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Autistic adults frequently show increased physical or mental health conditions and impairments in social, occupational, and other life domains. Accordingly, they often report reduced health-related quality of life. Yet, numerous barriers prevent effective healthcare for autistic adults. To date, the impact of healthcare barriers on health-related quality of life in autism has not been investigated. We, thus, sought to investigate the health-related quality of life of autistic adults without intellectual disability in Germany and analyze previously reported and novel predictors of health-related quality of life including healthcare barriers using multiple linear regression. Within a nationwide online survey, 311 autistic adults completed the Short-Form Health Survey and the Barriers to Healthcare Checklist. Demographic, clinical, and healthcare-related predictors were also assessed. Participants showed below-average mental and significantly reduced physical health-related quality of life compared to a German normative sample. Several independent variables differentially predicted mental and physical health-related quality of life. Healthcare barriers resulted as the only predictor, which explained variations in both domains: the more barriers autistic adults experienced, the lower their mental and physical health-related quality of life. Barriers emerged as the strongest predictor for mental health-related quality of life. Our results raise awareness for the barriers autistic adults experience in getting appropriate healthcare and the possible consequences for the individual. Improved healthcare access might contribute to better health-related quality of life in autism.Health-related quality of life reflects a person’s perspective on their well-being in physical, mental, social, work-related, and other aspects of health or life. Autistic adults typically report difficulties in many or all of these domains and, thus, often experience their health-related quality of life being reduced. Nonetheless, they do not obtain the professional support they need and report barriers to accessing or receiving appropriate healthcare. We know little about the impact of barriers to healthcare on health-related quality of life in autistic adults. In the present study, 311 autistic adults without intellectual disability in Germany completed an online survey on their current health-related quality of life and the number of barriers to healthcare they experience. In addition, they were asked about their personal and clinical background as well as about the amount of healthcare and support they recently received. We investigated how this information and, particularly, barriers to healthcare explained variations in individual levels of health-related quality of life. We found that barriers to healthcare, compared to most other variables, were a strong predictor of health-related quality of life: The more barriers autistic adults reported, the lower their experienced psychological and physical well-being. To our knowledge, this is the first paper to examine the relationship between barriers to healthcare and health-related quality of life in autism. Our results suggest that healthcare providers need to become aware of the barriers individuals with autism have in seeking and getting healthcare. Improved access to services might contribute to better health-related quality of life in autistic adults. [ABSTRACT FROM AUTHOR]

Aim of the Study: The aim of this work was to update the 2015 unit costs (UC) for the monetary valuation of health-related resource use from a societal perspective for the years 2019 and 2020 in Germany., Methods: The update follows the methodology of Bock et al. 2015. Based on the newly established care levels, UC for care degree 1 to 5 are now provided. To account for change in price trends during the Covid-19 pandemic, average growth rates in UC are shown from 2011-2019 and compared to 2019-2020., Results: Updates of UC for the outpatient medical sector, remedies and aids, hospitals, (in)formal care services, and rehabilitation for 2019 and 2020 are provided., Conclusion: The updated UC can be used as reference values for the monetary valuation of individual resource use in health economic evaluations in Germany., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: Family members of autistic individuals often provide support for their autistic relative throughout the lifespan which can lead to massive burden themselves. Reduced health-related Quality of Life (HRQoL) in family caregivers is assumed; however, only a handful studies on the HRQoL of family caregivers providing care to adult relatives exist as opposed to autistic children. Thus, the current study aimed to (i) investigate the current state of physical and mental HRQoL of family caregivers of autistic adults compared to the general population, and (ii) examine caregiver-related (e.g., age, subjective caregiver burden) and care recipient-related variables (e.g., symptom severity, utilization of formal services) explaining variance in the caregivers' HRQoL., Methods: N = 149 family caregivers completed a nationwide online survey, including the Short-Form Health Survey (SF-8) in order to assess the HRQoL. T-tests were used to compare the HRQoL