Aug 27 2014

Perinatal depression comes with a high cost for offspring

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Children whose mothers suffered depression during their pregnancy have a much greater risk of impaired cognitive development leading to psychological problems as they mature. Recently published research in Psychological Medicine shows that perinatal depression comes at a high cost to offspring, who are more likely to experience mental health problems and adverse job prospects in adulthood. In what is effectively the first study of its kind, and jointly researched with Derek King, Martin Knapp, Susan Pawlby, Dominic Plant and Carmine Pariante, Annette Bauer comments on the economic consequences of perinatal depression from a child’s perspective.

Perinatal depression affects 13 per cent of pregnant women in the general population and increases to more than 20 per cent in lower socio-economic groups. A number of studies have evidenced the negative impact of perinatal depression on children and their increased risk of developing emotional, behavioural and intellectual problems; others have found a substantial economic impact associated with mental health problems starting in childhood that reaches into adulthood, and possibly later life, with wide-ranging implications for society. Our research looked at some of the early adulthood economic consequences of adverse child development effects linked to maternal depression during pregnancy and after birth.

What we found

We looked at longitudinal data sourced from children of 252 women who attended two South London antenatal clinics in 1986. The data showed that:

  • those exposed to perinatal depression were at higher risk of experiencing negative outcomes measured at 11 and 16 years
  • almost a third of these women were diagnosed with depression during pregnancy and 22 per cent with post-natal depression
  • between 5 to 21 per cent of children from the study group exposed to perinatal depression developed emotional, behavioural or cognitive problems into adulthood.

We found there was also a high risk of 24 per cent that children of these mothers diagnosed with depression had special educational needs by the time they started school; by adolescence, their behavioural problems were entrenched.

We also studied the effects of perinatal depression on children at 11 and 16 years of age and found a substantial economic impact associated with mental health problems starting in childhood with far-reaching implications for wider society. For each child exposed to perinatal depression, we estimated the costs to society at £8,000 per individual, including treatment costs (>£3,030), loss of earnings (£1,400) and reduced quality of life (£3,760).


These findings underline the importance of taking action to prevent or treat mothers’ depression during pregnancy and after birth. The key message from our research is that mothers need to be supported during pregnancy for health reasons and economic reasons.

Other risk factors, besides perinatal depression, also need to be considered in child development outcomes, such as the reported link between breastfeeding and cognitive development and the mother-infant relationship.

Full paper:

Bauer A, Pawlby S, Plant DT, King D, Pariante CM, Knapp M (2014) Perinatal depression and child development: exploring the economic consequences from a South London cohort, Psychological Medicine, Published online 23 June 2014.

About the authors:

Annette Bauer is Research Officer within the Personal Social Services Research Unit at the LSE.

Derek King is Research Fellow within the Personal Social Services Research Unit at the LSE

M. Knapp is Director of the Personal Social Services Research Unit; Director and Professor of Social Policy; Director, NIHR School for Social Care Research at the LSE.

Susan Pawlby, Dominic Plant and Carmine Pariante are researchers at the Department of Psychological Medicine, Institute of Psychiatry, King’s College London


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Jul 7 2014

Improving the relationship between social care providers and service users

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Guest blog by Chris Fennell, Head of Outreach, Kent Social Care Professionals Limited

For several years now there has been much political debate about the quality of care and service provided by health institutions and organisations. In times of widespread economic hardship it is becoming more and more important to remember that the people matter in these issues more than the bottom line.

The National Health Service (NHS) has faced increasing challenges over the past few years as budget cuts have applied pressure while demand for care services has increased. So how exactly are healthcare organisations and social care providers supposed to make time to hear the thoughts of patients, public and service users?

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Jun 20 2014

Eurohealth Volume 20, issue 2: Health behaviours and incentives

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Sherry Merkur, Anna Maresso and David McDaid

The last decade has seen an increasing interest in some countries of the potential of using behavioural science to inform our understanding and influence policy design. The Eurohealth Observer section kicks off with a look at the fashionable area of applying the principles of behavioural science to nudge populations towards better health and wellbeing. It discusses the growth in popularity of these health nudges and questions the evidence base on their effectiveness and cost effectiveness. It goes on to suggest where these principles may have a role to play in enhancing elements of health promotion and public health policy.

The latest issue of Eurohealth (volume 20, issue 2), which has just been published by the European Observatory on Health Systems and Policies (in which LSE Health is a partner), looks at some recent developments in this area.

