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Moreno-Peral P, Conejo-Cerón S, Wijnen B, Lokkerbol J, Fernández A, Smit F, Bellón JÁ. Health-Economic Evaluation of Psychological Interventions for Anxiety Prevention: A Systematic Review. Psychiatr Serv 2024; 75:667-677. [PMID: 38410039 DOI: 10.1176/appi.ps.20230101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Although evidence supports the effectiveness of psychological interventions for prevention of anxiety, little is known about their cost-effectiveness. The aim of this study was to conduct a systematic review of health-economic evaluations of psychological interventions for anxiety prevention. METHODS PubMed, PsycInfo, Web of Science, Embase, Cochrane Central Register of Controlled Trials, EconLit, National Health Service (NHS) Economic Evaluations Database, NHS Health Technology Assessment, and OpenGrey databases were searched electronically on December 23, 2022. Included studies focused on economic evaluations based on randomized controlled trials of psychological interventions to prevent anxiety. Study data were extracted, and the quality of the selected studies was assessed by using the Consensus on Health Economic Criteria and the Cochrane risk-of-bias tool. RESULTS All included studies (N=5) had economic evaluations that were considered to be of good quality. In two studies, the interventions showed favorable cost-effectiveness compared with usual care groups. In one study, the intervention was not cost-effective. Findings from another study cast doubt on the cost-effectiveness of the intervention, and the cost-effectiveness of the intervention in the remaining study could not be established. CONCLUSIONS Although the findings suggest some preliminary evidence of cost-effectiveness of psychological interventions for preventing anxiety, they were limited by the small number of included studies. Additional research on the cost-effectiveness of psychological interventions for anxiety in different countries and populations is required.
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Affiliation(s)
- Patricia Moreno-Peral
- IBIMA Plataforma BIONAND, Málaga, Spain (Moreno-Peral, Conejo-Cerón); Institute of Health Carlos III (ISCIII), Madrid (Moreno-Peral, Conejo-Cerón); Department of Personality, Evaluation and Psychological Treatment (Moreno-Peral) and Department of Public Health and Psychiatry (Bellón), University of Málaga, Málaga, Spain; Centre of Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, the Netherlands (Wijnen, Lokkerbol, Smit); Barcelona Agency of Public Health, Community Health Service, and Center for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain (Fernández); Department of Clinical Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Smit); El Palo Health Centre, Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain (Bellón)
| | - Sonia Conejo-Cerón
- IBIMA Plataforma BIONAND, Málaga, Spain (Moreno-Peral, Conejo-Cerón); Institute of Health Carlos III (ISCIII), Madrid (Moreno-Peral, Conejo-Cerón); Department of Personality, Evaluation and Psychological Treatment (Moreno-Peral) and Department of Public Health and Psychiatry (Bellón), University of Málaga, Málaga, Spain; Centre of Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, the Netherlands (Wijnen, Lokkerbol, Smit); Barcelona Agency of Public Health, Community Health Service, and Center for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain (Fernández); Department of Clinical Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Smit); El Palo Health Centre, Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain (Bellón)
| | - Ben Wijnen
- IBIMA Plataforma BIONAND, Málaga, Spain (Moreno-Peral, Conejo-Cerón); Institute of Health Carlos III (ISCIII), Madrid (Moreno-Peral, Conejo-Cerón); Department of Personality, Evaluation and Psychological Treatment (Moreno-Peral) and Department of Public Health and Psychiatry (Bellón), University of Málaga, Málaga, Spain; Centre of Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, the Netherlands (Wijnen, Lokkerbol, Smit); Barcelona Agency of Public Health, Community Health Service, and Center for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain (Fernández); Department of Clinical Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Smit); El Palo Health Centre, Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain (Bellón)
| | - Joran Lokkerbol
- IBIMA Plataforma BIONAND, Málaga, Spain (Moreno-Peral, Conejo-Cerón); Institute of Health Carlos III (ISCIII), Madrid (Moreno-Peral, Conejo-Cerón); Department of Personality, Evaluation and Psychological Treatment (Moreno-Peral) and Department of Public Health and Psychiatry (Bellón), University of Málaga, Málaga, Spain; Centre of Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, the Netherlands (Wijnen, Lokkerbol, Smit); Barcelona Agency of Public Health, Community Health Service, and Center for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain (Fernández); Department of Clinical Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Smit); El Palo Health Centre, Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain (Bellón)
| | - Anna Fernández
