MIND-ECON: The longer term, average & distributional effects of mental health interventions & the causal impact of mental illness on economic outcomes

南非的精神疾病负担很重，大约三分之一的成年人在一生中的某个时候患有精神障碍。大约四分之三的患有抑郁症、焦虑症和酗酒等精神障碍的人从未接受过心理健康治疗。未经治疗的精神疾病是造成国家疾病负担的第三大因素。精神疾病还加重了与慢性传染病(如艾滋病毒)和非传染性疾病(如糖尿病)有关的疾病的国家负担。将心理健康护理作为初级保健诊所慢性病护理的一部分，被视为改善获得精神健康治疗的机会以及改善慢性病结果的一种方式。目前，西开普省正在进行一项名为Mind的试验，研究在初级保健服务中为患有抑郁症或酒精使用障碍的同时患有糖尿病或艾滋病毒的患者提供简短心理健康咨询的不同方式。Mind的目的是研究通过社区卫生工作者提供精神健康咨询服务的最有效和最具成本效益的方式。Mind Trial将在三个时间点收集患者的心理健康信息，以查看患者的抑郁水平和有害/有害酒精使用是否因咨询而发生变化。我们建议在Mind-econ研究中建立Mind Trial。我们将分析心智试验的现有数据，并在另一个时间点(两年)从患者那里收集更多信息，以便我们可以检查咨询干预的长期效果。我们还将研究咨询对患者的抑郁或酒精障碍是否有不同的效果，这取决于他们的社会经济地位。我们将根据家庭特征(例如，患者居住的房屋类型、厕所类型、饮用水来源和烹饪能源)和资产所有权(例如，他们是否拥有冰箱、炉子、电视等)来衡量社会经济状况。我们还将研究心理健康的变化对个人就业、生产率和其他经济结果(如自付费用)的影响。除了患者的经济结果外，我们还将进一步收集家庭其他成员的信息，以便我们能够了解患者的精神疾病对家庭和照顾他们的人有什么影响，以及如何应对精神疾病的负担。在这方面，心理咨询对精神健康的长期影响知之甚少，对精神健康对经济结果或照顾负担的影响更是知之甚少。《心理经济学》将提供关于心理健康和经济结果之间的关系的宝贵信息，以及咨询的心理健康结果可能如何受到社会经济地位的影响。思维经济学将是收集更多亟需数据的有效方式，因为它建立在现有研究的基础上。在试验中有时会有风险的问题，比如研究是否能招募到足够的患者，已经到位。我们将寻求所需的额外伦理批准，以从患者及其家庭成员那里收集信息。我们将使用最先进的方法来分析这些数据，并将利用英国-SA合作中的一系列专业知识，这也将支持能力发展。我们将利用Mind现有的利益相关者咨询小组，该小组由政策制定者、艾滋病毒和糖尿病诊所的工作人员以及精神健康患者团体组成，以帮助我们确保我们的发现能够直接影响到不断变化的政策和实践，并产生重大影响。我们将确保我们的结果通过不同的媒体向不同的受众广泛宣传。我们将寻求影响南非和全球改善获得精神卫生保健服务的政策。

South Africa has a high burden of mental illness, with around a third of adults suffering from a mental disorder at some point in their life. Around three-quarters of people with mental disorders such as depression, anxiety and alcohol use never access mental health treatment. Untreated mental illness is the third largest contributor to the national burden of disease. Mental illness also contributes to the national burden of disease associated with chronic communicable diseases (such as HIV) and non-communicable diseases, such as diabetes. Including mental health care as part of chronic disease care in primary care clinics is seen as a way to improve access to mental health treatment, as well as improve chronic disease outcomes.A trial, called MIND, is currently being run in the Western Cape looking at different ways of providing brief mental health counselling in primary care services for patients with depression or alcohol use disorders who also suffer from diabetes or HIV. The aim of MIND is to examine the most effective and cost-effective way to provide mental health counselling services through community health workers. The MIND trial will collect information on patients' mental health at three points in time to look at whether there are changes in patients' level of depression and hazardous/harmful alcohol use as a result of the counselling.We are proposing to build on the MIND trial in the MIND-ECON study. We will analyse existing data from the MIND trial and collect additional information from patients at a further time point (2 years), so that we can examine the long-term effects of the counselling intervention. We will also examine whether the counselling had different effects on patients' depression or alcohol disorder, depending on their socio-economic status. We will measure socio-economic status by creating an index based on household characteristics (e.g. the type of house the patient lives in, type of toilet, their source of drinking water and energy for cooking) and asset ownership (e.g. whether they own a fridge, stove, TV, etc.). We will also look at the impact of changes in mental health on an individual's employment, productivity, and other economic outcomes such as out-of-pocket payments. In addition to patient economic outcomes, we will further capture information from other members of the household so that we can learn what impact patients' mental illness has on the family and those who care for them and what coping strategies are used to deal with the burden of mental illness.Very little is known about the long-term impact of psychological counselling on mental health in this context and even less is known about the impact of mental health on economic outcomes or on the caregiving burden. MIND-ECON will provide valuable information on the relationship between mental health and economic outcomes, as well as how mental health outcomes from the counselling may be affected by socio-economic status. MIND-ECON will be an efficient way to collect further much needed data since it builds on an existing study. Issues that are sometimes risky in trials, such as whether the study can recruit enough patients, are already in place. We will seek the needed additional ethical approvals to collect information from the patients and the members of their household.We will use state-of-the art methods to analyse these data and will draw on a range of expertise in this UK-SA collaboration, which will also support capacity development. We will use MIND's existing stakeholder advisory group consisting of policymakers, staff from the HIV and diabetes clinics, and mental health patient groups to help us ensure that our findings can feed directly into changing policy and practice and have a large impact. We will ensure our results are widely publicised to various audiences and through different media. We will seek to influence policy in South Africa and globally on improving access to mental health care.