In an effort to set out the broad context on why health behaviours matter, Mackenbach discusses their role within the persistence and widening of health inequalities in modern welfare states. With observed disparities in smoking and alcohol consumption, the uptake of exercise and healthy diet linked to socio-economic status, it becomes apparent that tackling these risk factors with effective interventions could have an impact on the inequalities in population health status. Whether or not incentives to change health behaviours are desirable or ethical depends on a complex mix of factors. The article by Schmidt attempts to disentangle the salient issues by identifying four goals and ten key dimensions of incentive programmes. The tool kit provided is a first step to systematically analysing different types of incentives, and could supply the basis for comparing incentive programmes of similar design.

Prainsack and Buyx contribute to this debate by bringing in a unique perspective – that of solidarity. They argue that by focusing on what people have in common rather than what sets them apart, solidarity is particularly relevant and compatible with ‘nudging’ practices because it can foster sensitivity to social inequalities and safeguard against inappropriate stigmatisation of target groups. Providing us with a national perspective, ten Have and Willems discuss the current debate in the Netherlands on using incentives to influence lifestyle and promote better health, and whether or not health insurance premiums should be differentiated to take into account people’s unhealthy lifestyle choices.

In the Eurohealth International section, Greer and Lillvis look at the difficulties of establishing intersectoral governance for Health in All Policies. They go on to suggest potential solutions for how policy-makers can create good functioning and enduring intersectoral governance to promote public health strategies.

Both of the articles in the Eurohealth Systems and Policies section reflect reforms to address budgetary pressures posed by the recent difficult economic climate. Kwong and colleagues discuss additional challenges faced by the health care payers in Poland and Hungary and how they have been confronted through pharmaceutical cost containment strategies. They also present the potential for risk-sharing schemes for medicines in the face of financial and performance uncertainty. Voncina and Sagan report on the newly implemented joint hospital procurement programme in Croatia. They describe the details of this decentralised approach and reflect on success in terms of the quality and the cost of procured goods.

Eurohealth Monitor features a new book on health professional mobility, which presents practical tools and policy responses in a changing Europe. Also featured is a new book on regulating long-term care quality that provides country-specific case studies to highlight policy options. As usual, the News section brings you a selection of national and international developments in the health sector. We hope you enjoy the Summer Issue.

Read the full issue

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Jun 19 2014

Have your say on the treatment gap in global mental health

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by Victoria de Menil and Valentina Iemmi

Lord Crisp chairing the APPG on global mental health (c) Victoria De Menil

Lord Crisp chairing the APPG on global mental health
(c) Victoria de Menil

An historic first took place in Portcullis House on 10 June. The UK All Party Parliamentary Groups (APPGs) on global health and mental health convened a joint hearing to discuss global mental health. The event, chaired by Lord Nigel Crisp together with James Morris MP, was the first of two oral evidence sessions to address the question of whether the UK government should be “doing more or doing differently” to address the treatment gap in global mental health. Three additional Parliamentarians, Meg Hillier MP, Vicount Eccles and Peter Bottomley MP, were also in attendance.

The session opened with evidence from three speakers: Professor Vikram Patel of the London School of Hygiene and Tropical Medicine, Professor Graham Thornicroft of the Institute of Psychiatry, and Dr Gary Belkin, director of New York University’s Global Mental Health Programme. Their task was to answer two questions: how significant a problem is mental illness in low- and middle-income countries; and what evidence is there for cost-effective ways to address mental health needs in low- and middle-income countries?

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Jun 16 2014

Informing and improving policy and practice for carers through research and evaluation

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Carers Week took place last week to raise awareness and improve the lives of carers and the people they care for. Much has been said about the need for a robust evidence base to support this aim. Last year a seminar series funded by the Economic and Social Care Research Council explored some of the evidence and next steps; and there is a growing body of studies exploring different aspects of carers’ lives. Here PSSRU at LSE colleagues Valentina Zigante, Nicola Brimblecombe, and Derek King reflect on a joint workshop by the Social Services Research Group and the NIHR School for Social Care Research on how research and evaluation could inform and improve policy and practice in relation to informal carers.

The day offered ample opportunity to reflect on issues ranging from the legal framework to the day-to-day reality of carers’ lives and the future of carers’ research.

Helena Herklots, Chief Executive of Carers UK chaired the event which brought together a mixed audience of carers, practitioners, researchers and stakeholders.

