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Background: Substance use disorders negatively affect global disease burden. Effective preventive interventions are available, but whether they provide value for money is unclear., Aims: This review looks at the cost-effectiveness evidence of preventive interventions for cannabis use, opioid misuse and illicit drug use., Method: Literature search was undertaken in Medline, CINAHL, PsycINFO, EconLit through EBSCOhost and EMBASE, up to May 2021. Grey literature search was conducted as supplement. Studies included were full economic evaluations or return-on-investment (ROI) analyses for preventing opioid misuse, cannabis and illicit drug use. English-language restriction was used. Outcomes extracted were incremental cost-effectiveness ratios (ICER) or ROI ratios, with costs presented in 2019 United States dollars. Quality was assessed with the Drummond checklist., Results: Eleven full economic evaluation studies were identified from 5674 citations, with all studies conducted in high-income countries. Most aimed to prevent opioid misuse ( n = 4), cannabis ( n = 3) or illicit drug use ( n = 5). Modelling was the predominant methodology ( n = 7). Five evaluated school-based universal interventions targeting children and adolescents (aged <18 years). Five cost-benefit studies reported cost-savings. One cost-effectiveness and two cost-utility analysis studies supported the cost-effectiveness of interventions, as ICERs fell under prespecified value-for-money thresholds., Conclusions: There are limited economic evaluations of preventive interventions for opioid misuse, cannabis and illicit drug use. Family-based intervention (ParentCorps), school-based interventions (Social and Emotional Training and Project ALERT) and a doctor's programme to assess patient risk of misusing narcotics ('the Network System to Prevent Doctor-Shopping for Narcotics') show promising cost-effectiveness and warrant consideration.

Background: Alcohol use is a leading risk factor for death and disability worldwide., Aims: We conducted a systematic review on the cost-effectiveness evidence for interventions to prevent alcohol use across the lifespan., Method: Electronic databases (EMBASE, Medline, PsycINFO, CINAHL and EconLit) were searched for full economic evaluations and return-on-investment studies of alcohol prevention interventions published up to May 2021. The methods and results of included studies were evaluated with narrative synthesis, and study quality was assessed by the Drummond ten-point checklist., Results: A total of 69 studies met the inclusion criteria for a full economic evaluation or return-on-investment study. Most studies targeted adults or a combination of age groups, seven studies comprised children/adolescents and one involved older adults. Half of the studies found that alcohol prevention interventions are cost-saving (i.e. more effective and less costly than the comparator). This was especially true for universal prevention interventions designed to restrict exposure to alcohol through taxation or advertising bans; and selective/indicated prevention interventions, which involve screening with or without brief intervention for at-risk adults. School-based interventions combined with parent/carer interventions were cost-effective in preventing alcohol use among those aged under 18 years. No interventions were cost-effective for preventing alcohol use in older adults., Conclusions: Alcohol prevention interventions show promising evidence of cost-effectiveness. Further economic analyses are needed to facilitate policy-making in low- and middle-income countries, and among child, adolescent and older adult populations.

Background: There are few very brief measures that accurately identify multiple common mental disorders., Aims: The aim of this study was to develop and assess the psychometric properties of a new composite measure to screen for five common mental disorders., Method: Two cross-sectional psychometric surveys were used to develop (n = 3175) and validate (n = 3620) the new measure, the Rapid Measurement Toolkit-20 (RMT20) against diagnostic criteria. The RMT20 was tested against a DSM-5 clinical checklist for major depression, generalised anxiety disorder, panic disorder, social anxiety disorder and post-traumatic stress disorder, with comparison with two measures of general psychological distress: the Kessler-10 and Distress Questionnaire-5., Results: The area under the curve for the RMT20 was significantly greater than for the distress measures, ranging from 0.86 to 0.92 across the five disorders. Sensitivity and specificity at prescribed cut-points were excellent, with sensitivity ranging from 0.85 to 0.93 and specificity ranging from 0.73 to 0.83 across the five disorders., Conclusions: The RMT20 outperformed two established scales assessing general psychological distress, is free to use and has low respondent burden. The measure is well-suited to clinical screening, internet-based screening and large-scale epidemiological surveys.

Background: Community-based screening for mental health problems may increase service use through feedback to individuals about their severity of symptoms and provision of contacts for appropriate services., Aims: The effect of symptom feedback on service use was assessed. Secondary outcomes included symptom change and study attrition., Method: Using online recruitment, 2773 participants completed a comprehensive survey including screening for depression ( n =1366) or social anxiety ( n =1407). Across these two versions, approximately half ( n =1342) of the participants were then randomly allocated to receive tailored feedback. Participants were reassessed after 3 months (Australian New Zealand Clinical Trials Registry ANZCTR12614000324617)., Results: A negative effect of providing social anxiety feedback to individuals was observed, with significant reductions in professional service use. Greater attrition and lower intentions to seek help were also observed after feedback., Conclusions: Online mental health screening with feedback is not effective for promoting professional service use. Alternative models of online screening require further investigation., Declaration of Interest: None., Copyright and Usage: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.