Collins Brendan, Downing Jennifer, Head Anna, Cornerford Terence, Nathan Rajan, Barr Benjamin
Department of Public Health, Policy and Systems, University of Liverpool, UK.
Forensic Psychiatry, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK.
BJPsych Open. 2023 Oct 27;9(6):e201. doi: 10.1192/bjo.2023.596.
There is uncertainty around the costs and health impacts of undiagnosed mental health problems.
Using survey data, we aim to understand the costs and health-related quality-of-life decrements from undiagnosed anxiety/depression.
We analysed survey data from two waves of the North West Coast Household Health Survey, which included questions on disease, medications, and Patient Health Questionnaire 9 (PHQ-9) and Generalised Anxiety Disorder 7 (GAD-7) scores (depression and anxiety scales). People were judged as having undiagnosed anxiety/depression problems if they scored ≥5 on the PHQ-9 or GAD-7, and did not declare a mental health issue or antidepressant prescription. Linear regression for EuroQol 5-Dimension 3-Level (EQ-5D-3L) index scores, and Tweedie regression for health and social care costs, were used to estimate the impact of undiagnosed mental health problems, controlling for age, gender, deprivation and other health conditions.
Around 26.5% of participants had undiagnosed anxiety/depression. The presence of undiagnosed anxiety/depression was associated with reduced EQ-5D-3L index scores (0.040 lower on average) and increased costs (£250 ($310) per year on average). Using a higher cut-off score of 10 on the PHQ-9 and GAD-7 for undiagnosed anxiety/depression had similar increased costs but a greater reduction in EQ-5D-3L index scores (0.076 on average), indicating a larger impact on health-related quality of life.
Having undiagnosed anxiety or depression increases costs and reduces health-related quality of life. Reducing stigma and increasing access to cost-effective treatments will have population health benefits.
未确诊的心理健康问题的成本和对健康的影响存在不确定性。
利用调查数据，我们旨在了解未确诊的焦虑/抑郁所带来的成本以及与健康相关的生活质量下降情况。
我们分析了西北海岸家庭健康调查两波的数据，其中包括关于疾病、药物治疗以及患者健康问卷9（PHQ - 9）和广泛性焦虑障碍7（GAD - 7）评分（抑郁和焦虑量表）的问题。如果人们在PHQ - 9或GAD - 7上的得分≥5，且未申报有心理健康问题或抗抑郁药物处方，则被判定为有未确诊的焦虑/抑郁问题。使用欧洲五维健康量表3级（EQ - 5D - 3L）指数得分的线性回归以及健康和社会护理成本的 Tweedie 回归，来估计未确诊的心理健康问题的影响，并控制年龄、性别、贫困程度和其他健康状况。
约26.5%的参与者有未确诊的焦虑/抑郁。未确诊的焦虑/抑郁与 EQ - 5D - 3L 指数得分降低（平均低0.040）和成本增加（平均每年增加250英镑（310美元））相关。对于未确诊的焦虑/抑郁，在PHQ - 9和GAD - 7上使用更高的临界值10有类似的成本增加，但 EQ - 5D - 3L 指数得分下降幅度更大（平均为0.076），表明对与健康相关的生活质量影响更大。
患有未确诊的焦虑或抑郁会增加成本并降低与健康相关的生活质量。减少污名化并增加获得具有成本效益的治疗的机会将对人群健康有益。
