This Letter presents the main findings of a systematic review of 21 studies (n = 33 398) on the psychosocial consequences of COVID-19 in children, adolescents, and young adults, following the PRISMA guidelines; the background, methods and results are presented as an online Supplement. According to our findings, excess worrying, irritability, home confinement, and fear of COVID-19 infection and transmission are associated with mild to severe anxiety symptoms during the COVID-19 epidemic. 1 Isolation could be a risk factor for deterioration in mental health, including depressive and anxiety symptoms, distress, fear, post-traumatic stress, and insomnia. 2 Regarding anxiety disorders, the fear of COVID-19, widely known as 'coronaphobia,' has enhanced anxiety symptoms, with a further aggravating role mediated by isolation at home. 2 Individuals with anxiety disorders tend to be preoccupied with excessive hand-washing, extreme cautiousness, social distancing measures and unnecessary shopping. 3 Furthermore, a strong correlation between family relations and fear of contracting COVID-19 was noted. 4 Focusing especially on COVID-19-infected patients, they were also affected, expressing high anxiety levels, as reported in SARS and MERS patients in the past. 5 states among school-age children with attention-deficit/hyperactive disorder during the COVID-19 outbreak.

BackgroundMajor depressive disorder (MDD) constitutes an important public health problem, as it is highly prevalent in the industrialized world and it is associated with substantial economic consequences for patients, health care providers, insurance and social security organizations and employers. To conduct an economic evaluation comparing agomelatine with other commonly used alternatives for treating patients with major depressive disorder (MDD) in Greece.MethodsAn existing international Markov model designed to evaluate the cost-effectiveness of agomelatine was adapted to the Greek setting. It reflects six different health states, in which patients may move on a monthly basis. The analysis was undertaken from a societal perspective. Transition probabilities, utilities and costs assigned to each health state were extracted from the published literature, government sources and expert opinion. Data reflects the year 2012 and was discounted using a rate of 3.5%. Probabilistic analysis was undertaken to deal with uncertainty.ResultsBase case analyses revealed that agomelatine is a dominant therapy for MDD relative to escitalopram, fluoxetine and sertraline, and it appeared to be cost-effective compared to venlafaxine (ICER: €547/QALY). Agomelatine remained a dominant treatment against generic sertraline and fluoxetine, and it appeared to be a cost-effective alternative compared to generic venlafaxine and escitalopram (ICER: €1,446/QALY and €3,303/QALY, respectively). Excluding the indirect cost from the analysis, agomelatine remained a cost-effective alternative over all comparators. In the probabilistic sensitivity analysis agomelatine was dominant in 44.5%, 89.6%, 70.6% and 84.6% of simulated samples against branded venlafaxine, escitalopram, fluoxetine and sertraline, respectively.ConclusionThe present evaluation indicates that agomelatine is either a dominant or a cost-effective alternative relative to branded or generic alternatives, in Greece.

BackgroundPatients having chronic schizophrenia with frequent relapses and hospitalizations represent a great challenge, both clinically and financially. Risperidone long-acting injection (RIS-LAI) has been the main LAI atypical antipsychotic treatment in Greece. Paliperidone palmitate (PP-LAI) has recently been approved. It is dosed monthly, as opposed to biweekly for RIS-LAI, but such advantages have not yet been analysed in terms of economic evaluation.PurposeTo compare costs and outcomes of PP-LAI versus RIS-LAI in Greece.MethodsA cost-utility analysis was performed using a previously validated decision tree to model clinical pathways and costs over 1 year for stable patients started on either medication. Rates were taken from the literature. A local expert panel provided feedback on treatment patterns. All direct costs incurred by the national healthcare system were obtained from the literature and standard price lists; all were inflated to 2011 costs. Patient outcomes analyzed included average days with stable disease, numbers of hospitalizations, emergency room visits, and quality-adjusted life-years (QALYs).ResultsThe total annual healthcare cost with PP-LAI was €3529; patients experienced 325 days in remission and 0.840 QALY; 28% were hospitalized and 15% received emergency room treatment. With RIS-LAI, the cost was €3695, patients experienced 318.6 days in remission and 0.815 QALY; 33% were hospitalized and 17% received emergency room treatment. Thus, PP-LAI dominated RIS-LAI. Results were generally robust in sensitivity analyses with PP-LAI dominating in 74.6% of simulations. Results were sensitive to the price of PP-LAI.ConclusionsPP-LAI appears to be a cost-effective option for treating chronic schizophrenia in Greece compared with RIS-LAI since it results in savings to the health care system along with better patient outcomes.

Since the seminal study of Steinbeck and Durell (1968), few epidemiological studies have attempted to replicate whether psychosocial stress precipitates the onset of a first psychotic episode. Our aim was to support or refute the finding of elevated psychosis incidence in the first month of army induction and to examine factors impacting the timing of onset. Data were collected from medical files of 186 army conscripts, hospitalized with a diagnosis of First Episode Psychosis (FEP) between 2005 and 2014 in the Psychiatric Military Hospital in Athens, Greece. FEP rates were at least 4.5 times higher in the first month of military service, compared with any other month. Earlier FEP onset was associated with rural environment at the time of birth, multiple drug use and service away from home. Psychosocial stress precipitates FEP, particularly in those exposed to other risk factors.

OBJECTIVES: Depression is a major health problem. Previous studies on the cost of depression have mainly taken a primary care perspective. Such studies do not include all patients with depression, and should be completed by cost estimates from psychiatric care. The objectives of this study were to estimate the annual societal cost of depression per patient in psychiatric care in Sweden, and to relate costs to disease severity, depressive episodes, hospitalization, and patient functioning. METHODS: Retrospective resource use data in inpatient and outpatient care for 2006-2008, as well as ICD-10 diagnoses and Global Assessment of Functioning (GAF), were obtained from Northern Stockholm psychiatric clinic with a catchment area including 47% of the adult inhabitants in Stockholm city. This data set was combined with national register data on prescription pharmaceuticals and sick leave to estimate the societal cost of depression. RESULTS: The study included 10,593 patients (63% women). The average annual societal cost per patient was around USD 21,000 in 2006-2008. The largest cost item was indirect costs due to productivity losses (89%), and the second largest was outpatient care (6%). Patients with mild, moderate or severe depression had an average cost of approximately USD 18,000, USD 21,000, and USD 29,000, respectively. Total costs were significantly higher during depressive episodes, for patients with co-morbid psychosis or anxiety, for hospitalized patients, and for patients with low GAF scores. CONCLUSIONS:The largest share of societal costs for patients with depression in psychiatric care is indirect. The total costs were higher than previously reported from a primary care setting, and strongly related to hospitalization, episodes of active depression, and global functioning. This suggests that effective treatment and rehabilitation that avoid depressive episodes and hospitalization may not only improve patient health, but also reduce the societal cost of depression.