Kristy Sanderson

Common mental disorders in the workforce: recent findings from descriptive and social epidemiology.

Objective: To review the recent descriptive and social epidemiology of common mental disorders in the workplace, including prevalence, participation, work disability, and impact of quality of work, as well as to discuss the implications for identifying targets for clinical and preventive interventions. Method: We conducted a structured review of epidemiologic studies in community settings (that is, in the general population or in workplaces). Evidence was restricted to the peer-reviewed, published, English-language literature up to the end of June 2005. We further restricted evidence to studies that used recent classification systems; then, if evidence was insufficient, we reviewed studies that used standardized psychiatric screening scales. To distinguish this article from recent reviews of health and work quality, we focused on new areas of investigation and new evidence for established areas of investigation: underemployment, organizational justice, job control and demand, effort–reward imbalance, and atypical (nonpermanent) employment. Results: Depression and simple phobia were found to be the most prevalent disorders in the working population. The limited data on rates of participation suggested higher participation among people with depression, simple phobia, social phobia, and generalized anxiety disorder. Depression and anxiety were more consistently associated with “presenteeism” (that is, lost productivity while at work) than with absenteeism, whether this was measured by cutback days or by direct questionnaires. Seven longitudinal studies, with an average sample size of 6264, showed a strong association between aspects of low job quality and incident depression and anxiety. There was some evidence that atypical work was associated with poorer mental health, although the findings for fixed-term work were mixed. Conclusions: Mental health risk reduction in the workplace is an important complement to clinical interventions for reducing the current and future burden of depression and anxiety in the workplace.

Why does the burden of disease persist? Relating the burden of anxiety and depression to effectiveness of treatment

Why does the burden of mental disorders persist in established market economies? There are four possibilities: the burden estimates are wrong; there are no effective treatments; people do not receive treatment; or people do not receive effective treatments. Data from the Australian National Survey of Mental Health and Wellbeing about the two commonest mental disorders, generalized anxiety disorder and depression, have been used in examining these issues. The burden of mental disorders in Australia is third in importance after heart disease and cancer, and anxiety and depressive disorders account for more than half of that burden. The efficacy of treatments for both disorders has been established. However, of those surveyed, 40% with current disorders did not seek treatment in the previous year and only 45% were offered a treatment that could have been beneficial. Treatment was not predictive of disorders that remitted during the year. The burden therefore persists for two reasons: too many people do not seek treatment and, when they do, efficacious treatments are not always used effectively.

The SF-12 in the Australian population: cross-validation of item selection

Objective: To cross‐validate the selection of the questionnaire items for the SF‐12 in an Australian sample.

Physical activity and depression in young adults

BACKGROUND Epidemiologic research suggests that physical activity is associated with decreased prevalence of depression. However, the relationship between physical activity accumulated in various domains and depression remains unclear. Further, previous population-based studies have predominantly utilized self-reported measures of physical activity and depression symptom subscales. Associations between physical activity in various domains (leisure, work, active commuting, yard/household) and depression were examined using both subjective and objective measures of physical activity and a diagnostic measure of depression. METHODS Analyses (conducted in 2007) included data from 1995 young adults participating in a national study (2004-2006). Physical activity was measured by self-report (International Physical Activity Questionnaire) and objectively as pedometer steps/day. Depression (DSM-IV 12-month diagnosis of major depression or dysthymic disorder) was assessed using the Composite International Diagnostic Interview. RESULTS For women, moderate levels of ambulatory activity (>or=7500 steps/day) were associated with approximately 50% lower prevalence of depression compared with being sedentary (<5000 steps/day) (p trend=0.005). Relatively low durations of leisure physical activity (>or=1.25 hours/week) were associated with approximately 45% lower prevalence compared with the sedentary group (0 hours/week) (p trend=0.003). In contrast, high durations of work physical activity (>or=10 hours/week) were associated with an approximate twofold higher prevalence of depression compared with being sedentary (0 hours/week) (p trend=0.005). No significant associations were observed for steps/day in men or for other types of self-reported activity including total physical activity in both men and women. CONCLUSIONS These findings indicate that the context in which physical activity is assessed and the measurement methods utilized are important considerations when investigating associations between physical activity and depression.

