A HIDDEN COST OF MENTAL HEALTH Using linked data to study the impact of pre-injury mental health on cost of recovery after road traffic injury

Behrooz Hassani-M1,2, Janneke Berecki-Gisolf2, Youjin Hahn3, Rod McClure4 (1) Institute for Safety, Compensation and Recovery Research, Monash University, Australia, (2) Monash Injury Research Institute, Monash University, Australia,

3) Department of Economics, Monash University, Australia (4) Harvard Injury Control Research Centre, Harvard School of Population Health, USA

Pre-injury Mental Health

Quantified using Linked MBS and PBS Data

Injury Recovery Cost

Quantified using Linked TAC Payments Data

One year of pre-injury data provided by Department of Human Services, Canberra, Australia

Invited: ~11,000 TAC clients aged 18 years and above, with approved claims for a non-catastrophic injury that occurred between 2010 and 2012 were invited .

Sample: 738 clients gave linkage consent: 54% female; 43% above 55 years old, 53% had a driver role in the accident, and 67% had the accident in metropolitan areas.

Features: The sample had ~$1M MBS, ~$500K PBS and ~$14M TAC costs (categorized as short-term costs: the first 3 months, long-term costs: the first 12 months).

Method: Bayesian Model Averaging and Linear and Non-linear Regressions are used to identify the contributing factors and their effect on the selected outcomes.

One year of post-injury data provided by Transport Accident Commission, Victoria, Australia

Psycholeptics

Drugs with a calming effect Such as: Barbiturates & Anti-panics

Category N05 on ATC

* pp means per prescription

Mental Comorbidity Indicator

Psychoanaleptics Drugs with an arousing effect

Such as: Anti-depressants

Category N06 on ATC

* pp means per prescription

GP Consultation

Mental Health Plan Service Type: Attendance

Service Category A20 on Medicare

* pc means per consultation

Psychiatrist

Consultation Service Type: Attendance

Service Category A8 on Medicare

* pc means per consultation

Conclusion and Recommendations:

All of the four pre-injury mental health service use categories studied have a significant impact on the cost of injury recovery, controlling for

injury type and demographics. These results show that the cost of recovery cannot be predicted accurately without taking clients' pre-injury

mental health history into account. Further research is needed to determine to impact of mental health history on secondary outcomes of in-

jury, and to explore the scope for early intervention in these clients.

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Impact on Short-term Costs Selected Figures Impact on Long-term Costs

Acknowledgements: This project has been funded by Institute for Safety, Compensation

and Recovery and undertaken at Monash Injury Research Institute. The authors

acknowledge the support of the Transport Accident Commission in the conduct of this

research and Department of Human Services for providing the linkage opportunity. We

also thank 738 study participants who consented linkage, making this project possible.

We also appreciate the help received from David Attwood and the Client Research team

at the TAC, and the Compensation Research Database Team at ISCRR.

+ $1900 Medical Costs

+ $1200 Public Hospital Costs

+ $820 Medical Consultation Costs

+ $500 Medico-legal Costs

+ % 4.3 Pubic Hospital Costs (pp)

+ % 4.0 Psychology Costs (pp)

+ % 2.5 Chemist Costs (pp)

+ $3000 Medical Costs

+ $1800 Medical Consultation Costs

+ $20 Private Paramedical Costs

+ % 60 Treater Costs

+ % 5.1 Paramedical Costs (pc)

+ % 9.0 Income Benefit Costs (pc)

+ % 5.0 Travel Costs (pc) + % 9.6 Vocational Costs (pc) + % 8.7 Psychology Costs (pc)

+ $2500 Medical Costs

+ $1500 Public Hospital Cost

+ $580 Consultation (second half)

+ $200 Private Paramedical Costs

+ % 3.6 Information Costs (pp)

+ % 4.6 Psychology Costs (pp)

+ % 3.6 Chemist Costs (pp)

+ $4500 Medical Costs

+ $1300 Medical Consultation Costs

+ $200 Medico-legal Costs

+ $1900 Psychology Costs

+ $2000 Public Hospital Costs

+ % 41 Vocational Costs + % 12 Income Benefit Costs (pc)

+ % 5.6 Paramedical Costs (pc)

+ % 6.4 Home Help Costs (pc)

+ $630 Medical Consultation Costs

+ % 37 Medical Costs

+ % 35 Hospital Costs

+ % 79 Medico-legal Costs

+ % 4.0 Medical Costs (pp)

+ % 4.0 Hospital Costs (pp)

+ % 4.9 GP Costs (pp)

+ $500 Medical Consultation Costs

+ $1300 Psychology Costs

+ % 40 Total Costs

+ % 47 Medical Costs

+ % 54 Medico-legal Costs

+ % 3.8 Total Cost (pp)

+ % 6.0 GP Costs (pp)

+ $35 Chemist Costs (pc)

+ % 4.1 Attendance Costs (pc)

+ % 15 Vocational Costs (pc)

+ % 4.9 GP Costs (pc) + %9.3 Psychology Costs (pc)

+ $841 Medical Cost (pc)

+ % 20 Medical Costs (pc)

+ % 32 Medico-legal (pc)

+ % 14 Vocational Counselling (pc) + %18 Psychology Costs (pc)

Average Medical Costs

Average Pathology Costs

Average Psychology Costs

Average Total Costs

Notes: Only coefficients significant at %95 level are reported here. All models are controlled for age, gender, and type of injury.

Psycholeptics

Psychoanaleptics

GP Consultation Mental Health Plan

Psychiatrist Consultation