The relative value of mental health for pandemic response: a discrete choice experiment with stakeholders and the general population in Europe

Abstract

Background. During a public health emergency, health policies often prioritised physical over mental health, prompting concerns about whether these decisions reflected societal values. This study assessed stated preferences for mental health relative to other wellbeing domains and examined how these priorities align between the general population and health policy stakeholders across eight European countries. Method. A discrete choice experiment (DCE), grounded in random utility theory, was administered via an online survey to 1,615 members of the general population (nationally representative samples) and 145 health stakeholders in Belgium, France, Germany, Italy, the Netherlands, Spain, Sweden, and the United Kingdom. Participants assessed six pairs of hypothetical countries (A and B), differing in four attributes representing pandemic policy consequences: hospital admissions, psychological distress, employment loss, and movement restrictions. Results. Among the four attributes, psychological distress accounted for 34% of the relative importance in decision-making, compared to 30% for hospital admissions. In contrast, restrictions on mobility exerted the least influence on choice. On average, respondents expected 0.61 fewer hospitalisations (per 100,000) to accept a 1% increase in psychological distress. Compared to the general population, stakeholders placed greater emphasis on reducing psychological distress and were more willing to accept restrictions on mobility. Respondents who held more negative views towards individuals with mental health problems or those hospitalised due to COVID 19 were significantly less likely to prioritise reductions in psychological distress. Conclusion. There is similar importance attached to psychological distress and to the risk of COVID-19-related hospitalisation by the general population and stakeholders, but they diverge regarding civil liberties restrictions, providing insights into essential considerations for shaping effective mitigation policies for public health emergencies.