1
|
King D, Gronholm PC, Knapp M, Hoffmann MS, Bonin EM, Brimblecombe N, Kadel R, Maughan B, O'Shea N, Richards M, Hoomans T, Evans-Lacko S. Effects of mental health status during adolescence on primary care costs in adulthood across three British cohorts. Soc Psychiatry Psychiatr Epidemiol 2024; 59:917-928. [PMID: 37358606 PMCID: PMC11116205 DOI: 10.1007/s00127-023-02507-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/25/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE This study examines the association between mental health problems in adolescence and general practice (GP) costs during adulthood up to age 50 in the UK. METHODS We conducted secondary analyses of three British birth cohorts (individuals born in single weeks in 1946, 1958 and 1970). Data for the three cohorts were analysed separately. All respondents who participated in the cohort studies were included. Adolescent mental health status was assessed in each cohort using the Rutter scale (or, for one cohort, a forerunner of that scale) completed in interviews with parents and teachers when cohort members were aged around 16. Presence and severity of conduct and emotional problems were modelled as independent variables in two-part regression models in which the dependent variable was costs of GP services from data collection sweeps up to mid-adulthood. All analyses were adjusted for covariates (cognitive ability, mother's education, housing tenure, father's social class and childhood physical disability). RESULTS Adolescent conduct and emotional problems, particularly when coexisting, were associated with relatively high GP costs in adulthood up to age 50. Associations were generally stronger in females than males. CONCLUSION Associations between adolescent mental health problems and annual GP cost were evident decades later, to age 50, suggesting that there could be significant future savings to healthcare budgets if rates of adolescent conduct and emotional problems could be reduced. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Derek King
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK.
| | - Petra C Gronholm
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Mauricio S Hoffmann
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
- Department of Neuropsychiatry, Universidade Federal de Santa Maria, Avenida Roraima 1000, Building 26, Office 1446, Santa Maria, Brazil
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Porto Alegre, Brazil
| | - Eva-Maria Bonin
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Nicola Brimblecombe
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Rajendra Kadel
- Public Health Wales, Policy and International Health Directorate, WHO CC on Investment for Health and Wellbeing, Cardiff, UK
| | - Barbara Maughan
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nick O'Shea
- Chief Economist, Centre for Mental Health, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Ties Hoomans
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| |
Collapse
|
2
|
Micai M, Fulceri F, Salvitti T, Romano G, Scattoni ML. Access and cost of services for autistic children and adults in Italy: a carers' perspective. Front Psychiatry 2024; 15:1299473. [PMID: 38532989 PMCID: PMC10963481 DOI: 10.3389/fpsyt.2024.1299473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Background Limited information exists on autistic service access and costs in Italy. Objectives This study aims to investigate access to educational, healthcare, social, and related services for autistic individuals in Italy as part of the Autism Spectrum Disorder in the European Union (ASDEU) project. Methods Italian carers of autistic individuals completed an online survey regarding services and costs in the 6 months before completion. Results Three hundred and three carers of autistic people participated in the survey. The majority of those receiving care were children, males, and lived at home with their parents. Autistic adults were often students (17%) or unemployed but willing to work (17%). Employed carers (49%) worked on average 32.23 ± 9.27 hours per week. A significant portion (82%) took work or school absences to care for autistic individuals, averaging 15.56 ± 14.70 days. On average, carers spent 58.84 ± 48.36 hours per week on caregiving duties. Fifty-five of the autistic individuals received some form of support, 5% utilized residential care, and 6% were hospitalized. Thirty-four percent received outpatient hospital care, and 20% underwent some form of autism-related psychopharmacological therapy. School support was primarily provided by support teachers (18.16 ± 7.02 hours/week). Educational psychologists (80.73%), psychomotor therapists/physiotherapists (53.85%), and speech therapists (50.91%) were frequently paid by carers who paid more per hour. Autistic children received support from educators (73.96 hours/week), group therapy (32.36 hours/week), and speech therapists (31.19 hours/week). Psychologists (76.00%) and counseling/individual therapists (89.13%) were often paid by carers. Carers reported high costs for psychiatrists and psychologists, with frequent use of psychiatric services (8 ± 8 times in 6 months). Conclusions Carers' perspectives on the access and costs of services for autistic individuals in Italy can provide insights into areas for improvement in the delivery of autism services.
Collapse
Affiliation(s)
- Martina Micai
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Francesca Fulceri
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Tommaso Salvitti
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Giovanna Romano
- Directorate General of Health Prevention, Ministry of Health, Rome, Italy
| | - Maria Luisa Scattoni
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| |
Collapse
|
3
|
Zhao Y, Luo Y, Zhang R, Zheng X. Direct and indirect costs for families of children with autism spectrum disorder in China. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2337-2347. [PMID: 36880445 DOI: 10.1177/13623613231158862] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
LAY ABSTRACT This is the first comprehensive national study to explore the direct and indirect costs for families of children with autism spectrum disorder in China. The increasing prevalence of autism spectrum disorder highlights a growing need for resources to provide care for families of children with autism spectrum disorder. The medical and nonmedical costs and parents' productivity loss have caused a serious burden on their families. Our objective is to estimate the direct and indirect costs for the families of children with autism spectrum disorder in China. The target population was parents of children with autism spectrum disorder. We analyzed the costs using cross-sectional data from a Chinese national family survey with children aged 2-6 years (N = 3236) who were clinically diagnosed with autism spectrum disorder. Family data from 30 provinces in China were obtained. Cost items included direct medical costs, direct nonmedical costs, and indirect costs. In this study, we found that the largest part of family costs for autism spectrum disorder are nonmedical costs and productivity loss. Autism spectrum disorder has imposed a huge economic burden on parents having children with autism spectrum disorder in China, who need more support than the current health care system provides.
Collapse
Affiliation(s)
| | | | | | - Xiaoying Zheng
- Chinese Academy of Medical Sciences & Peking Union Medical College, china
| |
Collapse
|
4
|
Pollard J, Reardon T, Williams C, Creswell C, Ford T, Gray A, Roberts N, Stallard P, Ukoumunne OC, Violato M. The multifaceted consequences and economic costs of child anxiety problems: A systematic review and meta-analysis. JCPP ADVANCES 2023; 3:e12149. [PMID: 37720587 PMCID: PMC10501703 DOI: 10.1002/jcv2.12149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/26/2023] [Indexed: 09/19/2023] Open
Abstract
Background Over a quarter of people have an anxiety disorder at some point in their life, with many first experiencing difficulties during childhood or adolescence. Despite this, gaps still exist in the current evidence base of the multiple consequences of childhood anxiety problems and their costs. Methods A systematic review of Medline, PsycINFO, EconLit and the National Health Service Economic Evaluation Database was conducted for longitudinal and economic studies reporting on the association between childhood anxiety problems and at least one individual-, family- or societal-level outcome or cost. All studies were synthesised narratively. For longitudinal studies, 'effect direction' was used as a common metric, with random effects meta-analysis undertaken where possible. Results Eighty-three studies met inclusion criteria and were synthesised narratively. We identified 788 separate analyses from the longitudinal studies, which we grouped into 15 overarching outcome domains. Thirteen of the studies were incorporated into 13 meta-analyses, which indicated that childhood anxiety disorders were associated with future anxiety, mood, behaviour and substance disorders. Narrative synthesis also suggested associations between anxiety problems and worse physical health, behaviour, self-harm, eating, relationship, educational, health care, employment, and financial outcomes. 'Effect direction' was conflicting in some domains due to a sparse evidence base. Higher economic costs were identified for the child, their families, healthcare providers and wider society, although evidence was limited and only covered short follow-up periods, up to a maximum of 2 years. Total annual societal costs per anxious child were up to £4040 (2021 GBP). Conclusions Childhood anxiety problems are associated with impaired outcomes in numerous domains, and considerable economic costs, which highlight the need for cost-effective interventions and policies to tackle them. More economic evidence is needed to inform models of the long-term, economic-related, consequences of childhood anxiety problems.