- IBIMA Plataforma BIONAND, Málaga, Spain (Moreno-Peral, Conejo-Cerón); Institute of Health Carlos III (ISCIII), Madrid (Moreno-Peral, Conejo-Cerón); Department of Personality, Evaluation and Psychological Treatment (Moreno-Peral) and Department of Public Health and Psychiatry (Bellón), University of Málaga, Málaga, Spain; Centre of Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, the Netherlands (Wijnen, Lokkerbol, Smit); Barcelona Agency of Public Health, Community Health Service, and Center for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain (Fernández); Department of Clinical Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Smit); El Palo Health Centre, Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain (Bellón)
| | - Filip Smit
- IBIMA Plataforma BIONAND, Málaga, Spain (Moreno-Peral, Conejo-Cerón); Institute of Health Carlos III (ISCIII), Madrid (Moreno-Peral, Conejo-Cerón); Department of Personality, Evaluation and Psychological Treatment (Moreno-Peral) and Department of Public Health and Psychiatry (Bellón), University of Málaga, Málaga, Spain; Centre of Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, the Netherlands (Wijnen, Lokkerbol, Smit); Barcelona Agency of Public Health, Community Health Service, and Center for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain (Fernández); Department of Clinical Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Smit); El Palo Health Centre, Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain (Bellón)
| | - Juan Ángel Bellón
- IBIMA Plataforma BIONAND, Málaga, Spain (Moreno-Peral, Conejo-Cerón); Institute of Health Carlos III (ISCIII), Madrid (Moreno-Peral, Conejo-Cerón); Department of Personality, Evaluation and Psychological Treatment (Moreno-Peral) and Department of Public Health and Psychiatry (Bellón), University of Málaga, Málaga, Spain; Centre of Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, the Netherlands (Wijnen, Lokkerbol, Smit); Barcelona Agency of Public Health, Community Health Service, and Center for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain (Fernández); Department of Clinical Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Smit); El Palo Health Centre, Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain (Bellón)
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Yang Y, Zheng R, Yang L, Huang X, Zhang T. Decision tree-Markov model of perinatal depression screening: a cost-utility analysis. Front Public Health 2024; 12:1308867. [PMID: 38832225 PMCID: PMC11144866 DOI: 10.3389/fpubh.2024.1308867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 04/29/2024] [Indexed: 06/05/2024] Open
Abstract
Background Perinatal depression affects the physical and mental health of pregnant women. It also has a negative effect on children, families, and society, and the incidence is high. We constructed a cost-utility analysis model for perinatal depression screening in China and evaluated the model from the perspective of health economics. Methods We constructed a Markov model that was consistent with the screening strategy for perinatal depression in China, and two screening strategies (screening and non-screening) were constructed. Each strategy was set as a cycle of 3 months, corresponding to the first trimester, second trimester, third trimester, and postpartum. The state outcome parameters required for the model were obtained based on data from the National Prospective Cohort Study on the Mental Health of Chinese Pregnant Women from August 2015 to October 2016. The cost parameters were obtained from a field investigation on costs and screening effects conducted in maternal and child health care institutions in 2020. The cost-utility ratio and incremental cost-utility ratio of different screening strategies were obtained by multiplicative analysis to evaluate the health economic value of the two screening strategies. Finally, deterministic and probabilistic sensitivity analyses were conducted on the uncertain parameters in the model to explore the sensitivity factors that affected the selection of screening strategies. Results The cost-utility analysis showed that the per capita cost of the screening strategy was 129.54 yuan, 0.85 quality-adjusted life years (QALYs) could be obtained, and the average cost per QALY gained was 152.17 yuan. In the non-screening (routine health care) group, the average cost was 171.80 CNY per person, 0.84 QALYs could be obtained, and the average cost per QALY gained was 205.05 CNY. Using one gross domestic product per capita in 2021 as the willingness to pay threshold, the incremental cost-utility ratio of screening versus no screening (routine health care) was about -3,126.77 yuan, which was lower than one gross domestic product per capita. Therefore, the screening strategy was more cost-effective than no screening (routine health care). Sensitivity analysis was performed by adjusting the parameters in the model, and the results were stable and consistent, which did not affect the choice of the optimal strategy. Conclusion Compared with no screening (routine health care), the recommended perinatal depression screening strategy in China is cost-effective. In the future, it is necessary to continue to standardize screening and explore different screening modalities and tools suitable for specific regions.
