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

Anouk Boonstra, Ghislaine A P G van Mastrigt, Silvia M A A Evers, Sander Osstyn, Remco F P de Winter, Nynke Boonstra, @ease Consortium, Therese A M J van Amelsvoort and Sophie M J Leijdesdorff

PLOS ONE, 2026, vol. 21, issue 7, 1-20

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.

Date: 2026
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DOI: 10.1371/journal.pone.0352652

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