Bipolar Model

WHO - MSD - Bipolar Disorder: Model Documentation

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1. Overview of the Model

This document describes the WHO - MSD - Bipolar Disorder model, which is a botech implementation of the Spectrum Bipolar Disorder Model.

The primary purpose of this model is to simulate the progression of Bipolar Disorder within a population and to understand the potential impact of various interventions. It helps to model how an individual's health status regarding bipolar disorder can change over time, moving between states such as being healthy, having a bipolar episode, receiving treatment, or recovering.

By simulating these processes, the model can assist decision-makers in understanding the potential effects of different health programs and interventions aimed at addressing bipolar disorder. This can help in planning and allocating resources more effectively. The model runs from the year 2025 to 2050.

2. The Model's Building Blocks: Population Groups and How They Connect

The model is constructed from various components that represent different population segments, health states, and influential factors. These are connected to show how the population's health can change.

a. Population Groups and Key Factors (Nodes):

The model uses "states" or "groups" (called nodes) to represent different segments of the population or important factors that influence health.

Key population groups (STATE nodes) in this model include:

  • DsFreeSus: This group represents the healthy population, susceptible to developing bipolar disorder but currently free of the disease.
  • BipolarEpsd: This group represents individuals who are currently experiencing a bipolar episode.
  • Deceased-DsFreeSus: This represents individuals from the "DsFreeSus" group who have passed away due to general mortality.
  • Deceased-BipolarEpsd: This represents individuals from the "BipolarEpsd" group who have passed away.
  • Healthy Years Lived: This is a special state that accumulates the healthy years lived by the population, considering the impact of disability.

Other important nodes represent fixed numbers, rates, or intermediate calculations:

  • CONSTANT nodes: These are fixed values or rates used as inputs. Examples include:

    • Bipolar_Disability_Weight: A fixed value representing the disability associated with a bipolar episode.
    • Healthy_Disability_Weight: A fixed value representing the disability for the healthy population (typically zero).
    • BipolarEpsd_Incidence_Rate: The baseline rate at which new cases of bipolar episodes appear in the healthy population, based on data for the specified country and condition.
    • BipolarEpsd_Remission: The baseline rate at which individuals with a bipolar episode recover, based on data for the specified country and condition.
    • BipolarEpsd_CFR: The Case Fatality Rate for bipolar disorder.
    • MoodStableBasicPsych_Disability_Impact: The reduction in disability due to the "Basic psychosocial treatment, advice, and follow-up for bipolar disorder, plus mood-stabilizing medication" intervention. Similar nodes exist for other interventions (MoodStableIntensivePsych_Disability_Impact, MoodStableIntensivePsych_Mortality_Impact).
    • MoodStableBasicPsych_Coverage: The proportion of the eligible population reached by the "Basic psychosocial treatment..." intervention. This can change over time. Similar nodes exist for other interventions.
    • Adherence parameters (e.g., MoodStableIntensivePsych-Adherence).

  • SURROGATE nodes: These are temporary holding places for calculations that help the model progress. For example:

    • BipolarEpsd Incidence: A temporary store for the number of new bipolar cases calculated in a time step before they are added to the "BipolarEpsd" group.
    • BipolarEpsd Remission: A temporary store for the number of people recovering from bipolar disorder in a time step.
    • BipolarEpsd Mortality: A temporary store for calculations related to deaths among those with bipolar episodes.
    • DsFreeSus HYL: A temporary calculation for the healthy years lived by the "DsFreeSus" group.

  • FUNCTION nodes: These nodes perform calculations based on their inputs. Examples include:

    • Combined_HYL / Modified_HYL: Calculates the overall health-adjusted life years, considering disability weights and intervention effects.
    • Disability_Effect_Transform: Calculates the combined effect of interventions on reducing disability.
    • Mortality_Effect_Transform: Calculates the combined effect of interventions on reducing mortality.
    • Births: Stores the number of births occurring in the population during a time step.

b. Connections and Movements (Links):

"Links" show how people move between population groups or how factors influence each other.

