Determinants, costs, cost-effectiveness of initial care contacts after online depression screening

Background

Research on determinants of depression treatment uptake and associated costs after systematic depression screening is scarce. This post-hoc analysis aims at the evaluation of determinants, costs, and cost-effectiveness of initial mental healthcare contacts post-screening.

Methods

Data from a German RCT on feedback interventions after online depression screening including positively screened individuals (PHQ-9 ≥ 10 points) without a previous depression diagnosis or treatment were used. Participants were assigned to ‘initial care contact’ (ICC) or ‘no ICC’ based on their survey responses during 6 months follow-up. Analyses were conducted separately for participants with and without a confirmed depression diagnosis, assessed via a diagnostic interview 2-3 days after baseline. ICC determinants were tested using multinomial logistic regressions, informing the covariate selection for subsequent analyses. Societal costs were calculated using standardised German unit costs; cost differences were estimated by generalised linear models using a log-link function. Quality-adjusted life-years were calculated and differences estimated using linear OLS regressions. Incremental cost-effectiveness ratios were calculated using seemingly unrelated regressions, uncertainty was considered with bootstrapped cost-effectiveness acceptability curves.

Results

Of 595 participants, 114 (19%) had an ICC. ICC rates were higher among participants with confirmed depression. None of the examined determinants were significantly associated with ICC; trends indicated subjective depression belief and higher depressive distress as possible predictors of ICC. ICC had higher societal costs than no ICC, mainly attributable to mental healthcare costs and absenteeism, and was not cost-effective.

Conclusions

Low ICC rates highlighted existing access barriers to specialised mental healthcare. Given limited resources, subjective depression beliefs should be clinically verified prior to treatment.

Key messages

• Within 6 months after online depression screening, approximately 1 in 5 participants had an initial mental healthcare contact; rates were higher among those with confirmed depression.

• Initial mental healthcare contacts after online depression screening were associated with high societal costs and were not cost-effective within six months post-screening.