Collapse
Affiliation(s)
- Jack Pollard
- Health Economics Research CentreNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Tessa Reardon
- Departments of Experimental Psychology and PsychiatryUniversity of OxfordOxfordUK
| | - Chloe Williams
- Departments of Experimental Psychology and PsychiatryUniversity of OxfordOxfordUK
| | - Cathy Creswell
- Departments of Experimental Psychology and PsychiatryUniversity of OxfordOxfordUK
| | - Tamsin Ford
- University of Cambridge and Cambridge and Peterborough Foundation TrustCambridgeUK
| | - Alastair Gray
- Health Economics Research CentreNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Nia Roberts
- Bodleian Health Care LibrariesUniversity of OxfordOxfordUK
| | | | - Obioha C. Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of ExeterExeterUK
| | - Mara Violato
- Health Economics Research CentreNuffield Department of Population HealthUniversity of OxfordOxfordUK
| |
Collapse
|
5
|
Dhakal S, Gupta S, Sharma NP, Upadhyay A, Oliver A, Sumich A, Kumari V, Niraula S, Pandey R, Lau JYF. Can we challenge attention and interpretation threat biases in rescued child labourers with a history of physical abuse using a computerised cognitive training task? Data on feasibility, acceptability and target engagement. Behav Res Ther 2023; 162:104267. [PMID: 36780810 DOI: 10.1016/j.brat.2023.104267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 01/30/2023]
Abstract
Child labourers are more likely to have experienced physical victimisation, which may increase risk for anxiety/depression, by shaping threat biases in information-processing. To target threat biases and vulnerability for anxiety/depression, we evaluated whether Cognitive Bias Modification (CBM) training could be feasibly and acceptably delivered to rescued youth labourers. Seventy-six physically abused rescued labourers aged 14-17 (40 from Nepal, 36 from India) in out-of-home care institutions received either multi-session computerised CBM or control training. Training targeted attention away from threat to positive cues and the endorsement of benign over threat interpretations. Feasibility and acceptability data were gathered along with pre and post intervention measures of attention and interpretation bias and emotional and behavioural symptoms. In terms of feasibility, uptake (proportion of those who completed the pre-intervention assessment from those who consented) and retention (proportion of those who completed the post-intervention assessment from those who completed the pre-intervention assessment) were above 75% in both countries. Average acceptability ratings were mostly 'moderate' on most indices for both countries, and none of the participants reported experiencing serious adverse events or reactions in response to or during the trial. Secondarily, CBM participants showed increased attention to positive and decreased attention to threatening stimuli, as well as increased endorsement of benign interpretation and decreased endorsement in negative interpretations of ambiguous social situations. Symptom changes were less clear. Delivering CBM to former child labourers in out-of-home care institutions has interventive potential. ClinicalTrials.gov Identifier: NCT03625206, Date of registration: August 10, 2018.
Collapse
Affiliation(s)
- Sandesh Dhakal
- Central Department of Psychology, Tribhuvan University, Kathmandu, Nepal
| | - Shulka Gupta
- Department of Psychology, Banaras Hindu University, Varanasi, 221 005, UP, India
| | | | - Aakanksha Upadhyay
- Department of Psychology, Banaras Hindu University, Varanasi, 221 005, UP, India
| | - Abigail Oliver
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Alex Sumich
- Division of Psychology, Nottingham Trent University, Nottingham, UK
| | - Veena Kumari
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK; Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UB8 3PH, UK
| | - Shanta Niraula
- Central Department of Psychology, Tribhuvan University, Kathmandu, Nepal
| | - Rakesh Pandey
- Department of Psychology, Banaras Hindu University, Varanasi, 221 005, UP, India
| | - Jennifer Y F Lau
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK; Youth Resilience Unit, Wolfson Institute of Population Health, Queen Mary, University of London, London, E1 4NS, UK.
| |
Collapse
|
6
|
Hooley C, Salvo D, Brown DS, Brookman-Frazee L, Lau AS, Brownson RC, Fowler PJ, Innes-Gomberg D, Proctor EK. Scaling-up Child and Youth Mental Health Services: Assessing Coverage of a County-Wide Prevention and Early Intervention Initiative During One Fiscal Year. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:17-32. [PMID: 36289142 PMCID: PMC9977707 DOI: 10.1007/s10488-022-01220-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE In the U.S., the percentage of youth in need of evidence-based mental health practices (EBPs) who receive them (i.e., coverage rate) is low. We know little about what influences coverage rates. In 2010, the Los Angeles County Department of Mental Health (LACDMH) launched a reimbursement-driven implementation of multiple EBPs in youth mental health care. This study examines two questions: (1) What was the coverage rate of EBPs delivered three years following initial implementation? (2) What factors are associated with the coverage rates? METHODS To assess coverage rates of publicly insured youth, we used LACDMH administrative claims data from July 1, 2013 to June 30, 2014 and estimates of the size of the targeted eligible youth population from the 2014 American Community Survey (ACS). The unit of analysis was clinic service areas (n = 254). We used Geographic Information Systems and an OLS regression to assess community and clinic characteristics related to coverage. RESULTS The county coverage rate was estimated at 17%, much higher than national estimates. The proportion of ethnic minorities, individuals who are foreign-born, adults with a college degree within a geographic area were negatively associated with clinic service area coverage rates. Having more therapists who speak a language other than English, providing care outside of clinics, and higher proportion of households without a car were associated with higher coverage rates. CONCLUSION Heterogeneity in municipal mental health record type and availability makes it difficult to compare the LACDMH coverage rate with other efforts. However, the LACDMH initiative has higher coverage than published national rates. Having bilingual therapists and providing services outside the clinic was associated with higher coverage. Even with higher coverage, inequities persisted.
Collapse
Affiliation(s)
- Cole Hooley
- Brigham Young University, 84602, Provo, UT, USA.
| | - Deborah Salvo
- Department of Kinesiology and Health Education, The University of Texas at Austin, Bellmont Hall 822J, 2109 San Jacinto Blvd, Stp D3700, 78712, Austin, TX, United States
| | - Derek S Brown
- Brown School, Washington University in St. Louis, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive #0812, 92093, La Jolla, CA, USA
| | - Anna S Lau
- UCLA Department of Psychology, 502 Portola Plaza, 90095, Los Angeles, CA, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School, Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University in St. Louis, Washington University School of Medicine, Washington University in St. Louis CDC U48DP006395, the Foundation for Barnes-Jewish Hospital, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Patrick J Fowler
- Brown School, Washington University in St. Louis, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Debbie Innes-Gomberg
- Los Angeles County Department of Mental Health, 510 S. Vermont Avenue, 17th Floor, 90020, Los Angeles, CA, USA
| | - Enola K Proctor
- Brown School, Washington University in St. Louis, 1 Brookings Drive, 63130, St. Louis, MO, USA
| |
Collapse
|
7
|
Chequer de Castro Paiva G, Ferreira e Santos DA, Silva Jales J, Romano-Silva MA, Marques de Miranda D. Online parent training platform for complementary treatment of disruptive behavior disorders in attention deficit hyperactivity disorder: A randomized controlled trial protocol. PLoS One 2022; 17:e0272516. [PMID: 36301983 PMCID: PMC9612579 DOI: 10.1371/journal.pone.0272516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/15/2022] [Indexed: 11/05/2022] Open
Abstract
Background Attention Deficit/Hyperactivity Disorder (ADHD) is associated with a diversity of impairments and Oppositional Defiant Disorder (ODD) is a very frequent comorbidity. Parent Training, as an evidence-based intervention, seems effective in reducing externalizing/disruptive behaviors, possibly leading to a better prognosis. This clinical trial aims to evaluate the effectiveness of an online parent training model as a complementary treatment for ADHD and ODD. Methods Patients and their families will be screened upon their entry into the Research Center of Impulsivity and Attention (NITIDA) at UFMG—Brazil. Ninety families whose children are male, between 6–12 years old, and have significant externalizing symptoms and whose primary caregiver have complete high school education will be invited to participate. Families will be randomized (1:1) into 03 groups: 1) standard care; 2) standard care + face-to-face parent training; 3) standard care + online parent training. Interventions are analogous, differing only in delivery format. In the face-to-face format, the intervention will be conducted by a specialized therapist and the online format will be carried out through a platform. There will be six sessions/modules, arranged on a weekly basis. Measures of externalizing symptoms, parental and children quality of life, parental stress and parenting style will be collected at baseline and after the intervention. Discussion This clinical trial intends to verify the effects of a new, online, model of an evidence-based intervention, which would allow a wider access in the Brazilian context. Trial registration Registered on Brazilian Registry of Clinical Trials (ReBEC). Number: RBR-6cvc85. July 24th (2020) 05:35 pm.
Collapse
Affiliation(s)
- Gabrielle Chequer de Castro Paiva
- Molecular Medicine Postgraduate Program, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| | - Daniel Augusto Ferreira e Santos
- Molecular Medicine Postgraduate Program, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Julia Silva Jales
- Research Center of Impulsivity and Attention, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marco Aurélio Romano-Silva
- Department of Mental Health, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Débora Marques de Miranda
- Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
8
|
Kularatna S, Jadambaa A, Senanayake S, Brain D, Hawker N, Kasparian NA, Abell B, Auld B, Eagleson K, Justo R, McPhail SM. The Cost of Neurodevelopmental Disability: Scoping Review of Economic Evaluation Methods. Clinicoecon Outcomes Res 2022; 14:665-682. [PMID: 36304697 PMCID: PMC9596191 DOI: 10.2147/ceor.s370311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/23/2022] [Indexed: 11/11/2022]
Abstract
The provision of effective care models for children with neurodevelopmental delay or disability can be challenging in resource constrained healthcare systems. Economic evaluations have an important role in informing resource allocation decisions. This review systematically examined the scope and methods of economic models evaluating interventions for supporting neurodevelopment among children with common neurodevelopmental disorders and identified methods of economic models and presented policy implications. This scoping review employed the Arksey and O'Malley framework and aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Four electronic databases were systematically searched to identify eligible model-based economic evaluations of neurodevelopmental care models published since 2000. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to assess quality of reporting. Data were systematically extracted, tabulated, and qualitatively synthesised across diagnostic categories. Searches identified 1431 unique articles. Twelve studies used a decision analytic model to evaluate care for neurodevelopmental disorders and were included in the review. Included studies focused on attention-deficit/hyperactivity disorder (ADHD, n=6), autism spectrum disorder (ASD, n=3), cerebral palsy (n=2), and dyslexia (n=1). The most used decision analytic modelling approach was a Markov model (n=6), followed by a decision tree (n=3), and a combination of decision tree and Markov model (n=3). Most studies (n=7) adopted a societal perspective for reporting costs. None of the reviewed studies modelled impact on families and caregivers. Four studies reported cost-savings, three identified greater quality of life, and three identified cost increases.