The Relationship Between Return on Investment and Quality of Study Methodology in Workplace Health Promotion Programs

Objective. To determine the relationship between return on investment (ROI) and quality of study methodology in workplace health promotion programs. Data Source. Data were obtained through a systematic literature search of National Health Service Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Database (HTA), Cost Effectiveness Analysis (CEA) Registry, EconLit, PubMed, Embase, Wiley, and Scopus. Study Inclusion and Exclusion Criteria. Included were articles written in English or German reporting cost(s) and benefit(s) and single or multicomponent health promotion programs on working adults. Return-to-work and workplace injury prevention studies were excluded. Data Extraction. Methodological quality was graded using British Medical Journal Economic Evaluation Working Party checklist. Economic outcomes were presented as ROI. Data Synthesis. ROI was calculated as ROI = (benefits − costs of program)/costs of program. Results were weighted by study size and combined using meta-analysis techniques. Sensitivity analysis was performed using two additional methodological quality checklists. The influences of quality score and important study characteristics on ROI were explored. Results. Fifty-one studies (61 intervention arms) published between 1984 and 2012 included 261,901 participants and 122,242 controls from nine industry types across 12 countries. Methodological quality scores were highly correlated between checklists (r = .84–.93). Methodological quality improved over time. Overall weighted ROI [mean ± standard deviation (confidence interval)] was 1.38 ± 1.97 (1.38–1.39), which indicated a 138% return on investment. When accounting for methodological quality, an inverse relationship to ROI was found. High-quality studies (n= 18) had a smaller mean ROI, 0.26 ± 1.74 (.23–.30), compared to moderate (n= 16) 0.90 ± 1.25 (.90–.91) and low-quality (n= 27) 2.32 ± 2.14 (2.30–2.33) studies. Randomized control trials (RCTs) (n= 12) exhibited negative ROI, −0.22 ± 2.41(–.27 to –.16). Financial returns become increasingly positive across quasi-experimental nonexperimental, and modeled studies: 1.12 ± 2.16 (1.11–1.14), 1.61 ± 0.91 (1.56–1.65), and 2.05 ± 0.88 (2.04–2.06), respectively. Conclusion. Overall, mean weighted ROI in workplace health promotion demonstrated a positive ROI. Higher methodological quality studies provided evidence of smaller financial returns. Methodological quality and study design are important determinants.

Overweight and obesity in childhood and risk of mental disorder: a 20-year cohort study.

Objective: Very little is known about whether overweight and obese children have long-term risk for mental health problems. This study examined the association between overweight and obesity in childhood and DSM-IV mood, anxiety, and substance use disorders in young adulthood. Method: Participants in a national Australian school survey when aged 7–15 years in 1985 were re-interviewed 20 years later as young adults aged 26–36 years (1135 women, 1108 men). Body mass index (BMI) was calculated from measured height and weight in childhood and adulthood. Children were classified as overweight or obese based on a BMI ≥85th centile for age and sex-specific height and weight. Obesity in adulthood was defined as BMI of ≥30. Twelve-month DSM-IV diagnoses of mood, anxiety and substance use disorders were obtained from the Composite International Diagnostic Interview. The relative risk (RR) for each class of mental disorder was estimated for childhood overweight/obesity versus non-overweight, and for four weight trajectories: non-overweight in childhood and non-obese in adulthood; overweight in childhood and non-obese in adulthood; non-overweight in childhood and obese in adulthood; and overweight in childhood and obese in adulthood. Results: Childhood overweight and obesity was associated with an increased risk of mood disorder in adulthood (RR = 1.54, 95%CI 1.06–2.23, p = 0.03), with a similar risk observed among girls and boys. When weight in adulthood was taken into consideration, increased risk of mood disorder was observed only among overweight girls who were obese in adulthood (adjusted RR = 2.03, 95%CI 1.22–3.66, p = 0.006), with childhood overweight or obesity in non-obese adults not associated with any mental disorder. Conclusions: Childhood overweight may increase risk for mood disorder in adulthood, especially among overweight girls who become obese women. These results suggest that prevention of childhood overweight is equally important in both sexes for reducing risk of diagnosed mood disorder in adulthood.

Reducing the burden of affective disorders: is evidence-based health care affordable?

