Correspondence

Economic crisis and mental health in Spain

We examine the linkages between fiscal austerity and life satisfaction across twelve European countries using a sample of repeated cross-sections of individuals from 1999 to 2014. Austerity policies may trigger several responses at both the macro and micro-level, which in turn may affect life satisfaction directly or indirectly. We employ mediation analysis to account for these complex relationships linking austerity to an individual’s life satisfaction, their economic expectations and their likelihood of unemployment. We find that austerity policies primarily affect individual life satisfaction via the economic expectations channel. Austerity dampens optimism about the future and this response has a negative effect on life satisfaction across a range of measures of economic expectations. In addition, our results suggest that changes in government expenditure, as opposed to taxation, matter for life satisfaction.

Coronavirus disease 2019 (COVID-19) was declared as pandemic and measures adopted for its control included quarantine of at-risk, isolation of infected along with other measures such as lockdown, restrictions on movement, and social interactions. Both the pandemic and these measures have the potential to cause mental health problems among individuals.

The present study aimed to investigate and estimate the prevalence of psychological well-being, particularly from an Indian perspective using systematic review and meta-analysis of existing literature.

We searched in the PubMed database, starting from the onset of the current pandemic and until 10th October 2020 to synthesize evidence on mental health outcomes from India. DerSimonian and Laird method of the random-effects meta-analysis was employed and heterogeneity between studies was assessed using the Chi-square based Cochran's Q statistic and I-squared (I²) statistics.

The pooled prevalence of stress in nine studies was 60.7% (95% CI: 42.3%–77.7%), depression in eight studies was 32.7% (95% CI: 24.6%–41.3%), anxiety in six studies was 34.1% (95% CI: 26.3%–42.3%) and sleep disturbances in six studies was 26.7% (95% CI: 13.9%–41.8%). As expected, high heterogeneity was observed in the above-mentioned outcomes. Sub-group analysis showed that Health Care Workers (HCWs) had a higher prevalence of stress, anxiety, depression & psychological distress in comparison to the general population.

A significant impact on psychological well-being during COVID-19 was observed in India as common adverse outcomes were stress (61%), psychological distress (43%), anxiety (34%), depression (33%), and sleep disturbances (27%). Thus the COVID-19 pandemic represents an unprecedented threat to mental health, which should become a priority for public health strategies.

The current coronavirus pandemic (COVID-19) has led the world toward severe socio-economic crisis and psychological distress. It has severely hit the economy; but the service sector, particularly the hospitality industry, is hard hit by it. It increases the sense of insecurity among the employees and their perception of being unemployed, adversely affecting their mental health. This research aims to contribute to the emerging debate by investigating the effect of economic crisis and non-employability on employees’ mental health through perceived job insecurity under the pandemic situation. It empirically examines the underlying framework by surveying 372 employees of the hospitality industry during COVID-19. Results indicate that perceived job insecurity mediates the relationship of fear of economic crisis, non-employability, and mental health. Furthermore, the contingency of fear of COVID-19 strengthens the indirect relationship of fear of economic crisis on mental health through perceived job insecurity. The findings will provide a new dimension to the managers to deal with the psychological factors associated with the employees’ mental health and add to the emerging literature of behavioral sciences. The study also highlights the increasing need for investment in the digital infrastructure and smart technologies for the hospitality industry.

The unpredictability and uncertainty of the COVID-19 pandemic; the associated lockdowns, physical distancing, and other containment strategies; and the resulting economic breakdown could increase the risk of mental health problems and exacerbate health inequalities. Preliminary findings suggest adverse mental health effects in previously healthy people and especially in people with pre-existing mental health disorders. Despite the heterogeneity of worldwide health systems, efforts have been made to adapt the delivery of mental health care to the demands of COVID-19. Mental health concerns have been addressed via the public mental health response and by adapting mental health services, mostly focusing on infection control, modifying access to diagnosis and treatment, ensuring continuity of care for mental health service users, and paying attention to new cases of mental ill health and populations at high risk of mental health problems. Sustainable adaptations of delivery systems for mental health care should be developed by experts, clinicians, and service users, and should be specifically designed to mitigate disparities in health-care provision. Thorough and continuous assessment of health and service-use outcomes in mental health clinical practice will be crucial for defining which practices should be further developed and which discontinued. For this Position Paper, an international group of clinicians, mental health experts, and users of mental health services has come together to reflect on the challenges for mental health that COVID-19 poses. The interconnectedness of the world made society vulnerable to this infection, but it also provides the infrastructure to address previous system failings by disseminating good practices that can result in sustained, efficient, and equitable delivery of mental health-care delivery. Thus, the COVID-19 pandemic could be an opportunity to improve mental health services.

We aimed at describing the trends in antidepressants use (AD) by age and sex, during 2007–2011, in 5 European settings (Sweden, Norway, Denmark, Catalonia and Veneto), and to assess whether the differences found across settings could be related to economic, social and cultural determinants.

We collected data of AD use expressed in defined daily doses (DDD). Data were retrieved from population-based databases. We calculated DDD/1000 inhabitants/day. We analysed which economic, social, and cultural covariates determined between-settings differences in AD consumption.

The use of AD showed an increasing trend during the study period, being Selective Serotonin Reuptake Inhibitors the most consumed, followed “others AD”. Women and the elderly showed the highest AD consumption. Between-settings variability in AD consumption showed a positive correlation with pharmaceutical expenditure and a negative one with general practitioner's rate. After adjusting by pharmaceutical expenditure and general practitioners rate Masculinity, Long-Term Orientation and Individualism cultural dimensions were associated with AD use by using the Hofstede´s cultural dimensions model.

This study has been conducted in administrative databases, with no information on AD use by indication; differences among AD use could be related to their prescription for other disorders. Analyses were based on a small dataset and none of the results reached statistical significance.

AD use increased through 2007–2011. Pharmaceutical expenditure and General Practitioners rate, Masculinity, Long-Term Orientation and Individualism explained the differences in AD use between countries. People's attitude should be considered when designing national campaigns to improve antidepressant use.

The Spanish five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) valuation study was the first to use the EuroQol Valuation Technology protocol, including composite time trade-off (C-TTO) and discrete choice experiments (DCE). In this study, its investigators noticed that some interviewers did not fully explain the C-TTO task to respondents. Evidence from a follow-up study in 2014 confirmed that when interviewers followed the protocol, the distribution of C-TTO responses widened.

To handle the data quality issues in the C-TTO responses by estimating a hybrid interval regression model to produce a Spanish EQ-5D-5L value set.

Four different models were tested. Model 0 integrated C-TTO and DCE responses in a hybrid model and models 1 to 3 altered the interpretation of the C-TTO responses: model 1 allowed for censoring of the C-TTO responses, whereas model 2 incorporated interval responses and model 3 included the interviewer-specific protocol violations. For external validation, the predictions of the four models were compared with those of the follow-up study using the Lin’s concordance correlation coefficient.

This stepwise approach to modeling C-TTO and DCE responses improved the concordance between the valuation and follow-up studies (concordance correlation coefficient: 0.948 [model 0], 0.958 [model 1], 0.952 [model 2], and 0.989 [model 3]). We recommend the estimates from model 3, because its hybrid interval regression model addresses the data quality issues found in the valuation study.

Protocol violations may occur in any valuation study; handling them in the analysis can improve external validity. The resulting EQ-5D-5L value set (model 3) can be applied to inform Spanish health technology assessments.