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May 22 2014

Reflecting on Professor John Bolton’s LSEHSC seminar: Policy, practice and austerity

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by Michael Griffiths

We recently held a seminar by Professor John Bolton*, JRFB Ltd and visiting Professor at the Institute of Public Care at Oxford Brookes, as part of the LSE Health and Social Care Formal Seminar Series. Professor Bolton’s presentation on Policy, Practice and Austerity focused on two themes: why social care’s current policy isn’t affordable; and, the examination of an emerging care model in the UK that has its roots in practice rather than academia or policy.

The policy

According to Professor Bolton, the big challenge faced is this: can we manage demand in social care at a time of increasing demographic pressures and decreasing resources?

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May 12 2014

A 20-year follow-up of childhood hyperactivity and conduct problems: Service use and public expenditure costs in adulthood

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by Francesco D’Amico, Martin Knapp, Jennifer Beecham, Seija Sandberg, Eric Taylor and Kapil Sayal

High levels of early childhood conduct problems are associated with increased health, social care and criminal justice costs in adulthood. There is a two-to-threefold increase in early adulthood costs for children with conduct disorders. These results are particularly important as little is known about the effect of hyperactivity and conduct problems in childhood on service provision or public expenditure. These findings come from a study by researchers from the Personal Social Services Research Unit at LSE and Nottingham University using a 20-year follow-up survey to quantify the impact that behavioural problems in children can have when they reach adulthood. Continue reading

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May 6 2014

Is more better? The effects of private health insurance on mental health care in a Kenyan mental hospital

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by Victoria de Menil, Martin Knapp, David McDaid and Frank Njenga

Art therapy at Chiromo Lane Medical Center © Victoria de Menil

Art therapy at Chiromo Lane Medical Center
© Victoria de Menil

In 2004, Kenya’s parliament passed a promising bill to create a National Social Health Insurance Fund to pay for outpatient and hospital care for all Kenyans, but the bill was not signed into law out of concerns over financing. Today, Kenya’s only social insurance is the National Hospital Insurance Fund (NHIF), which is under investigation by the Ethics and Anti-Corruption Commission. Private health insurance (PHI) remains one alternative to out-of-pocket payments for financing healthcare, including mental healthcare, among those who can afford it. In Kenya, PHI is used by 2% of the population and accounts for 4% of health expenditure. Critics of PHI argue that it leads to spiralling use and costs of services, while proponents suggest that it increases early access to services and improves financial protection.

Our paper looks in detail at one private psychiatric facility, Chiromo Lane Medical Center, a 30-bed hospital with the motto “recovery in dignity”. Chiromo Lane is part of a five-facility hospital group that is one of the largest providers of private psychiatric care in East Africa. In the course of a year, 455 individuals were seen at Chiromo Lane, half of them for schizophrenia or bipolar disorder, a third for substance use, and the remainder for a mix of other disorders. They were mostly men (66%), and they came from Kenya and a range of East African countries. Our paper examines the effects of private insurance on the amount of mental health services received, the price of services, and whether more care means better care.

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Mar 20 2014

How important is patient brand loyalty in the uptake of generic drugs?

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by Joan Costa Font, Caroline Rudisill and Stefanie Tan

Many western countries have developed policies to promote the substitution of branded ‘originator’ drugs with generic drugs, with the aim of containing pharmaceutical costs. However, success has been patchy and in some countries the phenomenon of the ‘generics paradox’ has been observed, where manufacturers are able to increase the prices of branded drugs after the market has been opened to generics. Using data from Spain, our study explored the extent to which the brand loyalty of patients – as opposed to their doctors or health insurers – plays a part in keeping the market penetration of generic drugs at a low level. Its findings suggest that the uptake of generics could be increased through targeted education and information on the identical properties of generics and the branded drugs they are intended to replace.

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Mar 18 2014

Strengthening child health and health services

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by Sherry Merkur, Anna Maresso and David McDaid

Because children are not just small adults, efforts to improve their health and the relevant health services they use must be tailored accordingly. Each stage of early life – from infancy to adolescence – has distinct illnesses, developmental issues and challenges. Furthermore, children rely on their families and other caregivers to identify and manage any ill health and are particularly sensitive to the effects of social conditions. The latest issue of Eurohealth (volume 20, issue 1), which has just been published by the European Observatory on Health Systems and Policies (in which LSE Health is a partner), looks at some recent developments in this area. It aims to draw attention to the challenges of child health and health services in Europe, and to strengthen our understanding of the challenges facing European Member States and health systems in this regard.

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