BackgroundAnxiety and depression are common among women during pregnancy and the year after birth. The consequences, both for the women themselves and for their children, can be considerable and last for many years. This study focuses on the economic consequences, aiming to estimate the total costs and health-related quality of life losses over the lifetime of mothers and their children. MethodA pathway or decision modelling approach was employed, based on data from previous studies. Systematic and pragmatic literature reviews were conducted to identify evidence of impacts of perinatal anxiety and depression on mothers and their children. ResultsThe present value of total lifetime costs of perinatal depression (anxiety) was £75,728 (£34,811) per woman with condition. If prevalence estimates were applied the respective cost of perinatal anxiety and depression combined was about £8,500 per woman giving birth; for the United Kingdom, the aggregated costs were £6.6 billion. The majority of the costs related to adverse impacts on children and almost a fifth were borne by the public sector. LimitationsThe method was exploratory in nature, based on a diverse range of literature and encountered important data gaps. ConclusionsFindings suggest the need to allocate more resources to support women with perinatal mental illness. More research is required to understand the type of interventions that can reduce long-term negative effects for both mothers and offspring. Highlights Using modelling techniques, we estimated the lifetime costs of perinatal depression and anxiety reflecting the impact on mothers and children 1 ALSPAC = Avon Longitudinal Study of Parents and Children, ED = Education, HRQoL = Health-related quality of life, HSC = Health and social care, OOP = Out-of-pocket expenditure, NHS = National Health Service, p = probability, PL = Productivity loss, pp. = percentage points, PTB = Pre-term birth, RD = Risk difference, UC = Unpaid care, UK = United Kingdom, wks. = weeks, yrs. = years 2  We found that costs were substantial and that the majority related to the impact on children  There is a need to understand the role of interventions in alleviating symptoms and reducing long-term negative effects for both mothers and offspring.  New costing methods are required for conditions with transgenerational origins and impact.

Traumatic brain injury (TBI) is the biggest cause of death and disability in children and young people. TBI compromises important neurological functions for self-regulation and social behaviour and increases risk of behavioural disorder and psychiatric morbidity. Crime in young people is a major social issue. So-called early starters often continue for a lifetime. A substantial majority of young offenders are reconvicted soon after release. Multiple factors play a role in crime. We show how TBI is a risk factor for earlier, more violent, offending. TBI is linked to poor engagement in treatment, in-custody infractions, and reconviction. Schemes to assess and manage TBI are under development. These might improve engagement of offenders in forensic psychotherapeutic rehabilitation and reduce crime.

BackgroundConduct disorders are the most common psychiatric disorders in children and may persist into adulthood in about 50% of cases. The costs to society are high and impact many public sector agencies. Parenting programmes have been shown to positively affect child behaviour, but little is known about their potential long-term cost-effectiveness. We therefore estimate the costs of and longer-term savings from evidence-based parenting programmes for the prevention of persistent conduct disorder.MethodsA decision-analytic Markov model compares two scenarios: 1) a 5-year old with clinical conduct disorder receives an evidence-based parenting programme; 2) the same 5-year old does not receive the programme. Cost-savings analysis is performed by comparing the probability that conduct disorder persists over time in each scenario, adopting both a public sector and a societal perspective. If the intervention is successful in reducing persistent conduct disorder, cost savings may arise from reduced use of health services, education support, social care, voluntary agencies and from crimes averted.ResultsResults strongly suggest that parenting programmes reduce the chance that conduct disorder persists into adulthood and are cost-saving to the public sector within 5-8 years under base case conditions. Total savings to society over 25 years are estimated at £16,435 per family, which compares with an intervention cost in the range of £952-£2,078 (2008/09 prices).ConclusionsEffective implementation of evidence-based parenting programmes is likely to yield cost savings to the public sector and society. More research is needed to address evidence gaps regarding the current level of provision, longer-term effectiveness and questions of implementation, engagement and equity.

This paper argues that non-monetary health benefits should not be discounted at the same rate as variables expressed in monetary terms. It argues instead that the appropriate discount rate should be at or close to zero. It explores the various influences of rising income, age and pure time preference on the relative value of current and future health states. It examines various arguments advanced to justify the current practice of discounting health benefits at the same rate as monetary costs. These include uncertainty and delay. The article concludes with an analysis of the likely impact of adopting a zero discount rate on the ranking of health interventions.

Gender-specific pathways of conduct problems (CP) from toddlerhood have received little attention. Using a nationally representative sample of UK children born in 2000–2001 (6458 boys and 6340 girls), the current study (a) identified subgroups of CP pathways separately for boys and girls from ages 3 to 11 and (b) examined early precursors (pregnancy to 9 months) of these trajectories. Group-based trajectory models identified four distinct trajectories for both boys and girls: each characterized as ‘low’; ‘early-onset, desisting’; ‘early-onset, persistent’ and ‘school-onset’. This suggests that the taxonomic framework developed to conceptualise childhood-onset CP among males is also applicable to females, though needing some revision to capture heterogeneity identified during early and middle childhood. We also found significant precursors of the different trajectory groups with some variation by gender. Early socioeconomic deprivation was a significant risk factor of the early-onset pathways among both genders, but played no significant role for ‘school-onset’. Childhood-onset trajectories of boys, but not girls, were predicted by parenting attitudes and behaviour.

This paper uses economic analysis to develop the case for greater investment in mental health promotion. One example of a common mental health problem for which there is robust evidence of effective interventions is conduct disorder. The paper estimates that preventing conduct disorders in those children who are most disturbed would save around £150,000 per case (lifetime costs), and that promoting positive mental health in those children with moderate mental health would yield lifetime benefits of around £75,000 per case. Investment in support for parents is therefore the top priority in a provisional list of ‘best buys’ in promoting mental health.

Background: Previous evidence indicates that mental health problems are becoming more common for adolescents. Less is known about whether these trends have continued and there has been no study to date which has specifically focused on early adolescents over a sufficiently long period. The present study examines changes in parent-and teacherreported mental health problems among 10-and 11-year-olds in 1999, 2004 and 2012 in Great Britain.  Less is known about whether these trends have continued for children born in the new millennium and there has been no study to date which has specifically focused on early adolescents over a sufficiently long period. Findings indicate that mental health among 10-and 11-year-old children in Great Britain generally improved rather than deteriorated between 1999 and 2012. Teacher reports were more optimistic than parent reports, suggesting different priorities for school and home-based interventions. This study provides up-to-date information on the changing scale and nature of mental health problems among early adolescents, which is essential for service planning.

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