Collapse
Affiliation(s)
- Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia,Correspondence: Sanjeewa Kularatna, Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia, Tel +61 7 3138 0050, Email
| | - Amarzaya Jadambaa
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - David Brain
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nadia Hawker
- Metro South Health, Queensland Health, Brisbane, QLD, Australia
| | - Nadine A Kasparian
- Cincinnati Children’s Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Benjamin Auld
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, Brisbane, QLD, Australia
| | - Karen Eagleson
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, Brisbane, QLD, Australia
| | - Robert Justo
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, Brisbane, QLD, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia,Digital Health and Informatics Directorate, Metro South Health, Brisbane, QLD, Australia
| |
Collapse
|
9
|
Brock-Baca AH, Zundel C, Fox D, Johnson Nagel N. Partnering with Family Advocates to Understand the Impact on Families Caring for a Child with a Serious Mental Health Challenge. J Behav Health Serv Res 2022; 50:315-332. [PMID: 36241957 PMCID: PMC9568908 DOI: 10.1007/s11414-022-09821-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 10/31/2022]
Abstract
Family-driven care is a key principle of the system of care framework, but little research has documented the impact caring for a child with a serious mental health challenge has on families. In partnership with family advocates, this prospective, descriptive study was conducted to understand the impact a child's mental health challenge has on families' time, finances, life events, and caregiver employment. Study results showed the average family spent over $250 a week in unreimbursed costs, even though 84% of the children in the study received Medicaid. Caregivers spent approximately 10 h per week attending to the child's mental health needs, not including direct care for the child. Caregivers also reported a substantial impact on their employment. The results of this study have implications for the system of care supports for families. Perhaps most importantly, systems must utilize two-generation strategies in systems of care to minimize the impact on caregiver employment.
Collapse
Affiliation(s)
- Ashley H Brock-Baca
- Butler Institute for Families, University of Denver Graduate School of Social Work, Denver, CO, 512-663-4377, USA.
| | - Claudia Zundel
- Colorado Office of Behavioral Health, 3824 W. Princeton Circle, Denver, CO, 80236, USA
| | - Diane Fox
- Colorado Office of Behavioral Health, 3824 W. Princeton Circle, Denver, CO, 80236, USA
| | - Nancy Johnson Nagel
- Colorado Office of Behavioral Health, 3824 W. Princeton Circle, Denver, CO, 80236, USA
| |
Collapse
|
10
|
Ziebold C, Silva-Ribeiro W, King D, McDaid D, Hoffmann MS, Romeo R, Pan PM, Miguel EC, Bressan RA, Rohde LA, Salum GA, Mari JDJ, Evans-Lacko S. Utilisation and costs of mental health-related service use among adolescents. PLoS One 2022; 17:e0273628. [PMID: 36084089 PMCID: PMC9462733 DOI: 10.1371/journal.pone.0273628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background The high level of care needs for adolescents with mental health conditions represents a challenge to the public sector, especially in low and middle-income countries. We estimated the costs to the public purse of health, education, criminal justice and social care service use associated with psychiatric conditions among adolescents in Brazil; and examined whether the trajectory of psychopathology and its impact on daily life, and parental stigma towards mental illness, was associated with service utilisation and costs. Methods Data on reported service use among adolescents from a prospective community cohort (n = 1,400) were combined with Brazilian unit costs. Logistic regression and generalised linear models were used to examine factors associated with service use and associated costs, respectively. Results Twenty-two percent of those who presented with a psychiatric disorder used some type of service for their mental health in the previous twelve months. Higher odds of service use were associated with having a diagnosed mental disorder (either incident, [OR = 2.49, 95%CI = 1.44–4.30, p = 0.001], remittent [OR = 2.16, 95%CI = 1.27–3.69, p = 0.005] or persistent [OR = 3.01, 95%CI = 1.69–5.36, p<0.001]), higher impact of symptoms on adolescent’s life (OR = 1.32, 95%CI = 1.19–1.47, p<0.001) and lower parental stigma toward mental illness (OR = 1.12, 95%CI = 1.05–1.20, p = 0.001). Average annual cost of service use was 527.14 USD (s.d. = 908.10). Higher cost was associated with higher disorder impact (β = 0.25, 95%CI = 0.12–0.39, p<0.001), lower parental stigma (β = 0.12, 95%CI = 0.02–0.23, p = 0.020) and white ethnicity (β = 0.55, 95%CI = 0.04–1.07, p = 0.036). Conclusion The impact of mental health problems on adolescents’ daily lives and parental stigmatising attitudes toward mental illness were the main predictors of both service use and costs.
Collapse
Affiliation(s)
- Carolina Ziebold
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Wagner Silva-Ribeiro
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Derek King
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - David McDaid
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Mauricio Scopel Hoffmann
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
- Universidade Federal de Santa Maria, Santa Maria, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Renee Romeo
- King’s College London, London, United Kingdom
| | - Pedro Mario Pan
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Eurípedes Constantino Miguel
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
- Universidade de São Paulo, São Paulo, Brazil
| | - Rodrigo Affonseca Bressan
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Luis Augusto Rohde
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clínicas de Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Giovanni Abrahão Salum
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jair de Jesus Mari
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
- * E-mail:
| |
Collapse
|
11
|
Metcalfe RE, Osa ML, Jones JA, DeGarmo DS. Emotion Regulation, Coercive Parenting, and Child Adjustment: A Serial Mediation Clinical Trial. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2022; 10:295-306. [PMID: 36777258 PMCID: PMC9909837 DOI: 10.1037/cpp0000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective Prior intent to treat (ITT) evaluation of the Fathering Through Change (FTC) online interactive behavioral parent training program demonstrated a causal link from the FTC intervention to reductions in pre-post changes in fathers' coercive parenting, and in turn, reductions in pre-post changes in child behavioral problems (a moderate indirect effect size d = .30). The present study expands on this work by investigating mediational mechanisms. Methods The present study employed a sample of 426 recently divorced or separated fathers who were each randomly assigned to either the FTC program or to the waitlist control. We tested a set of ITT serial mediation hypotheses positing effects of the FTC on fathers' reductions in coercive parenting would be mediated through reductions in emotion regulation problems. To be included in this intervention, fathers had been separated or divorced within the past two years and also had children between the ages of four and twelve. Results The intervention obtained a significant total and set of unique pathways linking the FTC intervention to improved child adjustment. This supports a causal experimental link to reduced child behavior problems (d = .39). Emotion regulation did not fully mediate the intervention effect on parenting. Conclusions Emotion regulation added both direct and indirect experimental explained variance over and above parenting alone. Clinical implications are discussed for the application of online training through pediatric settings.
Collapse
Affiliation(s)
- Robyn E. Metcalfe
- Department of Counseling Psychology and Human Services, University of Oregon
- Prevention Science Institute, University of Oregon
| | - Maggie L. Osa
- Department of Counseling Psychology and Human Services, University of Oregon
- Prevention Science Institute, University of Oregon
| | - Jeremy A. Jones
- Influents Innovations, Eugene, Oregon
- Candor Therapy and Consultation, PLLC, Eugene, Oregon
| | - David S. DeGarmo
- Department of Counseling Psychology and Human Services, University of Oregon
- Prevention Science Institute, University of Oregon
| |
Collapse
|
12
|
Tougas AM, Houle AA, Leduc K, Frenette-Bergeron É, Marcil K. School Reintegration Following Psychiatric Hospitalization: A Review of Available Transition Programs. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2022; 31:75-92. [PMID: 35614957 PMCID: PMC9084372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/24/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to 1) identify transition programs for school reintegration after youth psychiatric hospitalization, and 2) assess these programs using criteria established by Blueprints for Healthy Youth Development. METHOD Principles outlined by the Evidence for Policy and Practice Information and Coordinating Centre were used to systematically search 15 electronic databases up to October 2021 for both published and unpublished reports of transition programs. Reports meeting inclusion criteria were examined through three steps: 1) coding of available information, 2) synthesis of programs and 3) assessment of intervention specificity. RESULTS Thirteen reports met the inclusion criteria and identified eight transition programs. Program theories were rarely explicit about the causal mechanisms and outcomes of their interventions. Nevertheless, areas of consensus emerge as to core components of these programs including: 1) the involvement of a multidisciplinary team, 2) the implementation of a multicomponent intervention, 3) the development of a reintegration plan, 4) the need for gradual transitions, and 5) extended support through frequent contact. CONCLUSION School reintegration programs following psychiatric hospitalization are still rare. They can be hard to implement due to the challenges they impose for inter-professional and intersectoral collaborations. Despite this, four of the eight programs are in a good position for an evaluation of their promising standing. Nevertheless, well-designed controlled trials and cohort studies are needed.
