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Cost-effectiveness analyses of new cancer treatments in real-world settings (e.g., post-clinical trials) inform healthcare decision makers about their healthcare investments for patient populations. The results of these analyses are often, though not always, presented with statistical uncertainty. This paper identifies five ways to characterize statistical uncertainty: (1) a 95% confidence interval (CI) for the incremental cost-effectiveness ratio (ICER); (2) a 95% CI for the incremental net benefit (INB); (3) an INB by willingness-to-pay (WTP) plot; (4) a cost-effectiveness acceptability curve (CEAC); and (5) a cost-effectiveness scatterplot. It also explores their usage in 22 articles previously identified by a rapid review of real-world cost effectiveness of novel cancer treatments. Seventy-seven percent of these articles presented uncertainty results. The majority those papers (59%) used administrative data to inform their analyses while the remaining were conducted using models. Cost-effectiveness scatterplots were the most commonly used method (34.3%), with 40% indicating high levels of statistical uncertainty, suggesting the possibility of a qualitatively different result from the estimate given. Understanding the necessity for and the meaning of uncertainty in real-world cost-effectiveness analysis will strengthen knowledge translation efforts to improve patient outcomes in an efficient manner.

To examine how public health policy was reinforced by peer workers who were called Public Health Ambassadors (PHAs) at a West Coast university during the COVID-19 pandemic.Descriptions of PHA community interactions were collected. Analyses were conducted using data from the 12-weeks of the 2020 Fall Quarter.In total, there were 5,112 interactions of which there were three types: (1) educational (4%), (2) noncompliance (90%), and (3) thanking (6%). About 1.3% of interactions were met with resistance.Overall, compliance with campus public health guidance was high. Trends suggest compliance fatigue may have occurred after the first four weeks as evidenced by increased noncompliance rates and test positivity rates.These results suggest the feasibility of the implementing US Centers for Disease Control and Prevention recommendations of using trusted messengers to reinforce critical behaviors to support community health.

Economic evaluation studies the costs and outcomes of two or more alternative activities to estimate the relative efficiency of each course of action. Economic evaluation is both important and necessary in the management of speech and language issues. Economic evaluation can help focus attention on interventions that provide value for improving population health. The purpose of this article is to introduce readers to fundamental economic concepts. Readers are also introduced to common issues when conducting economic evaluations and how to address them in practice.

Acts of violence are the fifth leading cause of nonfatal occupational injuries in the United States. Experiencing a traumatic event at work can have serious mental health consequences, including the development of posttraumatic stress disorder (PTSD). This study aimed to quantify the prevalence of PTSD caused by workplace violence (WPV) in a statewide workers' compensation system and compare the outcomes and treatment of WPV cases versus those caused by other traumatic events. Using a retrospective cohort study design, workers who reported PTSD as the primary reason for a workers' compensation claim and had no coexisting physical injuries were found in California during 2009-2018. A total of 3,772 PTSD cases were identified, 48.9% of which were attributed to WPV. Demographic risk factors associated with WPV PTSD included lower income, younger age, female gender, and employment in retail or finance, p < .001-p = .007. For individuals who returned to work, claims due to WPV resulted in longer medically approved time away from work than non-WPV causes (Mdn = 132.5 days vs. Mdn = 91 days, respectively), p < .001. Three of the top 10 most frequently prescribed medications were administered against evidence-based guidelines. This study found that many treatments prescribed to PTSD patients are based on insufficient evidence, and the provision of existing empirically supported treatments is needed, particularly in generalized populations. The findings support the need for additional recognition of the cause of workplace PTSD to facilitate appropriate referrals to WPV or PTSD specialists to support return-to-work efforts.

This article offers examples of how modeling can motivate health equity inquiry and research. This article also considers how equity fits into cost-effectiveness frameworks, how economic modeling can broaden the range of options for improving health equity, and how information other than results of cost-effectiveness analyses can inform health technology assessment.

Cost-effectiveness analysis (CE Analysis) provides evidence about the incremental gains in patient outcomes costs from new treatments and interventions in cancer care. The utilization of “real-world” data allows these analyses to better reflect differences in costs and effects for actual patient populations with comorbidities and a range of ages as opposed to randomized controlled trials, which use a restricted population. This rapid review was done through PubMed and Google Scholar in July 2022. Relevant articles were summarized and data extracted to summarize changes in costs (in 2022 CAD) and effectiveness in cancer care once funded by the Canadian government payer system. We conducted statistical analyses to examine the differences between means and medians of costs, effects, and incremental cost effectiveness ratios (ICERs). Twenty-two studies were selected for review. Of those, the majority performed a CE Analysis on cancer drugs. Real-world cancer drug studies had significantly higher costs and effects than non-drug therapies. Studies that utilized a model to project longer time-horizons saw significantly smaller ICER values for the treatments they examined. Further, differences in drug costs increased over time. This review highlights the importance of performing real-world CE Analysis on cancer treatments to better understand their costs and impacts on a general patient population.

Background: Smoking among patients diagnosed with cancer poses important health and financial challenges including reduced effectiveness of expensive cancer therapies. This study explores the value of smoking cessation programs (SCPs) for patients already diagnosed with cancer. It also identifies conditions under which SPCs may be wise investments. Methods: Using a simplified decision analytic model combined with insights from a literature review, we explored the cost-effectiveness of SCPs. Results: The findings provide insights about the potential impact of cessation probabilities among cancer patients in SCPs and the potential impact of SCPs on cancer patients’ lives. Conclusion: The evidence suggests that there is good reason to believe that SCPs are an economically attractive way to improve outcomes for cancer patients when SCPs are offered in conjunction with standard cancer care.

