Health-related quality of life and cost-of-illness in young people seeking peer support at @ease: A Dutch burden of disease study

@ease consortium

doi:10.1371/journal.pone.0352652

Health-related quality of life and cost-of-illness in young people seeking peer support at @ease: A Dutch burden of disease study

@ease consortium

Clinical Psychology

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

INTRODUCTION: The burden of mental health problems remains largely unexplored among vulnerable young people, especially those seeking peer support. Accessing peer support is often a first form of help-seeking, allowing early identification of signs of distress. The lost (mental) health and expenses of these young people upon presenting for peer support can be revealed through monitoring of health-related quality of life (HRQoL) and costs of mental healthcare and productivity loss, examined in this study among young people visiting the @ease peer-to-peer walk-in centres in the Netherlands. METHODS: From @ease's inception in January 2018 to mid-2024, a total of 940 answered questionnaires gathered through consecutive sampling contained minimally one required item. This bottom-up prevalence-based study focused on youth aged 12-30 who sought peer counselling at @ease. Burden of disease was estimated by: (1) HRQoL (EQ-5D-5L), and (2) Cost-of-illness through school absenteeism and mental healthcare use. Multiple imputation was used before conducting regression analyses, followed by non-parametric bootstrapping. This study expands upon an earlier publication that analysed data up to May 2019. RESULTS: HRQoL was impaired (M = 0.64, SD = 0.24) and significantly lower if living alone or having parents with mental health problems, and higher if having a higher level of social and occupational functioning. In the three months before presenting, 35.2% of young people had been absent from school (3 days on average, costing €358 per individual) and 33.4% had visited mental healthcare (2 visits on average, costing €234 per individual). Total cost-of-illness was €1,501,743 annually, and €2,318 per individual. Mental healthcare costs were higher for those born in the Netherlands and without occupation, and school absenteeism costs were higher outside the COVID-19 pandemic and if not born in the Netherlands. CONCLUSIONS: Found impairments and costs underscore the importance of investing in early-stage low-threshold services where substantial burden is already detectable, and of strengthening their capacity and links to stepped-care pathways to ensure timely support. Initiatives that help improve functioning and aid with challenging contexts may be advantageous in lowering the burden. Prospective (cost-)effectiveness studies are needed.

Original language	English
Article number	e0352652
Pages (from-to)	1-19
Number of pages	19
Journal	PLoS ONE
Volume	21
Issue number	7
Early online date	6 Jul 2026
DOIs	https://doi.org/10.1371/journal.pone.0352652
Publication status	Published - Jul 2026

Bibliographical note

Publisher Copyright:
Copyright: © 2026 Boonstra et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding

@ease has received funding from the participating municipalities, healthcare partners (in kind), the Dutch Health Insurers Innovation Fund (Innovatiefonds Zorgverzekeraars), ZonMW and the Dutch Ministry of Health, Welfare and Sport (number 06360332210024, Ministerie van Volksgezondheid, Welzijn en Sport), awarded to SMJ Leijdesdorff. Sponsors did not play a role in the study decisions.https://www.zonmw.nl/enhttps://www.government.nl/ministries/ministry-of-health-welfare-and-sport. We are highly appreciative of all the @ease visitors and volunteers who participated in this research and to the research intern of the master’s education in Healthcare Policy, Innovation and Management of Maastricht University, Maral Aghababai, who calculated costs per day together with the first author while writing a thesis on earlier data. Furthermore, @ease would not be possible without the pronounced contribution of staff members, stakeholders and partners, for which we are very grateful.The @ease consortium authors are:prof. dr. Thérèse AMJ van Amelsvoort(Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, the Netherlands),prof. dr. Nynke Boonstra(NHL Stenden University of Applied Sciences, Leeuwarden, the Netherlands; KieN VIP, Metal Health Care Services, Leeuwarden, the Netherlands; Department of Psychiatry UMCC Utrecht Brain Center, Utrecht, the Netherlands),dr. Nina H Grootendorst-van Mil(Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands),dr. Rianne MC Klaassen(Department of Child and Adolescent Psychiatry, Levvel, Duivendrecht, the Netherlands),dr. Sophie MJ Leijdesdorff(Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, the Netherlands),prof. dr. Arne Popma(Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC, the Netherlands),dr. Remco FP de Winter(Mental Health Institute Rivierduinen, Leiden, the Netherlands; Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, the Netherlands). Contact person: [email protected].

