Balancing health and mental health in a pandemic : A Discrete Choice Experiment in 8 EU Countries.

Background. Policy decisions, often made hastily and prioritising short-term considerations with a focus on physical health, raise questions about the alignment of policymakers' choices with the preferences of the general population. This study addresses this uncertainty through a discrete choice experiment (DCE), examining the preferences of both the population and stakeholders regarding four well-being attributes (physical health, mental health, employment and liberty) during a pandemic. The aim is to uncover the core values guiding mitigation policies.



Method. The DCE method, rooted in random utility theory, modelled individuals' choice behaviour. An online survey gathered responses from 1,600 individuals, representative of the general population and 250 health stakeholders across eight European countries (Belgium, France, Germany, Italy, The Netherlands, Spain, Sweden, United Kingdom). Respondents assessed two fictitious countries (A and B) in six blocks, each representing pandemic mitigation policy consequences differing on four attributes: hospital admissions(low, medium, high), psychological distress, job loss, movement restrictions.



Results indicated that most respondents engaged in trade-offs between attributes, with psychological distress exerting the greatest influence and mobility restrictions the least. Stakeholders prioritised psychological distress more than the general population (Chi2=15,7, p<0.01), while the opposite was true for mobility restrictions mobility (Chi2=22,5, p<0.01). Respondents with higher stigmatisation of mental health issues were less sensitive to psychological distress.



In conclusion, this study reveals divergent preferences between stakeholders and the general population regarding mental health and civil liberties restrictions, providing insights into essential considerations for shaping effective mitigation policies.