Socioeconomic and gender inequalities in mental disorders among adolescents and young adults.

BACKGROUND: Socioeconomic status (SES) and gender play a key role in mental health. The objective of this study was to assess socioeconomic and gender mental health inequalities in adolescents and young adults using a population-based registry. MATERIALS AND METHODS: We conducted a lifetime follow-up study of all residents in the Basque Country between 1 and 30 years old (n=609,381) as of 31 December 2018. Primary care, specialized outpatient, and hospital care records were searched for diagnoses. SES was assessed based on household income. We estimated disaggregated lifetime prevalence of substance use, behaviour, anxiety, depression, psychosis, and attention deficit hyperactivity disorder. The local Institute of Statistics validated the mortality data. The likelihood of risks was estimated using logistic regression. RESULTS: Overall, 96,671 individuals (15.9%) had a diagnosed mental disorder, with clear gradients by gender and SES. Females of medium-to-high SES had the lowest prevalence of all mental disorders, except anxiety and depression. This group was followed by males of the same SES and females of low SES, while the highest prevalence of mental disorders was observed in low-SES males. The lower income categories had higher risks of psychiatric admission (adjusted odds ratio [AOR]: 3.64 for females; 6.66 for males) and death (AOR: 5.42). People with a mental health diagnosis had higher mortality (AOR: 2.38). CONCLUSIONS: Our work evidenced important SES and gender inequalities in the mental health and premature mortality of adolescents and young adults, findings that should drive the development and implementation of early preventive interventions.

Cost-utility analysis of the UPRIGHT intervention promoting resilience in adolescents.

BACKGROUND: As mental health in adulthood is related to mental status during adolescence, school-based interventions have been proposed to improve resilience. The objective of this study was to build a simulation model representing the natural history of mental disorders in childhood, adolescence and youth to estimate the cost-effectiveness of the UPRIGHT school-based intervention in promoting resilience and mental health in adolescence. METHODS: We built a discrete event simulation model fed with real-world data (cumulative incidence disaggregated into eight clusters) from the Basque Health Service database (609,381 individuals) to calculate utilities (quality-adjusted life years [QALYs]) and costs for the general population in two scenarios (base case and intervention). The model translated changes in the wellbeing of adolescents into different risks of mental illnesses for a time horizon of 30 years. RESULTS: The number of cases of anxiety was estimated to fall by 5,125 or 9,592 and those of depression by 1,269 and 2,165 if the effect of the intervention lasted 2 or 5 years respectively. From a healthcare system perspective, the intervention was cost-effective for all cases considered with incremental cost-utility ratios always lower than €10,000/QALY and dominant for some subgroups. The intervention was always dominant when including indirect and non-medical costs (societal perspective). CONCLUSIONS: Although the primary analysis of the trial did not did not detect significant differences, the UPRIGHT intervention promoting positive mental health was dominant in the economic evaluation from the societal perspective. Promoting resilience was more cost-effective in the most deprived group. Despite a lack of information about the spillover effect in some sectors, the economic evaluation framework developed principally for pharmacoeconomics can be applied to interventions to promote resilience in adolescents. As prevention of mental health disorders is even more necessary in the post-coronavirus disease-19 era, such evaluation is essential to assess whether investment in mental health promotion would be good value for money by avoiding costs for healthcare providers and other stakeholders.

Psychometric characteristics of the Spanish version of the Barthel Index.

BACKGROUND: The Barthel Index is one of the most employed questionnaires for the evaluation of functionality, but there is no information on its psychometric properties. OBJECTIVE: The aim was to evaluate the reliability, validity, and responsiveness of the Spanish version of the Barthel Index. METHODS: The data employed in this paper were obtained from four Spanish cohorts of elderly people of 60 years or older. We collected data on age, gender, education level, comorbidities, and questionnaires regarding functionality, health-related quality of life, depression, and social support. RESULTS: The Cronbach's alpha coefficients were greater than 0.70. The confirmatory factor analysis provided satisfactory fit indexes and factor loadings. The correlation coefficients between the Barthel Index and the other questionnaires were lower than the Cronbach's alpha coefficients. Known-groups validity showed significant differences in the Barthel Index according to age, number of comorbidities, and gender. The standardized effect size and the standardized response mean were between 0.68 and 1.81. DISCUSSION: This version of the Barthel Index has good reliability, its structural validity has been confirmed, and the questionnaire can discriminate between groups and detect changes at follow-up points. CONCLUSIONS: This questionnaire can be used in the evaluation of functionality and basic activities of daily living in elderly people with different conditions.

Quality of life among caregivers of patients with eating disorders.

PURPOSE: To analyse health-related quality of life (HRQoL) and its associated social and clinical variables among a sample of caregivers of patients with eating disorders (ED). METHODS: It is a cross-sectional study involving 145 patients receiving outpatient treatment for an ED and 246 related caregivers. ED patients completed two self-administered questionnaires: the Health-Related Quality of Life in ED-short form and Eating Attitudes Test-26 questionnaires. Caregivers completed four self-administered questionnaires: the Short Form-12, Involvement Evaluation Questionnaire-EU version, Hospital Anxiety and Depression Scale and Anorectic Behaviour Observation Scale. Descriptive statistics, ANOVA, Chi-square and Fisher's exact test were applied to examine the inter-variable relationships. RESULTS: Caregivers had low scores on the mental health component of the SF-12 (P < 0.05). Low SF-12 scores were associated with a greater perceived care burden in the stress domains in interpersonal relationships (beta = -0.360, SE = 0.162, P = 0.029) and the need to urge their sick relatives to undertake healthful activities (beta = -0.340, SE = 0.155, P = 0.031). CONCLUSIONS: Low scores in the mental health domain of HRQoL among caregivers of patients with EDs indicate the need to pay particular attention to caregivers' emotional status, especially among mothers and partners.