Collapse
Affiliation(s)
- Anne-Marie Tougas
- Département de psychoéducation, Université de Sherbrooke, Sherbrooke, Quebec
- Groupe de recherche et d'intervention sur les adaptations sociales de l'enfance, Montreal, Quebec
- Institut universitaire de première ligne en santé et services sociaux, Sherbrooke, Quebec
| | - Andrée-Anne Houle
- Département de psychoéducation, Université de Sherbrooke, Sherbrooke, Quebec
- Groupe de recherche et d'intervention sur les adaptations sociales de l'enfance, Montreal, Quebec
- Centre RBC d'expertise universitaire en santé mentale destiné aux enfants adolescents et adolescentes et aux jeunes adultes, Sherbrooke, Quebec
| | - Karissa Leduc
- Groupe de recherche et d'intervention sur les adaptations sociales de l'enfance, Montreal, Quebec
- Department of Educational and Counseling Psychology, McGill University, Montreal, Quebec
| | - Émilie Frenette-Bergeron
- Département de psychoéducation, Université de Sherbrooke, Sherbrooke, Quebec
- Groupe de recherche et d'intervention sur les adaptations sociales de l'enfance, Montreal, Quebec
| | - Katherine Marcil
- Département de psychoéducation, Université de Sherbrooke, Sherbrooke, Quebec
- Groupe de recherche et d'intervention sur les adaptations sociales de l'enfance, Montreal, Quebec
| |
Collapse
|
13
|
Wang B, Feldman I, Chkonia E, Pinchuk I, Panteleeva L, Skokauskas N. Mental health services in Scandinavia and Eurasia: comparison of financing and provision. Int Rev Psychiatry 2022; 34:118-127. [PMID: 35699102 DOI: 10.1080/09540261.2022.2065190] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of this study was to compare financial and human resources for mental health services in selected Scandinavian and Eurasian countries. A cross-sectional descriptive and analytical approach was adopted to analyse questionnaire data provided by members of the Ukraine-Norway-Armenia Partnership Project. We compared Scandinavia (Sweden and Norway) and Eurasia (Armenia, Georgia, Kyrgyzstan and Ukraine). Health expenditure in Eurasia was generally below 4% of gross domestic product, with the exception of Georgia (10.2%), compared with 11% in Scandinavia. Inpatient hospital care commonly exceeded 50% of the mental health budget. The central governments in Eurasia paid for over 50% of the health expenditure, compared to 2% in Scandinavia. The number of mental health personnel per head of population was much smaller in Eurasia than Scandinavia. Financial and human resources were limited in Eurasia and mainly concentrated on institutional services. Health activities were largely managed by central governments. Community-based mental healthcare was poorly implemented, compared to Scandinavia, especially for children and adolescents.
Collapse
Affiliation(s)
- Bo Wang
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Social Medicine (CHAP), Uppsala University, Uppsala, Sweden
| | - Eka Chkonia
- Department of Psychiatry, Georgia University Hospital - Tbilisi Mental Health Center, Tbilisi State Medical University, Tbilisi, Georgia
| | - Irina Pinchuk
- Institute of Psychiatry, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Lilia Panteleeva
- Department of Medical Psychology, Psychiatry and Psychotherapy, Kyrgyzstan-Russian Slavic University Named After B. N. Yeltsin, Bishkek, Kyrgyzstan
| | - Norbert Skokauskas
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| |
Collapse
|
14
|
Dopp AR, Gilbert M, Silovsky J, Ringel JS, Schmidt S, Funderburk B, Jorgensen A, Powell BJ, Luke DA, Mandell D, Edwards D, Blythe M, Hagele D. Coordination of sustainable financing for evidence-based youth mental health treatments: protocol for development and evaluation of the fiscal mapping process. Implement Sci Commun 2022; 3:1. [PMID: 34983689 PMCID: PMC8724666 DOI: 10.1186/s43058-021-00234-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sustained delivery of evidence-based treatments (EBTs) is essential to addressing the public health and economic impacts of youth mental health problems, but is complicated by the limited and fragmented funding available to youth mental health service agencies (hereafter, "service agencies"). Strategic planning tools are needed that can guide these service agencies in their coordination of sustainable funding for EBTs. This protocol describes a mixed-methods research project designed to (1) develop and (2) evaluate our novel fiscal mapping process that guides strategic planning efforts to finance the sustainment of EBTs in youth mental health services. METHOD Participants will be 48 expert stakeholder participants, including representatives from ten service agencies and their partners from funding agencies (various public and private sources) and intermediary organizations (which provide guidance and support on the delivery of specific EBTs). Aim 1 is to develop the fiscal mapping process: a multi-step, structured tool that guides service agencies in selecting the optimal combination of strategies for financing their EBT sustainment efforts. We will adapt the fiscal mapping process from an established intervention mapping process and will incorporate an existing compilation of 23 financing strategies. We will then engage participants in a modified Delphi exercise to achieve consensus on the fiscal mapping process steps and gather information that can inform the selection of strategies. Aim 2 is to evaluate preliminary impacts of the fiscal mapping process on service agencies' EBT sustainment capacities (i.e., structures and processes that support sustainment) and outcomes (e.g., intentions to sustain). The ten agencies will pilot test the fiscal mapping process. We will evaluate how the fiscal mapping process impacts EBT sustainment capacities and outcomes using a comparative case study approach, incorporating data from focus groups and document review. After pilot testing, the stakeholder participants will conceptualize the process and outcomes of fiscal mapping in a participatory modeling exercise to help inform future use and evaluation of the tool. DISCUSSION This project will generate the fiscal mapping process, which will facilitate the coordination of an array of financing strategies to sustain EBTs in community youth mental health services. This tool will promote the sustainment of youth-focused EBTs.
Collapse
Affiliation(s)
- Alex R Dopp
- Department of Behavioral and Policy Sciences, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Marylou Gilbert
- Department of Behavioral and Policy Sciences, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Jane Silovsky
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Jeanne S Ringel
- Department of Economics, Sociology, and Statistics, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Susan Schmidt
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Beverly Funderburk
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Ashley Jorgensen
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School and School of Medicine, Washington University, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Douglas A Luke
- Brown School, Washington University, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - David Mandell
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Fl., Philadelphia, PA, 19104, USA
| | - Daniel Edwards
- Evidence-Based Associates, 1311 Delaware Ave, Suite 637, Washington, DC, 20024, USA
| | - Mellicent Blythe
- NC Child Treatment Program c/o Center for Child and Family Health, 1121 W, Chapel Hill St. Ste. 100, Durham, NC, 27701, USA
| | - Dana Hagele
- NC Child Treatment Program c/o Center for Child and Family Health, 1121 W, Chapel Hill St. Ste. 100, Durham, NC, 27701, USA
| |
Collapse
|
15
|
Bothe T, Walker J, Kröger C. Gender-related differences in health-care and economic costs for eating disorders: A comparative cost-development analysis for anorexia and bulimia nervosa based on anonymized claims data. Int J Eat Disord 2022; 55:61-75. [PMID: 34599621 DOI: 10.1002/eat.23610] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) and bulimia nervosa (BN) impose a significant financial burden and immense sufferings on affected individuals. Yet little is known about the differences between how each disorder affects males and females, respectively. METHOD We performed a retrospective cost-development analysis of anonymized claims data from the German statutory health-insurance system. Insured persons who suffered from an onset of AN (F50.0; N = 1,242 females and 71 males) or BN (F50.2; N = 1,104 females and 64 males) were analyzed for cost-of-illness over a 5-year period, beginning 2 years before the index diagnosis. RESULTS In total, all groups incurred similar distributions of total costs over the 5-year observation period, with roughly 14,000-20,000 EUR median costs. About two-thirds of the total costs for females and males with AN are associated with mental illness, whereas for females and males with BN, this applies to approximately half the total costs. Analyses revealed differences between disorders and genders for single outcomes. AN is associated with a stronger increase in costs within a short period following onset and higher inpatient treatment costs, whereas BN entails more instances of incapacity to work before and after onset. Compared to females, males incurred lower costs in outpatient treatments. DISCUSSION Our study adds evidence as to the disparities in health-care utilizations and costs over the course of illness, in outcome ratios, and between genders, for both AN and BN.