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Affiliation(s)
- Yehuan Yang
- National Center for Women and Children's Health Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ruimin Zheng
- National Center for Women and Children's Health Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Yang
- National Center for Women and Children's Health Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xing Huang
- National Center for Women and Children's Health Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tong Zhang
- Capital Institute of Pediatrics, Beijing, China
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Bellón JA, Rodríguez-Morejón A, Conejo-Cerón S, Campos-Paíno H, Rodríguez-Bayón A, Ballesta-Rodríguez MI, Rodríguez-Sánchez E, Mendive JM, López del Hoyo Y, Luna JD, Tamayo-Morales O, Moreno-Peral P. A personalized intervention to prevent depression in primary care based on risk predictive algorithms and decision support systems: protocol of the e-predictD study. Front Psychiatry 2023; 14:1163800. [PMID: 37333911 PMCID: PMC10275079 DOI: 10.3389/fpsyt.2023.1163800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023] Open
Abstract
The predictD is an intervention implemented by general practitioners (GPs) to prevent depression, which reduced the incidence of depression-anxiety and was cost-effective. The e-predictD study aims to design, develop, and evaluate an evolved predictD intervention to prevent the onset of major depression in primary care based on Information and Communication Technologies, predictive risk algorithms, decision support systems (DSSs), and personalized prevention plans (PPPs). A multicenter cluster randomized trial with GPs randomly assigned to the e-predictD intervention + care-as-usual (CAU) group or the active-control + CAU group and 1-year follow-up is being conducted. The required sample size is 720 non-depressed patients (aged 18-55 years), with moderate-to-high depression risk, under the care of 72 GPs in six Spanish cities. The GPs assigned to the e-predictD-intervention group receive brief training, and those assigned to the control group do not. Recruited patients of the GPs allocated to the e-predictD group download the e-predictD app, which incorporates validated risk algorithms to predict depression, monitoring systems, and DSSs. Integrating all inputs, the DSS automatically proposes to the patients a PPP for depression based on eight intervention modules: physical exercise, social relationships, improving sleep, problem-solving, communication skills, decision-making, assertiveness, and working with thoughts. This PPP is discussed in a 15-min semi-structured GP-patient interview. Patients then choose one or more of the intervention modules proposed by the DSS to be self-implemented over the next 3 months. This process will be reformulated at 3, 6, and 9 months but without the GP-patient interview. Recruited patients of the GPs allocated to the control-group+CAU download another version of the e-predictD app, but the only intervention that they receive via the app is weekly brief psychoeducational messages (active-control group). The primary outcome is the cumulative incidence of major depression measured by the Composite International Diagnostic Interview at 6 and 12 months. Other outcomes include depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7), depression risk (predictD risk algorithm), mental and physical quality of life (SF-12), and acceptability and satisfaction ('e-Health Impact' questionnaire) with the intervention. Patients are evaluated at baseline and 3, 6, 9, and 12 months. An economic evaluation will also be performed (cost-effectiveness and cost-utility analysis) from two perspectives, societal and health systems. Trial registration ClinicalTrials.gov, identifier: NCT03990792.