Key connections in the model include:

  • Population Dynamics:

    • DsFreeSus -> Births and BipolarEpsd -> Births: These links calculate the number of births from individuals in the "DsFreeSus" (healthy) and "BipolarEpsd" groups, respectively. This is based on fertility rates from the specified country. The total births are stored in the "Births" node.
    • Births -> DsFreeSus: New male and female births are added to the "DsFreeSus" (healthy) population group. This uses sex ratio data for the specified country.
    • Migration - DsFreeSus and Migration - BipolarEpsd: These links adjust the number of people in the "DsFreeSus" and "BipolarEpsd" groups to account for people moving into or out of the area, based on national migration data.
    • BackgroundMortality DsFreeSus (DsFreeSus -> Deceased-DsFreeSus) and Background Mortality BipolarEpsd (BipolarEpsd -> Deceased-BipolarEpsd): These links move individuals from the "DsFreeSus" and "BipolarEpsd" groups to their respective "Deceased" states. This movement is based on general death rates obtained for the specified country. People are removed from the source group.

  • Bipolar Disorder Progression and Recovery:

    • Prevalence DsFreeSus -> BipolarEpsd: This link represents the initial allocation of the population into the "BipolarEpsd" state based on existing prevalence data for the specified country and condition. People are moved out of "DsFreeSus".
    • BipolarEpsd_Incidence_Rate influences BipolarEpsd Incidence -> BipolarEpsd: New cases of bipolar disorder arise from the "DsFreeSus" group and move to the "BipolarEpsd" group. The rate is determined by BipolarEpsd_Incidence_Rate.
    • BipolarEpsd_Remission influences BipolarEpsd Remission -> DsFreeSus: Individuals in the "BipolarEpsd" group can recover and move back to the "DsFreeSus" group. The base rate is determined by BipolarEpsd_Remission.
    • BipolarEpsd_CFR influences BipolarEpsd Mortality -> Deceased-BipolarEpsd: This pathway represents deaths due to bipolar disorder, using the Case Fatality Rate. This can be modified by intervention effects on mortality.

  • Intervention Effects on Disability and Mortality: The model includes interventions such as "MoodStableBasicPsych" (Basic psychosocial treatment, advice, and follow-up for bipolar disorder, plus mood-stabilizing medication) and "MoodStableIntensivePsych" (Intensive psychosocial intervention for bipolar disorder, plus mood-stabilizing medication).

    • Links like MoodStableBasicPsych_Disability_Impact -> MoodStableBasicPsych_Disability_Effect: The inherent disability reduction efficacy of an intervention (MoodStableBasicPsych_Disability_Impact) is combined with its coverage (e.g., MoodStableBasicPsych_Calculated_Coverage) and population in need (MoodStableBasicPsych_PIN) to determine the overall MoodStableBasicPsych_Disability_Effect. This effect then influences the Combined_DW (Combined Disability Weight). Adherence (e.g., MoodStableBasicPsych-Adherence -> MoodStableBasicPsych_Disability_Impact) also modifies the intervention's impact.
    • Links like MoodStableIntensivePsych_Mortality_Impact -> MoodStableIntensivePsych_Mortality_Effect: Similarly, the mortality reduction efficacy of an intervention is combined with coverage, PIN, and adherence to calculate its overall effect on mortality. This modifies the BipolarEpsd Mortality rate via the Mortality_Effect_Transform node.
    • These effects are aggregated. For instance, MoodStableBasicPsych_Disability_Effect -> Disability_Effect_Transform shows individual intervention effects contributing to an overall transformation factor for disability.

  • Calculating Health Outcomes (DALYs, HYL):

    • Bipolar_Disability_Weight and Healthy_Disability_Weight are used in HYL calculations. For instance, DsFreeSus HYL (contribution from DsFreeSus state to "Healthy Years Lived") is adjusted by Healthy_HYL (which considers Healthy_Disability_Weight).
    • BipolarEpsd HYL (contribution from BipolarEpsd state) is adjusted by Modified_HYL (which incorporates the Combined_DW, potentially reduced by intervention effects).
    • These contributions are summed into the "Healthy Years Lived" state.
    • Years of Life Lost (YLLs) are calculated when individuals move to Deceased-DsFreeSus (recorded as YLL-DsFreeSus) or Deceased-BipolarEpsd (recorded as YLL-BipolarEpsd).
    • Years Lived with Disability (YLDs) are calculated for DsFreeSus (recorded as YLD-DsFreeSus, based on Healthy_Disability_Weight) and for BipolarEpsd (recorded as YLD-BipolarEpsd, based on Combined_DW).
    • DALYs (Disability-Adjusted Life Years) are then calculated by summing the relevant YLL and YLD components into a "DALYs" node.