Funders	Funder number
Innovatiefonds Zorgverzekeraars
participating municipalities
ZonMw
Ministerie van Volksgezondheid, Welzijn en Sport	06360332210024

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title = "Health-related quality of life and cost-of-illness in young people seeking peer support at @ease: A Dutch burden of disease study",

abstract = "INTRODUCTION: The burden of mental health problems remains largely unexplored among vulnerable young people, especially those seeking peer support. Accessing peer support is often a first form of help-seeking, allowing early identification of signs of distress. The lost (mental) health and expenses of these young people upon presenting for peer support can be revealed through monitoring of health-related quality of life (HRQoL) and costs of mental healthcare and productivity loss, examined in this study among young people visiting the @ease peer-to-peer walk-in centres in the Netherlands. METHODS: From @ease's inception in January 2018 to mid-2024, a total of 940 answered questionnaires gathered through consecutive sampling contained minimally one required item. This bottom-up prevalence-based study focused on youth aged 12-30 who sought peer counselling at @ease. Burden of disease was estimated by: (1) HRQoL (EQ-5D-5L), and (2) Cost-of-illness through school absenteeism and mental healthcare use. Multiple imputation was used before conducting regression analyses, followed by non-parametric bootstrapping. This study expands upon an earlier publication that analysed data up to May 2019. RESULTS: HRQoL was impaired (M = 0.64, SD = 0.24) and significantly lower if living alone or having parents with mental health problems, and higher if having a higher level of social and occupational functioning. In the three months before presenting, 35.2\% of young people had been absent from school (3 days on average, costing €358 per individual) and 33.4\% had visited mental healthcare (2 visits on average, costing €234 per individual). Total cost-of-illness was €1,501,743 annually, and €2,318 per individual. Mental healthcare costs were higher for those born in the Netherlands and without occupation, and school absenteeism costs were higher outside the COVID-19 pandemic and if not born in the Netherlands. CONCLUSIONS: Found impairments and costs underscore the importance of investing in early-stage low-threshold services where substantial burden is already detectable, and of strengthening their capacity and links to stepped-care pathways to ensure timely support. Initiatives that help improve functioning and aid with challenging contexts may be advantageous in lowering the burden. Prospective (cost-)effectiveness studies are needed.",

author = "Anouk Boonstra and \{van Mastrigt\}, \{Ghislaine A.P.G.\} and Evers, \{Silvia M.A.A.\} and Sander Osstyn and \{de Winter\}, \{Remco F.P.\} and Nynke Boonstra and \{van Amelsvoort\}, \{Therese A.M.J.\} and Leijdesdorff, \{Sophie M.J.\} and \{@ease consortium\}",

note = "Publisher Copyright: Copyright: {\textcopyright} 2026 Boonstra et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2026",

month = jul,

doi = "10.1371/journal.pone.0352652",

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T1 - Health-related quality of life and cost-of-illness in young people seeking peer support at @ease

T2 - A Dutch burden of disease study

AU - Boonstra, Anouk

AU - van Mastrigt, Ghislaine A.P.G.

AU - Evers, Silvia M.A.A.

AU - Osstyn, Sander

AU - de Winter, Remco F.P.

AU - Boonstra, Nynke

AU - van Amelsvoort, Therese A.M.J.

AU - Leijdesdorff, Sophie M.J.