Author(s): Gaspar, Fraser W; Jolivet, Daniel N; Wizner, Kerri; Schott, Fred; Dewa, Carolyn S | Abstract: ObjectivesTo examine the influence of depression and/or anxiety on work leaves and the impact of work leaves on experiencing a new-onset depression and/or anxiety disorder.MethodsIBM's MarketScan® research databases were linked to investigate depressive and anxiety disorders in workers with a work leave due to an injury or non-mental health illness (n = 467,930) and without a work leave (n = 2,764,447).ResultsThe odds of a work leave within a year were 2.10 times higher (95%CI: 2.08-2.13) in individuals with depression and/or anxiety compared to those without. The odds of developing a new-onset depression and/or anxiety within a year was 4.21 times higher (95% CI: 4.14-4.27) in individuals with a work leave compared to those without.ConclusionDepression and anxiety are both risk factors for and subsequent outcomes of injuries or illnesses that require a work leave.

Purpose The purpose of this systematic literature review (SLR) is to examine the state of knowledge about the cost-effectiveness of return-to-work (RTW) interventions targeted at workers with medically certified sickness absences related to mental disorders. Our SLR addresses the question, "What is the evidence for the cost-effectiveness of RTW interventions for mental illness related sickness absences?" Methods This SLR used a reviewer pair multi-phase screening of publically available peer-reviewed studies published between 2002 and 2019. Five electronic databases were searched: (1) MEDLINE 1946-Present, (2) MEDLINE: Epub-Ahead of Print and In-Process, (3) PsycINFO, (4) Econlit, and (5) Web of Science. Results 6138 unique citations were identified. Ten articles were included in the review. Eight of the ten studies were conducted in the Netherlands, one in Sweden, and one in Canada. Results of this SLR suggest there is evidence that RTW interventions for workers with medically certified sickness absences can be cost-effective. Conclusions Although this SLR's results suggest that economic evaluations of RTW interventions can be cost-effective, the use of economic evaluations for studies of these program types is in its infancy. Some jurisdictions (e.g., the Netherlands) seem to have recognized the need for economic evaluations. However, more research is needed in different disability system contexts. Furthermore, use of the standard economic evaluation approaches for healthcare interventions may limit the usefulness of results if the end-user is an employer or non-health organization. This may present the opportunity to introduce newer approaches that include work-related measures of effectiveness and analytical approaches.

Background The reopening of college and university campuses was seen as presenting a high risk for transmission of COVID-19. Thus, these institutions faced with a new public health challenge never heretofore faced on this scale. To magnify the problem, they needed to rapidly develop and implement re-opening plans in an environment filled with uncertainty and for a population that was significantly less likely to observe COVID-19 mitigation behaviors. In response, within three weeks of opening, as part of its COVID-19 public health strategy, a West Coast university created and trained a public health workforce comprised of 282 undergraduates tasked with encouraging compliance with COVID-19 mitigating healthy behaviors. Main objectives This paper describes the use and outcomes of a practicum framework to quickly create a university-based public health workforce. It addresses two questions: (1) Using a practicum framework, what are important considerations in designing and building a public health workforce for a university campus? and (2) What are the benefits to the workforce in terms of public health education and professional growth? Methods Program administrative data were used to describe the workforce and their learning outcomes. Results The majority of students indicated that through the practicum, they learned new skills/developed new attitudes (71.7%) and became aware of their own strengths and opportunities for professional growth (73.7%). The types of new skills and attitudes learned included communication (49.2%), conflict management (20.4%), time management (7.5%), and open-mindedness/less judgmental attitude (14.6%). In terms of public health, they gained an understanding of infectious disease prevention (40.9%) that is multi-disciplinary (20.5%), and involves a community effort (36.8%). Conclusions These findings demonstrate an effective way of rapidly addressing public health concerns that allowed for on the job training and opportunities for young adults to learn and grow. The practicum framework allowed the expeditious development of a public health workforce that ensured a fit between student interests and the role. This led to high retention with the majority of students continuing into the winter quarter. Only 5% of students reported not being satisfied with their position. None of the students contracted job-related COVID-19. The role gave students a sense of purpose during the pandemic’s uncertain times that helped to protect them from the negative effects of stress. The practicum structure and support fostered a safe environment in which students were able to feel part of the larger community while gaining valuable work experience and skills and serve their community.

Objective: To seek to find a way to address stress and build social bonds among U.S. college students, an East Coast private institution and a West Coast state institution each offered an undergraduate Nature Rx course. Participants: Seventeen undergraduate students were enrolled in the West Coast state institution seminar, and sixteen undergraduate students were enrolled in the East Coast private institution seminar. Methods: A mixed methods approach was used to evaluate the effectiveness of the pilot such that students were given pre- and post-course questionnaires and asked to write reflective essays to describe their experiences in the class. Results: While no significant changes in self-perceived stress were reported in questionnaire items, the qualitative data indicated students attributed their participation in the course with factors that contributed to reduced stress and important social connections. These included a strengthened belief in the value of spending time in nature to reduce stress, the creation and solidification of social bonds, and an expectation that the class would have a lasting impact. Conclusion: Overall, participants indicated they experienced frequent and meaningful interactions with other students and the instructors while gaining greater familiarity with the natural elements of their respective campuses.

Mental health courts were created to help criminal defendants who have a mental illness that significantly contributes to their criminal offense. The purpose of this systematic literature review is to assess the current evidence to address the question, "How effective are mental health courts in reducing recidivism and police contact?" Systematic literature searches of eight electronic databases were performed. A total of 2590 unique citations were identified. Of these, 20 studies were included in the final analysis. The results of this systematic review suggest there is some evidence to show that mental health courts help to reduce recidivism rates, but the effect on police contact is less clear. Results also suggest case managers or access to vocational and housing services may be important components of effective mental health courts.

Social firms (SFs) are an appealing model for people with a mental health condition who are having difficulties maintaining their employment in a competitive labour market. The goal of this study is to compare the availability of work accommodations in two types of Canadian SFs, by interviewing supervisors working in adapted enterprises and consumer/survivor-run businesses, and by obtaining the perceptions of the workers with a mental health condition regarding the usefulness of these accommodations. Results indicate accommodations in both types of SFs are readily available and useful. A significant difference between the two types of SFs is the availability of a job coach whose presence workers found useful in adapted enterprises. Natural supports from stakeholders (e.g., supervisors, job coach) are important for work sustainability.