  • Resource Utilization:

    • When individuals receive an intervention (represented by "PopulationReached" nodes like PopulationReached-MoodStableBasicPsych or PopulationReached-MoodStableIntensivePsych), this triggers resource use. The model calculates the demand for various resources (personnel time, medicines, tests, visits, inpatient days) and their associated costs based on the number of people reached by each specific intervention, as detailed in Section 4.

This structure allows the model to simulate how the population moves between health states, how interventions affect these transitions and outcomes, and what resources are consumed.

3. How the Model Simulates Changes Over Time (Subroutines)

The model simulates changes year by year (or for other defined time periods) by following a sequence of steps, called "subroutines." Here's what happens in each main step:

  • Flush unneeded values: This step resets or clears out temporary values from the previous time period to prepare for new calculations.
  • Generate the population: This step sets up the initial numbers of people in the main healthy population group ("DsFreeSus") at the beginning of a time period.
  • Allocate prevalence: This step distributes the initial population into the "BipolarEpsd" state based on existing disease prevalence at the start of the simulation (for the first year) or adjusts based on incidence in subsequent years.
  • Generate the base values of the surrogate nodes: Calculates starting values for temporary holding places used in calculations (e.g., for new cases, remissions, HYL contributions, mortality).
  • Generate the base values of the function nodes for constants: Sets up initial values for nodes that perform calculations based on other inputs.
  • Generate the values of the constants: Loads or calculates fixed input values like disability weights, baseline incidence/remission rates, CFR, and intervention characteristics (coverage, efficacy).
  • Update the impact (efficacy) by adherence: Adjusts the effectiveness of interventions based on how well people adhere to treatment.
  • Calculate the Incidence Surrogate: Computes the number of new bipolar episodes based on the incidence rate.
  • Calculate the remission surrogate: Computes the number of people recovering from bipolar episodes based on the remission rate.
  • Calculate Coverage: Determines the actual coverage levels for each intervention, considering baseline, target, and scale-up parameters.
  • Calculate Disability Effects: Computes the impact of interventions on reducing the disability associated with bipolar disorder.
  • Add remission impact to mortality effect (interpreted as: Calculate Mortality Effects): Computes the impact of interventions (specifically intensive treatment) on reducing mortality associated with bipolar disorder.
  • Modify mortality effect by coverage: Adjusts the overall mortality reduction effect based on the proportion of the population reached by interventions.
  • Modify mortality effect by PIN: Further refines the mortality reduction effect based on the proportion of the population in need of the intervention.
  • Add calculated mortality impact to transform: Aggregates the mortality reduction effects of different interventions.
  • Modify mortality surrogate by remission effect (interpreted as: Modify mortality surrogate by intervention mortality effect): Adjusts the number of disease-specific deaths based on the combined impact of interventions on mortality.
  • Remove Disability Effects from 1.0: This step calculates a factor representing the remaining disability after accounting for intervention effects (where 1.0 is full disability and effects reduce this).
  • Calculate Healthy and Bipolar HYL: Calculates Health-Adjusted Life Years for healthy individuals and those with bipolar disorder, considering their respective disability weights.
  • Calculated Combined HYL: Aggregates HYL contributions, potentially modified by intervention effects on disability.
  • Calculate Combined DW: Calculates the overall disability weight experienced by those with bipolar disorder, considering intervention effects.
  • Modify Combined DW with intervention effects: Adjusts the disability weight based on the effectiveness of interventions in reducing disability.
  • Calculated Modified HYL: Calculates the final Health-Adjusted Life Years for those with bipolar disorder after accounting for intervention-modified disability.
  • Calculate DsFreeSus Disability Surrogate: Calculates HYL for the healthy, susceptible population.
  • Calculated Bipolar HYL Surrogate: Calculates HYL for the population with bipolar episodes, considering modified disability.
  • Calculate Mortality Surrogate (Add CFR to Surrogate): Incorporates the base case fatality rate into the calculation of disease-specific deaths, which is then modified by intervention effects.
  • Record Births to Birth Node: The model calculates the number of births occurring in both healthy and bipolar-affected populations and stores this total.
  • Main Routine (Synchronous transfer): In this core step, the model applies rates and proportions to simulate people moving between groups (e.g., from healthy to having a bipolar episode, from bipolar episode to recovered, or to a deceased state due to background or disease-specific mortality). This also includes applying migration effects.
  • Push BipolarEpsd to Population Reached: Determines the number of individuals with bipolar disorder who are eligible for and could potentially receive each intervention.
  • Modify Population Reached by PIN and Coverage: Calculates the actual number of people reached by each intervention by applying the population in need (PIN) proportions and the calculated coverage rates.
  • Record HYL: The model updates the total "Healthy Years Lived" by summing contributions from different population groups.
  • Add prevalence to YLD nodes: Calculates the number of people living with disability in each state for YLD calculations.
  • Multiply YLDs by Disability Weights: Applies the relevant disability weights (including those modified by interventions) to the populations in each state to quantify YLDs.
  • Migration of Populations: Adjusts population numbers in states to account for net migration.
  • Age the populations: This step simulates the entire population in each state getting older by one time unit (e.g., one year).
  • Women give birth: New births (calculated earlier) are added to the healthy population group, distributed by sex.
  • Add values to DALYs: This step aggregates YLDs and YLLs to calculate the total DALYs.
  • Calculate resource requirements and costs: Based on the number of people receiving interventions, this step calculates the demand for various resources (personnel time, medicines, visits, tests, inpatient days) and their associated costs.
  • Record Metrics: This step records important results and numbers from the model for the current time period, such as population sizes in different states, DALYs, HYL, and resource utilization.

