Association of cannabis use with the development of elevated anxiety symptoms in the general population: a meta-analysis.

BACKGROUND: The directionality and magnitude of the association of cannabis use with elevated anxiety symptoms in the general population is unclear. The aim of this meta-analysis was to investigate the association of cannabis use with the development of elevated anxiety symptoms in the general population. METHODS: A 'random effects' meta-analysis of prospective longitudinal studies was undertaken in line with Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Six databases were systematically searched up until 20 May 2016: PsycINFO, MEDLINE, EMBASE, CINAHL Plus, Social Science Citation Index and System for Information on Grey Literature in Europe (SIGLE). Searching ceased on 20 May 2016. The exposure was cannabis use (or use frequency), measured at baseline and the outcome was anxiety, using diagnosis or cut-off points on standardised scales measuring symptoms. RESULTS: The main analysis (k=10; N=58 538) demonstrated an association of cannabis use with anxiety, with a very small OR of 1.15 (95% CI 1.03 to 1.29). Restricting the analysis to high-quality studies (k=5) decreased the OR considerably (OR=1.04; 95% CI 0.91 to 1.19), as did adjusting for publication bias (OR=1.08; 95% CI 0.94 to 1.23). Studies with a baseline in the last 10 years yielded a lower pooled OR than studies with an earlier baseline and studies set in the Americas yielded a markedly higher pooled OR than European studies and Australasian studies. CONCLUSIONS: The findings indicate that cannabis use is no more than a minor risk factor for the development of elevated anxiety symptoms in the general population. They may inform the debate surrounding the legalisation of cannabis.

Capturing patients' needs in casemix: a systematic literature review on the value of adding functioning information in reimbursement systems.

BACKGROUND: Contemporary casemix systems for health services need to ensure that payment rates adequately account for actual resource consumption based on patients' needs for services. It has been argued that functioning information, as one important determinant of health service provision and resource use, should be taken into account when developing casemix systems. However, there has to date been little systematic collation of the evidence on the extent to which the addition of functioning information into existing casemix systems adds value to those systems with regard to the predictive power and resource variation explained by the groupings of these systems. Thus, the objective of this research was to examine the value of adding functioning information into casemix systems with respect to the prediction of resource use as measured by costs and length of stay. METHODS: A systematic literature review was performed. Peer-reviewed studies, published before May 2014 were retrieved from CINAHL, EconLit, Embase, JSTOR, PubMed and Sociological Abstracts using keywords related to functioning ('Functioning', 'Functional status', 'Function*, 'ICF', 'International Classification of Functioning, Disability and Health', 'Activities of Daily Living' or 'ADL') and casemix systems ('Casemix', 'case mix', 'Diagnosis Related Groups', 'Function Related Groups', 'Resource Utilization Groups' or 'AN-SNAP'). In addition, a hand search of reference lists of included articles was conducted. Information about study aims, design, country, setting, methods, outcome variables, study results, and information regarding the authors' discussion of results, study limitations and implications was extracted. RESULTS: Ten included studies provided evidence demonstrating that adding functioning information into casemix systems improves predictive ability and fosters homogeneity in casemix groups with regard to costs and length of stay. Collection and integration of functioning information varied across studies. Results suggest that, in particular, DRG casemix systems can be improved in predicting resource use and capturing outcomes for frail elderly or severely functioning-impaired patients. CONCLUSION: Further exploration of the value of adding functioning information into casemix systems is one promising approach to improve casemix systems ability to adequately capture the differences in patient's needs for services and to better predict resource use.

The effectiveness of interventions targeting the stigma of mental illness at the workplace: a systematic review.