Collapse
Affiliation(s)
- Tim Bothe
- InGef-Institute for Applied Health Research Berlin, Berlin, Germany.,Department of Psychology, University of Hildesheim, Hildesheim, Germany
| | - Jochen Walker
- InGef-Institute for Applied Health Research Berlin, Berlin, Germany
| | - Christoph Kröger
- Department of Psychology, University of Hildesheim, Hildesheim, Germany
| |
Collapse
|
16
|
Sampaio F, Feldman I, Lavelle TA, Skokauskas N. The cost-effectiveness of treatments for attention deficit-hyperactivity disorder and autism spectrum disorder in children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2022; 31:1655-1670. [PMID: 33751229 PMCID: PMC9666301 DOI: 10.1007/s00787-021-01748-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/17/2021] [Indexed: 12/24/2022]
Abstract
Economic evaluations can help decision makers identify what services for children with neurodevelopmental disorders provide best value-for-money. The aim of this paper is to review the best available economic evidence to support decision making for attention deficit-hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in children and adolescents. We conducted a systematic review of economic evaluations of ADHD and ASD interventions including studies published 2010-2020, identified through Econlit, Medline, PsychINFO, and ERIC databases. Only full economic evaluations comparing two or more options, considering both costs and consequences were included. The quality of the studies was assessed using the Drummond checklist. We identified ten studies of moderate-to-good quality on the cost-effectiveness of treatments for ADHD and two studies of good quality of interventions for ASD. The majority of ADHD studies evaluated pharmacotherapy (n = 8), and two investigated the economic value of psychosocial/behavioral interventions. Both economic evaluations for ASD investigated early and communication interventions. Included studies support the cost-effectiveness of behavioral parenting interventions for younger children with ADHD. Among pharmacotherapies for ADHD, different combinations of stimulant/non-stimulant medications for children were cost-effective at willingness-to-pay thresholds reported in the original papers. Early intervention for children with suspected ASD was cost-effective, but communication-focused therapy for preschool children with ASD was not. Prioritizing more studies in this area would allow decision makers to promote cost-effective and clinically effective interventions for this target group.
Collapse
Affiliation(s)
- Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, P.O Box 564, 751 22, Uppsala, Sweden.
| | - Inna Feldman
- grid.8993.b0000 0004 1936 9457Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, P.O Box 564, 751 22 Uppsala, Sweden ,grid.12650.300000 0001 1034 3451Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Tara A. Lavelle
- grid.67033.310000 0000 8934 4045Center for the Evaluation of Value and Risk, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA USA
| | - Norbert Skokauskas
- grid.5947.f0000 0001 1516 2393Regional Centre for Child and Youth Mental Health and Child Welfare, IPH, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway ,Child and Adolescent Mental Health Services, St. Olav Hospital, Trondheim, Norway
| |
Collapse
|
17
|
Klassen JA, Stewart SL, Lapshina N. School Disengagement and Mental Health Service Intensity Need Among Clinically Referred Students Utilizing the interRAI Child and Youth Mental Health Assessment Instrument. Front Psychiatry 2021; 12:690917. [PMID: 34938208 PMCID: PMC8685215 DOI: 10.3389/fpsyt.2021.690917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 11/02/2021] [Indexed: 01/27/2023] Open
Abstract
Although mental health challenges are widespread, impacting 1 in 5 children and youth, only 25% of these young people receive the required mental health supports. Unmet mental health needs are strongly associated with functional impairments including poor self-care, interpersonal challenges, and school difficulties among young people. School disengagement, or a student's lack of involvement in education through interest, curiosity, motivation, and active participation, is associated with a wide array of detrimental outcomes including chronic mental health difficulties, conduct and delinquent behaviors, criminal justice involvement, and unemployment in adolescence and adulthood. Disengagement observed within the school setting may be indicative of underlying mental health challenges and reflective of service intensity need. The current study extends the literature by examining the relationship between school disengagement and mental health service intensity need among 14,750 clinically referred students across elementary and secondary school utilizing the interRAI Child and Youth Mental Health instrument. Findings indicated that more than 25% of clinically referred students were at heighted risk for school disengagement and required high-intensity services. Further, mental health service intensity need was positively associated with risk of school disengagement among students, along with the specific reason for referral (i.e., psychiatric symptoms, harm to self, harm to others, or addiction or dependency), after controlling for sex and age. Implications of the findings are explored within the context of the school setting and future directions are suggested.
Collapse
|
18
|
Schosser A, Senft B, Rauner M. The benefit of an ambulant psychiatric rehabilitation program in Vienna, Austria: an uncontrolled repeated measures study. CENTRAL EUROPEAN JOURNAL OF OPERATIONS RESEARCH 2021; 30:19-48. [PMID: 34658666 PMCID: PMC8501920 DOI: 10.1007/s10100-021-00773-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
We investigated the benefit of a 6-week ambulant psychiatric rehabilitation program in an ambulant psychiatric rehabilitation clinic in Vienna, Austria, from January 2014 to December 2016 by an uncontrolled repeated measures study. The potential of this intervention program was assessed by effectiveness and cost measures using suitable statistical analyses. We compared the effectiveness and cost measures of this ambulant psychiatric rehabilitation program on patients for the period of up to 12 months after discharge to the period of 12 months before admission to the intervention program based on self-reported catamnesis questionnaires. For the program's effectiveness measures, we accounted for both psychological indices for measuring depression severity, symptom burden, and functioning to document the health improvement of patients and economy-related indices such as the number of sick leave days for patients. For the program's cost measures, both direct tangible treatment and medication costs and indirect tangible costs based on the productivity loss measured in non-working days of the patients were considered. The results significantly demonstrated that all psychological effectiveness measures for the patients highly improved by the 6-weeks rehabilitation program and remained rather stable 12 months after discharge. We found that costs for the 6-week ambulant psychiatric rehabilitation program could be easily covered within 12 months after discharge once a total societal cost perspective was considered. Even additional total cost savings of up to over 5000 Euro could be achieved which were highest for employed patients, followed by unemployed patients receiving rehabilitation allowance due to both their high direct medication and treatment costs as well as high indirect costs for productivity loss. The most important finding was that this treatment program was especially beneficial for rehabilitation patients in earlier stages of psychiatric diseases who were still employed, indicating the need for early intervention in mental disorder.
Collapse
Affiliation(s)
- Alexandra Schosser
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Zentren für seelische Gesundheit, BBRZ-Med, Schererstrasse 30, 1210 Vienna, Austria
- Faculty of Medicine, Sigmund Freud University, Freudplatz 3, 1020 Vienna, Austria
- Arbeitsgemeinschaft für Verhaltensmodifikation, Paris-Lodron-Straße 32, 5020 Salzburg, Austria Birgit Senf Vienna, Austria
| | - Birgit Senft
- Zentren für seelische Gesundheit, BBRZ-Med, Schererstrasse 30, 1210 Vienna, Austria
| | - Marion Rauner
- Faculty of
Business, Economics, and Statistics, Institute for Business Decisions and
Analytics, University of Vienna, Oskar-Morgenstern-Platz
1, 1090 Vienna, Austria
| |
Collapse
|
19
|
Pokhilenko I, Janssen LMM, Evers SMAA, Drost RMWA, Schnitzler L, Paulus ATG. Do Costs in the Education Sector Matter? A Systematic Literature Review of the Economic Impact of Psychosocial Problems on the Education Sector. PHARMACOECONOMICS 2021; 39:889-900. [PMID: 34121169 PMCID: PMC8298334 DOI: 10.1007/s40273-021-01049-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Psychosocial (e.g., anxiety or behavior) problems lead to costs not only in the healthcare sector but also in education and other sectors. As psychosocial problems develop during the critical period of establishing educational trajectories, education costs are particularly relevant in the context of psychosocial problems among children and adolescents. OBJECTIVES This study aimed to gain insights into the methods used for the inclusion of education costs in health economics studies and into the proportion of the education costs in relation to the total costs associated with a condition or an intervention. METHODS We systematically searched the PubMed, Embase, SSCI, CINAHL, PsycINFO, ERIC, and Econlit databases in August 2019 for economic evaluations of mental health, psychosocial and educational interventions, and cost-of-illness studies of mental, behavioral, and neurodevelopmental disorders conducted from a societal perspective in populations of children and adolescents. An additional search was conducted in February 2021 to update the review. RESULTS In total, 49 articles were included in the analysis. The most common cost items were special education, school absenteeism, and various educational professionals (educational psychologist). A variety of methods were employed for the identification, measurement, and/or valuation of education costs. The proportion of education costs to the total costs of condition/intervention ranged from 0 to 67%, with the mean being 18.5%. DISCUSSION Since education costs can constitute a significant proportion of the total costs of an intervention or condition, including them in health economics studies might be important in informing optimal resource allocation decisions. Although various methods are available for including education costs in health economics studies, further research is needed to develop evidence-based methods for producing comparable estimates.
