Leonard S. Miller

Economic costs of anxiety disorders

Anxiety disorders are estimated to affect 26.9 million individuals in the United States at some point during their lives. This study used the human capital approach to estimate the direct and indirect costs of these highly prevalent disorders. In 1990, costs associated with anxiety disorders were

Prevention of depression with primary care patients: A randomized controlled trial

46.6 billion, 31.5% of total expenditures for mental illness. Less than one-quarter of costs associated with anxiety disorders were for direct medical treatment; over three-quarters were attributable to lost or reduced productivity. Most of these indirect costs were associated with morbidity, as mortality accounted for just 2.7% of the total. Greater availability of effective, relatively low-cost outpatient treatment could substantially reduce the economic and social burden of these common and often crippling disorders.

A Longitudinal Study of the Causal Relationship Between Social Networks and Health of the Poor Frail Elderly

The prevention of major depression is an important research goal which deserves increased attention. Depressive symptoms and disorders are particularly common in primary care patients and have a negative impact on functioning and well-being comparable with other major chronic medical conditions. The San Francisco Depression Prevention Research project conducted a randomized, controlled, prevention trial to demonstrate the feasibility of implementing such research in a public sector setting serving low-income, predominantly minority individuals: 150 primary care patients free from depression or other major mental disorders were randomized to an experimental cognitive-behavioral intervention or to a control condition. The experimental intervention group reported a significantly greater reduction in depressive levels. Decline in depressive levels was significantly mediated by decline in the frequency of negative conditions. Group differences in the number of new episodes (incidence) of major depression did not reach significance during the 1-year trial. We conclude that depression prevention trials in public sector primary care settings are feasbile, and that depressive symptoms can be reduced even in low-income, minority populations. To conduct randomized prevention trials that can test effects on incidence with sufficient statistical power, subgroups at greater imminent risk have to be identified.

Evaluation of the economic impact of California's Tobacco Control Program: a dynamic model approach

Research over the past two decades has documented a positive relationship between social support and health. The causal interpretation of these associations has, however, been unclear. This study aims at filling the gap in our understanding of this causal link with respect to the frail poor elderly. The main questions addressed are, Does lack of social ties affect the elderlys health? or are unhealthy people less likely to establish and maintain social ties? We employed a time-series panel design to overcome problems of causal explanations and examine social networks and health in a sample of 3,559 poor frail elderly, participants of the California Multipurpose Senior Services Project. The results indicate that social networks have a positive effect on health (though only in the short run). However, neither the subjective nor the objective health measures have a significant effect on social networks. Implications for intervention are discussed .

Introducing Simultaneous Equation Modeling for Social Work Research: A Theoretical Approach to Examining Complex Social Problems

Objective To evaluate the long-term net economic impact of the California Tobacco Control Program. Methods This study developed a series of dynamic models of smoking-caused mortality, morbidity, health status and healthcare expenditures. The models were used to evaluate the impact of the tobacco control programme. Outcomes of interest in the evaluation include net healthcare expenditures saved, years of life saved, years of treating smoking-related diseases averted and the total economic value of net healthcare savings and life saved by the programme. These outcomes are evaluated to 2079. Due to data limitations, the evaluations are conducted only for men. Results The California Tobacco Control Program resulted in over 700 000 person-years of life saved and over 150 000 person-years of treatment averted for the 14.7 million male California residents alive in 1990. The value of net healthcare savings and years of life saved resulting from the programme was

Service Selection: Concordance Between Alzheimer's Disease Diagnostic and Treatment Center Clients' Choices and Program Staff Recommendations

22 billion or

TREATING CLIENTS FAIRLY

107 billion in 1990 dollars, depending on how a year of life is discounted. If women were included, the impact would likely be much greater. Conclusions The benefits of Californias Tobacco Control Program are substantial and will continue to accrue for many years. Although the programme has resulted in increased longevity and additional healthcare resources for some, this impact is more than outweighed by the value of the additional years of life. Modelling the programmes impact in a dynamic framework makes it possible to evaluate the multiple impacts that the programme has on life, health and medical expenditures.

EVALUATIONS IN CARE PROGRAMS:: WITH ILLUSTRATIONS FROM HOMEMAKER-CHORE IN CALIFORNIA

Abstract Social science researchers generally use simple, single equation descriptions of complex social problems. More accurate descriptions would portray the joint dependency among a models variables by using a separate equation for each dependent variable. When the parameters of these more accurately described models are estimated with ordinary least squares (OLS), the resulting estimates do not have good statistical properties. A two-stage least squares procedure to estimate the parameters of simultaneous equation models is described using an example about heavy workplace drinking and the social climate at work. In addition, this article defines key concepts related to simultaneous equation modeling and provides an interpretation of the results for practitioners.

Health economics and cost implications of anxiety and other mental disorders in the United States

Service choices of Alzheimers Disease Diagnostic and Treatment Centers (ADDTC) enrollees (N = 822) and ADDTC professional staff are compared. Results suggest that community- dwelling Alzheimers patients are not high service consumers, and ADDTC staff generally agree with their service choices. Limited discordance noted pertained to recommended decreases in homemaker chore, senior center, meals, transportation, and home health use; and suggested increases in psychiatric service, case management, and adult day care use. Findings confirm the high degree of informal care of the demented and the reluctance or inability of patients and caregivers to use formal services. Results also indicate that as ADDTC-like programs prolifer ate, long-term care costs may remain unchanged because patients and caregivers may already know what formal care they need and want.

Estimates of economic costs of alcohol and drug abuse and mental illness, 1985 and 1988.

The equitable distribution of maintenance, or care, services derives principally from the decision-making activities of the line workers in a service program. When program rules and guidelines are relatively general and awards are specific, workers develop functions which relate client need to program benefit. However, among counties and offices within a county, these functions may differ, resulting in inequitable service awards to clients. An empirical study of the In-home Supportive Services program in California reveals office distributive functions and determines the consistency with which workers follow them. Through factor analysis and linear regression, the distributive rules are made explicit so that workers can determine how they may be unintentionally treating clients unfairly.