AIMS:Mental health literacy (MHL) is increasingly recognised as a key component of public mental health promotion. While widely cited definitions focus on recognising and managing mental disorders, recent perspectives call for broader, more holistic frameworks that also address positive mental health. However, conceptual and measurement inconsistencies persist, highlighting the need for a clearer understanding of how MHL is defined and applied across disciplines. METHODS:This umbrella review synthesised 40 systematic and scoping reviews (2000-2024) to explore how MHL is conceptualised and operationalised across disciplines. Following a registered PROSPERO protocol, the review applied rigorous methods across five databases and assessed quality using the JBI Checklist. RESULTS:Most studies relied on a common definition by Jorm and colleagues, focusing on knowledge and beliefs about mental disorders. More recent frameworks, such as that proposed by Kutcher and colleagues, adopt a broader, salutogenic view, emphasising positive mental health, stigma reduction and help-seeking efficacy. Thirty-three MHL measures were identified, with most tools prioritising disorder-related literacy over wellbeing-focused components. The most common way the reviews operationalised MHL was by exploring it as an outcome variable in intervention studies. CONCLUSIONS:The review highlights the need for more comprehensive and context-sensitive MHL frameworks and tools that align with contemporary mental health promotion strategies. It underscores the importance of integrating both pathogenic and salutogenic perspectives to support mental wellbeing across diverse populations and settings. Future research should prioritise refining theoretical models, improving measurement tools and exploring implementation strategies that reflect the multifaceted nature of MHL.
After the marketing authorisation of biologicals, uncertainty often remains regarding their real-world effectiveness, safety, and rational use. This study investigates how frequently the recommended use of biologicals changes post-authorisation, and who funds the studies leading to these changes. Biologicals receiving a positive opinion for adult indications by the Committee for Medicinal Products for Human use (CHMP) between 2006 and 2010 were identified. For each indication, we compared the initial and current Summary of Product Characteristics (SmPC), as well as current SmPC and European clinical guidelines, to identify discrepancies in start and stop criteria, dosage, and administration frequency. We assessed whether discrepancies led to increased or decreased use of the biological and whether this was associated with the sponsor type of supporting publications. SmPC changes, driven by Marketing Authorisation Holder (MAH)-sponsored studies, were found in 47
OBJECTIVES:Proton therapy is an alternative treatment to photon therapy in head and neck cancer. The Normal Tissue Complication Probability (NTCP) model assists in the patient selection process. This study explores how health technology assessment (HTA) recommendations in lower-income European countries (LIECs) in head and neck cancer can be supported by transferring the NTCP model. METHODS:Through 2 workshops in November 2022 and May 2023, the scope of transferability recommendations was established for the head and neck cancer case study of the HTx project. HTA experts from LIECs and HTx consortium representatives reviewed draft recommendations at a final transferability workshop in November 2023. Experts anonymously voted on the main challenges of transferring the NTCP model to LIECs and ranked these by importance. Finally, an open discussion took place about potential solutions for overcoming the main challenges. RESULTS:Main challenges of transferring the NTCP model to LIECs include lack of available local data, differences in patient pathways, and shortage of HTA experts. Workshop participants agreed that the NTCP model is an improvement to current standard HTA methods. Multiple key recommendations were formed, including that dissemination of real-world data and real-world evidence should be gold standard, coupled with a wide collaboration across stakeholders, and that consideration of transferability aspects could help LIECs when adapting novel methods. CONCLUSIONS:According to a multinational panel of experts, the NTCP model is an improvement over current HTA methods. To overcome challenges of its adoption in LIECs, 5 key recommendations were formulated.
In the Netherlands, proportional shortfall is the primary metric for threshold-setting in cost-effectiveness analyses, while absolute shortfall is also reported and considered during appraisal. Although conceptually and mathematically related, the two metrics can yield discordant results. Their theoretical differences are well recognised; nevertheless, debate continues regarding which metric should be used for operationalising disease severity in health technology assessment (HTA). This study describes the rationale behind the combined use of proportional and absolute shortfall by the National Health Care Institute (ZIN) and provides empirical evidence on how the two severity metrics relate in real-world reimbursement practice. We analysed proportional and absolute shortfall levels reported in 56 of all 57 appraised reimbursement dossiers published by ZIN between May 2018 and April 2026. While the two metrics are systematically related, we observed a distinct cluster of 28 dossiers showed high proportional shortfall (mean 0.88) but relatively low absolute shortfall (mean 14.28 QALYs). Of these, 27 concerned oncology drugs for older patients, which were significantly more likely to fall into this cluster than non-oncology drugs. These findings demonstrate that differences between proportional and absolute shortfall, previously discussed largely at a theoretical level, translate into observable patterns in reimbursement practice. By making explicit how the two metrics profile technologies differently, this study contributes empirical evidence to ongoing policy discussions about the operationalisation of disease severity in HTA. More specifically, the analysis clarifies how ZIN’s current practice of reporting both metrics may support more transparent, better-informed and consistent use of disease severity in reimbursement decision-making.
INTRODUCTION:The COVID-19 pandemic restricted healthcare access. Mental illness in combination with isolation and fear of the virus possibly decreased routine monitoring for lithium using patients during the lockdown. Our aim was to study if monitoring frequencies and serum level values for lithium, TSH (thyroid stimulating hormone), and renal function changed during the COVID-19 pandemic. METHODS:Using the PHARMO database (laboratory, pharmacy, and hospitalization data), we identified lithium users in The Netherlands over 2 years (14 October 2018-14 October 2020). The first year served as the control period; the second year was divided into pre-COVID, lockdown, and post-lockdown segments. A time series analysis with a linear regression model was performed to test for differences in monitoring frequency and aberrant serum levels at the beginning of the lockdown (immediate effect) and during the lockdown (post-lockdown trend, effect over 12 weeks). RESULTS:We identified 2835 patients using lithium. Monitoring measurements declined by 52% (7.74% vs. 4.01%) for lithium serum levels, 28% (5.56% vs. 4.20%) for TSH, and 26% (17.7% vs. 13.2%) for renal function in the first week of lockdown. These reductions were statistically significant compared to the control period. Monitoring for all measurements gradually recovered during lockdown. Changes in aberrant serum levels were not statistically different during the exposure and control periods. CONCLUSION:Monitoring for lithium, TSH and renal function declined at the beginning of lockdown. However, it is unlikely that postponed laboratory measurements had clinically relevant negative treatment effects since no differences in aberrant serum levels were identified.