Objective Low productivity while at work (presenteeism) has been reported to produce significant cost excesses for organizations and economies. However, many of these reports have been based on estimates drawn from self-report instruments that are not supported by evidence showing their efficacy. Thus, the aim of this study was to assess associations between responses to leading self-report tests of presenteeism and self-recorded on-the-job productivity. Methods Health care worker self-ratings of productivity were taken from a questionnaire that contained the key item from each presenteeism instrument. Productivity levels were drawn from employee reported daily work activity logs. Results Test-based productivity estimates did not show strong associations with daily recordings of work activity. Conclusions Associations were too low to recommend any test as a proxy measure for reported productivity. It is suggested that objective measures of work output be explored.

Currently, an estimated 20%–40% of graduate students have depression and anxiety. In addition, more than half report experiencing high chronic stress. Thus, organizations such as the Plant Science Research Network have highlighted the need to prioritize trainee well‐being. This has led to a search for strategies to introduce this cultural change into scientific training. However, for faculty who do not have experience with this topic area, there are few readily available resources from which to draw. In this paper, we describe how two graduate groups, one focused on plant biology and the other on genomics and genetics approached this challenge together by introducing a course on mental and emotional well‐being to their incoming first‐year graduate students. We describe the research on workplace mental and emotional well‐being and disability prevention which served as the basis for the course content. We review the course curriculum, student reflections about what they learned, and implications for future classes.

Objectives People with mental illnesses are more likely to experience diabetes-related complications that can reduce life expectancy by 10 to 15 years. Diabetes management and outcomes can be improved when lifestyle interventions addressing healthful eating habits and physical activity use content tailored to the learning needs of individuals or groups. Understanding the challenges that prevent adherence to diabetes recommendations can start to inform the design of tailored diabetes education care. The purpose of this pilot study was to explore the perspectives of clients with mental illnesses and type 2 diabetes with regard to challenges faced when engaging in diabetes self-care behaviours. Methods Focus groups were held with 17 people who had type 2 diabetes and mental illnesses, including depressive disorder, bipolar disorder, anxiety disorder, schizophrenia and schizoaffective disorder. In the groups, participants were asked to share their experiences with diabetes self-care and access to diabetes-education services. Data were transcribed verbatim, assessed for quality and saturation and coded to identify relationships and meanings among identified themes. Results Participants identified many challenges and unmet needs that created multidimensional and interrelated barriers to care, ultimately resulting in poor diabetes self-care behaviours. Some challenges were psychological in nature and related to emotional states, lifestyles and food habits, perceptions of affordability, health literacy and value of health information. Other challenges included the physical states of health and social environments. Conclusions Multidimensional diabetes education programs that consider psychological, physical and social challenges are needed to address the needs of people with mental illnesses.

Ethical practice compels evaluators to obtain informed consent from evaluation participants. When those participants are minors, parental consent is routinely sought. However, seeking parental consent may not be appropriate in all evaluation contexts. This practice note presents one context (mental health services research in rural Canada) where seeking parental consent for youths’ participation in research was considered unethical and unfeasible. We present a two-step “capacity-to-consent” protocol that we developed to obtain consent from youth participants. This protocol offers an ethical and feasible alternative to seeking parental consent for youth. The implications for evaluation practice are discussed. Resume : Pour se conformer a des pratiques ethiques, les evaluateurs doivent obte-nir le consentement eclaire de participants au projet. Lorsque ces participants sont des mineurs, le consentement des parents est generalement demande. Cependant, il n’est pas toujours possible ou souhaitable d’obtenir le consentement des parents dans tous les contextes d’evaluation. La presente note de pratique presente un con-texte (recherche sur les services de sante mentale en milieu rural au Canada) ou l’obtention du consentement d’un parent est consideree non ethique et impossible. Nous presentons un protocole en deux etapes de « capacite a consentir » que nous avons mis au point pour obtenir le consentement de jeunes participants. Ce protocole offre une solution de rechange ethique et applicable a l’obtention du consentement des parents pour les jeunes. On discute des ramifications du protocole pour la pratique de l’evaluation.

Purpose: Compared to groups with other disabilities, people with a severe mental illness face the greatest stigma and barriers to employment opportunities. This study contributes to the understanding of the relationship between workplace social support and work productivity in people with severe mental illness working in Social Enterprises by taking into account the mediating role of self-stigma and job tenure self-efficacy. Method: A total of 170 individuals with a severe mental disorder employed in a Social Enterprise filled out questionnaires assessing personal and work-related variables at Phase-1 (baseline) and Phase-2 (6-month follow-up). Process modeling was used to test for serial mediation. Results: In the Social Enterprise workplace, social support yields better perceptions of work productivity through lower levels of internalized stigma and higher confidence in facing job-related problems. When testing serial multiple mediations, the specific indirect effect of high workplace social support on work productivity through both low internalized stigma and high job tenure self-efficacy was significant with a point estimate of 1.01 (95% CI = 0.42, 2.28). Conclusions: Continued work in this area can provide guidance for organizations in the open labor market addressing the challenges posed by the work integration of people with severe mental illness.Implications for Rehabilitation:Work integration of people with severe mental disorders is difficult because of limited access to supportive and nondiscriminatory workplaces.Social enterprise represents an effective model for supporting people with severe mental disorders to integrate the labor market.In the social enterprise workplace, social support yields better perceptions of work productivity through lower levels of internalized stigma and higher confidence in facing job-related problems.

The Individual Placement and Support (IPS) program is a well-studied vocational rehabilitation program. Although it is more effective than usual care, it is not effective for everyone. This offers an opportunity for program improvement.This systematic literature review examines the state of knowledge regarding the effectiveness of augmented versus standard IPS for people with severe mental illness (SMI). We address the questions, "What IPS augmentations have been tested?" and "What is the evidence for the effectiveness of augmented IPS versus standard IPS in terms of employment?"This systematic literature review used publically available peer-reviewed studies published between January 2002 and January 2016 in either: (1) Medline Current, (2) Medline In-process, (3) PsycINFO, (4) Econlit or (5) Web of Science.5718 unique citations were identified; seven articles from five studies were included. Of these studies, four were rated as having moderate risk of bias and one as having high risk.The results suggest that augmentations of IPS focusing on cognitive and psychosocial skills training, may have additional effects to standard IPS. Areas in need of further research related to the process and targeting of those interventions are discussed.

