Mental Health Costs Research Articles

How much time, effort and money is spent caring for wombats?

Wildlife care and rehabilitation are undertaken by thousands of volunteers throughout Australia every year. Bare-nosed (Vombatus ursinus) and southern hairy-nosed wombats (Lasiorhinus latifrons) regularly come into care, with the demands on wombat carers and the numbers of wombats increasing. Understanding the burdens placed on wombat carers and rehabilitators will provide information to wildlife managers to assess the risks to wombats and document the concerns of wildlife carers. Data were collected via an online quantitative and qualitative survey using Qualtrics. The survey was distributed through Facebook groups to wombat carers and rehabilitators and received 22 responses. The survey confirmed that caring for wombats is time-consuming and expensive, particularly when raising wombat joeys. Both adult and juvenile wombats were brought into care; the most common reasons were vehicle collisions, sarcoptic mange, and injuries resulting from dog or wombat attacks. Despite the significant financial and mental health costs to wombat carers, in most cases, carers thought young wombats that came into care were successfully rehabilitated and re-introduced into their natural habitat. Our study provides insights into the issues facing wombats, the people that care for wombats, and the wider carer sector.

How Do People Make Sense of Intimate Partner Violence (IPV) in the Context of Perpetrator PTSD Diagnostic Status and Gender Identity?

Background: Intimate partner violence (IPV) has profound effects on victim physical and mental health, considerable social and economic costs and is a significant public health concern. Research suggests that the way the public make sense of IPV may vary in different contexts, as certain contextual factors may be used to explain, excuse or legitimise IPV. PTSD diagnostic status and perpetrator gender may be such contextual factors, but little research exists in this area. Objectives: This study explored how the public make sense of IPV in the context of perpetrator diagnostic status (PTSD or no PTSD) and gender identity (female, male or nonbinary) by exploring IPV ratings and IPV discourses. Methods: Two hundred and sixty-five (265) community participants were recruited via snowball sampling and presented one of six versions of the same story containing an account of IPV. Stories were identical across conditions bar perpetrator diagnostic status and gender identity. Participants rated the degree to which they thought the behaviour in the story constituted IPV. Approximately half the participants also completed a story completion task, and stories were analysed for themes. Results: IPV ratings were weighted towards abuse and did not vary with diagnostic status or gender identity. Five themes were identified in participant stories: (i) characterise the behaviour; (ii) trajectory of IPV; (iii) show compassion towards victim of IPV; (iv) hold victim of IPV responsible; and (v) context influences decision-making. Limitations, implications and directions for future research are discussed.

Proceedings from a National Summit on Workplace Mental Health and Well-Being: A Focus on the Graduate Academic Environment.

To spotlight the challenges, gaps, and opportunities to improve workforce mental health and well-being in higher education institutions (HEIs). We convened a full-day summit of subject matter experts from academia, business, government, and practice to share research and best practices on workplace mental health. Highlights from the summit are presented in this paper covering the importance of leadership and culture; the mental health costs associated with being a Black STEM scholar; the role of the environment; case studies of three university mental health and well-being programs; and the future of work. Establishing a culture of caring requires leadership commitment; strategic planning; accountability and shared responsibility; and measurement and evaluation. HEI leaders are called to lead by example; foster community partnerships; adopt a Total Worker Health framework; and regularly evaluate progress.

