Author
ZECHMEISTER Ingrid; et al.;
Title
Is it worth investing in mental health promotion and prevention of mental illness? A systematic review of the evidence from economic evaluations.
Journal citation/publication details
BMC Public Health, 8:20, January 2008.
Summary
Only fourteen studies, mainly from the USA, were eligible for inclusion. There was evidence that interventions can be cost-effective, especially when aimed at children and adolescents, but the wide variation in the methods used, the quality of the studies, and the target populations do not allow specific recommendations to be drawn.
Context
Promotion and prevention strategies have been shown to reduce the individual and social impacts of poor mental health; such programmes could also be cost-effective. The aim of the study was to identify areas in which economic evaluations have most commonly been used and report on the techniques employed. In addition, the extent to which available economic studies have focused solely on prevention of mental health disorders without assessing the cost-effectiveness of the promotion of improved mental well-being is explored.
Methods
What sources were searched?
The following databases were searched: Medline, PubMed, EMBASE, CINAHL, PsycINFO, PSYNDEX, EconLit, ERIC, and NHS EED (Economic Evaluation Database). Key journals (unspecified) were hand searched and the internet was searched for grey literature.
What search terms/strategies were used?
A combination of medical subject headings and free text searching of titles and abstracts using ‘mental disorder’, ‘mental illness’, ‘(primary) prevention’, ‘health promotion’, ‘preventive measures’, ‘occupational health’, ‘workplace health promotion’, and ‘suicide promotion’, ‘economics’, ‘cost effectiveness’, ‘cost utility’, ‘cost benefit’, ‘cost consequences’, and ‘economical evaluation’ was used. There are no details of specific strategies.
What criteria were used to decide on which studies to include?
Economic evaluations of mental health promotion or prevention interventions that addressed either mental well-being or mental disorder as an outcome were eligible for inclusion. In addition, studies focusing on preventing outcomes that are recognised as risk factors for mental health disorders were included, as were papers on suicide prevention. The definition of mental disorders had to be based on ICD classification. Tertiary prevention, including studies of drug treatment, and drug and alcohol interventions were excluded. Only studies in English and German were included.
Who decided on their relevance and quality?
Two unnamed reviewers undertook study selection based on the abstracts. There is no indication that study quality was formally assessed.
How many studies were included and where were they from?
Initially 398 papers were identified; 361 were excluded after examination of the abstracts and another five were excluded because the full text was unobtainable. Fourteen of the 32 studies examined in full were included in the review. Seven of the studies were set in the USA, five in the UK, one in Sweden and one in the Netherlands. Further details of the selection process are available in Figure 1 and a full list of the excluded studies is available as an appendix.
How were the study findings combined?
Data extraction was carried out independently by two unnamed reviewers. Quantitative monetary results were converted into US dollars and Euros using GDP Purchasin-Power-Parities and adjusted to 2006 price levels. The review is narrative; the results are presented separately in the text for programmes to prevent depression and suicide, and for those targeting overall risk factors, and summarised in Table 1.
Findings of the review
Six studies were prospective and eight were retrospective. Most of the studies used conventional economic techniques such as cost benefit, cost effectiveness, cost utility or cost consequence analysis, and some included simulation models. The interventions were highly diverse in nature; nine were aimed at preventing depression and suicide and five addressed overall risk factors for mental disorders. The target populations included new mothers, young people and families, as well as the general population. No economic evaluations were found for studies aimed at mental well-being as an outcome rather than mental illness.
Favourable economic outcomes were reported in ten of the 14 studies. The strongest evidence was seen in three early intervention programmes aimed at children and adults from the USA.
Authors' conclusions
‘MHP (mental health promotion) and MDP (mental disorder prevention) have a high potential to be of economic benefit to society’ but the evidence base ‘is scant, making it difficult to formulate general recommendations on how to prioritise between individual interventions’. ‘More country and population specific economic evaluations are required to strengthen this evidence base’.
Implications for policy or practice
None are discussed.