BACKGROUND Paediatric dentists in the United States may be at greater risk for occupational burnout and/or depression because of chronic stress associated with provision of paediatric dental care and increasing prevalence of females in the workforce. AIMS To determine the prevalence of occupational burnout and/or depression among US paediatric dentists. DESIGN A self-administered online anonymous survey was sent to members of the American Academy of Pediatric Dentistry (n = 4735). The questionnaire consisted of seven demographic items, 22 items of Maslach Burnout Inventory (Three subscales: Emotional exhaustion, Depersonalization, and Personal accomplishment), and eight items of Patient Health Questionnaire-8. RESULTS The survey had a response rate of 11.4% (females = 53%). Twenty-three per cent of respondents had high emotional exhaustion while fewer respondents had high depersonalization (12%) or low personal accomplishment (10%). Nine per cent fulfilled the study's definition of occupational burnout (high emotional exhaustion + high depersonalization). Seven per cent of respondents had moderate-to-severe depression and showed significant correlations (P

Background Economic evaluations commonly accompany trials of new treatments or interventions; however, regression methods and their corresponding advantages for the analysis of cost-effectiveness data are not widely appreciated. Methods To illustrate regression-based economic evaluation, we review a cost-effectiveness analysis conducted by the Canadian Cancer Trials Group’s Committee on Economic Analysis and implement net benefit regression. Results Net benefit regression offers a simple option for cost-effectiveness analyses of person-level data. By placing economic evaluation in a regression framework, regression-based techniques can facilitate the analysis and provide simple solutions to commonly encountered challenges (e.g., the need to adjust for potential confounders, identify key patient subgroups, and/or summarize “challenging” findings, like when a more effective regimen has the potential to be cost-saving). Conclusions Economic evaluations of patient-level data (e.g., from a clinical trial) can use net benefit regression to facilitate analysis and enhance results.

California's Mental Health Services Act Prevention and Early Intervention funds provide a unique opportunity for counties to initiate programs focused on early intervention in mental health, including early psychosis. To explain the configuration of early psychosis programs and plan for a statewide evaluation, this report provides an overview of California's early psychosis programming, including service composition, funding sources, inclusion criteria, and data collection practices.Following a comprehensive identification process, early psychosis program representatives were contacted to complete the California Early Psychosis Assessment Survey (CEPAS).The response rate to the CEPAS was excellent (97%, 29 of 30 active programs across 24 of 58 counties). Most programs (N=27, 93%) serve individuals with first-episode psychosis between the ages of 12 and 25. Twenty-two programs (79%) provide more than half of the standard components of early psychosis care outlined in the First-Episode Psychosis Service Fidelity Scale. Sixty-four percent of programs collect client-level data at intake and follow up on five or more relevant outcome domains; however, these varied significantly across sites.Substantial variability in services, inclusion criteria, and data recorded was evident across programs. Prior to conducting any large-scale evaluation, these findings highlight the significant challenges in retrospectively evaluating program effectiveness, need to harmonize program data collection methods, and importance of assessing the impact of program variability on outcomes.

Rates and determinants of pharmacological and psychotherapy use were assessed after a major depressive disorder diagnosis.In a retrospective claims study that included 2007-2016 records from the IBM MarketScan research databases, use of pharmacotherapy and psychotherapy was tracked in a population of 24,579 patients with a diagnosis of major depressive disorder. Univariate and multiple variable analyses were used to identify determinants of antidepressant adherence (proportion of days covered ≥.8) and intensive psychotherapy at the beginning of treatment (at least four psychotherapy visits in the first 4 weeks after initiating psychotherapy).In the 12 months following a diagnosis of major depressive disorder, most individuals received pharmacotherapy or psychotherapy (94.7%), and unimodal therapy was more common (58.5%) than bimodal therapy (36.2%). When antidepressants were initiated (N=13,524), 41.7% and 32.0% of patients were adherent in the acute and continuation phases, respectively. Initial antidepressant dosages were outside guideline recommendations for 34.5% of patients prescribed these medications. When psychotherapy was initiated, the median number of visits in the year after a patient's diagnosis was seven. Most patients (54.7%) did not continue to receive either antidepressant or psychotherapy treatment after month 5 following their diagnosis. A shorter time from diagnosis to treatment and a lower percentage of treatment costs paid by the patient were associated with increased antidepressant adherence and intensive psychotherapy use.Findings indicate that treatment guideline recommendations are not followed for a large proportion of patients with major depressive disorder and that improvement is needed in multiple areas to enhance effective treatment.

Most organizations feel they have insufficient resources. Budgets never seem to stretch far enough. There always seems to be a shortage of staff, equipment, or both. At the same time, they face significant costs related to covering worker healthcare and mental illness-related work disability costs. Choosing the most cost-effective way to intervene can be confusing. This chapter gives an overview of how to conduct an economic evaluation, a method that helps decision-makers make informed choices. Using an example of three work colleagues who are tasked with evaluating two types of workplace mental health interventions, the chapter discusses the factors that should be considered before beginning an economic evaluation, the types of economic evaluations from which to choose, the data needed to conduct an economic evaluation, how to use the data, interpreting the results of an economic evaluation, and how organizations could use an economic evaluation to make decisions.

Global inequity in access to and availability of essential mental health services is well recognized. The mental health treatment gap is approximately 50% in all countries, with up to 90% of people in the lowest-income countries lacking access to required mental health services. Increased investment in global mental health (GMH) has increased innovation in mental health service delivery in LMICs. Situational analyses in areas where mental health services and systems are poorly developed and resourced are essential when planning for research and implementation, however, little guidance is available to inform methodological approaches to conducting these types of studies. This scoping review provides an analysis of methodological approaches to situational analysis in GMH, including an assessment of the extent to which situational analyses include equity in study designs. It is intended as a resource that identifies current gaps and areas for future development in GMH. Formative research, including situational analysis, is an essential first step in conducting robust implementation research, an essential area of study in GMH that will help to promote improved availability of, access to and reach of mental health services for people living with mental illness in low- and middle-income countries (LMICs). While strong leadership in this field exists, there remain significant opportunities for enhanced research representing different LMICs and regions.