Clinical and cost-effectiveness of remote-delivered, online lifestyle therapy versus psychotherapy for reducing depression: results from the CALM non-inferiority, randomised trial

We conducted the first non-inferiority, randomised controlled trial to determine whether lifestyle therapy is non-inferior to psychotherapy with respect to mental health outcomes and costs when delivered via online videoconferencing. An individually randomised, group treatment design with computer-generated block randomisation was used. Between May 2021-April 2022, 182 adults with a Distress Questionnaire-5 score=≥8 (indicative depression) were recruited from a tertiary mental health service in regional Victoria, Australia and surrounds. Participants were assigned to six 90-min sessions over 8-weeks using group-based, online videoconferencing comprising: (1) lifestyle therapy (targeting nutrition, physical activity) with a dietitian and exercise physiologist (n=91) or (2) psychotherapy (Cognitive Behavioural Therapy) with psychologists (n=91). The primary outcome was Patient Health Questionnaire-9 (PHQ-9) depression at 8-weeks (non-inferiority margin ≤2) using Generalised Estimating Equations (GEE). Cost-minimisation analysis estimated the mean difference in total costs from health sector and societal perspectives. Outcomes were assessed by blinded research assistants using Computer Assisted Telephone Interviews. Results are presented per-protocol (PP) and Intention to Treat (ITT) using beta coefficients with 95% Confidence Intervals (CIs). The sample was 80% women (mean: 45-years [SD:13.4], mean PHQ-9:10.5 [SD:5.7]. An average 4.2 of 6 sessions were completed, with complete data for n=132. Over 8-weeks, depression reduced in both arms (PP: Lifestyle (n=70) mean difference:-3.97, 95% CIs:-5.10,-2.84; and Psychotherapy (n=62): mean difference:-3.74, 95% CIs:-5.12,-2.37; ITT: Lifestyle (n=91) mean difference:-4.42, 95% CIs:-4.59,-4.25; Psychotherapy (n=91) mean difference:-3.82, 95% CIs:-4.05,-3.69) with evidence of non-inferiority (PP GEE β:-0.59; 95% CIs:-1.87, 0.70, n=132; ITT GEE β:-0.49, 95% CIs:-1.73, 0.75, n=182). Three serious adverse events were recorded. While lifestyle therapy was delivered at lower cost, there were no differences in total costs (health sector adjusted mean difference: PP AUD$156 [95% CIs-$182, $611, ITT AUD$190 [95% CIs-$155, $651] ]; societal adjusted mean difference: PP AUD$350 [95% CIs:-$222, $1152] ITT AUD$ 408 [95% CIs-$139, $1157]. Remote-delivered lifestyle therapy was non-inferior to psychotherapy with respect to clinical and cost outcomes. If replicated in a fully powered RCT, this approach could increase access to allied health professionals who, with adequate training and guidelines, can deliver mental healthcare at comparable cost to psychologists. This trial was funded by the Australian Medical Research Future Fund (GA133346) under its Covid-19 Mental Health Research Grant Scheme.

The Mental Health Outcomes and Cost Estimates of Korean Medicine for Anxiety Disorder Patients.

Korean medicine (KM) is used to treat anxiety disorders, but there is limited research on its effects. This study aimed to examine the associations between improved QoL and reduced clinical symptoms and KM in patients with anxiety disorders. The medical records of patients with anxiety who were treated with KM (acupuncture, psychotherapy, Chuna therapy, aromatherapy, or herbal medicine) for at least 4 weeks were retrospectively analyzed. Clinical, QoL, and cost outcomes were measured at baseline and at weeks 4 and 12 (Anxiety: State-Trait Anxiety Inventory [STAI X-1 (state), X-2 (trait)], Beck Anxiety Inventory [BAI]; anger: State-Trait Anger Expression Inventory State [STAXI-S (state), T (trait)], Anger Expression Inventory [AXI-K-I (anger-in), AXI-K-O (anger-out), AXI-K-C (anger-control); depression: Beck Depression Inventory-II [BDI II], QoL: QoL-related instruments Euro Quality of Life 5 Dimensions utility score [EQ-5D], Euro QoL Visual Analog Scale [EQ-VAS]). The total costs for each item were calculated in terms of NHIS-covered costs and patients' out-of-pocket costs from the perspective of the healthcare system. The medical records of 67 patients were evaluated. The KM treatments were found to be associated with decreased anxiety (STAI X-1; STAI X-2; BAI, p < 0.0001), depression (BDI-II, p < 0.0001), and anger (AKI-K-I; AKI-K-O, p < 0.05) and increased QoL (EQ-5D; EQ-VAS, p < 0.0001). An average of USD 1360 was paid for the KM treatments for 4 weeks. The study findings suggested that KM may improve clinical symptoms and QoL outcomes in patients with anxiety disorders.

