Projecting the 10-year costs of care and mortality burden of depression until 2032: a Markov modelling study developed from real-world data

Background Based on real-world data, we developed a 10-year prediction model to estimate the burden among patients with depression from the public healthcare system payer's perspective to inform early resource planning in Hong Kong. Methods We developed a Markov cohort model with yearly cycles specifically capturing the pathway of treatment-resistant depression (TRD) and comorbidity development along the disease course. Projected from 2023 to 2032, primary outcomes included costs of all-cause and psychiatric care, and secondary outcomes were all-cause deaths, years of life lived, and quality-adjusted life-years. Using the territory-wide electronic medical records, we identified 25,190 patients aged ≥10 years with newly diagnosed depression from 2014 to 2016 with follow-up until 2020 to observe the real-world time-to-event pattern, based on which costs and time-varying transition inputs were derived using negative binomial modelling and parametric survival analysis. We applied the model as both closed cohort, which studied a fixed cohort of incident patients in 2023, and open cohort, which introduced incident patients by year from 2014 to 2032. Utilities and annual new patients were from published sources. Findings With 9217 new patients in 2023, our closed cohort model projected the 10-year cumulative costs of all-cause and psychiatric care to reach US$309.0 million and US$58.3 million, respectively, with 899 deaths (case fatality rate: 9.8%) by 2032. In our open cohort model, 55,849–57,896 active prevalent cases would cost more than US$322.3 million and US$60.7 million, respectively, with more than 943 deaths annually from 2023 to 2032. Fewer than 20% of cases would live with TRD or comorbidities but contribute 31–54% of the costs. The greatest collective burden would occur in women aged above 40, but men aged above 65 and below 25 with medical history would have the highest costs per patient-year. The key cost drivers were relevant to the early disease stages. Interpretation A limited proportion of patients would develop TRD and comorbidities but contribute to a high proportion of costs, which necessitates appropriate attention and resource allocation. Our projection also demonstrates the application of real-world data to model long-term costs and mortality, which aid policymakers anticipate foreseeable burden and undertake budget planning to prepare for the care need in alternative scenarios

Towards a global partnership model in interprofessional education for cross-sector problem-solving

Objectives A partnership model in interprofessional education (IPE) is important in promoting a sense of global citizenship while preparing students for cross-sector problem-solving. However, the literature remains scant in providing useful guidance for the development of an IPE programme co-implemented by external partners. In this pioneering study, we describe the processes of forging global partnerships in co-implementing IPE and evaluate the programme in light of the preliminary data available. Methods This study is generally quantitative. We collected data from a total of 747 health and social care students from four higher education institutions. We utilized a descriptive narrative format and a quantitative design to present our experiences of running IPE with external partners and performed independent t-tests and analysis of variance to examine pretest and posttest mean differences in students’ data. Results We identified factors in establishing a cross-institutional IPE programme. These factors include complementarity of expertise, mutual benefits, internet connectivity, interactivity of design, and time difference. We found significant pretest–posttest differences in students’ readiness for interprofessional learning (teamwork and collaboration, positive professional identity, roles, and responsibilities). We also found a significant decrease in students’ social interaction anxiety after the IPE simulation. Conclusions The narrative of our experiences described in this manuscript could be considered by higher education institutions seeking to forge meaningful external partnerships in their effort to establish interprofessional global health education

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

A study of ideas and delusions of reference in schizophrenia: phenomenological, cognitive, andphysiological explorations

published_or_final_versionPsychiatryDoctoralDoctor of Philosoph

Relationship between diminished expression and cognitive impairment in first-episode schizophrenia: A prospective three-year follow-up study

Background: Diminished expression (DE) is a core sub-domain of negative symptoms construct in schizophrenia. There is limited, yet inconsistent data regarding DE and its associations with cognition, particularly in the early illness course. This study aimed to examine cross-sectional and longitudinal relationships of DE with cognitive functions in first-episode schizophrenia utilizing a prospective design. Method: Ninety-three Hong Kong Chinese aged 18 to 55. years presenting with first-episode schizophrenia-spectrum disorder were studied. Severity of DE was measured as sum of individual item scores indicative of affect flattening and alogia. Symptom evaluation was conducted at intake, after clinical stabilization of first psychotic episode, at 12, 24 and 36. months. Cognitive functions were evaluated at clinical stabilization, 12, 24 and 36. months. Results: DE was significantly correlated with various cognitive functions in successive follow-up assessments. Regression analyses adjusting confounding effects of sex, pre-morbid adjustment, duration of untreated psychosis and chlorpromazine equivalents showed that DE was associated with performance on verbal fluency at 12 (p. <. 0.01) and 24. months (p. <. 0.05), visual reproduction at 24 (p. <. 0.05) and 36. months (p. <. 0.01), logical memory at 36. months (p. <. 0.05) and Modified Wisconsin Card Sorting test at 24 (p. <. 0.05) and 36. months (p. <. 0.05). Neither cross-lagged associations between DE and cognition nor significant correlations between changes in these two domains over three years were observed. Conclusions: DE and cognitive functions were correlated concurrently but no longitudinal associations between these two domains could be demonstrated. Our findings indicated that DE and cognitive impairment represented relatively independent domains of the illness with potentially distinctive therapeutic implications. © 2013 Elsevier B.V.link_to_subscribed_fulltex