There is growing evidence that diversion to a mental health court program (MHC) can reduce recidivism rates and improve the quality of life of clients. However, there is less known about MHC client characteristics and factors associated with recidivism. Yet, this information would be useful to increase the effectiveness of these programs. Cross-sectional quantitative data were collected on MHC clients in three consecutive years. Of the 155 program clients that were successfully interviewed, only 154 were included in the analysis due to one non-consent to collect further data from their case manager. The purpose of this secondary analysis was to examine “What individual factors are associated with recidivism among MHC program clients?” This analysis specifically explored the association of sex, age, low functional ability, homelessness, court site, and criminal history. From the multiple logistic regression results, the increased risk of recidivism was found to be significantly associated with younger clients and a prior criminal history. The results of this study suggest programs tailored to young adults and repeat offenders may be areas that MHCs could potentially focus on to increase their effectiveness.

Objective: Because health care resources are constrained, decision-making processes often require clarifying the potential costs and savings associated with different options. This involves calculating a program’s costs. The chosen costing perspective defines the costs to be considered and can ultimately influence decisions. Yet reviews of the literature suggest little attention has been paid to the perspective in economic evaluations. This article’s purpose is to explore how the costing perspective can affect cost estimates. Method: As a vehicle for our discussion, we use service use data for clients enrolled in 6 Ontario early psychosis intervention programs. Governmental and nongovernmental payer costing perspectives are considered. We examine annual costs associated with early psychosis intervention clients enrolled for ≤12 months versus those enrolled for >12 months. This also allows for an assessment of the impact that choice of time horizon can make on the results. Results: The difference in total between group cost for hospital, emergency room, and physicians is $2499; the >12-month group has relatively higher mean costs. When all governmental and nongovernmental costs are considered, there is a mean between-group cost difference of $1272, with lower mean costs for the >12-month group. Conclusions: Although the Ministry of Health bears a large proportion of costs, other governmental agencies and the private sector can incur a sizeable share. This example demonstrates the potential importance of including other cost perspectives with the hospital sector in analyses as well as the impact of time horizon on cost estimates.

Objectives People with mental illness and type 2 diabetes are more likely to experience diabetes complications than the general population. Diabetes management can be improved with tailored lifestyle intervention content. The purpose of this pilot study was to investigate diabetes insights of mental health-care patients after participation in a tailored education intervention. Methods A 12-session diabetes education program was created to address the learning needs and challenges that people with mental illness may experience. The program was assessed through conducting interviews with 6 participants combined with quantitative data to describe the population. Interviews were transcribed verbatim, assessed for quality and coded to identify relationships and meanings between identified themes. Results Throughout the year of participation, blood sugar control and physical activity level improved for some and worsened for others. Weight remained stable and dietary intake patterns appeared to improve overall. Participants described the appropriateness of the teaching strategies and program structure developed, and all improved their understanding about diabetes and gained practical self-management knowledge. Opportunities for program improvement included extending care beyond the counselling room to address financial limitations, incorporating a practical activity component and creating opportunities for social support. Additionally, leaving some sessions as patient directed would further individualize education care. Conclusions Our study offers a concrete education program strategy that aligns with Diabetes Canada’s self-management education guidelines to support the provision of diabetes care for people with mental illness. Modifying program delivery may help to curtail the increasing rates of morbidity and mortality currently observed in this population.

In a number of countries, unemployment rates for people with psychiatric disabilities are much higher than in the general population. On the one hand, the expenses for mental health reach 3.5% of the total public health and social services budget in Quebec. On the other hand, social firms (SFs) receive government subsidies. The objective was to compare public healthcare expenses for people with psychiatric disabilities who work in SFs with those associated with people with a similar condition who are looking for a job in the competitive labour market. This study followed a retrospective comparative design and considered two groups, namely: 122 employees working in SFs and 64 individuals participating in a supported employment program as job-seekers. Two complementary datasets were used: a self-report questionnaire and public healthcare databases. The cost analysis was performed from the perspective of the public healthcare system and included outpatient visit fees to physicians, outpatient visits to health professionals other than physicians in public healthcare centres, inpatient expenses due to hospitalisations, emergency room visits and amounts reimbursed to patients for medication. Regression analyses using generalised linear models with a gamma distribution and log link were used. Our results revealed that when controlling for sociodemographic variables (gender, age, marital status, education, physical disability), global health (EuroQol EQ-5D-5L), the severity of psychiatric symptoms (18-item Brief Symptom Inventory) and self-declared primary mental health diagnosis, annual healthcare costs paid by the public insurance system were between $1,924 and $3,912 lower for people working in SFs than for the comparison group. An explanatory hypothesis is that working in SFs could act as a substitute for medical treatments such as outpatient visits and medication use. There might be a form of compensation between supporting SFs and financing the public healthcare system, which provides valuable insights for public decision-making.

Objectives People with mental illness are more likely to experience poorer outcomes with type 2 diabetes than the general population. Diabetes management can be improved when lifestyle-intervention content is tailored to the learning needs of individuals or groups. The purpose of this pilot study was to explore the perspectives of clients and providers involved with mental health care with regard to how diabetes education can effectively address the challenges that may be faced when people with mental illness engage in diabetes self-care behaviours. Methods Focus groups included 17 people with mental illness and type 2 diabetes and 21 mental health clinicians. Data were transcribed verbatim, assessed for quality and saturation and coded to identify relationships and meanings among identified themes. Results Participants described strategies concerning how to consider symptoms of mental illness and address the psychosocial challenges that people with mental illness may be more likely to experience. Teaching strategies identified by clinicians and clients that were perceived to be effective included allowing clients to guide education session content, and being flexible when providing support, identifying education topics to discuss and teaching about diabetes. Participants also emphasized the importance of empowering clients by helping them to see how sustainable behaviour changes can be achieved. Differences between the perspectives of the clients receiving mental health care and the clinicians were often related to neglecting to begin with client-driven needs assessments. Conclusions Our study offers diabetes educators a strategy for applying Diabetes Canada’s self-management education guidelines to the needs of people with mental illness by using suggestions from clients and clinicians.