Collapse
Affiliation(s)
- Irina Pokhilenko
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Luca M M Janssen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Centre for Economic Evaluation and Machine Learning, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ruben M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Lena Schnitzler
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Aggie T G Paulus
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Faculty of Health Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
20
|
Torres DP, Gutiérrez EFA, Maresca IP. Psicoterapias intensivas prolongadas ambulatorias para niños y adolescentes con trastorno mental grave. CLÍNICA CONTEMPORÁNEA 2021. [DOI: 10.5093/cc2021a11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
21
|
Sung JY, Mumper E, Schleider JL. Empowering Anxious Parents to Manage Child Avoidance Behaviors: Randomized Control Trial of a Single-Session Intervention for Parental Accommodation. JMIR Ment Health 2021; 8:e29538. [PMID: 34255718 PMCID: PMC8292931 DOI: 10.2196/29538] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A majority of youth who need anxiety treatment never access support. This disparity reflects a need for more accessible, scalable interventions-particularly those that may prevent anxiety in high-risk children, mitigating future need for higher-intensity care. Self-guided single-session interventions (SSIs) may offer a promising path toward this goal, given their demonstrated clinical utility, potential for disseminability, and low cost. However, existing self-guided SSIs have been designed for completion by adolescents already experiencing symptoms, and their potential for preventing anxiety in children-for instance, by mitigating known anxiety risk factors-remains unexplored. OBJECTIVE This trial evaluated the acceptability and proximal effects of project EMPOWER: a web-based, self-guided SSI designed to reduce parental accommodation, a parenting behavior known to increase the risk of anxiety in offspring. METHODS In total, 301 parents who reported elevated anxiety symptoms with children aged 4-10 years received either project EMPOWER or an informational control (containing psychoeducational materials and resources); parents self-reported their accommodation of child anxiety and overall distress tolerance at baseline and 2-week follow-up. RESULTS Relative to control-group parents, those who received the intervention outlined in project EMPOWER reported significant reductions in their accommodation of child anxiety (ds=0.61; P<.001) and significant increases in their distress tolerance (ds=0.43; P<.001) from baseline to 2-week follow-up. Additionally, parents rated project EMPOWER as highly acceptable (ie, easy to use, helpful, and engaging) in accordance with preregistered benchmarks. CONCLUSIONS Project EMPOWER is an acceptable self-guided SSI for parents of children at-risk for anxiety, which yields proximal reductions in clinically relevant targets. TRIAL REGISTRATION ClinicalTrials.gov NCT04453865; https://tinyurl.com/4h84j8t9.
Collapse
Affiliation(s)
- Jenna Y Sung
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Emma Mumper
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | | |
Collapse
|
22
|
Danielson ML, Bitsko RH, Holbrook JR, Charania SN, Claussen AH, McKeown RE, Cuffe SP, Owens JS, Evans SW, Kubicek L, Flory K. Community-Based Prevalence of Externalizing and Internalizing Disorders among School-Aged Children and Adolescents in Four Geographically Dispersed School Districts in the United States. Child Psychiatry Hum Dev 2021; 52:500-514. [PMID: 32734339 PMCID: PMC8016018 DOI: 10.1007/s10578-020-01027-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The Project to Learn About Youth-Mental Health (PLAY-MH; 2014-2018) is a school-based, two-stage study designed to estimate the prevalence of selected mental disorders among K-12 students in four U.S.-based sites (Colorado, Florida, Ohio, and South Carolina). In Stage 1, teachers completed validated screeners to determine student risk status for externalizing or internalizing problems or tics; the percentage of students identified as being at high risk ranged from 17.8% to 34.4%. In Stage 2, parents completed a structured diagnostic interview to determine whether their child met criteria for fourteen externalizing or internalizing disorders; weighted prevalence estimates of meeting criteria for any disorder were similar in three sites (14.8%-17.8%) and higher in Ohio (33.3%). PLAY-MH produced point-in-time estimates of mental disorders in K-12 students, which may be used to supplement estimates from other modes of mental disorder surveillance and inform mental health screening and healthcare and educational services.
Collapse
Affiliation(s)
- Melissa L. Danielson
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-4, Atlanta, GA 30341-3717, USA
| | - Rebecca H. Bitsko
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-4, Atlanta, GA 30341-3717, USA
| | - Joseph R. Holbrook
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-4, Atlanta, GA 30341-3717, USA
| | - Sana N. Charania
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-4, Atlanta, GA 30341-3717, USA,Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Angelika H. Claussen
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-4, Atlanta, GA 30341-3717, USA
| | - Robert E. McKeown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Steven P. Cuffe
- Department of Psychiatry, University of Florida College of Medicine–Jacksonville, Jacksonville, FL, USA
| | | | | | - Lorraine Kubicek
- Department of Pediatrics and Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kate Flory
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
23
|
Le LKD, Shih S, Richards-Jones S, Chatterton ML, Engel L, Stevenson C, Lawrence D, Pepin G, Mihalopoulos C. The cost of Medicare-funded medical and pharmaceutical services for mental disorders in children and adolescents in Australia. PLoS One 2021; 16:e0249902. [PMID: 33836033 PMCID: PMC8034743 DOI: 10.1371/journal.pone.0249902] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 03/26/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine the health care costs associated with mental disorders and subthreshold mental disorders within a nationally representative sample of children and adolescents in Australia. METHOD Data were derived from the Young Minds Matter Survey (N = 6,310). Mental disorders were classified using the Diagnostic Interview Schedule for Children Version IV. Participant data were linked to administrative data on health care costs. Adjusted generalized linear regression models and two-part models were used to estimate mean differences in costs between those with a mental disorder or subthreshold disorder and those without. RESULTS Costs associated with health care attendances and medications were higher for children and adolescents with mental disorders and subthreshold mental disorders compared to those without a mental disorder. The additional population health care costs due to mental disorders amounted to AUD$234 million annually in children and adolescents, of which approximately 16% was attributed to out-of-pocket costs. Findings showed that those with subthreshold mental disorders or comorbid mental disorders have substantial additional costs of Medicare-funded medical and pharmaceutical services. CONCLUSION AND IMPLICATION Mental disorders in children and adolescents are associated with significant health care costs. Further research is needed to ensure that this population is receiving effective and efficient care.
Collapse
Affiliation(s)
- Long Khanh-Dao Le
- School of Health and Social Development, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
- * E-mail:
| | - Sophy Shih
- School of Health and Social Development, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Scott Richards-Jones
- School of Health and Social Development, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Mary Lou Chatterton
- School of Health and Social Development, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Lidia Engel
- School of Health and Social Development, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | | | - David Lawrence
- Graduate School of Education, The University of Western Australia, Perth, Australia
| | - Genevieve Pepin
- School of Health and Social Development, Deakin University, Geelong, Australia
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| |
Collapse
|
24
|
The Economic Costs of Childhood Disability: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073531. [PMID: 33805375 PMCID: PMC8036354 DOI: 10.3390/ijerph18073531] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND This literature review investigates the economic costs of childhood disability analysing methodologies used and summarizing the burden worldwide comparing developed and developing countries. METHODS Four electronic databases were searched. Studies were categorised according to country, perspective, methods of costing, disability category, and time horizon. Annual costs were converted to 2019 current US dollars then compared to the country's per capita current health expenditure (CHE) and gross domestic product (GDP). RESULTS Of 2468 references identified, 20 were included in the review. Annual burden of childhood disability ranged ≈$450-69,500 worldwide. Childhood disability imposes a heavy economic burden on families, health systems, and societies. The reason for the wide range of costs is the variability in perspective, costs included, methods, and disability type. CONCLUSION The annual societal costs for one disabled child could be up to the country's GDP per capita. The burden is heavier on households in developing countries as most of the costs are paid out-of-pocket leading to impoverishment of the whole family. Efforts should be directed to avoid preventable childhood disabilities and to support disabled children and their households to make them more independent and increase their productivity. More studies from developing countries are needed.
Collapse
|
25
|
Li Y, Xia X, Meng F, Zhang C. The association of physical fitness with mental health in children: A serial multiple mediation model. CURRENT PSYCHOLOGY 2021; 41:7280-7289. [PMID: 33424199 PMCID: PMC7778564 DOI: 10.1007/s12144-020-01327-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 11/28/2022]
Abstract
There is growing interest in the association between physical fitness and mental health. This study aimed to extend current knowledge by investigating the potential mediating roles of resilience and anxiety in the association between physical fitness and mental health in children. A total of 269 children were selected by stratified random sampling from three primary schools in China. Physical fitness was scored using the Chinese National Student Physical Fitness Standard. Resilience, anxiety, and mental health data were collected using the following questionnaires: Resilience Scale for Chinese Adolescents, Multidimensional Anxiety Scale for Children, and the Mental Health Test. The PROCESS macro developed by Hayes was used to conduct serial multiple mediation analysis. We found that physical fitness, resilience, anxiety, and mental health were significantly correlated. Children with higher physical fitness had lower mental health problems; however, this statistical significance was not detectable after controlling for resilience and anxiety. Serial multiple mediation analysis revealed that the association of physical fitness with mental health was partially mediated by resilience and anxiety. These results indicate that the positive association of physical fitness with mental health in children may be changed through resilience and anxiety, which appear to play serial multiple mediating roles in this association. These findings contribute to deeper understanding of the associations between these factors and suggest that promoting physical fitness independent of considering resilience and anxiety may be insufficient to achieve good mental health in children.