Clarifying terminology and definitions in education services for mental health users: A disambiguation study.

In the wake of the mental health crisis in children and adolescents, the coordination of education and mental health services has become a global priority. However, differing terminologies and classifications across sectors, hinder effective comparison. The classification in education focuses mainly on outputs like qualifications or throughputs like teaching programs. This proof-of-concept study tested the applicability of a standard classification of health services, the Description and Evaluation of Services and DirectoriEs (DESDE), to evaluate education services for mental health users in the context of Spain and The Netherlands. It was conducted alongside the PECUNIA project, that sought to develop methods for the assessment of mental health costs and outcomes in different sectors. The study followed an ontoterminology approach involving: 1) identification of services from a predefined list of 46 resource-use items, 2) disambiguation of identified services with the DESDE, and classifying them as accurate, ambiguous, vague or confuse; and 3) external validation by an expert panel. The analysis was conducted at the level of type of resource, target population and care provision. From the initial list, only ten of the resources could be categorized as services using DESDE, and not activities, interventions or professionals. Only four of them (8,65%) were accurate across all disambiguation categories. Experts were unaware of terminology problems in classification of service provision in the education sector. Classifications and glossaries can clarify service naming, description and costing allowing comparative effectiveness analysis and facilitating cross-sectoral planning. This should be grounded in common methodologies, tools, and units of analysis.

How does working time impact perceived mental disorders? New insights into the U-shaped relationship.

Based on a large-scale nationally representative survey in China, this paper uses the exogenous impact of automation on working hours as the instrumental variable to examine working time's impact on perceived mental disorders, on the basis of dealing with endogeneity. Different from existing literature, it is found that the impact of working time on perceived mental disorders is U-shaped, rather than linear. Mental disorders firstly decrease with working hours. After working more than 48.688 h per week, further increases in working time carry notable mental health costs, leading to a positive relationship between working hours and depression. The turning point of this U-shaped relationship is almost in line with the International Labor Organization's 48 working hours/week standard, justifying it from a mental health perspective. In addition, we further exclude the possibility of more complex nonlinear relationships between working time and perceived mental disorders. Furthermore, heterogeneities are found in the effects of working hours on mental disorders across different subgroups. Males are more depressed when working overtime. Older workers have a lower tolerance for overwork stress. The turning point is smaller for the highly educated group and they are more sensitive to working longer. Those with higher socioeconomic status are less depressed after exceeding the optimal hours of work. The increase in depression among rural workers faced with overwork is not prominent. Perceived mental disorders are lower among immigrants and those with higher health status. In addition, labor protection and social security help to weaken mental disorders caused by overtime work. In conclusion, this paper demonstrates that working time has a U-shaped impact on perceived mental disorders and highlights the vulnerability of certain groups, providing a reference for setting optimal working hours from a mental health perspective.

The Growing Storm: Increased Tropical Storms in Puerto Rico Carry Mental Health Cost

The Growing Storm: Increased Tropical Storms in Puerto Rico Carry Mental Health Cost

Exploring the multidimensional impact of ICT on academic achievement and mental health: Evidence from a large‐scale survey of higher vocational students in China

