barriers to health care and social protection schemes in this setting. Thus, this study aims to examine how social network type at baseline predicts all-cause mortality among older adults in six Latin American countries, China, and India. METHODS: Population-based surveys were conducted of all individuals aged 65+ years in eight countries (Cuba, Dominican Republic, Peru, Venezuela, Mexico, Puerto Rico, China, and India). Data on mortality were obtained at follow-up (mean 3.8 years after cohort inception). Follow-up data for 13,891 individuals were analysed. Social network types were assessed using Wenger's Practitioner Assessment of Network Type (PANT). Cox proportional hazard models were constructed to estimate the impact of social network type on mortality risk in each country, adjusting for socio-demographics, receipt of pension, disability, medical conditions, and depression. Meta-analysis was performed to obtain pooled estimates. RESULTS: The prevalence of private network type was 64.4% in urban China and 1.6% in rural China, while the prevalence of locally integrated type was 6.6% in urban China and 86.8% in rural China. The adjusted pooled estimates across (a) all countries and (b) Latin America showed that, compared to the locally integrated social network type, the locally self-contained [(b) HR = 1.24, 95%CI 1.01-1.51], family dependent [(a) HR = 1.13, 95%CI 1.01-1.26; (b) HR = 1.13, 95%CI 1.001-1.28], and private [(a) HR = 1.36, 95%CI 1.06-1.73; (b) HR = 1.45, 95%CI 1.20-1.75] social network types were significantly associated with higher mortality risk. CONCLUSION: Survival time is significantly reduced in individuals embedded in restricted social networks (i.e. locally self-contained, family dependent, and private network types). Social care interventions may be enhanced by addressing the needs of those most at risk of neglect and deteriorating health. Health policy makers in developing countries may use this information to plan efficient use of limited resources by targeting those embedded in restricted social networks. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved. KEYWORDS: Ageing; Developing countries; Interpersonal relations; Mortality; Social networks; Social support; Survival rat

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

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

The impact of social networks and social support on mental disorders and mortality

[eng] INTRODUCTION: There is conflicting evidence regarding the role of social support networks in health and wellbeing and more research is needed to address the lack of information. The objective of this project is to categorize key indicators of social support and social networks, and further to determine the impact of such indicators on mental disorder and mortality. METHODS: This project will include three research articles: paper I is a review of the literature which involves an investigation into the evidence on associations between social support networks and depression in the general population (systematic literature review). Paper II is an original research paper that involves an examination of how social network integration predicts all-cause mortality among older adults in six Latin-American countries, India, and China (prospective analysis). Finally, paper III is an original research paper involving an investigation into relationship quality (positive and negative aspects of social support) and social networks with depression, anxiety and suicidal ideation in a nationally representative sample of older Irish adults in intimate relationships (cross-sectional analysis). RESULTS: I) A number of key indicators of social support and social networks were identified to be associated with depression. Generally, studies have found protective effects of perceived social support and large, diverse social networks against depression in the general population. II) For older adults in developing countries, survival time is significantly reduced in individuals embedded in restricted social networks. III) For older Irish adults in intimate relationships, we found that worse relationship quality with the spouse is positively associated with depression, anxiety, and suicidal ideation, and that restricted social network integration is positively associated with depression. CONCLUSION: A number of recommendations have been made for future research in order to make a more comprehensive assessment of the role of social support networks in relation to mental health outcomes. Further, being embedded in good social support networks is negatively associated with mortality and also a number of outcomes on mental disorder among older adults in the general population. Social care and public mental health interventions may be enhanced by tailoring interventions to improve the quantity and quality of social support networks in order to promote population mental health and health status. Implications for health research, policy and future directions[spa] INTRODUCCIÓN: Hay pruebas contradictorias sobre el rol de las relaciones sociales en la salud y el bienestar y es necesaria más investigación para hacer frente a la falta de información. El objetivo de este proyecto es categorizar los indicadores clave identificados en relación con la salud y el bienestar, y determinar el impacto de este tipo de indicadores en la salud mental y mortalidad. MÉTODOS: Este proyecto incluirá tres artículos de investigación: El artículo I es una revisión de la literatura que investiga la evidencia sobre asociaciones entre las relaciones sociales y la depresión en la población general. El artículo II es un trabajo de investigación original con el objetivo de examinar cómo el tipo de red social identificada al inicio del estudio predice la mortalidad entre los adultos mayores en los países en desarrollo. El artículo III es un trabajo de investigación original que consiste en la investigación de las asociaciones de las interacciones sociales positivas y negativas y las redes sociales con la depresión, la ansiedad y la ideación suicida entre los adultos mayores irlandeses con una relación sentimental. RESULTADOS: I) Se identificaron asociaciones entre la depresión y un número de indicadores claves de apoyo social y redes sociales. En general, los estudios encontraron que el apoyo social percibido y tener redes sociales grandes y diversas tenían efectos protectores sobre la depresión en la población general. II) Para adultos mayores procedentes de países en vías desarrollo, el tiempo de supervivencia se reduce significativamente en individuos con redes sociales limitadas. III) En una muestra irlandesa de adultos mayores con una relación sentimental, encontramos que una peor calidad de la relación con la pareja se relacionaba positivamente con depresión, ansiedad e ideación suicida, y que redes sociales limitadas se asociaban positivamente con depresión. CONCLUSIÓN: Se hacen una serie de recomendaciones para hacer una evaluación más completa sobre el papel de las redes sociales de apoyo en relación con la salud mental en el futuro. Además, estar incluido en relaciones sociales de apoyo de calidad se asocia negativamente con mortalidad y con trastornos mentales entre los adultos mayores en la población general. La asistencia social y las intervenciones de salud mental pública podrían ser mejoradas mediante la adaptación de las intervenciones para aumentar la cantidad y calidad de las redes de apoyo social con el fin de promover la salud mental y el estado de salud general de la población. Se discuten las implicaciones para la investigación en salud, las políticas sanitarias y sociales, y direcciones futuras

The WELLBY: a new measure of social value and progress

We introduce the WELLBY, a new measure of social value and progress, which can contribute to the assessment of progress towards the wellbeing economy and steer towards activities with the most wellbeing per financial resources invested. After providing a short rationale for the WELLBY, we give a definition and an overview of its properties. We then show how WELLBYs can help decision-makers with ex-ante policy appraisals, and deliver a practical example on a youth traineeship programme. We also discuss how coefficients from ex-post wellbeing policy evaluations are now being collected as part of social value banks around the world, feeding into future appraisals. Finally, we illustrate how WELLBYs can be used to measure social progress overall, going beyond GDP