MichaelPlant comments on Is effective altruism overlooking human happiness and mental health? I argue it is. - Effective Altruism Forum

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Comment author: MichaelPlant 30 June 2016 05:04:12PM *  0 points [-]

Hello James.

in reply:

1) check figure 3 on p1681 of DCP3. The box says "Depression: episodic treatment in primary care with (generic) antidepressant medication and psychosocial treatment" at the box implies it's between $1000/DALY and $10,000/DALY. I'm not sure exactly where those numbers came from. Have I misread that?

2) I'd be really keen to see your calculations and how you're putting it all together!

3) Can you point out where in their spreadsheet they specify that? I've just spent 20 minutes looking through it and am a bit lost.

My estimate is then likely a miscalculation - thanks for pointing that out! What I should have done is use YLD figures for malaria and depression, and then transformed the disability rating using subjective well-being numbers.

Then I'd need to say something about the badness of losing a life. I think this indicates the perils of using DALY numbers...

Comment author: JamesSnowden 02 July 2016 11:39:13AM 1 point [-]

1) Ah yes - thanks for pointing out. Probably has limited external validity for the strongminds model though (which is psychosocial treatment alone for most patients delivered by community health workers, with only the most serious cases referred to clinics for medication). The numbers come from the Chisholm (2015) WHO-CHOICE model. http://www.bmj.com/content/344/bmj.e609

2) Analysis is here https://docs.google.com/spreadsheets/d/1-lCC1zQHVZlJS8f9OfqhzcZTetHMxuMkW7nT75QDGhk/edit#gid=960072536

[This is quick and dirty but gives a rough indication of cost-effectiveness. Most uncertain assumption is the long term impact of interpersonal group therapy on treated individuals 1-10 years down the line]

3) On the 'bednets' sheet you can see that the output measure is cost per under 5 child death averted. DALYs are then backcalculated from this to get c.$100 [not in sheet] . Something like $3,500 / 50 years of life for each death averted = c.$70/DALY. Because they're only looking at deaths, it's YLL not YLD. I haven't seen a quantitative estimate of the total morbidity burden of malaria. One important consequence of surviving severe (cerebral) malaria is a much higher chance of getting epilepsy later in life http://www.ncbi.nlm.nih.gov/pubmed/25631856 although I suspect there are many others. Child health is really important!

Also - could you specify what you mean by mental health being 10-18 times worse than we think. Does this mean: a) DALY weighting of severe depression is 0.65. Actually it should be 6.5 (so 6.5x worse than death. seems implausible) or b) Life with severe depression is worth 0.35 of healthy life. Actually it should be 0.035 (so 1 year of healthy life is worth c.30 years of life with severe depression. maybe but this seems like a lot)

Comment author: LTengberg 08 February 2017 06:15:58PM 0 points [-]

Hi James!

Your comments to this blog post are very much appreciated - thank you for contributing.

We are a group of students at Oxford University doing a research project where we are trying to find the most effective charity to donate to (see https://oxpr.io/). We are currently looking into StrongMinds, and found your helpful cost-effectiveness model. If we may ask, we were wondering if possibly you have a more up-to-date / complete version of the same? And possibly also ask which inputs you received from StrongMinds vs. inputs estimated (and if so, how those estimates were made)?

Completely understandable if you don't have time to answer all questions, but truly any feedback from you at all would be greatly appreciated.

Please do let us know. Many many thanks!

Comment author: MichaelPlant 03 July 2016 09:02:52PM 0 points [-]

1) Yeah, I never thought the numbers were that robust. More good measurement needed!

2) Thanks for this, will check this out soon.

3) Thanks

4). By being 10-18 times worse than we think, I mean anxiety/depression may cause about 10-18 more suffering than people expect them compared to other health conditions.

This is from the the Dolan and Metcalfe paper: they show people are prepared to trade off 15% of life to remove 'some difficulty walking' and 'moderate anxiety or depression', but that people with 'moderate anxiety or depression' report 10x the reduction in life satisfaction that those with 'some difficulty walking' do, and 18x reduction in terms of daily effect (their measure for what we might call 'happiness').

In other words, the average person imagines walking with a limp would be bad as moderate depression (as inferred from trade offs), but actually the depression would be much worse for their happiness than the limp. This is explained by the focusing illusion and the non-adaptation stuff.

If you look at the other numbers in the Dolan and Metcalfe paper, they show 'self care' and 'usual activities' are equally over-rated when people the trade-offs compared to how much they effect happiness.

In terms of weighting, my thought is that if we constructed well-being adjusted life years (WELBYs) depression would be 10-ish times worse than walking with a limb, but this would be rescaled. So if depression has a WELBY weight of 0.8 (e.g. 1 year with depression is worth 0.2 years of happy life), then minor mobility issues have a WELBY weight of 0.08 or something. I would not suggest all cases of mental health should be understood as being many times worse than death! I don't think I implied that anyway, but I would clarify that in future.

The overall thought is more like: daily life with depression is quite bad in terms of happiness, health conditions which don't cause depression (or pain) at all (or for very long) are probably not nearly as bad as we imagine they are, and we should re-prioritise bearing this in mind. Non-depression mental health disorders may also turn out to be much worse than we expect, and maybe also worse than most physical health conditions. This is all a bit broad ("what does 'most physical health conditions mean?'") but I hope you get the point.