Introduction Depression is one of the most prevalent mental disorders in the working population. About 10% of workers currently have at least one mental disorder; approximately 2%–7% of the workforce experiences depression. There is growing awareness of the social and economic costs of depression and its heavy workplace burden. Recognising the heterogeneity of workers’ experiences of depression, there have been suggestions to focus interventions on individual depression symptoms and symptom clusters (i.e., profiles) rather than depression severity alone. Our analyses explore the question, ‘What is the relationship between depression symptom profiles and work productivity loss?’ Methods These analyses use a population-based sample of 2219 employed adults living in Ontario, Canada. Based on PHQ-8 items, depression symptom profiles were identified using cluster analysis methods. Four work productivity loss dimensions (WPLD) were examined: (1) limitations handling time, (2) physical limitations, (3) mental-interpersonal limitations and (4) output demands limitations from the Work Limitations Questionnaire. Associations between the WPLD and the symptom profiles were examined using multiple linear regression. Results Depression symptom profile groups differed in the magnitude of productivity losses. The group experiencing the highest severity across all symptoms had 5%–20% more work productivity losses in all four WPLD compared to the other groups. The group with the most difficulty concentrating had 4%–13% greater productivity losses related to mental-interpersonal limitations than other groups. This group along with those who experienced disruption in sleep, energy, and appetite had 8%–12% greater productivity losses related to limitations handling time than other groups. Discussion Our results suggest workers have different experiences of depression. To assist workers with depression to continue being productive, attention should be paid to the combinations of types of difficulties and specific job characteristics. By understanding the specific challenges, work accommodations can be designed to target specific challenges workers face.

Common Mental Disorders (CMDs) have an extensive impact on the lives of those affected. Knowledge on how mental health problems and disorders affect workers has been accumulating over the last decade. Apart from absenteeism and long-term work disability, mental health problems affect the work functioning and productivity while present at work (presenteeism). The various stages of work disability in workers with CMDs, still at work, absent from work, and in the process of returning to work, pose different challenges to professionals and researchers alike. This presentation will highlight: emerging research methodologies in the field of work and mental health; evidence on the consequences of mental health problems for workers and employers; and evidence from evaluation studies of stay-at-work and return-to-work strategies for workers with mental health problems will be discussed.

Major depressive disorder significantly impacts work productivity.1–4 One of the ways in which work productivity losses could be curtailed is through mental health treatment.5 For example, a population-based study of Canadian workers found that those with moderate and severe depressive episodes who accessed mental health treatment were more likely to be highly productive than workers with moderate and severe depressive episodes who did not have mental health treatment.5 This suggests there is an intersection between health services and the workplace. For instance, one of the ways that employers have addressed mental health problems is by providing employees access to services through health care benefits (eg, prescription drug coverage and counseling) and programs (ie, employee assistance programs). Although there is evidence that the treatment of depression can reduce productivity losses, there is also evidence that a significant proportion of workers with depression do not use mental health services.1,5 In the general population, about 55% of people who meet the criteria for a Diagnostic and Statistical Manual, 4th revision, disorder do not use services.6 Similar patterns of non-use have been observed in the working population. Birnbaum et al1 reported that 56% of US workers with a major depressive disorder use treatment.1 Despite having a publically funded health care system that covers physician-provided mental health services, analogous patterns have been observed among Canadian workers. Estimates suggest that 57% of Canadian workers with a moderate depressive episode and about 40% with a severe depressive episode do not use treatment.5 These results suggest that cost alone may not be the most critical barrier to service. Indeed, Mojtabai et al6 identified three types of service use barriers within the general population. One was the lack of recognition that help is needed. Another was related to structural factors including finances, availability of services, and the convenience of using services. The third type was related to attitudinal factors such as wanting to handle the illness independently, perceiving that treatment was ineffective, not perceiving a need for services, and fear of stigma. They found that attitudinal barriers were more common than structural barriers. Of these attitudinal barriers, the desire to handle the illness independently was the most endorsed reason for not accessing treatment. Thus, the literature indicates that in the general population, there exists a lack of recognition for needed help as well as internal and external barriers to services for people with mental health disorders. There is also a large proportion of workers with mental disorders who do not use services. Given the impact of mental disorders on the workplace and the significant effects of treatment, are there ways that employers could address this gap? To answer this question efficiently, it will be important to understand the relative importance of the factors that contribute to the gap. Which barriers should we prioritize for action? Are they lack of recognition, structural, attitudinal, or all three? The answer to this question will be useful in designing programs to help employees increase the use of treatment. The purpose of this article is to estimate the impacts on work productivity of the three types of barriers at which interventions could be targeted to increase mental health service use among workers with depression.

Background Direct support providers (DSPs) in community residential services are often central figures in the lives of service recipients. There is little research to date focusing on what motivates these employees to remain in the field despite stressful work conditions.Methods An exploratory descriptive analysis of qualitative data obtained from semistructured interviews with 19 community residential DSPs in Ontario, Canada, was conducted. Data were analysed for modes of entry into the field and reasons for remaining.Results DSPs are motivated to remain in the sector because of the people supported, the nature of the work and the work environment, practical reasons like job security, and personal ambitions and reward. Most staff are motivated in multiple domains.Conclusion Future research can use these findings to further explore DSP work motivations and relationships to job performance and turnover. For researchers and human resource practitioners, adapting existing models and measures of organ...

Revisions to the posttraumatic stress disorder (PTSD) diagnostic criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) clarify that secondary exposure can lead to the development of impairing symptoms requiring treatment. Historically known as secondary traumatic stress (STS), this reaction occurs through repeatedly hearing the details of traumatic events experienced by others. Professionals who work therapeutically with trauma victims may be at particular risk for this exposure. This meta-analysis of 38 published studies examines 17 risk factors for STS among professionals indirectly exposed to trauma through their therapeutic work with trauma victims. Small significant effect sizes were found for trauma caseload volume (r = .16), caseload frequency (r = .12), caseload ratio (r = .19), and having a personal trauma history (r = .19). Small negative effect sizes were found for work support (r = -.17) and social support (r = -.26). Demographic variables appear to be less implicated although more work is needed that examines the role of gender in the context of particular personal traumas. Caseload frequency and personal trauma effect sizes were moderated by year of publication. Future work should examine the measurement of STS and associated impairment, understudied risk factors, and effective interventions.