AbstractBackgroundHigher vocational education is an essential part of the higher education system that complements conventional education. In the context of information and communication technology (ICT) development and academic competition, more and more literature has proved the importance of ICT use in educational development (academic achievement and mental health) and the relationship between information literacy and the educational development of higher vocational students.ObjectivesBased on one of the most extensive surveys of higher vocational students, the study combined the Opportunity‐Propensity (O‐P) framework and ecological model to explore the direct effects of different types of ICT use on educational development and the indirect effects from psychological and social factors.MethodsThe data involved 28,956 students from seven higher vocational colleges. The class fixed effect and causal mediation analysis models verified the results.Results and ConclusionThe results found differential effects of different types of ICT use on academic achievement and mental health. Information literacy ability can improve the academic achievement of higher vocational students, but at the cost of mental health. ICT use not only directly impacts the academic achievement and mental health, but also has an indirect impact through psychological factors represented by self‐efficacy and technostress and social factors represented by social support.ImplicationsThis study promotes integrating and expanding the O‐P framework and ecological model, enriching the relevant research in ICT use and educational development. Meanwhile, it also provides practical suggestions for realizing rational interventions in ICT use and improving the educational development level of higher vocational students.

The mental health benefits and costs of critical consciousness: A longitudinal investigation of the co-occurring positive and negative effects of critical consciousness among sexual minorities

Critical consciousness is a powerful tool for individuals from marginalized groups to transcend their oppressive conditions through engagement in critical reflection, motivation, and action. Nonetheless, the mental health benefits and costs of critical consciousness have received limited research attention. The present study utilized a longitudinal research design to explore the positive and negative relationships between critical consciousness and mental health among sexual minority individuals in different developmental stages. A total of 636 sexual minority individuals were involved in the baseline study and were asked to complete a follow-up questionnaire after one year. The results demonstrated a co-occurrence of positive and negative effects of critical consciousness on mental health among sexual minority individuals across time. On the one hand, critical consciousness was associated with better mental health outcomes through the mediation of internalized oppression and community connectedness. Specifically, critical consciousness was associated with reduced internalized oppression, which in turn was linked to lower levels of emotional distress. Critical consciousness was also associated with heightened levels of community connectedness, which in turn was associated with improved well-being. On the other hand, the results revealed a positive direct effect of critical consciousness on emotional distress, after controlling for internalized oppression and community connectedness. Notably, developmental stage moderated the relationship between critical consciousness and well-being. A negative association between critical consciousness and well-being was observed among sexual minority youth, whereas no such association was found among sexual minority adults. While the study highlights that critical consciousness can be a pedagogical and therapeutic tool for the liberation and empowerment of sexual minority individuals, it is equally important to acknowledge the potential risks associated with critical consciousness. Striking a balance between critical consciousness and self-care is crucial for sustaining meaningful engagement in the pursuit of social change.

Commentary: Health anxiety in youth during 'COVID'- some thoughts prompted by Rask etal. (2024).

Researchers continue to count the short- and longer-term mental health costs for children and adolescents of the COVID-19 pandemic and the associated exceptional restrictions imposed by governments on their lives in an attempt to control the pandemic and its impacts. Despite being at low risk of serious physical illness from COVID-19 themselves, some studies have reported a decline in the mental health of many young people during the pandemic. Some have suggested that this could even create a risk for long-term morbidity. In this commentary, we reflect on the excellent article by Rask and colleagues on paediatric health anxiety and consider key research gaps for the field in general and for the specific challenges and questions posed by the COVID-19 pandemic and its legacy.

The Shortfalls of Mental Health Compartment Models: A Call to Improve Mental Health Investment Cases in Developing Countries

ObjectivesThere are irregularities in investment cases generated by the Mental Health Compartment Model. We discuss these irregularities and highlight the costing techniques that may be introduced to improve mental health investment cases. MethodsThis analysis uses data from the World Bank, the World Health Organisation Mental Health Compartment Model, the United Nations Development Program, the Kenya Ministry of Health, and Statistics from the Kenyan National Commission of Human Rights. ResultsWe demonstrate that the Mental Health Compartment Model produces irrelevant outcomes that are not helpful for clinical settings. The model inflated the productivity gains generated from mental health investment. In some cases, the model underestimated the economic costs of mental health. Such limitation renders the investment cases poor in providing valuable intervention points from the perspectives of both the users and the providers. ConclusionThere is a need for further calibration and validation of the investment case outcomes. The current estimated results cannot be used to guide service provision, research, and mental health programming comprehensively.

