Prevention praised, cure preferred: Results of between-subjects experimental studies comparing (monetary) appreciation for preventive and curative interventions

Background: 'An ounce of prevention is worth a pound of cure' is a common saying, and indeed, most health economic studies conclude that people are more willing to pay for preventive measures than for treatment activities. This may be because most health economic studies ask respondents to compare preventive measures with treatment, and thus prompt respondents to consider other uses of resources. However, psychological theorizing suggests that, when methods do not challenge subjects to consider other uses of resources, curative treatment is favored over prevention. Could it be that while prevention is praised, cure is preferred?. Methods. In two experimental studies, we investigated, from a psychological perspective and using a between-subjects design, whether prevention or treatment is preferred and why. In both studies, participants first read a lung cancer prevention or treatment intervention scenario that varied on the prevention-treatment dimension, but that were the same on factors like 'costs per saved life' and kind of disease. Then participants completed a survey measuring appreciation (general and monetary) as well as a number of potential mediating variables. Results: Both studies clearly demonstrated that, when the design was between-subjects, participants had greater (general and monetary) appreciation for treatment interventions than for preventive interventions with perceived urgency of the intervention quite consistently mediating this effect. Differences in appreciation of treatmen

Testing the Effects of Automated Navigation in a General Population Web Survey

This study investigates how an auto-forward design, where respondents navigate through a web survey automatically, affects response times and navigation behavior in a long mixed-device web survey. We embedded an experiment in a health survey administered to the general population in The Netherlands to test the auto-forward design against a manual-forward design. Analyses are based on detailed paradata that keep track of the respondents’ behavior in navigating the survey. We find that an auto-forward design decreases comple­tion times and that questions on pages with automated navigation are answered significant­ly faster compared to questions on pages with manual navigation. However, we also find that respondents use the navigation buttons more in the auto-forward condition compared to the manual-forward condition, largely canceling out the reduction in survey duration. Furthermore, we also find that the answer options 'I don't know' and 'I rather not say' are used just as often in the auto-forward condition as in the manual-forward condition, indi­cating no differences in satisficing behavior. We conclude that auto-forwarding can be used to reduce completing times, but we also advice to carefully consider mixing manual and auto-forwarding within a survey

Demand for Mental Health Care and Changes in Service Use Patterns in the Netherlands, 1979 to 1995

Objective: Mental health services appear increasingly incapable of satisfying the demand for care, which may cause some segments of the population to be less effectively reached. This study investigated the rates of use of mental health services in the Netherlands from 1979 to 1995 and examined whether particular sociodemo-graphic groups made greater or lesser relative use of these services over time. Methods: Data were derived from the Facilities Use Surveys, a series of Dutch crosssectional population studies that have recorded household characteristics and service use since 1979. More than 28,000 households were included in the analyses. Results: The overall use of mental health services virtually doubled from 1979 to 1995; a particularly steep rise was seen in the first half of the 1980s. Households that had one parent, that had low income, that were dependent on benefits, and that were younger all had greater odds of using both specialized mental health care (for example, prevention programs for mental health problems and psychotherapeutic and social psychiatric treatment offered by psychologists, psychotherapists, or psychiatrists) and social work services (for example, psychosocial counselling and practical support offered by social workers to people with social problems, such as housing, finances, and psychosocial issues). Households with low education were less likely to use specialized mental health care but were more likely to use social work services. Nonreligious households and urban households were more likely to use specialized mental health care and were equally likely to use social work services. Overall, these relative use patterns did not change over time. Conclusions: Despite greater pressures on mental health services and the many changes in service delivery in recent decades, relative patterns of help seeking and referral to mental health services have not varied systematically over time. (Psychiatric Services 56:1409–1415, 2005)