Many direct support providers (DSPs) are exposed to aggressive behaviour in their work supporting adults with developmental disabilities service recipients. This is a work environment factor that has been linked to job burnout. The objective of this study was to examine the impact of positive work factors on emotional exhaustion (EE) among DSPs who are exposed to aggressive behaviour. Survey responses from 671 DSPs who were working in community service settings for adults with developmental disabilities, and were exposed to aggressive behaviour at least monthly were examined. Hierarchical linear regression examined the direct contribution and moderating role of positive work factors (self-efficacy for dealing with aggression and work contributions) on EE measured with the Maslach Burnout Inventory-Human Services Survey, after controlling for demographics, occupational variables, exposure to aggression and negative emotional reactions to aggression. Results showed that younger age, more experience, more depression/anger emotions in response to aggression, lower self-efficacy and low positive work contributions were significantly associated with EE. Positive work motivation was a moderator of exposure to aggression and EE. When work motivations were low, DSPs were more negatively affected by higher exposure to aggression. These findings suggest that in addition to addressing the negative emotional reactions to the aggressive behaviour encountered at work, it is also important to foster positive work factors which may be protective against EE.

Background There has been increasing interest in examining the relationship between physician wellbeing and quality of patient care. However, few reviews have specifically focused on resident burnout and quality of patient care. The purpose of this systematic literature review of the current scientific literature is to address the question, “How does resident burnout affect the quality of healthcare related to the dimensions of acceptability and safety?” Methods This systematic literature review uses a multi-step screening process of publicly available peer-reviewed studies from five electronic databases: (1) Medline Current, (2) Medline In-process, (3) PsycINFO, (4) Embase, and (5) Web of Science. Results The electronic literature search resulted in the identification of 4638 unique citations. Of these, 10 articles were included in the review. Studies were assessed for risk of bias. Of the 10 studies that met the inclusion criteria, eight were conducted in the US, one in The Netherlands, and one in Mexico. Eight of the 10 studies focused on patient safety. The results of these included studies suggest there is moderate evidence that burnout is associated with patient safety (i.e., resident self-perceived medical errors and sub-optimal care). There is less evidence that specific dimensions of burnout are related to acceptability (i.e., quality of care, communication with patients). Conclusions The results of this systematic literature review suggest a relationship between patient safety and burnout. These results potentially have important implications for the medical training milieu because residents are still in training and at the same time are asked to teach students. The results also indicate a need for more evidence-based interventions that support continued research examining quality of care measures, especially as they relate to acceptability. Electronic supplementary material The online version of this article (10.1186/s12909-017-1040-y) contains supplementary material, which is available to authorized users.

This exploratory and descriptive study contributes to the growing knowledge about the return-to-work (RTW) experience of head and neck cancer (HNC) survivors. Viewing RTW as a process, participants were asked to consider the work-related experience with HNC at different phases: (1) at diagnosis/pre-treatment, (2) working during treatment (if the respondent did not take a work disability leave), and (3) post-treatment/RTW (if the respondent took a work disability leave). Data were gathered in nine individual semi-structured in-depth interviews with patients receiving treatment at a quaternary cancer center's HNC clinic in Ontario, Canada. Using a constant comparative method of theme development, codes were identified in and derived from the data. Codes with similar characteristics were grouped, used to develop overarching themes, and were organized according to the RTW factors identified in the literature. Each phase has different barriers that are in turn addressed by different facilitators. As reflected in the literature, we found that RTW or the process of work continuation is complex. Many players and interactions contribute to the worker's experience. By recognizing that work-related experiences differ by phases, clinicians and employers can better support HNC survivors depending on the phase of the RTW process. Implications for Rehabilitation Our findings suggest that when rehabilitation specialists are working with survivors to develop interventions, the return-to-work phase and work context rather than diagnosis should be considered as a starting point. At every phase, supportive and empathetic managers are a key to successful work experiences for people who have been diagnosed and are being treated for head and neck cancer. Rehabilitation specialists should help survivors to seek supportive interactions with the environment that are essential to enable the ability to work

© 2017 Article author(s). Objectives This study reviews the current state of the published peer-reviewed literature related to physician burnout and two quality of care dimensions. The purpose of this systematic literature review is to address the question, € How does physician burnout affect the quality of healthcare related to the dimensions of acceptability and safety' Design Using a multiphase screening process, this systematic literature review is based on publically available peer-reviewed studies published between 2002 and 2017. Six electronic databases were searched: (1) MEDLINE Current, (2) MEDLINE In-process, (3) MEDLINE Epub Ahead of Print, (4) PsycINFO, (5) Embase and (6) Web of Science. Setting Physicians practicing in civilian settings. Participants Practicing physicians who have completed training. Primary and secondary outcome measures Quality of healthcare related to acceptability (ie, patient satisfaction, physician communication and physician attitudes) and safety (ie, minimising risks or harm to patients). Results 4114 unique citations were identified. Of these, 12 articles were included in the review. Two studies were rated as having high risk of bias and 10 as having moderate risk. Four studies were conducted in North America, four in Europe, one in the Middle East and three in East Asia. Results of this systematic literature review suggest there is moderate evidence that burnout is associated with safety-related quality of care. Because of the variability in the way patient acceptability-related quality of care was measured and the inconsistency in study findings, the evidence supporting the relationship between burnout and patient acceptability-related quality of care is less strong. Conclusions The focus on direct care-related quality highlights additional ways that physician burnout affects the healthcare system. These studies can help to inform decisions about how to improve patient care by addressing physician burnout. Continued work looking at the relationship between dimensions of acceptability-related quality of care measures and burnout is needed to advance the field.