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Affiliation(s)
- Juan A. Bellón
- Biomedical Research Institute of Malaga (IBIMA Plataforma Bionand), Málaga, Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- ‘El Palo' Health Centre, Servicio Andaluz de Salud (SAS), Málaga, Spain
- Department of Public Health and Psychiatry, University of Málaga (UMA), Málaga, Spain
| | - Alberto Rodríguez-Morejón
- Biomedical Research Institute of Malaga (IBIMA Plataforma Bionand), Málaga, Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatment, University of Málaga (UMA), Málaga, Spain
| | - Sonia Conejo-Cerón
- Biomedical Research Institute of Malaga (IBIMA Plataforma Bionand), Málaga, Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
| | - Henar Campos-Paíno
- Biomedical Research Institute of Malaga (IBIMA Plataforma Bionand), Málaga, Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
| | - Antonina Rodríguez-Bayón
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Centro de Salud San José, Distrito Sanitario Jaén Norte, Servicio Andaluz de Salud (SAS), Linares, Jaén, Spain
| | - María I. Ballesta-Rodríguez
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Centro de Salud Federico del Castillo, Distrito Sanitario Jaén, Servicio Andaluz de Salud (SAS), Jaén, Spain
| | - Emiliano Rodríguez-Sánchez
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
| | - Juan M. Mendive
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- ‘La Mina' Health Centre, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Yolanda López del Hoyo
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria de Aragón (IISA), Universidad de Zaragoza (UNIZAR), Zaragoza, Spain
| | - Juan D. Luna
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Department of Statistics and Operational Research, University of Granada (UGR), Granada, Spain
| | - Olaya Tamayo-Morales
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Patricia Moreno-Peral
- Biomedical Research Institute of Malaga (IBIMA Plataforma Bionand), Málaga, Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatment, University of Málaga (UMA), Málaga, Spain
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Campos-Paíno H, Moreno-Peral P, Gómez-Gómez I, Conejo-Cerón S, Galán S, Reyes-Martín S, Bellón JÁ. Effectiveness of social support-based interventions in preventing depression in people without clinical depression: A systematic review and meta-analysis of randomized controlled trials. Int J Soc Psychiatry 2023; 69:253-266. [PMID: 36419332 DOI: 10.1177/00207640221134232] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The evidence available on the association between social support and prevention of depression has been basically obtained from observational studies. AIM We evaluated the effectiveness of social support-based interventions for the prevention of depression in people without clinical depression. METHODS Systematic review and meta-analysis (SR/MA) of randomized controlled trials (RCT), which were searched for in MEDLINE, EMBASE, CENTRAL, WOS, PsycINFO, OpenGrey and other sources from the inception dates to June 8, 2022. We selected RCTs that assessed the effectiveness of social support-based interventions as compared to controls, included subjects without baseline clinical depression, and measured as results a reduction in depressive symptoms and/or the incidence of new cases of depression. Pooled standardized mean differences (SMDs) were calculated from random effects models. RESULTS Nine RCTs involving 927 patients from North America, Asia and Europe were included. The pooled SMD was -0.43 [95% confidence interval (CI) -0.82 to -0.04; p = .031]. Sensitivity analyses confirmed the robustness of results. Heterogeneity was substantial [I2 = 80% (95% CI: 64% to 89%)]. A meta-regression model that included usual care as comparator and the continent (Europe), explained 53% of heterogeneity. Eight RCTs had a moderate overall risk of bias and one had a high risk of bias. Follow-up was ⩾1 year in only three RCTs. There was no statistical evidence of publication bias. The quality of evidence, as measured on GRADE guidelines, was low. CONCLUSION Social support-based interventions had a small preventive effect on depression. Longer RCTs with a low risk of bias are necessary.
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Affiliation(s)
- Henar Campos-Paíno
- Biomedical Research Institute of Malaga (IBIMA Platform Bionand), Malaga, Spain.,Prevention and Health Promotion Research Network (redIAPP) & Chronicity, Primary Care and Health Promotion Research Network, (RICAPPS), ISCIII, Madrid, Spain
| | - Patricia Moreno-Peral
- Biomedical Research Institute of Malaga (IBIMA Platform Bionand), Malaga, Spain.,Prevention and Health Promotion Research Network (redIAPP) & Chronicity, Primary Care and Health Promotion Research Network, (RICAPPS), ISCIII, Madrid, Spain.,Department of Personality, Assessment and Psychological Treatment, University of Malaga(UMA), Spain
| | - Irene Gómez-Gómez
- Prevention and Health Promotion Research Network (redIAPP) & Chronicity, Primary Care and Health Promotion Research Network, (RICAPPS), ISCIII, Madrid, Spain.,Department of Psychology, Universidad Loyola Andalucía, Sevilla, Spain
| | - Sonia Conejo-Cerón
- Biomedical Research Institute of Malaga (IBIMA Platform Bionand), Malaga, Spain.,Prevention and Health Promotion Research Network (redIAPP) & Chronicity, Primary Care and Health Promotion Research Network, (RICAPPS), ISCIII, Madrid, Spain
| | - Santiago Galán
