Stress, mental and physical health and the costs of health care in German high school students
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ORIGINAL CONTRIBUTION
Stress, mental and physical health and the costs of health care in German high school students Lena Eppelmann1,2 · Peter Parzer1 · Hans‑Joachim Salize3 · Elke Voss3 · Franz Resch1 · Michael Kaess1,4 Received: 25 February 2019 / Accepted: 12 November 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Stress is a mind–body phenomenon, which affects both mental and physical health and is highly relevant to the health care system. Yet, knowledge on the costs of stress and related health problems in adolescence is missing. The present study addresses this gap by investigating direct health care costs in relation to stress, mental health problems and physical health in high school students. The sample comprised 284 pupils from four schools in Heidelberg (mean age 16.75 ± 0.64 years, 59.64% female). Self-reported health care utilization and medication intake within 1 month were translated into costs. We established correlative associations of the dichotomized overall costs (no vs. any) with stress, mental health problems and physical health within generalized structural equation models. In particular, mental health problems and physical health were examined as mediators of the association between stress and costs. An increase of stress by 1 SD corresponded increased chances for costs by OR 1.39 (Odds Ratio; 95% CI 0.13–0.53, p = 0.001). When mediators were analysed separately, both mental and physical health (problems) fully mediated the association. Yet, when examined together, only mental health problems acted as a mediator. Our results indicate the health economic relevance of stress-related mental health problems in high school students. The finding is meant to set the stage for further cost-of-illness studies of stress and related health problems, as well as economic evaluations. Longitudinal research is needed to allow conclusions on directionality. Keywords Direct costs · Health care utilization · Stress · Mental health · Adolescence
Introduction Stress is a mind–body phenomenon, which affects both mental and physical health and thus is highly relevant to the health care system [1]. While hormones associated with stress promote adaptation and protect the body in the short
* Michael Kaess [email protected] 1
Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University Hospital, Blumenstraße 8, 69115 Heidelberg, Germany
2
Faculty of Behavioural and Cultural Studies, Institute of Psychology, University of Heidelberg, Hauptstraße 47‑51, 69117 Heidelberg, Germany
3
Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, J5, 68159 Mannheim, Germany
4
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland, Bolligenstrasse 111, 3000 Bern 60, Switzerland
run, in the long run the physiologic response to stress causes changes in the body, especially in the brain, which can lead to diseases [2]. Besides the physiologic pathway via c
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