Aim The aim of this study was to fill a gap in the literature by examining agreement on need as rated by clients and their key workers from first-episode psychosis early intervention programmes. Compared with adult populations and more chronic courses of illness, these clients may have unique needs given the onset of their illness in adolescence or early adulthood. Methods Needs agreement between clients and key workers was assessed using the Camberwell Assessment of Need in a sample of 188 client–key worker pairs recruited from six early intervention programmes in Ontario, Canada. Ratings were assessed with percentage agreement and prevalence-adjusted Cohen's kappa. Results At the aggregate level, both clients and key workers rated a mean of 2.6 unmet needs. Compared with other diagnoses, key workers rated significantly more unmet need in clients with primary psychotic disorders. Agreement between individual client and key worker ratings was highest (adjusted κ > 0.85) in the domains of telephone, risk to others, child care and accommodation. Lowest agreement (adjusted κ

Research on staff supporting individuals with intellectual and developmental disabilities (IDD) tends to focus on negative aspects of the work. This study expanded on previous research on the positive consequences that work in the IDD field has on staff using a brief version of the Staff Positive Contributions Questionnaire with 926 staff. Factor analysis suggested two factors: General positive contributions and Positive work motivation. Positive work motivation was associated with high levels of personal accomplishment, but shared limited variance with the other two burnout dimensions (emotional exhaustion, depersonalization). Findings lend support to the idea that we need to consider both positive and negative aspects of work life. This brief scale may be a useful index of how staff benefit from their work.

OBJECTIVE This article estimates the net benefit for a company incorporating a collaborative care model into its return-to-work program for workers on short-term disability related to a mental disorder. METHODS Employing a simple decision model, the net benefit and uncertainty were explored. RESULTS The breakeven point occurs when the average short-term disability episode is reduced by at least 7 days. In addition, 85% of the time, benefits could outweigh costs. CONCLUSIONS Model results and sensitivity analyses indicate that organizational benefits can be greater than the costs of incorporating a collaborative care model into a return-to-work program for workers on short-term disability related to a mental disorder. The results also demonstrate how the probability of a program's effectiveness and the magnitude of its effectiveness are key factors that determine whether the benefits of a program outweigh its costs.

Objective Economic evaluations commonly accompany trials of new treatments or interventions; however, regression methods and their corresponding advantages for the analysis of cost-effectiveness data are not well known. Methods To illustrate regression-based economic evaluation, we present a case study investigating the cost-effectiveness of a collaborative mental health care program for people receiving short-term disability benefits for psychiatric disorders. We implement net benefit regression to illustrate its strengths and limitations. Results Net benefit regression offers a simple option for cost-effectiveness analyses of person-level data. By placing economic evaluation in a regression framework, regression-based techniques can facilitate the analysis and provide simple solutions to commonly encountered challenges. Conclusions Economic evaluations of person-level data (eg, from a clinical trial) should use net benefit regression to facilitate analysis and enhance results.

Objective To examine the cost and performance implications of introducing cell-free fetal DNA (cffDNA) testing within modeled scenarios in a publicly funded Canadian provincial Down syndrome (DS) prenatal screening program. Method Two clinical algorithms were created: the first to represent the current screening program and the second to represent one that incorporates cffDNA testing. From these algorithms, eight distinct scenarios were modeled to examine: (1) the current program (no cffDNA), (2) the current program with first trimester screening (FTS) as the nuchal translucency-based primary screen (no cffDNA), (3) a program substituting current screening with primary cffDNA, (4) contingent cffDNA with current FTS performance, (5) contingent cffDNA at a fixed price to result in overall cost neutrality,(6) contingent cffDNA with an improved detection rate (DR) of FTS, (7) contingent cffDNA with higher uptake of FTS, and (8) contingent cffDNA with optimized FTS (higher uptake and improved DR). Results This modeling study demonstrates that introducing contingent cffDNA testing improves performance by increasing the number of cases of DS detected prenatally, and reducing the number of amniocenteses performed and concomitant iatrogenic pregnancy loss of pregnancies not affected by DS. Costs are modestly increased, although the cost per case of DS detected is decreased with contingent cffDNA testing. Conclusion Contingent models of cffDNA testing can improve overall screening performance while maintaining the provision of an 11- to 13-week scan. Costs are modestly increased, but cost per prenatally detected case of DS is decreased. © 2013 John Wiley & Sons, Ltd.

BACKGROUND: Whether healthcare provider burnout contributes to lower quality of patient care is unclear. PURPOSE: To estimate the overall relationship between burnout and quality of care, and to evaluate if published studies provide exaggerated estimates of this relationship. DATA SOURCES: MEDLINE, Embase, and Web of Science, with no language restrictions, from inception through May 28, 2019. STUDY SELECTION: Peer-reviewed publications published in any language that quantified healthcare provider burnout in relation to patient quality of care. DATA EXTRACTION: Two reviewers independently selected studies, extracted measures of association of burnout and quality of care, and assessed potential bias using the Ioannidis (excess significance) and Egger (small-study effect) tests. DATA SYNTHESIS: We screened 11,703 citations, selecting 123 publications with 142 study populations encompassing 241,553 healthcare providers. Relations between burnout and quality of care were highly heterogeneous (I(2) 93.4%−98.8%). Only 4 studies specified a primary outcome. Of 114 unique burnout and quality combinations, 58 indicated burnout related to poor quality of care, 6 indicated burnout related to high quality of care, and 50 showed no significant effect. Excess significance was apparent (73% observed vs 62% predicted studies with statistically significant results, P = 0.011), with this indicator of potential bias most prominent for the least rigorous quality measures of Best Practices and Quality and Safety. LIMITATIONS: Primarily observational studies; unable to determine causality or directionality. CONCLUSION: Healthcare professional burnout frequently associates with poor quality of care in the published literature. The true effect size may be smaller than reported. Future studies should pre-specify outcomes to lower the risk of exaggerated effect size estimates. FUNDING SOURCES: Stanford Maternal and Child Health Research Institute (PI: Tawfik), Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01 HD084679–01, PIs: Profit and Sexton)