Healthcare, caregiver and human capital costs associated with anxiety and depression among Indonesian youths.

BACKGROUND: In Indonesia, at least 5% of youths aged 10-17 report having a diagnosed mental health condition. Despite evidence from other countries showing substantial economic costs associated with youth mental health conditions, data on their broader economic impact in Indonesia remain limited. This study estimates the economic costs of anxiety and depression among Indonesian youths aged 10-17. METHODS: This study employs a low-cost web panel approach to estimate economic costs, providing a replicable model for countries lacking data. We administered a cross-sectional online survey to 3038 Indonesian citizens (adult proxies) aged at least 18 years via a web panel. Respondents filled out the Patient Health Questionnaire-4 (PHQ-4) on behalf of youths in their household to capture prevalence rates, resulting in data on 4328 youths. Proxies of youths who screened positive for anxiety and/or depression symptoms based on the PHQ-4 (N=174) were then asked about mental healthcare utilisation (medication use, outpatient visits, and ED visits and hospitalisations), days missed from work by caregivers to provide care, and days missed from school and reductions in productivity resulting from mental health symptoms. Healthcare utilisation and caregiver costs were monetised and extrapolated based on unit costs/average wages, prevalence rates within the sample and national youth population counts. RESULTS: 10.6% reported symptoms consistent with anxiety and/or depression, yet 68.9% were never formally diagnosed, indicating a substantial diagnosis gap. Direct healthcare costs averaged IDR1 319 872 (US$83.15) per youth. Lost productivity of caregivers due to missing work to take care of these youths averaged IDR7 510 576 (US$473.17) per youth. These costs generate total annual medical costs of IDR5577.54 billion (US$0.35 billion) and total caregiver costs of IDR27 771.06 billion (US$1.75 billion). Overall, the total annual economic burden is IDR33 348.60 billion (US$2.1 billion). Youths with these symptoms also missed 187.1 hours of school per year and experienced a 45% decline in school performance. CONCLUSIONS: Evidence-based interventions should be adopted to address the significant health and economic burden associated with these symptoms.

Duke Scholars

Author Eric Andrew Finkelstein Population Health Sciences