This sequence is repeated for each year of the simulation, allowing the model to project changes in population health and intervention impact over time.

4. Resource Requirement Assumptions

The model incorporates specific assumptions about the resources needed for each intervention. These are detailed below for each intervention type:

Intervention 1 (Model Intervention 21): Basic psychosocial treatment, advice, and follow-up for bipolar disorder, plus mood-stabilizing medication

Target Population Node in Model: PopulationReached-MoodStableBasicPsych

Drugs and Supplies required Per Client:

  • Lithium, 400 mg: 69% use, 1 unit/day, 365 days
  • Valproate, 500 mg: 11% use, 1 unit, 2 times per day, 365 days
  • Thyroid function test: 69% use, 1 test
  • Olanzapine, 10mg: 5% use, 2 units/day, 365 days
  • Lamotrigine oral 200 mg: 10% use, 1 unit/day, 365 days
  • Quetiapine 300mg: 4% use, 1 unit/day, 365 days
  • Clozapine, 100mg: 1% use, 1 unit/day, 365 days
  • Lithium test: 69% use, 2 tests
  • Urea test: 69% use, 2 tests
  • Creatinine test: 69% use, 2 tests
  • Calcium test: 69% use, 1 test
  • Neutrophil count: 1% use, 12 counts/tests

Personnel Time Required per Case:

  • Medication monitoring (clinic level): 100% require three 10-minute visits with a generalist/primary care doctor.
  • Medication monitoring (clinic level): 100% require three 10-minute visits with a psychiatric nurse.
  • Psychosocial support: 100% require four 20-minute visits with a professional nurse (supervision by DHMTs).

Visits or Inpatient Time Required per Case:

  • Psychosocial treatment: 100% get 4 outpatient visits.
  • Medication monitoring: 100% get 6 outpatient visits.
  • Acute inpatient care: 15% require 28 inpatient days.
  • Long-term care: 10% require 90 inpatient days.