- Biomedical Research Institute of Malaga (IBIMA Platform Bionand), Malaga, Spain.,Prevention and Health Promotion Research Network (redIAPP) & Chronicity, Primary Care and Health Promotion Research Network, (RICAPPS), ISCIII, Madrid, Spain
| | - Sara Reyes-Martín
- Biomedical Research Institute of Malaga (IBIMA Platform Bionand), Malaga, Spain.,Prevention and Health Promotion Research Network (redIAPP) & Chronicity, Primary Care and Health Promotion Research Network, (RICAPPS), ISCIII, Madrid, Spain
| | - Juan Ángel Bellón
- Biomedical Research Institute of Malaga (IBIMA Platform Bionand), Malaga, Spain.,Prevention and Health Promotion Research Network (redIAPP) & Chronicity, Primary Care and Health Promotion Research Network, (RICAPPS), ISCIII, Madrid, Spain.,El Palo Health Centre, Andalusian Health Service (SAS), Malaga, Spain.,Department of Public Health and Psychiatry, University of Malaga, Spain
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Kählke F, Buntrock C, Smit F, Ebert DD. Systematic review of economic evaluations for internet- and mobile-based interventions for mental health problems. NPJ Digit Med 2022; 5:175. [PMID: 36424463 PMCID: PMC9686241 DOI: 10.1038/s41746-022-00702-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022] Open
Abstract
In view of the staggering disease and economic burden of mental disorders, internet and mobile-based interventions (IMIs) targeting mental disorders have often been touted to be cost-effective; however, available evidence is inconclusive and outdated. This review aimed to provide an overview of the cost-effectiveness of IMIs for mental disorders and symptoms. A systematic search was conducted for trial-based economic evaluations published before 10th May 2021. Electronic databases (including MEDLINE, PsycINFO, CENTRAL, PSYNDEX, and NHS Economic Evaluations Database) were searched for randomized controlled trials examining IMIs targeting mental disorders and symptoms and conducting a full health economic evaluation. Methodological quality and risk of bias were assessed. Cost-effectiveness was assumed at or below £30,000 per quality-adjusted life year gained. Of the 4044 studies, 36 economic evaluations were reviewed. Guided IMIs were likely to be cost-effective in depression and anxiety. The quality of most evaluations was good, albeit with some risks of bias. Heterogeneity across studies was high because of factors such as different costing methods, design, comparison groups, and outcomes used. IMIs for anxiety and depression have potential to be cost-effective. However, more research is needed into unguided (preventive) IMIs with active control conditions (e.g., treatment as usual) and longer time horizon across a wider range of disorders.Trial registration: PROSPERO Registration No. CRD42018093808.
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Affiliation(s)
- Fanny Kählke
- grid.6936.a0000000123222966Department of Sport and Health Sciences, Professorship of Psychology and Digital Mental Health Care, Technische Universität München, Munich, Germany
| | - Claudia Buntrock
- grid.5807.a0000 0001 1018 4307Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
| | - Filip Smit
- grid.12380.380000 0004 1754 9227Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands ,grid.416017.50000 0001 0835 8259Centre of Health-Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - David Daniel Ebert
- grid.6936.a0000000123222966Department of Sport and Health Sciences, Professorship of Psychology and Digital Mental Health Care, Technische Universität München, Munich, Germany
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The Efficacy of Digital Cognitive–Behavioral Interventions in Supporting the Psychological Adjustment and Sleep Quality of Pregnant Women with Sub-Clinical Symptoms: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159549. [PMID: 35954901 PMCID: PMC9368246 DOI: 10.3390/ijerph19159549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 12/10/2022]
Abstract
The present meta-analysis investigated the overall and differential efficacy of digital cognitive–behavioral therapies (CBTs) vs. third-generation CBTs deployed to pregnant women in reducing sub-clinical depression, anxiety, and stress symptoms while fostering sleep quality and quality of life. A PRISMA-guided systematic search was used, including randomized controlled trials (RCTs) evaluating the above-mentioned interventions. Data were pooled using either the mean difference (MD) or standardized MD (SMD). Sub-group analyses were carried out when appropriate. The primary outcomes were depression, anxiety, and stress symptoms, as well as sleep quality and quality of life. The interventions’ acceptability was evaluated through the odds ratio (OR) of drop-out rates. Seven RCTs were included, comprising 1873 pregnant women. The results showed the interventions’ efficacy in terms of reducing depression symptoms (SMD = −0.36, CI = 0.61, −0.11, k = 9) at the endpoint, although it was not maintained at follow-up during the postpartum period. The interventions’ efficacy in terms of reducing anxiety symptoms (SMD = 1.96, CI = −2.72, −1.21, k = 3) at the endpoint was also significant, while having no effect on sleep quality. The interventions were well accepted (OR = 1.68; 95% CI = 0.84, 3.35; k = 7). Although no sound conclusions can be drawn concerning the joint or differential efficacy of the considered interventions, this study was useful in highlighting the need to develop evidence-based digital prevention programs for pregnant women with sub-clinical symptoms.