Racial Hate at the Intersection of Online and Offline Worlds: The Joint Impact of Online and Offline Racism on the Mental Health of Racially Minoritized Individuals.

With the everyday influence of social media and online platforms, racially minoritized individuals face the risk of experiencing racial discrimination in both offline and online contexts. Yet, there is scant research on how online and offline racism could jointly impact the mental health of racially minoritized individuals. Thus, the study examined online racism as a moderator in the link between offline racism and mental health issues. Using data from 651 racially minoritized emerging adults (Mage = 22.15, SD = 3.39), a moderation analysis was conducted using the PROCESS macro with bias-corrected bootstrapping (10,000 resamples). Experiencing more offline racism was significantly associated with greater mental health issues. Online racism was a significant moderator in the link between offline racism and mental health issues. The link between offline racism and mental health issues was not significant at low levels of online racism. However, the link was significant and strengthened at mean to high levels of online racism. The results suggest complex interactions in understanding the compounding impact of online and offline racism on mental health costs among racially minoritized individuals. Implications for future research on understanding the interplay between online and offline racism are discussed.

ACTIVE PARTICIPATION OF OLDER ADULTS AT POLITICAL RALLIES AS A SOURCE OF RESILIENCE: THE CASE OF THE ISRAELI PROTEST

Abstract The governing Israeli coalition suggested on Dec 2022 a reform plan that would fundamentally alter the system of checks and balances within Israeli society. According to law experts, the plan would effectively end liberal democracy in Israel. This turn of events sparked the largest protest movement in the 75year history of Israel. The current situation is unparalleled, and the mental health costs appear to be significant. However, the toll on older adults has not been directly examined yet. The breadth of the protest movement is remarkable. A July 2023 poll conducted by the Israel Democracy Institute estimated that almost a quarter of Israeli citizens had participated at a protest action at least once. It was primarily through participation at large rallies held weekly across the country - one of the main symbols of the protest movement. Interestingly, the survey reported a 37% participation rate among older adults, the highesy participation rate among all tested age groups. Since older Israelis are members of the founding generation of the state, their participation is not surprising. They feel threatened as their way of life and heritage are at risk. In the current study, we conducted a survey that examined mental health indices among older Israelis. Specifically, we wanted to test whether active participation at the protest could serve as a source for resilience in older age. Unfortunately, political turmoil is not unique to Israel. Thus, we hope that our findings could assist practitioners globally.

AN INTEGRATED TRANSITIONAL CARE INTERVENTION IMPROVES PATIENT-REPORTED OUTCOMES IN OLDER ADULTS WITH STROKE

Abstract The transition between hospital and home is associated with significant challenges resulting in hospital readmissions and poor health outcomes. This study aimed to test, in real-world clinical practice, the effectiveness of a Transitional Care Stroke Intervention (TCSI) compared to usual care on patient-reported outcomes and health and social service use costs in older adults (&amp;gt; 55 years) with stroke and multimorbidity (&amp;gt; 2 chronic conditions). The TCSI was delivered virtually by an interprofessional (IP) team, and included care coordination/system navigation support, phone/video visits, monthly IP team conferences, and an online resource co-designed with patient partners to support self-management and system navigation. The primary outcome was risk of hospital readmission after six-months. Secondary outcomes included physical and mental functioning, stroke self-management, patient experience, and health and social service costs. Ninety participants were enrolled (44 intervention, 46 control); 11 (12%) participants were lost to follow-up, leaving 79 (39 intervention, 40 control). Differences favoring the intervention group were seen in physical functioning (SF-12 PCS mean difference: 5.10; 95% CI: 1.58-8.62, p=0.005), self-management (Southampton Stroke Self-Management Questionnaire mean difference: 6.00; 95% CI: 0.51—11.50, p=0.03), and patient experience (Person-Centred Coordinated Care Experiences Questionnaire mean difference: 2.64, 95% CI: 0.81, 4.47, p=0.005). No significant between-group differences were seen for baseline to six-month risk of hospital readmission or total health and social service costs. The TCSI produced greater gains in patient-reported physical health, self-management and experience compared with usual stroke care. These improvements were achieved without increasing total healthcare costs.