Intervention 2 (Model Intervention 22): Intensive psychosocial intervention for bipolar disorder, plus mood-stabilizing medication

Target Population Node in Model: PopulationReached-MoodStableIntensivePsych

Drugs and Supplies required Per Client:

  • Lithium, 400 mg: 69% use, 1 unit/day, 365 days
  • Valproate, 500 mg: 11% use, 1 unit, 2 times per day, 365 days
  • Thyroid function test: 69% use, 1 test
  • Olanzapine, 10mg: 5% use, 2 units/day, 365 days
  • Lamotrigine oral 200 mg: 10% use, 1 unit/day, 365 days
  • Quetiapine 300mg: 4% use, 1 unit/day, 365 days
  • Clozapine, 100mg: 1% use, 1 unit/day, 365 days
  • Lithium test: 69% use, 2 tests
  • Urea test: 69% use, 2 tests
  • Creatinine test: 69% use, 2 tests
  • Calcium test: 69% use, 1 test
  • Neutrophil count: 1% use, 12 counts/tests

Personnel Time Required per Case:

  • 100% get 2 x 10-minute visits with a doctor for medication and medication monitoring.
  • 100% get 4 x 10-minute visits with a psychiatric nurse for medication and medication monitoring (supervised by DHMT).
  • 90% get 18 individual therapy sessions delivered by an occupational therapist for 50 minutes each.
  • 10% get 2 individual therapy sessions delivered by an occupational therapist for 50 minutes each.
  • 10% (the same 10% receiving fewer individual sessions) get 24 group therapy sessions delivered by an occupational therapist for 50 minutes each (to a group of 5 participants).

Visits or Inpatient Time Required per Case:

  • Medication monitoring: 100% get 6 outpatient visits.
  • Individual therapy: 90% get 18 outpatient visits.
  • Group therapy: 10% get 26 outpatient visits (2 individual followed by 24 group therapy sessions).
  • Acute inpatient care: 15% of patients require 28 inpatient days.
  • Long-term inpatient care: 10% of patients require 90 inpatient days.

Intervention 3 (Model Intervention 23): Residential care and Rehab

Target Population Node in Model: Not explicitly linked to a "PopulationReached" node in the main model's intervention pathways for coverage scaling.

Drugs and Supplies required Per Client:

  • Included in Basic/Intensive psychosocial support and mood-stabilizing medication (i.e., no separate drug costs here).

Personnel Time Required per Case:

  • Rehab services delivered by a full-time Occupational Therapist Assistant.
  • OTAs receive weekly support from an Occupational Therapist (visits once a week for half a day).
  • Full-time social worker manager provided.
  • PN visits once a month (average 15 minutes per person) for medication and support.

Visits or Inpatient Time Required per Case:

  • 100% receive 365 inpatient days in a community residential facility.

Intervention 4 (Model Intervention 24): Day care

Target Population Node in Model: Not explicitly linked to a "PopulationReached" node in the main model's intervention pathways for coverage scaling.

Drugs and Supplies required Per Client:

  • Included in Basic/Intensive psychosocial support and mood-stabilizing medication (i.e., no separate drug costs here).

Personnel Time Required per Case:

  • 100% get 100 days of day care.
  • Rehab services delivered by a full-time Occupational Therapist Assistant.
  • OTAs receive monthly support from an Occupational Therapist (visits once a month for half a day, three visits total).
  • Full-time social worker manager provided.

Visits or Inpatient Time Required per Case:

  • 100% receive 100 day-care days in a community day care facility.

5. Coverage Assumptions for Scenarios

The model can be run under different scenarios, each with specific assumptions about intervention coverage levels and how they change over the simulation period (2025-2050).

Scenario: Default Scenario

Description: Where default coverage rates stay the same. All relevant parameters are exposed for editing.

