The socio-economical burden of schizophrenia: a simulation of cost-offset of early intervention program in Italy.

Schizophrenia is associated with a high familiar, social and economic burden. During the recent years early and specific intervention for first psychotic episodes has been suggested to improve the long term outcome of the disease. Despite the promising results obtained so far, early intervention is still scarcely applied. One major problem arises from the translation of research findings into stakeholder policies. In fact very few analyses of cost reductions obtained with early intervention have been reported. In the present paper we present a simulation of direct cost reduction that can be obtained with early intervention programmes. We based our analysis on available data about schizophrenia care costs in Italy and the expected cost reduction with the use of early intervention. We observed that the increase in costs due to the more intensive early intervention is largely compensated by the reduction of inpatient admissions with a reduction of direct costs of 6.01%. Despite the apparently small economic gain, early intervention offers more clinical and social benefits as it seems to be effective also in decreasing relapse rates, in improving the patients' quality of life and disability associated with psychosis and in increasing employment rates. Those indirect costs however are difficult to estimate and were not included in our model. In conclusion, our study supports the use of early intervention in schizophrenia, which could allow an outcome improvement with lower direct and indirect costs.

Depression and frequent attendance in elderly primary care patients.

OBJECTIVE: The aim of this study is to investigate the association between depression and frequent attendance in elderly primary care patients. Moreover, we compare the prevalence and clinical characteristics of frequent attenders (FAs) in the elderly and the nonelderly patients. METHODS: This nationwide, cross-sectional, two-phase epidemiological study involved 191 primary care physicians (PCPs) and 1896 patients aged 14 and over. We consider FAs those subjects attending PCP practice more than once a month in the last 6 months. Screening for psychiatric disorders was conducted by using the General Health Questionnaire-12. Subsequently, probable cases were assessed by the PCPs with the WHO ICD-10 Checklist for Depression. RESULTS: Prevalence value of frequent attendance was 22.4% in the elderly. Depression was associated with frequent attendance in the elderly even after controlling for physical illness and unexplained somatic complaints. The risk for being an FA was more than twofold in the elderly than in the nonelderly (cOR=2.58; 95% confidence interval, 1.97-3.37). Considering subjects without medical illness, depression increased the risk of being an FA fivefold among the elderly and threefold among the nonelderly. CONCLUSION: Frequent attendance in primary care is associated with depressive disorder in the elderly. Depression seems to play a more important role in determining frequent attendance in the elderly patients in respect to the nonelderly.

Increased recognition of depression in primary care. Comparison between primary-care physician and ICD-10 diagnosis of depression.

BACKGROUND: Underrecognition and undertreatment of depression in primary care has been regarded as a major public health problem. In contrast, some studies found that among patients labeled as depressed by primary-care physicians (PCPs), a relevant proportion do not satisfy international diagnostic criteria for depression. The aims of this study are: (1) to assess disparity between PCP diagnosis and research diagnosis of depression; (2) to compare antidepressant treatment in concordant and discordant cases of depression. METHODS: Data are gathered from a national survey on depressive disorders in primary care, conducted with the collaboration of 191 PCPs. Three hundred and sixty-one PCP patients were evaluated, and their psychiatric diagnosis was established by the 'unaided' PCPs and by using a research interview for depression. RESULTS: PCPs recognized 79.4% of cases of depression and prescribed antidepressants to 40.9% of them. Yet, 45.0% of patients labeled as depressed by the PCPs were not cases of depression according to ICD-10 criteria; 26.9% of false-positive cases received an antidepressant. Globally, 35% of antidepressants for 'depression' were prescribed to false-positive cases. CONCLUSIONS: Underrecognition and undertreatment of depression in primary care seem to be less alarming. Conversely, PCP diagnoses of depression appear to be more inclusive than psychiatric diagnostic criteria. A possible consequence of this apparently more inclusive diagnostic threshold may be an excessive use of antidepressants. These changes require a corresponding change in research, toward efficacy and safety of the treatment of milder cases, and in education, toward the distinction between the management of mild and severe cases of depression.