of family caregivers with the general population. Bivariate correlational and multiple linear regression analyses were conducted in order to identify predictors explaining variance in family caregivers' HRQoL., Results: Family caregivers of autistic adults reported significantly lower physical ( M = 46.71, SD = 8.72, Cohen's d = 0.42) and mental HRQoL ( M = 40.15, SD = 11.28, Cohen's d = 1.35) compared to the general population. Multiple linear regression with the mental HRQoL as the outcome showed a significant model ( F (11, 95) = 5.53, p < .001, adj. R 2 = .32) with increased subjective burden explaining most of the variance in mental HRQoL ( ß = .32, GDW = .141, p < .001). Multiple linear regression analysis with the outcome physical HRQoL did not reveal a statistically significant model ( F (11,95) = 1.09, p = .38). However, bivariate analyses also showed a positive correlation with the subjective caregiver burden ( r = .20, p < .05)., Discussion: Findings highlight the need to consider HRQoL (and caregiver burden) of family caregivers of autistic adults in several healthcare settings to monitor a potential comprised health status in early stages, with the long-term goal to improve family caregivers' HRQoL., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Dückert, Bart, Gewohn, König, Schöttle, Konnopka, Rahlff, Erik, Vogeley, Schulz, David and Peth.)

Objective: Depression is a common mental disorder associated with a high economic burden. Aim of this study was to review cost-of-illness studies of depression in Germany., Methods: We conducted a systematic literature search of bottom-up cost-of-illness-studies of depression in adults in Germany. Included studies were classified into three groups depending on their costing approach (total health care cost studies, disease-specific health care cost studies, excess cost studies)., Results: Depending on the type of cost calculation the average total costs per patient and year varied between 400-3,300 € for disease-specific costs, 3,000 € for excess costs and 3,000-5,000 € for total health care costs. There were no results for indirect costs in most studies., Conclusion: Depression in Germany is associated with high costs, but especially indirect costs are missing in the current literature and should be examined more intensively., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Aim of the Study: The aim of this paper was to conduct a systematic review of cost-of-illness studies for overweight and adiposity in Germany., Methods: We conducted a PubMed search to identify relevant studies. To increase comparability, all cost data were inflated to 2014 prices. For bottom-up studies, we additionally calculated relative cost-differences between normal weight and overweight, as well as adiposity. These relative differences were pooled using meta-analytical techniques and extrapolated to the German population., Results: We identified 15 bottom-up studies, 6 top-down studies and 2 Markov simulations. On average, top-down studies reported direct costs of 7.9 billion Euros and indirect costs of 3.6 billion Euros. Due to between-study heterogeneity, we were not able to pool absolute costs reported in bottom-up studies. The pooled relative cost-differences for studies conducted with adult persons were +22% for the difference between normal weight and overweight and +53% for the difference between normal weight and adiposity. The corresponding effect sizes were 0.07 (- 0.05; 0.19) and 0.15 (0.02; 0.28), respectively. In studies conducted with children and adolescents, relative cost-differences were considerably smaller with corresponding effect sizes being close to zero. Extrapolation of relative pooled cost-differences from bottom-up studies to the German total population yielded direct and indirect excess costs of 22.2 billion Euros for overweight and 23.0 billion Euros for adiposity., Conclusion: We found substantial heterogeneity of cost findings between studies for top-down and bottom-up studies as well, which points to substantial uncertainty and strongly hampers clear statements about the costs of overweight and adiposity. Our findings imply that costs are underestimated by top-down studies, whereas overestimated by our extrapolation. The true costs presumably lie between the findings of both approaches., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: In Germany, patients with mental disorders can benefit from many medical and non-medical services. However, assessing the consumption of these services is difficult. We developed the questionnaire FIMPsy that can be used to assess health care consumption in patients with mental disorders and thereby facilitate economic evaluations., Methods: We identified relevant medical and non-medical services for patients with mental disorders and included frequently consumed services in the questionnaire., Results: FIMPsy can be utilized to assess the consumption of the following services in the preceding six months retrospectively: informal care, psychiatric counselling, psychosocial care, assisted living and occupational integration. Furthermore, FIMPsy assesses contacts with outpatient and inpatient medical providers as well as the intake of medication., Conclusion: FIMPsy covers many services for patients with mental disorders. It can be applied in economic