Tagmental health

Reading of the Week: Pushing Past the Headlines – Substances & Health Services, and Medically Assisted Death & Cost Savings

From the Editor

It makes sense that those with substance use problems and mental illness consume more health resources – but how much more? As Canadians opt for medical assistance in dying, what will the impact be on health spending?

Readings don’t necessarily follow a theme. But this week, we push past newspaper headlines to consider two topical issues in more detail, tapping the latest in the literature.

Pushing past the headlines

In the first paper, Graham et al. consider health costs and utilization for people with mental health and/or substance use problems. Spoiler alert: these individuals are much more likely to use health services, resulting in higher costs. That’s not exactly a surprise, but Graham et al. provide a detailed analysis in an area that has been understudied.

In the second paper, drawing from Dutch data, Trachtenberg and Manns estimate the savings from medically assisted death.

Both papers are timely. Both reach interesting conclusions.

DG Continue reading

Reading of the Week: Depression: Is There an App for That?

Depression is a serious, common, and recurring disorder linked to diminished functioning, quality of life, medical morbidity, and mortality. There has been a 37.5% increase in health life years lost to depression over the past two decades. Depression was the third-leading cause of global burden of disease in 2004 and the leading cause of burden of disease in high- and middle-income countries. It is projected to be the leading cause globally in 2030. While effective treatments for depression are available, they are underused. Barriers to treatment include geography, socioeconomic status, system capacity, treatment costs (direct and indirect), low mental health literacy, cultural beliefs, and stigma. A 2010 study found that 75% of primary care patients with depression in urban areas could identify more than one structural, psychological, cultural, or emotional barrier to accessing behavioral treatments. The rate was substantially higher in rural areas.

So begins a new paper that considers an old problem – the difficulty of patients accessing mental health care.

But this paper is different. It considers a modern approach to access: smartphone and tablet applications (or apps) for depression. And it’s not just the topic that is so modern with this week’s Reading. Consider: the paper was published in a new journal, JMIR mHealth and uHealth, available only on-line, and focused on the very modern topic of mobile health. (This journal is a spin-off of JMIR, the Journal of Medical Internet Research, itself a relatively new journal, which boasts an impact factor of 4.7 in 2013.)

This week’s Reading: “Finding a Depression App: A Review and Content Analysis of the Depression App Marketplace” by Nelson Shen et al. In it, the authors seek to shed light on a poorly studied area. As they note early in the paper, despite the incredible popularity of apps, only one recent systemic review looked at depression apps, and included just 4 papers. And so, Shen et al. consider apps for depression, drawing out common characteristics and purposes.

This is, then, an important topic. The potential here is great: with so many of our patients empowering themselves with apps, those with depression could potentially access good information, screening tools and even treatments such as CBT.

What did Shen et al. find in their paper? It’s best summarized by the old Roman phrase caveat emptor (let the buyer beware). Continue reading