BACKGROUND Affective disorders remain the leading cause of disability burden despite the availability of efficacious treatment. A wider dissemination of evidence-based health care is likely to impact this burden, however the affordability of such a strategy at the population level is unknown. This study calculated the cost-effectiveness of evidence-based health care for depression, dysthymia and bipolar disorder in the Australian population, and determined whether it was affordable, based on current mental health-related expenditure and outcomes for these disorders. METHODS Cost-effectiveness was expressed in costs per years lived with disability (YLDs) averted, a population health summary measure of disability burden. Data from the Australian National Survey of Mental Health and Wellbeing, in conjunction with published randomized trials and direct cost estimates, were used to estimate the 1-year costs and YLDs averted by current health care services, and costs and outcomes for an optimal strategy of evidence-based health care. RESULTS Current direct mental health-related health care costs for affective disorders in Australia were 615 million dollars (1997-98 Australian dollars). This treatment averted just under 30,000 YLDs giving a cost-effectiveness ratio of 20,633 dollars per YLD. Outcome could be increased by nearly 50% at similar cost with implementation of an evidence-based package of optimal treatment, halving the cost-effectiveness ratio to 10,737 dollars per YLD. LIMITATIONS The method to estimate YLDs averted from the literature requires replication. The costs of implementing evidence-based health care have not been estimated. CONCLUSIONS Evidence-based health care for affective disorders should be encouraged on both efficacy and efficiency grounds.

Intensive case management in Australia: a randomized controlled trial

This study compared intensive case management (ICM) with standard clinical case management in a well‐resourced community mental health service in Australia. A total of 73 severely disabled clients of an existing clinical service were randomly allocated to either ICM (caseload 10 clients per clinician) or standard case management (caseload up to 30 clients per clinician) and followed up for 12 months. A greater proportion of clients receiving ICM showed improved social functioning, these clients had fewer psychiatric hospital admissions involving police, and were more likely to engage and remain in treatment compared to those who received standard case management. Clients receiving ICM did not show a reduction in hospitalization duration or total number of episodes. It is suggested that future studies of ICM should focus on which aspects of treatment produce positive outcomes, how they can be applied to routine clinical settings, and over what period of time outcomes are sustained.

The impact of statins on psychological wellbeing: a systematic review and meta-analysis

BackgroundCholesterol-lowering medications such as statins have anti-inflammatory and antioxidant properties, which may be beneficial for treating depression and improving mood. However, evidence regarding their effects remains inconsistent, with some studies reporting links to mood disturbances. We aimed to conduct a meta-analysis to determine the impact of statins on psychological wellbeing of individuals with or without hypercholesterolemia.MethodsArticles were identified using medical, health, psychiatric and social science databases, evaluated for quality, and data were synthesized and analyzed in RevMan-5 software using a random effects model.ResultsThe 7 randomized controlled trials included in the analysis represented 2,105 participants. A test for overall effect demonstrated no statistically significant differences in psychological wellbeing between participants receiving statins or a placebo (standardized mean difference (SMD) = -0.08, 95% CI -0.29 to 0.12; P = 0.42). Sensitivity analyses were conducted to separately analyze depression (n = 5) and mood (n = 2) outcomes; statins were associated with statistically significant improvements in mood scores (SMD = -0.43, 95% CI -0.61 to -0.24).ConclusionsOur findings refute evidence of negative effects of statins on psychological outcomes, providing some support for mood-related benefits. Future studies could examine the effects of statins in depressed populations.

Using the effect size to model change in preference values from descriptive health status

Objectives: This pilot study describes a modelling approach to translate group-level changes in health status into changes in preference values, by using the effect size (ES) to summarize group-level improvement. Methods: ESs are the standardized mean difference between treatment groups in standard deviation (SD) units. Vignettes depicting varying severity in SD decrements on the SF-12 mental health summary scale, with corresponding symptom severity profiles, were valued by a convenience sample of general practitioners (n = 42) using the rating scale (RS) and time trade-off methods. Translation factors between ES differences and change in preference value were developed for five mental disorders, such that ES from published meta-analyses could be transformed into predicted changes in preference values. Results: An ES difference in health status was associated with an average 0.171–0.204 difference in preference value using the RS, and 0.104–0.158 using the time trade off. Conclusions: This observed relationship may be particular to the specific versions of the measures employed in the present study. With further development using different raters and preference measures, this approach may expand the evidence base available for modelling preference change for economic analyses from existing data.