Opportunities for cost-effective prevention of late-life depression - An epidemiological approach
Opportunities for cost-effective prevention of late-life depression - An epidemiological approach
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DOI：
10.1001/archpsyc.63.3.290
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发表时间：
2006-03-01
影响因子：
--
通讯作者：
Beekman, A
中科院分区：
文献类型：
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作者：
Smit, F;Ederveen, A;Beekman, A
背景：临床上相关的老年抑郁症的患病率为16%，并通过其疾病负担和不良预后与巨大的社会成本相关。从公共卫生的角度来看，抑郁症预防可能是产生健康收益和降低未来成本的一种有吸引力的手段，如果不是必须的话。目标：针对抑郁症预防的高危群体，以便在最低成本的情况下获得最大的健康收益。设计：为期3年的基于人群的队列研究。背景：荷兰的普通人口。参与者：2200名55岁至85岁的社区居民。在这些患者中，有1925人在基线水平上没有抑郁。主要结果衡量标准：临床相关抑郁的发病情况用流行病学研究中心抑郁量表来衡量。对于每个危险因素(及其组合)，我们计算了潜在的健康收益指数和产生这些健康收益所需的努力(成本)。结果：每5例临床相关的老年抑郁症患者中就有1例是新病例。因此，抑郁症预防必须在减少新病例涌入方面发挥关键作用。最好是针对有抑郁症状、经历功能障碍、社交网络较小的老年人，特别是女性，以及只有低教育水平或患有慢性病的人进行预防。结论：针对选定的高危群体进行预防有助于降低抑郁症的发生率，而且可能比其他方法更具成本效益。这篇文章进一步表明，我们拥有在预防性精神病学中进行临时成本效益分析的方法论。这有助于在耗时且昂贵的试验中测试干预措施的成本效益之前，制定合理的研究和发展议程。
Context: Clinically relevant late-life depression has a prevalence of 16% and is associated with substantial societal costs through its disease burden and unfavorable prognosis. From the public health perspective, depression prevention may be an attractive, if not imperative, means to generate health gains and reduce future costs.Objective: To target high-risk groups for depression prevention such that maximum health gains are generated against the lowest cost.Design: Population-based cohort study over 3 years.Setting: General population in the Netherlands.Participants: Twenty-two hundred community residents aged 55 to 85 years. Of these, 1925 were not depressed at baseline.Main Outcome Measure: The onset of clinically relevant depression was measured with the Center for Epidemiological Studies Depression Scale. For each of the risk factors (and their combinations), we calculated indices of potential health gain and the effort ( costs) required to generate those health gains.Results: One in every 5 cases of clinically relevant late-life depression is a new case. Consequently, depression prevention has to play a key role in reducing the influx of new cases. This is best done by directing prevention efforts toward elderly people who have depressive symptoms, experience functional impairment, and have a small social network, in particular women, as well as people who have attained only a low educational level or who suffer from chronic diseases.Conclusions: Directing prevention efforts toward selected high-risk groups could help reduce the incidence of depression and is likely to be more cost-effective than alternative approaches. This article further shows that we have the methodology at our disposal to conduct ante hoc cost-benefit analysis in preventive psychiatry. This helps set a rational research and development agenda before testing the cost-effectiveness of interventions in time-consuming and expensive trials.