evaluations and thus facilitate and standardize their implementation., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Assessing resource utilisation and costs for treating mental disorders in Germany is difficult. This pertains especially to the numerous non-medical services that are financed by a considerable number of payers. To standardise and simplify cost calculation, we created a database of unit costs for the most important services for mental disorders. Method: We performed a literature and internet search to identify services provided to persons with mental disorders. Unit costs were calculated either by means of public statistics or data directly obtained from payers. If data could not be obtained that way, health care providers were interviewed to collect data relevant for cost estimation. Results: Unit costs were calculated for medical and vocational rehabilitation, assisted living, sociopsychiatric services, counselling centres, daycare facilities, ambulant psychiatric nursing care, occupational therapy, sociotherapy, psychoeducation, caretaker, domestic help, creative therapies, physical therapy, and relaxation techniques. Discussion and Conclusion: Calculating unit costs for non-medical services was essential, since these services constitute a central element in the treatment of persons with mental disorders. Nevertheless, the large amount of different services and payers complicated a comprehensive assessment of costs. Thus, uncertainty associated with the calculation of costs should be taken into account., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To analyze direct costs and cost determinants in psychotic patients with persistent positive symptoms (PPS)., Methods: A total of 330 patients with PPS were recruited via 6 university clinics and interviewed about service utilization in the previous 3 months. After monetary valuation, costs were analyzed via generalized linear mixed models with gamma distribution and log-link function to identify determinants of direct costs., Results: The mean costs were 7,065 € and resulted predominantly from psychiatric hospital care (63 %), assisted living (17 %) and complementary services (8 %). We found statistically significant associations between direct costs and an increasing score of the negative subscale of the Positive and Negative Syndrome Scale (+ 2,484 € per point, p < 0.001) and experiencing less than one social contact per week (- 2,272 €, p = 0.003)., Conclusion: PPS incurred substantial direct costs which primarily resulted from hospital treatment, and were strongly associated with symptom severity., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background and Aims of the Study: Mental disorders are frequently investigated in economic evaluations. However, measuring direct costs of mental disorders is complex, in particular in Germany. We conducted a systematic review that investigated the following research questions: Which cost categories are assessed? Is the used data source (patient-reported data from interviews or questionnaires; claims data from health insurance; medical records from patient charts) associated with specific study characteristics?, Methods: We conducted a systematic literature search in PubMed. We included cost-of-illness studies (COIs) and cost-effectiveness analyses (CEAs) that measured patient level data on direct costs of mental disorders in Germany., Results: We found 31 COIs and 17 CEAs. Cost items could be assigned to the cost categories outpatient medical, outpatient non-medical, sheltered living, hospital, rehabilitation, nursing care, outpatient goods (medication and medical goods), other direct costs, and indirect costs. Most studies, in particular COIs and studies conducted from a societal perspective, used patient-reported data which suited to assess cost categories comprehensively. Studies based on claims data or medical records tended to include fewer cost categories., Discussion: The sample size of 48 analyzed studies was rather small. However, our study investigated three methods to assess health care utilization -- using patient-reported data, claims data, or medical records -- and identified their respective strengths and weaknesses in the context of covered cost categories and further attributes., Conclusion: Studies measuring the direct costs of mental disorders in Germany mostly relied on patient-reported data to assess resource consumption. Although more objective, claims data were used less frequently and covered less cost categories., Implications for Health Policies: The direct costs of mental disorders are likely to be underreported as relevant cost factors such as non-medical services or sheltered living were often neglected in the studies. Policy makers should consider this when deciding on measures that aim at reducing the costs of care., Implications for Further Research: Eliciting data from patients seems to constitute an adequate instrument to assess a broad range of cost categories, even though this bears various methodological challenges. Further research should (i) ameliorate the methods of collecting data from patients in ensuring that all relevant costs are covered and that methodological flaws are minimised (ii) develop or improve methods for the combination of claims data from different data holders.