  • Intervention: Basic psychosocial treatment, advice, and follow-up for bipolar disorder, plus mood-stabilizing medication (Intervention 1 / Model Int. 21)

    • Baseline Coverage: 20%
    • Target Coverage: 20%
    • Scale-up Period: from 2025 to 2030 (coverage remains constant at baseline)
    • Population In Need: 100%
    • Adherence: 71.5%
    • Disability Efficacy: 34% reduction

  • Intervention: Intensive psychosocial intervention for bipolar disorder, plus mood-stabilizing medication (Intervention 2 / Model Int. 22)

    • Baseline Coverage: 20%
    • Target Coverage: 20%
    • Scale-up Period: from 2025 to 2030 (coverage remains constant at baseline; original doc "Not applicable" for scale-up start/end as target=baseline)
    • Population In Need: 100%
    • Adherence: 65%
    • Disability Efficacy: 34% reduction
    • Mortality Efficacy: 65% reduction

Resource Calculation Basis: Resources are calculated based on the populations reached by PopulationReached-MoodStableBasicPsych and PopulationReached-MoodStableIntensivePsych respectively.

Scenario: All-On Scenario

Description: Where all interventions are scaled up to their target coverage.

  • Intervention: Basic psychosocial treatment, advice, and follow-up for bipolar disorder, plus mood-stabilizing medication (Intervention 1 / Model Int. 21)

    • Baseline Coverage: 20%
    • Target Coverage: 50%
    • Scale-up Period: from 2025 to 2030
    • Population In Need: 100%
    • Adherence: 71.5%
    • Disability Efficacy: 34% reduction

  • Intervention: Intensive psychosocial intervention for bipolar disorder, plus mood-stabilizing medication (Intervention 2 / Model Int. 22)

    • Baseline Coverage: 20%
    • Target Coverage: 50%
    • Scale-up Period: from 2025 to 2030 (assumed to follow general scenario timing if applicable, or target reached by 2030)
    • Population In Need: 100%
    • Adherence: 65%
    • Disability Efficacy: 34% reduction
    • Mortality Efficacy: 65% reduction

Resource Calculation Basis: Resources are calculated based on the populations reached by PopulationReached-MoodStableBasicPsych and PopulationReached-MoodStableIntensivePsych respectively.

Scenario: Psychological treatment and mood-stabilizing medication (valproate) Scenario

Description: Scaling up Intervention 1 (Basic psychosocial treatment, advice, and follow-up for bipolar disorder, plus mood-stabilizing medication) to target coverage.

  • Intervention: Basic psychosocial treatment, advice, and follow-up for bipolar disorder, plus mood-stabilizing medication (Intervention 1 / Model Int. 21)
    • Baseline Coverage: 20%
    • Target Coverage: 50%
    • Scale-up Period: from 2025 to 2030
    • Population In Need: 100%
    • Adherence: 71.5%
    • Disability Efficacy: 34% reduction (Other interventions, e.g., Intensive psychosocial intervention (Intervention 2), remain at their default/baseline levels as per the "Default Scenario" unless explicitly overridden).

Resource Calculation Basis: In this scenario configuration, resources for the scaled-up Intervention 1 are calculated based on the population size of PopulationReached-MoodStableBasicPsych (Note: original document states PopulationReached-MoodStableIntensivePsych, which appears to be a mismatch, see Issues section).

Scenario: Basic psychosocial support and mood-stabilizing medication (lithium) Scenario

Description: Scaling up Intervention 2 (Intensive psychosocial intervention for bipolar disorder, plus mood-stabilizing medication) to target coverage.

  • Intervention: Intensive psychosocial intervention for bipolar disorder, plus mood-stabilizing medication (Intervention 2 / Model Int. 22)
    • Baseline Coverage: 20%
    • Target Coverage: 50%
    • Scale-up Period: from 2025 to 2030 (assumed to follow general scenario timing if applicable, or target reached by 2030)
    • Population In Need: 100%
    • Adherence: 65%
    • Disability Efficacy: 34% reduction
    • Mortality Efficacy: 65% reduction (Other interventions, e.g., Basic psychosocial treatment (Intervention 1), remain at their default/baseline levels as per the "Default Scenario" unless explicitly overridden).

Resource Calculation Basis: In this scenario configuration, resources for the scaled-up Intervention 2 are calculated based on the population size of PopulationReached-MoodStableIntensivePsych (Note: original document states PopulationReached-MoodStableBasicPsych, which appears to be a mismatch, see Issues section).

