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P40 Are health issues exacerbated by undiagnosed mental health problems? Cross-sectional study using a household health survey to estimate healthcare costs and quality of life related to multimorbidity
  1. Brendan Collins1,
  2. Jennifer Downing1,
  3. Anna Head1,
  4. Terence Cornerford2,
  5. Rajan Nathan3,
  6. Benjamin Barr1
  1. 1Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
  2. 2Lay advisor, NIHR ARC North West, Liverpool, UK


Background There is a lot of evidence for unmet need for mental health treatment and that pharmaceutical and psychological therapies are cost effective. However, there is a lack of evidence for the excess healthcare costs of undiagnosed mental health problems.

Methods We analysed survey data from two waves of the North West Coast Household Health Survey which targeted deprived areas of North West England included questions on disease, medications and PHQ9 and GAD7 (depression and anxiety scales). People were judged as having undiagnosed anxiety/depression problems if they scored above 5 on PHQ9 or GAD7, and did not declare a mental health issue or antidepressant prescription. Linear regression for EQ-5D-3L (Euroqol-5-dimension-3-level) index scores, and Tweedie regression for health and social care costs were used to estimate the impacts of undiagnosed mental health problems, controlling for age, sex, deprivation, and other health conditions.

Results Around 26.5% of participants had undiagnosed anxiety/depression. The presence of undiagnosed anxiety/depression was associated with reduced EQ-5D index scores (0.040 lower on average) and increased costs (£250 per year on average). Using a higher cutoff score of 10 on PHQ9/GAD7 for undiagnosed anxiety/depression had similar increased costs but a greater reduction in EQ-5D index scores (0.076 on average) indicating a larger impact on health-related quality of life. Deprivation was also associated with higher costs and lower EQ-5D index scores.

Discussion Having undiagnosed anxiety or depression increases costs and reduces health-related quality of life. Reducing stigma and increasing access to cost effective treatments will have population health benefits.

  • anxiety
  • depression
  • health-related quality of life
  • healthcare costs
  • unmet needs
  • survey data
  • health inequalities

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