Depressive symptoms in the general population a multifactorial social approach

This research aimed to provide a more systematic theoretical and empirical analysis of the relationships between social factors and depressive symptoms in the general population. A multifactorial social approach has been applied to study depressive symptoms in the general population more profoundly using several perspectives: a longitudinal perspective, a static and dynamic perspective, a contextual perspective and an explanatory perspective. Theoretical progress has been attained in this study by using a theoretical framework in which these perspectives have been incorporated and from which hypotheses have been derived on differences in people’s levels of resources that account for suffering from depressive symptoms. Testing several indicators of resources simultaneously in a large-scale research design had lead to empirical progress. The multivariate analyses were done using survey data of the national and the regional general population. With respect to a longitudinal perspective, we made the longitudinal development of depressive symptoms in society empirically feasible using data from the national population of the Netherlands. We made progress in epidemiological and sociological research since the assumption of an expected tendency for depressive symptoms to increase had, up till now, not been able to be supported. Moreover, as far as we know, this is the first study that examined the impact of over-time changes on depressive symptoms in the effects of specific positions, as well as testing period and cohort effects of national conditions of society. The static and dynamic perspective led to new hypotheses about life change events. It seemed very fruitful to look at changes in people’s positions that incorporate decreasing levels of resources and their effects on depressive symptoms. Moreover, it seemed to be even more useful to include a dynamic aspect that distinguishes between a recent and a less recent decrease in levels of resources. The results of this study clearly indicate that the distinction of recent and less recent social and economic changes, as well as inter-generational and intra-generational economic mobility, form an essential approach for understanding the effects of particular dynamic effects on depressive symptoms. The elaboration of a contextual perspective on depressive symptoms, in combination with a dynamic perspective is an enhancement on ‘places matters’ research on depressive symptoms. The theoretical specification of various neighbourhood characteristics and the empirical test using multi-level analyses offered new possibilities for testing a contextual influence on mental disorders in general and depressive symptoms specifically, more extensively. Moreover, the dynamic aspect of neighbourhoods appeared to be relevant, as we demonstrated that socio-economic improvements of neighbourhoods decrease depressive symptoms. The reducing or preventing effects on depressive symptoms as a result of redevelopments of neighbourhoods support the efforts of local policies to stimulate programs on neighbourhood improvement. From a public health perspective, these investments seem to be worthwhile, given the expected effectiveness of prevention and intervention programmes of health care policies in the local community. Finally, examining an explanatory perspective on depressive symptoms produced hypotheses on the extent to which specific subjective perceptions of distress explain the effects of resources on depressive symptoms. This application of including particular subjective perceptions of distress in addition to indicators of people’s levels of resources simultaneously, provided strong evidence that these subjective perceptions can to some extent explain suffering from depressive symptoms among specific subgroups. Subsequently, in this study, we were able to specify the conditions under which the mechanisms of subjective perceptions of distress are intensified. This explanatory perspective appears to be a theoretical constructive factor in sociological research on depressive symptoms. Moreover, we assessed empirically the effects of particular perceptions of distress on depressive symptoms, which in many studies remained an implicit theoretical factor. Studying the role of intervening factors of subjective perspectives is an important factor that leads to theoretical and empirical progress in sociological research on depressive symptoms. The results show the importance of a simultaneous test of different social factors that induce depressive symptoms in the general population.

Depressive symptoms in the Netherlands 1975–1996: a theoretical framework and an empirical analysis of socio-demographic characteristics, gender differences and changes over time

This article examines the longitudinal trend of depressive symptoms in the Netherlands, using large-scale national data recorded over the period 1975–1996. Our analyses showed fluctuations in the overall longitudinal trend. On the basis of a general theoretical framework, we formulated hypotheses concerning which socio-demographic characteristics determine the likelihood of suffering from depressive symptoms and how these associations might have changed over time. Our results revealed that people on low incomes, unemployed people, unmarried people and those who had given up their church membership were associated with depressive symptoms. Some associations between socio-demographic categories and depressive symptoms have changed over time. Divorced people have become progressively less likely to suffer from depressive symptoms compared with married people, whereas the reverse holds for those who were never married. People on low incomes have become more likely to suffer from depressive symptoms over time in comparison to people with the highest incomes. Gender differences in these associations were also found: educational level and church attendance were more beneficial to women in protecting them from depressive symptoms than they were to men