Healthcare utilization and costs of singaporean youth with symptoms of depression and anxiety: results from a 2022 web panel

Abstract

Background There is evidence that the prevalence of depression and anxiety among youth is increasing and that these factors contribute to high healthcare costs and poor school performance. The goal of this study is to provide up-to-date estimates of the prevalence and economic burden of depression and anxiety among youth in Singapore. Methods Using an existing web panel, 991 parents filled out the PHQ-4 screener on behalf of 1,515 youth. 104 of these parents whose children (ages 4 to 21) had symptoms consistent with depression or anxiety filled out a full survey with questions on mental health symptoms, school absences, school performance, and healthcare utilization. The survey was fielded between April and June 2022. Publicly available prices were used to estimate the cost associated with the observed rates of health service use. Findings Based on parental responses, 11.7% (95% CI:10.2 − 13.5%) of youth had symptoms consistent with depression and 12.8% (95% CI:11.2 − 14.6%) had symptoms consistent with anxiety. In total, 16.2% (95% CI:14.5 − 18.3%) were reported to have symptoms consistent with at least one of these conditions. These youths missed an average of 190 (95% CI: 126–254) hours of school per year due to their mental health conditions and parents reported that school and daily activities performance was significantly degraded. Per capita annual healthcare costs averaged S$10,250 (95% CI: 7,150–13,350), with 64% of youth receiving emergency or inpatient services. In aggregate, annual costs associated with these conditions were estimated to be S$1.2 billion (95% CI:S$1.1bn – S$1.4bn). Interpretation Even with significant potential for underreporting, these results reveal concerning rates of Singaporean youth with symptoms consistent with depression or anxiety, many of whom remain untreated. Results also reveal the short-term economic burden caused by these symptoms and hint at longer-term consequences resulting from poor school performance. This study should represent a call to action for Singapore to address poor mental health among youth.

Using the HEADSS Assessment to Screen for Adolescent Mental Health Concerns in the Community

“…3,4 In a recent study of Singaporean youth, 16.2 percent of youth had symptoms consistent with depression and anxiety. 5 While depression and anxiety are the leading cause of morbidity worldwide for adolescents and young people, other mental health conditions remain prevalent in this age group, including eating disorders, problematic internet usage, bipolar disorder, conduct disorder, and ADHD. 6,7 While causes of mental health conditions are complex and often multifactorial, academic stress, peer relationships, and social media are often unique contributing factors in adolescents.…”

“…8,9 If left untreated, mental health conditions in adolescence are likely to lead to decreased school attendance, worsening school performance, adult mental health disorders, poorer quality of life, higher risk of substance use, and social isolation. 5,10,11 Significantly, these conditions are also associated with increased healthcare costs, both for direct treatment as well as evaluation of possible organic causes or somatic symptoms. In Singapore, these costs are estimated at $1.2 billion per year.…”

“…In Singapore, these costs are estimated at $1.2 billion per year. 5 Despite the high prevalence of mental health conditions in adolescents, studies have shown that less than one-third of youth seek help. 12 In a recent Singapore study, almost 85 percent of youth with symptoms of depression and anxiety did not have a formal diagnosis despite interaction with the healthcare system.…”

“…12 In a recent Singapore study, almost 85 percent of youth with symptoms of depression and anxiety did not have a formal diagnosis despite interaction with the healthcare system. 5 While the low rates of formal diagnosis are likely multifactorial, this may suggest that youth mental health conditions remain underdiagnosed and undertreated. Family physicians have a unique role in addressing this gap.…”

Adolescent Depression

“…1 A recent 2022 study in Singapore showed that 11.7 percent of youth displayed symptoms indicative of depression. 2 As is the case for many common medical conditions, family doctors play an essential role in detecting and managing adolescent depression. Identifying the signs, elucidating causal and contributory factors, and implementing appropriate interventions are essential steps in closing the large treatment gap 3 and providing effective care to the generation that will be tomorrow's working adults.…”