AU - @ease consortium

N1 - Publisher Copyright: Copyright: © 2026 Boonstra et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2026/7

Y1 - 2026/7

N2 - INTRODUCTION: The burden of mental health problems remains largely unexplored among vulnerable young people, especially those seeking peer support. Accessing peer support is often a first form of help-seeking, allowing early identification of signs of distress. The lost (mental) health and expenses of these young people upon presenting for peer support can be revealed through monitoring of health-related quality of life (HRQoL) and costs of mental healthcare and productivity loss, examined in this study among young people visiting the @ease peer-to-peer walk-in centres in the Netherlands. METHODS: From @ease's inception in January 2018 to mid-2024, a total of 940 answered questionnaires gathered through consecutive sampling contained minimally one required item. This bottom-up prevalence-based study focused on youth aged 12-30 who sought peer counselling at @ease. Burden of disease was estimated by: (1) HRQoL (EQ-5D-5L), and (2) Cost-of-illness through school absenteeism and mental healthcare use. Multiple imputation was used before conducting regression analyses, followed by non-parametric bootstrapping. This study expands upon an earlier publication that analysed data up to May 2019. RESULTS: HRQoL was impaired (M = 0.64, SD = 0.24) and significantly lower if living alone or having parents with mental health problems, and higher if having a higher level of social and occupational functioning. In the three months before presenting, 35.2% of young people had been absent from school (3 days on average, costing €358 per individual) and 33.4% had visited mental healthcare (2 visits on average, costing €234 per individual). Total cost-of-illness was €1,501,743 annually, and €2,318 per individual. Mental healthcare costs were higher for those born in the Netherlands and without occupation, and school absenteeism costs were higher outside the COVID-19 pandemic and if not born in the Netherlands. CONCLUSIONS: Found impairments and costs underscore the importance of investing in early-stage low-threshold services where substantial burden is already detectable, and of strengthening their capacity and links to stepped-care pathways to ensure timely support. Initiatives that help improve functioning and aid with challenging contexts may be advantageous in lowering the burden. Prospective (cost-)effectiveness studies are needed.

AB - INTRODUCTION: The burden of mental health problems remains largely unexplored among vulnerable young people, especially those seeking peer support. Accessing peer support is often a first form of help-seeking, allowing early identification of signs of distress. The lost (mental) health and expenses of these young people upon presenting for peer support can be revealed through monitoring of health-related quality of life (HRQoL) and costs of mental healthcare and productivity loss, examined in this study among young people visiting the @ease peer-to-peer walk-in centres in the Netherlands. METHODS: From @ease's inception in January 2018 to mid-2024, a total of 940 answered questionnaires gathered through consecutive sampling contained minimally one required item. This bottom-up prevalence-based study focused on youth aged 12-30 who sought peer counselling at @ease. Burden of disease was estimated by: (1) HRQoL (EQ-5D-5L), and (2) Cost-of-illness through school absenteeism and mental healthcare use. Multiple imputation was used before conducting regression analyses, followed by non-parametric bootstrapping. This study expands upon an earlier publication that analysed data up to May 2019. RESULTS: HRQoL was impaired (M = 0.64, SD = 0.24) and significantly lower if living alone or having parents with mental health problems, and higher if having a higher level of social and occupational functioning. In the three months before presenting, 35.2% of young people had been absent from school (3 days on average, costing €358 per individual) and 33.4% had visited mental healthcare (2 visits on average, costing €234 per individual). Total cost-of-illness was €1,501,743 annually, and €2,318 per individual. Mental healthcare costs were higher for those born in the Netherlands and without occupation, and school absenteeism costs were higher outside the COVID-19 pandemic and if not born in the Netherlands. CONCLUSIONS: Found impairments and costs underscore the importance of investing in early-stage low-threshold services where substantial burden is already detectable, and of strengthening their capacity and links to stepped-care pathways to ensure timely support. Initiatives that help improve functioning and aid with challenging contexts may be advantageous in lowering the burden. Prospective (cost-)effectiveness studies are needed.

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Health-related quality of life and cost-of-illness in young people seeking peer support at @ease: A Dutch burden of disease study

Abstract

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