Depression risk among community-dwelling older people is associated with perceived COVID-19 infection risk: effects of news report latency and focusing on number of infected cases

Objectives: Awareness of COVID-19 infection risk and oscillation patterns (‘waves’) may affect older people’s mental health. Empirical data from populations experiencing multiple waves of community outbreaks can inform guidance for maintaining mental health. This study aims to investigate the effects of COVID-19 infection risk and oscillations on depression among community-dwelling older people in Hong Kong. Methods: A rolling cross-sectional telephone survey method was used. Screening for depression risk was conducted among 8,163 older people (age ≥ 60) using the Patient Health Questionnaire-2 (PHQ-2) from February to August 2020. The relationships between PHQ-2, COVID-19 infection risk proxies–change in newly infected cases and effective reproductive number (Rt), and oscillations–stage of a ‘wave’ reported in the media, were analysed using correlation and regression. Results: 8.4% of survey respondents screened positive for depression risk. Being female (β =.08), having a pre-existing mental health issue (β =.21), change in newly infected cases (β =.05), and screening during the latency period before the media called out new waves (β =.03), contributed to higher depression risk (R 2 =.06, all p <.01). Conclusion: While depression risk does not appear alarming in this sample, our results highlight that older people are sensitive to reporting of infection, particularly among those with existing mental health needs. Future public health communication should balance awareness of infection risks with mental health protection

Correlates of insight with symptomatology and executive function in patients with first-episode schizophrenia-spectrum disorder: A longitudinal perspective

The present study aimed to examine the relationships of insight with symptomatology and executive function, both cross-sectionally and longitudinally in patients with first-episode schizophrenia-spectrum disorders. Ninety-two medication-naïve patients were recruited and 71 completed the assessments. Insight, symptoms and executive function were assessed at baseline, 6 months and 1 year. Insight was measured with the abridged version of Scale of Unawareness of Mental Disorder (SUMD). Symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Executive function was measured with the Modified Wisconsin Card Sorting Test (MCST). The most significant improvement of insight and symptomatology was found over the first 6 months, whereas the perseverative errors of MCST were significantly improved between 6 and 12 months. Differential correlations of perseverative errors of the MCST and PANSS scores with SUMD were found at different time points. This suggests the involvement of different mechanisms in insight deficit at different stages of the illness. The baseline MCST perseverative errors were correlated significantly with the SUMD total score at 6 months and the change of SUMD scores over the first 6 months. Although the variance explained was small, it suggests better set-shifting capacity facilitates the improvement of insight at an early stage of the illness. © 2013 Elsevier Ireland Ltd.link_to_subscribed_fulltex

Prospective relationship between duration of untreated psychosis and 13-year clinical outcome: A first-episode psychosis study

Background: The adverse effects of a long duration of untreated psychosis (DUP) have been explored in numerous short-term studies. These studies support the development of early interventions that reduce treatment delay and promote recovery. However, the enduring impact of DUP is largely unknown, partly due to the paucity of prospective long-term studies. Although the DUP-outcome relationship is commonly assumed to be linear, the threshold effect has not been adequately examined. Objective: To explore the relationship between DUP and long-term symptomatic remission. Methods: This was a prospective study of a cohort of 153 first-episode psychosis patients in Hong Kong at the 13-year follow-up. The patients were categorized into short (≤. 30. days), medium (31-180. days) and long (>. 180. days) DUP groups. Results: The long-term outcome was ascertained in 73% of the patients. Nearly half of the patients (47%) fulfilled the criteria for symptomatic remission. The short DUP group experienced a significantly higher remission rate over the course of the illness. The odds of long-term symptomatic remission was significantly reduced in the medium DUP (by 89%) and long DUP (by 85%) groups compared with the short DUP group. Further analysis showed that DUP had a specific impact on negative symptom remission. Conclusion: The findings support the threshold theory that DUP longer than 30. days adversely impacts the long-term outcome. The present study is one of the few studies that confirmed the enduring impact of DUP on long-term outcomes based on well-defined criteria and adequate statistical adjustment. © 2014 Elsevier B.V.link_to_subscribed_fulltex