Economic Burden Of Depression: An Empirical Study Based On Inpatients From One Tertiary Mental Health Hospital In Shanghai

Depression is one of worldwide concerns for public health. According to WHO, it will be the second cause of mortality and disability in 2020. Its negative impact on physical, functional and social attribute can be serious if not detected in time, and the consequence could be even worse in terms of suicide, economic burden on families and the country as a whole.To analyze the structure of and factors influencing the economic burden of depression, this study conducted an economic evaluation. During Mar 1st and Dec 31st, data of 226 inpatients and 197 carers were collected, covering demographic and economic items. Through SPSS 13.0, T-test, ANOVA and regression analysis were employed to detect the main influencing factors and raise certain suggestions to relieve the economic burden of depression.I main findings1. Characteristics and treatment situation of depression inpatientsOf all the respondents, female inpatients are 1.4 times as much as male inpatients, average age is 41,31.0% have household genetic history,69.0% have covered by differeent social security schemes, and 42.9% have hospitalized more than once, which shows a high recurrence rate.76.1% have difficulties in learning, house working and social activities, quality of live is under great pressure due to direct and indirect economic burden.Treatment choices show that 65.5% of the inpatients used one medicine and 34.5% used comprehensive treatment, such as a combination of medicine, psychotherapy and ECT. Further analysis shows that comprehensive treatment is more effective for readmission inpatients.45.1% of the inpatients used SSRIs medicine and 23.0% adopted SNRIs. This figure shows that advanced medicine with fewer side effects is widely used.2. Main factors influencing economic burden for inpatients Annual total cost is 70387.4 Yuan, of which 64.0% is indirect cost,30.0% is direct medical cost and 6.0% is direct non-medical cost. Indirect cost is the major burden for individuals and families. Regression of logarithmic transformation of expenditure shows that outpatient visits is major factor influencing outpatient cost. Times of hospitalization, length of stay and medical treatment are major factors influencing hospitalization cost. Occupation, region, outpatient visits and household income are major factors influencing direct non-medical treatment cost. Length of stay is major factor influencing indirect cost. Occupation, outpatient visits, times of hospitalization and length of stay are major factors influencing total cost.Length of stay is positively related with hospitalization cost, indirect cost and total cost. Hospitalization cost and total cost incurred in the past 12 months for patients that hospitalized more than once are higher than that of patients who had onehospitalization. Patients with more outpatient visits spent more in terms of outpatient cost, direct non-medical cost and total cost. Direct non-medical cost and total cost for patients with job are higher than that of patients who are not employed. Patients from other regions and with higher household income cost more than did the local patients in terms of direct non-medical cost. Combination of medicine, psychotherapy and ECT also cost higher in terms of hospitalization cost. All these comparisons are significant statistically. Economic burden is likely to decrease with lower rate of recurrence, outpatient visits, hospitalization and length of stay.â…¡Suggestions1. For government, public health policy should be set up and input should be added.Specific fiscal input should be formulated to aid patients. Ensuring delivery of medicine and reasonable pricing would be helpful. And depression medicine should be covered by social security and reimbursement should be increased. The centralized planning of mental health institution should be carried out to optimize resources and provide better access to care, and lower non-medical cost. The three-layer of mental health institution system should be established, especially for the information integration among all care providers. Social network is of great helpful for providing continued, dynamic and sustainable mental health services. Setup of Act of mental health should be speed up to facilitate provision of mental health services and protect patients' right and the sustainable, healthy and swift development of mental health services.2. Detection, diagnosis and treatment should be set priority in early stage and medical staffs should be trained to enhance service capacity. Economic research on process, cost, and treatment should be encouraged to formulate clinical pathway for the relief of pain and length of stay and to contain economic burden.Training resident physician and specialties should be centralized. Early detection, diagnosis, reasonable treatment, and control of recurrence are critical. Furthermore, internal management should be strengthened in terms of optimizing process, lowering length of stay and patients foremost to solve the problem of "difficulty and expensive for seeking medical treatment".3. Propaganda should be carried out through various media.Community-based propaganda should use newspaper, TV and internet to disseminate education and increase awareness of depression. Self-control, such as maintaining fair psychological condition, should be the priority of propaganda. This is also important to eliminate bias towards depression and establish social security system and contain non-medication rate and recurrence rate.