Objective: To conduct a systematic literature review of cost-of-illness studies and economic evaluations for diabetic patients with comorbid depression., Methods: Systematic literature search in PubMed and NHS EED in March 2011, complemented by a bibliographic search within all eligible articles., Results: The search produced a total of 388 studies of which 16 were analysed in full text. Altogether, eleven studies were included into the review, all of which were conducted in the USA. The results from cost-of-illness studies (n = 8) indicate excess costs in between 35 % and 300 % for diabetics with comorbid depression, in comparison to those without depression. Three economic evaluations indicate that appropriate interventions can lead to improved health (i. e. more depression free days) at no extra cost. The results from two cost-effectiveness analyses indicate dominance (more depression free days and cost-savings compared to "usual care") for the evaluated interventions., Conclusions: Depressive symptoms are associated with increased health care costs in diabetic patients. Part of these excess costs can be attributed to the treatment of diabetes. Appropriate interventions aimed at depression treatment can increase time free of depression at no greater cost than usual care., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: The aim of this study was a systematic literature review of cost-of-illness studies for schizophrenia in Germany., Methods: We conducted a database search in Pubmed and PsychINFO. Cost data were inflated to the year 2007., Results: We finally included 11 studies in our review which show that schizophrenia causes societal cost of several billion Euros per year. After adjustment for inflation, costs per patient and year estimated between 1980 and 2002 tended to be relatively stable at around 14,000 to 18,000 Euro. Additionally, relatives are confronted with spending of 950 to 1,700 Euro due to the patients' disorder. Indirect costs are mainly due to early retirement or unemployment and amount to 25,000 to 30,000 Euro per patient when using the human capital approach. We found that changes in treatment settings and increasing costs of drug treatment seem to be reflected in published cost-of-illness studies., Conclusions: When corrected for inflation, treatment cost per patient for schizophrenia show changes in their distribution over different cost sectors in the health care system but no substantial increases between 1980 and 2002.

This paper presents the Social Phobia Psychotherapy Research Network (SOPHO-NET). SOPHO-NET is among the five research networks on psychotherapy funded by "Bundesministerium für Bildung und Forschung". The research program encompasses a coordinated group of studies of social phobia. In the central project (Study A), a multi-center randomized controlled trial, refined models of manualized cognitive-behavioral therapy (CBT) and manualized short-term psychodynamic psychotherapy (STPP) are compared in the treatment of social phobia. A sample of n=512 outpatients will be randomized to either CBT, STPP or wait list. For quality assurance and treatment integrity, a specific project has been established (Project Q). Study A is complemented by four interrelated projects focusing on attachment style (Study B1), cost-effectiveness (Study B2), polymorphisms in the serotonin transporter gene (Study C1) and on structural and functional deviations of hippocampus and amygdala (Study C2). Thus, the SOPHO-NET program allows for a highly interdisciplinary research of psychotherapy in social phobia.

Objective: To analyze the discriminative ability, construct validity and sensitivity to change of the EQ-5D in paranoid schizophrenia (ICD-10 F20.0)., Methods: Data of 408 patients was analyzed in a longitudinal study by comparing EQ-5D with SF-36, CGI-S, PANSS, and GAF., Results: EQ-5D showed considerable discriminative ability in the patient sample when compared to a representative population sample. If a measure used for comparison and a EQ-5D dimension were theoretically corresponding, the measure's mean score differed significantly between EQ-5D answer levels, with largest effect sizes for SF-36 scales (0.34<|d|<1.76), but rather small values for CGI-S, PANSS and GAF (|d|<0.5). EQ-5D VAS (mean 61.3) and German EQ-5D index (mean 0.84) showed rather moderate correlations with most other scales (0.18<|r|<0.62). ROC-analysis indicated a very low sensitivity to change of EQ VAS and German EQ-5D index (0.50