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7
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Vander Zwalmen Y, Hoorelbeke K, Liebaert E, Nève de Mévergnies C, Koster EHW. Cognitive remediation for depression vulnerability: Current challenges and new directions. Front Psychol 2022; 13:903446. [PMID: 35936259 PMCID: PMC9352853 DOI: 10.3389/fpsyg.2022.903446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
It is increasingly acknowledged that cognitive impairment can play an important role in depression vulnerability. Therefore, cognitive remediation strategies, and cognitive control training (CCT) procedures have gained attention in recent years as possible interventions for depression. Recent studies suggest a small to medium effect on indicators of depression vulnerability. Despite initial evidence for the efficacy and effectiveness of CCT, several central questions remain. In this paper we consider the key challenges for the clinical implementation of CCT, including exploration of (1) potential working mechanisms and related to this, moderators of training effects, (2) necessary conditions under which CCT could be optimally administered, such as dose requirements and training schedules, and (3) how CCT could interact with or augment existing treatments of depression. Revisiting the CCT literature, we also reflect upon the possibilities to evolve toward a stratified medicine approach, in which individual differences could be taken into account and used to optimize prevention of depression.
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Affiliation(s)
- Yannick Vander Zwalmen
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
- *Correspondence: Yannick Vander Zwalmen,
| | - Kristof Hoorelbeke
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Eveline Liebaert
- Department of Head and Skin, Ghent University Hospital, Ghent, Belgium
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Luo N, Wang Y, Xia Y, Tu M, Wu X, Shao X, Fang J. The effect of acupuncture on condition being studied emotional disorders in patients with postpartum: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e28669. [PMID: 35089211 PMCID: PMC8797587 DOI: 10.1097/md.0000000000028669] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/06/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND As one of the common postpartum diseases, postpartum emotional disorders (PEDs) mainly include postpartum depression, postpartum anxiety, posttraumatic stress disorder, and obsessive-compulsive disorder, which significantly affect the patient's quality of life. Acupuncture has been widely used as a popular alternative complementary therapy for the treatment of PEDs. Nevertheless, its effectiveness and safety remain uncertain. Hence, the first systematic review and meta-analysis will be urgently executed to explore the effectiveness and safety of acupuncture in the treatment of PEDs. METHODS Eight databases will be searched, including the PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang Database, and Technology Periodical Database. Only randomized controlled trials of acupuncture for PEDs will be considered. The languages are limited to English and Chinese. All publications were retrieved by 2 researchers independently. Assessment of the Edinburgh Postpartum Depression Scale will be dedicated as a primary outcome, and secondary outcomes include the Hamilton Anxiety Inventory, the Hamilton Depression Inventory, the Orientation to Life Questionnaire (sense of coherence 29-item scale), and adverse effects of acupuncture. The Cochrane Risk of Bias tool will be used to assess the quality of the eligible publications. Additionally, the level of evidence for results will be evaluated by using the Grades of Recommendation, Assessment, Development, and Evaluation method. All data will be analyzed statistically by using RevMan V.5.3 software. RESULTS This study will provide a high level of the evidence-based basis for the effectiveness and safety of acupuncture in the treatment of PEDs. CONCLUSION The findings of this study will assess the safety, efficacy, and adverse effects of acupuncture in the treatment of PEDs. ETHICS AND DISSEMINATION No ethical approval is required as patient data will not be collected. In addition, the results of this meta-analysis will be disseminated through publication in peer-reviewed scholarly journals or relevant academic conferences. REGISTRATION NUMBER INPLASY 2021120091.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.
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