Collapse
Affiliation(s)
- Yansong Li
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Xue Xia
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Fanying Meng
- Institute of Physical Education, Huzhou University, Huzhou, China
| | - Chunhua Zhang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| |
Collapse
|
26
|
Pokhilenko I, Janssen LMM, Hiligsmann M, Evers SMAA, Drost RMWA, Paulus ATG, Bremmers LGM. The Relative Importance of Education and Criminal Justice Costs and Benefits in Economic Evaluations: A Best-Worst Scaling Experiment. PHARMACOECONOMICS 2021; 39:99-108. [PMID: 33026633 PMCID: PMC7790798 DOI: 10.1007/s40273-020-00966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Mental and behavioural disorders (MBDs) and interventions targeting MBDs lead to costs and cost savings in the healthcare sector, but also in other sectors. The latter are referred to as intersectoral costs and benefits (ICBs). Interventions targeting MBDs often lead to ICBs in the education and criminal justice sectors, yet these are rarely included in economic evaluations. This study aimed to investigate the attitudes held by health economists and health technology assessment experts towards education and criminal justice ICBs in economic evaluations and to quantify the relative importance of these ICBs in the context of MBDs. METHODS An online survey containing open-ended questions and two best-worst scaling object case studies was conducted in order to prioritise a list of 20 education ICBs and 20 criminal justice ICBs. Mean relative importance scores for each ICB were generated using hierarchical Bayes analysis. RESULTS Thirty-nine experts completed the survey. The majority of the respondents (68%) reported that ICBs were relevant, but only a few (32%) included them in economic evaluations. The most important education ICBs were "special education school attendance", "absenteeism from school", and "reduced school attainment". The most important criminal justice ICBs were "decreased chance of committing a crime as a consequence/effect of mental health programmes/interventions", "jail and prison expenditures", and "long-term pain and suffering of victims/victimisation". CONCLUSIONS This study identified the most important education and criminal justice ICBs for economic evaluations of interventions targeting MBDs and suggests that it could be relevant to include these ICBs in economic evaluations.
Collapse
Affiliation(s)
- Irina Pokhilenko
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Luca M M Janssen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Mickael Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Centre for Economic Evaluation and Machine Learning, Netherlands Institute of Mental Health and Addiction, Trimbos Institute, Utrecht, The Netherlands
| | - Ruben M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Aggie T G Paulus
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Leonarda G M Bremmers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Health Services Management and Organisation and Health Technology Assessment Research Groups, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
27
|
Dedousis-Wallace A, Drysdale SA, McAloon J, Ollendick TH. Parental and Familial Predictors and Moderators of Parent Management Treatment Programs for Conduct Problems in Youth. Clin Child Fam Psychol Rev 2020; 24:92-119. [PMID: 33074467 DOI: 10.1007/s10567-020-00330-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Abstract
Despite the established efficacy of Parent Management Training (PMT) for conduct problems in youth, evidence suggests that up to half of all treated youth still display clinical levels of disruptive behavior post-treatment. The reasons for these unsatisfactory outcomes are poorly understood. The aim of the present review was to provide an updated analysis of studies from the past 15 years that examined parental and familial predictors and moderators of improvement in PMT for conduct problems. A systematic literature review of indicated prevention (children with conduct problem symptoms) and intervention (children with clinical diagnoses) studies published between 2004 and 2019 was conducted. This 15-year time period was examined since the last systematic reviews were reported in 2006 and summarized studies completed through mid-2004 (see Lundahl et al. in Clin Psychol Rev 26(1):86-104, 2006; Reyno and McGrath in J Child Psychol Psychiatry 47(1):99-111, 2006). Risk of bias indices was also computed (see Higgins et al. in Revised Cochrane risk of bias tool for randomized trials (RoB 2.0), University of Bristol, Bristol, 2016) in our review. A total of 21 studies met inclusion criteria. Results indicated that a positive parent-child relationship was most strongly associated with better outcomes; however, little additional consistency in findings was evident. Future PMT research should routinely examine predictors and moderators that are both conceptually and empirically associated with treatment outcomes. This would further our understanding of factors that are associated with poorer treatment outcome and inform the development of treatment components or modes of delivery that might likely enhance evidence-based treatments and our clinical science. Protocol Registration Number: PROSPERO CRD42017058996.
Collapse
Affiliation(s)
- Anna Dedousis-Wallace
- The Kidman Centre, University of Technology Sydney, Randwick, NSW, 2031, Australia. .,Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Sophia A Drysdale
- The Kidman Centre, University of Technology Sydney, Randwick, NSW, 2031, Australia
| | - John McAloon
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Thomas H Ollendick
- Department of Psychology, Virginia Polytechnic Institute & State University, Blacksburg, VA, USA
| |
Collapse
|
28
|
Abstract
The purpose of the study was to estimate the burden to families of raising a child with attention-deficit/hyperactivity disorder (ADHD). Data were drawn from a longitudinal sample recruited in western Pennsylvania. When participants were between 14 and 17 years old, parents completed a questionnaire assessing economic burden over the course of raising their children. Domains of economic burden to families included direct costs related to child's behaviors (excluding treatment expenses) and indirect costs related to caregiver strain. On average, participants with ADHD incurred a total economic burden over the course of child development that was more than five times greater compared to youths without ADHD (ADHD = $15,036 per child, Control = $2,848 per child), and this difference remained significant after controlling for intellectual functioning, oppositional defiant symptoms, or conduct problems. Parents of participants with ADHD were more likely to have changed their job responsibilities or been fired and reported lower work efficiency. The current evaluation of economic burden to individual families extends previous estimates of annual societal cost of illness (COI) of ADHD. Our rough annual estimate of COI for ADHD in children and adolescents is $124.5 billion (2017 US Dollars). Findings underscore the need for interventions to reduce the costly dysfunctional outcomes in families of children with ADHD.
Collapse
|
29
|
van IJzendoorn MH, Bakermans-Kranenburg MJ. Problematic cost-utility analysis of interventions for behavior problems in children and adolescents. New Dir Child Adolesc Dev 2020; 2020:89-102. [PMID: 32909695 PMCID: PMC7590126 DOI: 10.1002/cad.20360] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cost–utility analyses are slowly becoming part of randomized control trials evaluating physical and mental health treatments and (preventive) interventions in child and adolescent development. The British National Institute of Health and Care Excellence, for example, insists on the use of gains in Quality Adjusted Life Years (QALYs) to compute the “value for money” of interventions. But what counts as a gain in quality of life? For one of the most widely used instruments, the EuroQol 5 Dimensions scale (EQ‐5D), QALYs are estimated by healthy individuals who provide utility scores for specific health states, assuming that the best life is a life without self‐experienced problems in five domains: mobility, self‐care, usual activities, pain/discomfort, and anxiety/depression. The worst imaginable outcome is defined as “a lot of problems” in each of these five domains. The impact of the individual's problems on the social network is not weighted, and important social–developmental domains (externalizing problems, social competence) are missing. Current cost–utility computations based on EQ‐5D favor physical health over mental health, and they rely on adult weights for child and adolescent quality of life. Thus, a level playing field is absent, and developmental expertise is sorely missing.
Collapse
Affiliation(s)
- Marinus H van IJzendoorn
- Erasmus University Rotterdam, Rotterdam, The Netherlands.,University of Cambridge, Cambridge, UK
| | | |
Collapse
|
30
|
Tymofiyeva O, Zhou VX, Lee CM, Xu D, Hess CP, Yang TT. MRI Insights Into Adolescent Neurocircuitry-A Vision for the Future. Front Hum Neurosci 2020; 14:237. [PMID: 32733218 PMCID: PMC7359264 DOI: 10.3389/fnhum.2020.00237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/29/2020] [Indexed: 11/13/2022] Open
Abstract
Adolescence is the time of onset of many psychiatric disorders. Half of pediatric patients present with comorbid psychiatric disorders that complicate both their medical and psychiatric care. Currently, diagnosis and treatment decisions are based on symptoms. The field urgently needs brain-based diagnosis and personalized care. Neuroimaging can shed light on how aberrations in brain circuits might underlie psychiatric disorders and their development in adolescents. In this perspective article, we summarize recent MRI literature that provides insights into development of psychiatric disorders in adolescents. We specifically focus on studies of brain structural and functional connectivity. Ninety-six included studies demonstrate the potential of MRI to assess psychiatrically relevant constructs, diagnose psychiatric disorders, predict their development or predict response to treatment. Limitations of the included studies are discussed, and recommendations for future research are offered. We also present a vision for the role that neuroimaging may play in pediatrics and primary care in the future: a routine neuropsychological and neuropsychiatric imaging (NPPI) protocol for adolescent patients, which would include a 30-min brain scan, a quality control and safety read of the scan, followed by computer-based calculation of the structural and functional brain network metrics that can be compared to the normative data by the pediatrician. We also perform a cost-benefit analysis to support this vision and provide a roadmap of the steps required for this vision to be implemented.