Digital Mental Health Interventions: A Comprehensive Systematic Review

With the emergence of smartphone applications, chatbots, and AI-powered technologies in recent years, digital mental health interventions have grown in popularity. The purpose of this systematic review was to assess the efficacy and morality of these technologies in delivering care and support for mental health. A thorough review of the relevant research revealed that digital treatments in mental health have the potential for increasing the availability and cost of mental health care. However, difficulties with data privacy, ethical issues, and the requirement for more study were also noted. This study gives recommendations for future research and practice as well as insightful information about the state of digital mental health interventions now. Keywords: Digital health, AI-powered technologies, mental health treatment, costs, ethical issues, and digital interventions

Everyday emotional functioning in COVID-19 lockdowns.

Throughout the COVID-19 pandemic, policy makers have tried to balance the effectiveness of lockdowns (i.e., stay-at-home orders) with their potential mental health costs. Yet, several years into the pandemic, policy makers lack solid evidence about the toll of lockdowns on daily emotional functioning. Using data from two intensive longitudinal studies conducted in Australia in 2021, we compared the intensity, persistence, and regulation of emotions on days in and out of lockdown. Participants (N = 441, observations = 14,511) completed a 7-day study either entirely in lockdown, entirely out of lockdown, or both in and out of lockdown. We assessed emotions in general (Dataset 1) and in the context of social interactions (Dataset 2). Lockdowns took an emotional toll, but this toll was relatively mild: In lockdown, people experienced slightly more negative and less positive emotion; returned to a mildly negative emotional state more quickly; and used low-effort emotion-regulation strategies (i.e., distraction). There are three interpretations for our findings, which are not mutually exclusive. First, people may be relatively resilient to the emotional challenges posed by repeated lockdowns. Second, lockdowns may not compound the emotional challenges of the pandemic. Third, because we found effects even in a mostly childless and well-educated sample, lockdowns may take a greater emotional toll in samples with less pandemic privilege. Indeed, the high level of pandemic privilege of our sample limits the generalizability of our findings (e.g., to people with caregiving roles). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Developing and evaluating an interprofessional shared decision-making care model for patients with perinatal depression in maternal care in urban China: a study protocol

BackgroundThe majority of patients with perinatal depression (PND) in China do not receive adequate treatment. As forming a therapeutic alliance with patients is crucial for depression treatment, shared decision-making (SDM) shows promise in promoting patients’ uptake of evidence-based mental health services, but its impact on patient outcomes and implementation in real-world maternal care remain uncertain. Therefore, this study aims to develop and evaluate an interprofessional shared decision-making (IP-SDM) model for PND to enhance maternal mental health services.MethodsThis study contains four research phases: feasibility testing (Phase 1), toolkit development (Phase 2), usability evaluation (Phase 3), and effectiveness evaluation (Phase 4). During the development stage, focus group interviews will be conducted with expectant and new mothers, as well as maternal care providers for feasibility testing. A toolkit, including a patient decision aid along with its user guide and training materials, will be developed based on the findings of Phase 1 and syntheses of up-to-date evidence and appraised by the Delphi method. Additionally, a cognitive task analysis will be used for assessing the usability of the toolkit. During the evaluation stage, a prospective randomized controlled trial embedded in a mixed methods design will be used to evaluate the effectiveness and cost-effectiveness of the IP-SDM care model. The study targets to recruit 410 expectant and new mothers who screen positive for depression. They will be randomly assigned to either an intervention group or a control group in a 1:1 ratio. Participants in the intervention group will receive decision aid, decision coaching, and clinical consultation, in addition to usual services, while the control group will receive usual services. The primary outcome is the quality of decision-making process, and the secondary outcomes include SDM, mental health service utilization and costs, depressive symptoms, and health-related quality of life. In-depth interviews will be used to explore the facilitating and hindering factors of SDM.DiscussionThis study will develop an IP-SDM care model for PND that can be implemented in maternal care settings in China. This study will contribute to the understanding of how SDM impacts mental health outcomes and facilitate the integration of mental health services into maternal care.Trial registrationChiCTR2300072559. Registered on 16 June 2023.