Note on Interventions 3 and 4 (Model Interventions 23 and 24): The provided scenario configurations primarily detail coverage parameters for Interventions 1 and 2 (Model Interventions 21 and 22). Interventions 3 (Residential care and Rehab) and 4 (Day care) are described in terms of their resource components but do not have explicit coverage scale-up parameters within these specific scenario files. Their implementation and coverage would need to be defined separately or assumed to be part of a broader service delivery context not directly managed by these particular coverage parameters.

Issues for Authors

  1. Subroutine Clarification:
    • In Section 3 (Subroutines), step 12 "Add remission impact to mortality effect" and step 16 "Modify mortality surrogate by remission effect" seem to conflate "remission impact" with "mortality impact/effect". This has been interpreted as relating to mortality effects from interventions, but the original phrasing should be reviewed for clarity.
  2. Resource Calculation Basis Mismatch in Scenarios:
    • In Section 5, for the "Psychological treatment and mood-stabilizing medication (valproate) Scenario" (which scales up Intervention 1 / Model Int. 21), the resource calculation basis is stated as PopulationReached-MoodStableIntensivePsych. This seems incorrect; it should likely be PopulationReached-MoodStableBasicPsych if Intervention 1 is being scaled.
    • Similarly, for the "Basic psychosocial support and mood-stabilizing medication (lithium) Scenario" (which scales up Intervention 2 / Model Int. 22), the resource calculation basis is stated as PopulationReached-MoodStableBasicPsych. This also seems incorrect; it should likely be PopulationReached-MoodStableIntensivePsych.
    • These mismatches should be verified and corrected.
  3. Scenario Naming vs. Intervention Naming:
    • The scenario names in Section 5 (e.g., "Psychological treatment and mood-stabilizing medication (valproate) Scenario") are descriptive but differ from the more formal intervention names used in Section 4 (e.g., "Intervention 1 (Model Intervention 21): Basic psychosocial treatment, advice, and follow-up for bipolar disorder, plus mood-stabilizing medication"). While the mapping is made in the reformatted document, ensuring consistent terminology or clear cross-referencing in the source might be beneficial. The "(valproate)" and "(lithium)" parts of scenario names are not explicitly defining features of the interventions themselves in Section 4, which list multiple drug options.
  4. Scale-Up Period Terminology:
    • The Bipolar documentation sometimes used "Year 0 of model" / "Year 5 of model" or "Not applicable" for scale-up periods. This has been translated to specific years (2025-2030) or descriptive notes to align with the Anxiety document. The original intent, especially for "Not applicable" or vaguely defined scale-up for Intervention 22 in the All-On scenario, should be confirmed.
  5. Intervention Numbering:
    • The Bipolar document refers to interventions as 21, 22, 23, 24. For clarity in the reformatted document, they've been referred to as "Intervention 1 (Model Intervention 21)", etc., in Section 4 and 5 to maintain a 1, 2, 3, 4 sequence consistent with the Anxiety doc's style, while retaining the original model numbers. This mapping should be clear to authors.
  6. "Population In Need" (PIN) in Subroutines:
    • The Bipolar subroutines (Section 3, step 14 "Modify mortality effect by PIN" and step 29 "Modify Population Reached by PIN and Coverage") mention PIN. The Anxiety document also implies PIN's role in linking efficacy/coverage to effects. The consistency of PIN's application and definition across both models (if intended) might be worth confirming. For Bipolar, Section 5 notes PIN as 100% for the specified interventions.
  7. Resource Linkages in Section 2.b:
    • Section 2.b (Links) for Bipolar now includes a general statement about resource utilization. Unlike the Anxiety document, the Bipolar source did not detail specific PopulationReached-X -> ResourceNode links in its Section 2.b. The resource connections are primarily detailed in Section 4 (Resource Requirements) by stating the "Target Population Node in Model" for Interventions 1 and 2. This difference in descriptive detail between the source documents is reflected.
Anxiety ModelDepression Model