BACKGROUND: The majority of people experiencing mental-health problems do not seek help, and the stigma of mental illness is considered a major barrier to seeking appropriate treatment. More targeted interventions (e.g. at the workplace) seem to be a promising and necessary supplement to public campaigns, but little is known about their effectiveness. The aim of this systematic review is to provide an overview of the evidence on the effectiveness of interventions targeting the stigma of mental illness at the workplace. METHODS: Sixteen studies were included after the literature review. The effectiveness of anti-stigma interventions at the workplace was assessed by examining changes in: (1) knowledge of mental disorders and their treatment and recognition of signs/symptoms of mental illness, (2) attitudes towards people with mental-health problems, and (3) supportive behavior. RESULTS: The results indicate that anti-stigma interventions at the workplace can lead to improved employee knowledge and supportive behavior towards people with mental-health problems. The effects of interventions on employees' attitudes were mixed, but generally positive. The quality of evidence varied across studies. CONCLUSIONS: This highlights the need for more rigorous, higher-quality evaluations conducted with more diverse samples of the working population. Future research should explore to what extent changes in employees' knowledge, attitudes, and supportive behavior lead to affected individuals seeking help earlier. Such investigations are likely to inform important stakeholders about the potential benefits of current workplace anti-stigma interventions and provide guidance for the development and implementation of effective future interventions.

A systematic review of the predictors of health service utilisation by adults with mental disorders in the UK.

OBJECTIVES: To identify variables that predict health service utilisation (HSU) by adults with mental disorders in the UK, and to determine the evidence level for these predictors. DESIGN: A narrative synthesis of peer-reviewed studies published after the year 2000. The search was conducted using four databases (ie, PsycINFO, CINAHL Plus with full text, MEDLINE and EMBASE) and completed on 25 March 2014. SETTING: The majority of included studies were set in health services across primary, secondary, specialist and inpatient care. Some studies used data from household and postal surveys. PARTICIPANTS: Included were UK-based studies that predicted HSU by adults with mental disorders. Participants had a range of mental disorders including psychotic disorders, personality disorders, depression, anxiety disorders, eating disorders and dementia. PRIMARY OUTCOME: A wide range of HSU outcomes were examined, including general practitioner (GP) contacts, medication usage, psychiatrist contacts, psychotherapy attendances, inpatient days, accident and emergency admissions and 'total HSU'. RESULTS: Taking into account study quality, 28 studies identified a range of variables with good preliminary evidence supporting their ability to predict HSU. Of these variables, comorbidity, personality disorder, age (heterogeneous age ranges), neurotic symptoms, female gender, a marital status of divorced, separated or widowed, non-white ethnicity, high previous HSU and activities of daily living, were associated with increased HSU. Moreover, good preliminary evidence was found for associations of accessing a primary care psychological treatment service and medication use with decreased HSU. CONCLUSIONS: The findings can inform decisions about which variables might be used to derive mental health clusters in 'payment by results' systems in the UK. The findings also support the need to investigate whether combining broad diagnoses with care pathways is an effective method for mental health clustering, and the need for research to further examine the association between mental health clusters and HSU.

Cross-sectional associations of depressive symptom severity and functioning with health service use by older people in low-and-middle income countries.

BACKGROUND: Comprehensive understanding of the determinants of health service use (HSU) by older people with depression is essential for health service planning for an ageing global population. This study aimed to determine the extent to which depressive symptom severity and functioning are associated with HSU by older people with depression in low and middle income countries (LMICs). METHODS: A cross-sectional analysis of the 10/66 Dementia Research Group population-based surveys dataset. Participants (n = 4590) were those aged 65 or older, in the clinical range for depressive symptoms (defined as scoring four or more on the EURO-D), living in 13 urban and/or rural catchment areas in nine LMICs. Associations were calculated using Poisson regression and random-effects meta-analysis. RESULTS: After adjustment for confounding variables, (EURO-D) depressive symptom severity was significantly associated with "any community HSU" (Pooled Prevalence Ratios = 1.02; 95% CI = 1.01-1.03) but not hospital admission. Conversely, after adjustment, (WHODAS-II) functioning was significantly associated with hospital admission (Pooled PR = 1.14; 95% CI = 1.02-1.26) but not "any community HSU". CONCLUSIONS: Depressive symptom severity does not explain a large proportion of the variance in HSU by older people with depression in LMICs. The association of functioning with this HSU is worthy of further investigation. In LMICs, variables related to accessibility may be more important correlates of HSU than variables directly related to health problems.