The stroke transitional care intervention for older adults with stroke and multimorbidity: a multisite pragmatic randomized controlled trial

BackgroundThis study aimed to test, in real-world clinical practice, the effectiveness of a Transitional Care Stroke Intervention (TCSI) compared to usual care on health outcomes, self-management, patient experience, and health and social service use costs in older adults (≥ 55 years) with stroke and multimorbidity (≥ 2 chronic conditions).MethodsThis pragmatic randomized controlled trial (RCT) included older adults discharged from hospital to community with stroke and multimorbidity using outpatient stroke rehabilitation services in two communities in Ontario, Canada. Participants were randomized 1:1 to usual care (control group) or usual care plus the 6-month TCSI (intervention group). The TCSI was delivered virtually by an interprofessional (IP) team, and included care coordination/system navigation support, phone/video visits, monthly IP team conferences, and an online resource to support system navigation. The primary outcome was risk of hospital readmission (all cause) after six-months. Secondary outcomes included physical and mental functioning, stroke self-management, patient experience, and health and social service use costs. The intention-to-treat principle was used to conduct the primary and secondary analyses.ResultsNinety participants were enrolled (44 intervention, 46 control); 11 (12%) participants were lost to follow-up, leaving 79 (39 intervention, 40 control). No significant between-group differences were seen for baseline to six-month risk of hospital readmission. Differences favouring the intervention group were seen in the following secondary outcomes: physical functioning (SF-12 PCS mean difference: 5.10; 95% CI: 1.58–8.62, p = 0.005), stroke self-management (Southampton Stroke Self-Management Questionnaire mean difference: 6.00; 95% CI: 0.51—11.50, p = 0.03), and patient experience (Person-Centred Coordinated Care Experiences Questionnaire mean difference: 2.64, 95% CI: 0.81, 4.47, p = 0.005). No between-group differences were found in total healthcare costs or other secondary outcomes.ConclusionsAlthough participation in the TCSI did not impact hospital readmissions, there were improvements in physical functioning, stroke self-management and patient experience in older adults with stroke and multimorbidity without increasing total healthcare costs. Challenges associated with the COVID-19 pandemic, including the shift from in-person to virtual delivery, and re-deployment of interventionists could have influenced the results. A larger pragmatic RCT is needed to determine intervention effectiveness in diverse geographic settings and ethno-cultural populations and examine intervention scalability.Trial registrationClinicalTrials.gov Identifier: NCT04278794. Registered May 2, 2020.

Locked down in distress: A quasi‐experimental estimation of the mental‐health fallout from the COVID‐19 pandemic

AbstractWe use a large‐scale longitudinal survey with a differences‐in‐differences research design to estimate the impact of the COVID‐19 pandemic on mental health in the United Kingdom. We report substantial increases in psychological distress for the population overall during the first wave. These impacts were not uniformly distributed, with the mental health costs being more pronounced for females, younger cohorts, the black, Asian and minority ethnic community, and migrants. We also identified characteristics capable of predicting resilience to the mental health effects. We find that people with financial worries, loneliness or living in overcrowded dwellings experienced significantly worse mental health deterioration during the first wave.