Collapse
Affiliation(s)
- Olga Tymofiyeva
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Vivian X Zhou
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Chuan-Mei Lee
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Clinical Excellence Research Center, Stanford University, Stanford, CA, United States
| | - Duan Xu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Tony T Yang
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
31
|
Luca DL, Margiotta C, Staatz C, Garlow E, Christensen A, Zivin K. Financial Toll of Untreated Perinatal Mood and Anxiety Disorders Among 2017 Births in the United States. Am J Public Health 2020; 110:888-896. [PMID: 32298167 PMCID: PMC7204436 DOI: 10.2105/ajph.2020.305619] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2020] [Indexed: 11/04/2022]
Abstract
Objectives. To estimate the economic burden of untreated perinatal mood and anxiety disorders (PMADs) among 2017 births in the United States.Methods. We developed a mathematical model based on a cost-of-illness approach to estimate the impacts of exposure to untreated PMADs on mothers and children. Our model estimated the costs incurred by mothers and their babies born in 2017, projected from conception through the first 5 years of the birth cohort's lives. We determined model inputs from secondary data sources and a literature review.Results. We estimated PMADs to cost $14 billion for the 2017 birth cohort from conception to 5 years postpartum. The average cost per affected mother-child dyad was about $31 800. Mothers incurred 65% of the costs; children incurred 35%. The largest costs were attributable to reduced economic productivity among affected mothers, more preterm births, and increases in other maternal health expenditures.Conclusions. The US economic burden of PMADs is high. Efforts to lower the prevalence of untreated PMADs could lead to substantial economic savings for employers, insurers, the government, and society.
Collapse
Affiliation(s)
- Dara Lee Luca
- Dara Lee Luca is with Mathematica and Harvard Kennedy School, Cambridge, MA. Caroline Margiotta and Colleen Staatz are with Mathematica, Cambridge. Eleanor Garlow is with Mathematica, Washington, DC, and Emory University, Atlanta, GA. Anna Christensen is with Mathematica, Washington, DC. Kara Zivin is with Mathematica, University of Michigan Medical School, and Department of Veterans Affairs, Ann Arbor
| | - Caroline Margiotta
- Dara Lee Luca is with Mathematica and Harvard Kennedy School, Cambridge, MA. Caroline Margiotta and Colleen Staatz are with Mathematica, Cambridge. Eleanor Garlow is with Mathematica, Washington, DC, and Emory University, Atlanta, GA. Anna Christensen is with Mathematica, Washington, DC. Kara Zivin is with Mathematica, University of Michigan Medical School, and Department of Veterans Affairs, Ann Arbor
| | - Colleen Staatz
- Dara Lee Luca is with Mathematica and Harvard Kennedy School, Cambridge, MA. Caroline Margiotta and Colleen Staatz are with Mathematica, Cambridge. Eleanor Garlow is with Mathematica, Washington, DC, and Emory University, Atlanta, GA. Anna Christensen is with Mathematica, Washington, DC. Kara Zivin is with Mathematica, University of Michigan Medical School, and Department of Veterans Affairs, Ann Arbor
| | - Eleanor Garlow
- Dara Lee Luca is with Mathematica and Harvard Kennedy School, Cambridge, MA. Caroline Margiotta and Colleen Staatz are with Mathematica, Cambridge. Eleanor Garlow is with Mathematica, Washington, DC, and Emory University, Atlanta, GA. Anna Christensen is with Mathematica, Washington, DC. Kara Zivin is with Mathematica, University of Michigan Medical School, and Department of Veterans Affairs, Ann Arbor
| | - Anna Christensen
- Dara Lee Luca is with Mathematica and Harvard Kennedy School, Cambridge, MA. Caroline Margiotta and Colleen Staatz are with Mathematica, Cambridge. Eleanor Garlow is with Mathematica, Washington, DC, and Emory University, Atlanta, GA. Anna Christensen is with Mathematica, Washington, DC. Kara Zivin is with Mathematica, University of Michigan Medical School, and Department of Veterans Affairs, Ann Arbor
| | - Kara Zivin
- Dara Lee Luca is with Mathematica and Harvard Kennedy School, Cambridge, MA. Caroline Margiotta and Colleen Staatz are with Mathematica, Cambridge. Eleanor Garlow is with Mathematica, Washington, DC, and Emory University, Atlanta, GA. Anna Christensen is with Mathematica, Washington, DC. Kara Zivin is with Mathematica, University of Michigan Medical School, and Department of Veterans Affairs, Ann Arbor
| |
Collapse
|
32
|
Exploring the identification, validation, and categorization of costs and benefits of education in mental health: The PECUNIA project. Int J Technol Assess Health Care 2020. [DOI: 10.1017/s0266462320000203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BackgroundMental health problems can lead to costs and benefits in other sectors (e.g. in the education sector) in addition to the healthcare sector. These related costs and benefits are known as intersectoral costs and benefits (ICBs). Although some ICBs within the education sector have been identified previously, little is known about their extensiveness and transferability, which is crucial for their inclusion in health economics research.ObjectivesThe aim of this study was to identify ICBs in the education sector, to validate the list of ICBs in a broader European context, and to categorize the ICBs using mental health as a case study.MethodsPreviously identified ICBs in the education sector were used as a basis for this study. Additional ICBs were extracted from peer-reviewed literature in PubMed and grey literature from six European countries. A comprehensive list of unique items was developed based on the identified ICBs. The list was validated by surveying an international group of educational experts. The survey results were used to finalize the list, which was categorized according to the care atom.ResultsAdditional ICBs in the education sector were retrieved from ninety-six sources. Fourteen experts from six European countries assessed the list for completeness, clarity, and relevance. The final list contained twenty-four ICBs categorized into input, throughput, and output.ConclusionBy providing a comprehensive list of ICBs in the education sector, this study laid further foundations for the inclusion of important societal costs in health economics research in the broader European context.
Collapse
|
33
|
Antonyms: A Computer Game to Improve Inhibitory Control of Impulsivity in Children with Attention Deficit/Hyperactivity Disorder (ADHD). INFORMATION 2020. [DOI: 10.3390/info11040230] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The design of a computer-supported serious game concerning inhibition skills in children with Attention Deficit/Hyperactivity Disorder (ADHD) is reported. The game consists of a series of activities, each eliciting the tendency to respond in an immediate, inadequate way. The game is based on the Dual Pathway Model of ADHD proposed by Sonuga-Barke. In the game, children must block impulsive tendencies, reflect upon the situation, inhibit irrelevant thoughts, and find the non-intuitive solution. In the game, the player personifies a superhero, who is asked to save a realm on the opposite side of the Earth (Antonyms) where things happen according to the opposite of the usual rules. The hero faces a series of challenges, in the form of mini-games, to free the planet from enemies crossing different scenarios. To succeed in the game, the player should change his/her attitude by thinking before performing any action rather than acting on impulse. The player is induced to be reflective and thoughtful as well. Results from the evaluation of a preliminary version of the serious game are reported. They support the notion that Antonyms is an adequate tool to lead children to inhibit their tendency to behave impulsively.
Collapse
|
34
|
Miller JS, Anderson JG, Lindley LC. Behavioral development in children with prenatal substance exposure and neonatal abstinence syndrome: Associated factors and implications. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2020; 33:67-76. [PMID: 32275115 DOI: 10.1111/jcap.12273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 11/29/2022]
Abstract
PROBLEM Prenatal substance exposure and neonatal abstinence syndrome (NAS) are risk factors for adverse behavioral outcomes in children at 24 months of age. METHODS The purpose of this study was to examine factors associated with abnormal behavioral development in children with prenatal substance exposure or NAS through 10 years of age. A retrospective, nonexperimental, longitudinal design to examine the effects of prenatal substance exposure and NAS on behavioral development at 1, 5, and 10 years of age, while controlling for intrapersonal, interpersonal, community, organizational, and public policy characteristics. A hierarchical multivariate logistic regression model was used to evaluate the influence of substance exposure and NAS on behavioral outcomes. FINDINGS Abnormal behavioral development was predicted at 10 years of age with polysubstance exposure to three substances (odds ratio [OR] = 2.711, p < 0.01) and NAS (OR = 2.077, p < .001). CONCLUSION Psychiatric nursing care for children with prenatal substance exposure and NAS should include implementation of early and continued behavioral evaluation and childhood trauma and adversity surveillance in children through middle childhood.
Collapse
Affiliation(s)
- Jennifer S Miller
- The University of Tennessee, College of Nursing, Knoxville, Tennessee
| | - Joel G Anderson
- The University of Tennessee, College of Nursing, Knoxville, Tennessee
| | - Lisa C Lindley
- The University of Tennessee, College of Nursing, Knoxville, Tennessee
| |
Collapse
|
35
|
Abstract
Economics and mental health are intertwined. Apart from the accumulating evidence of the huge economic impacts of mental ill-health, and the growing recognition of the effects that economic circumstances can exert on mental health, governments and other budget-holders are putting increasing emphasis on economic data to support their decisions. Here we consider how economic evaluation (including cost-effectiveness analysis, cost-utility analysis and related techniques) can contribute evidence to inform the development of mental health policy strategies, and to identify some consequences at the treatment or care level that are of relevance to service providers and funding bodies. We provide an update and reflection on economic evidence relating to mental health using a lifespan perspective, analyzing costs and outcomes to shed light on a range of pressing issues. The past 30 years have witnessed a rapid growth in mental health economics, but major knowledge gaps remain. Across the lifespan, clearer evidence exists in the areas of perinatal depression identification-plus-treatment; risk-reduction of mental health problems in childhood and adolescence; scaling up treatment, particularly psychotherapy, for depression; community-based early intervention and employment support for psychosis; and cognitive stimulation and multicomponent carer interventions for dementia. From this discussion, we pull out the main challenges that are faced when trying to take evidence from research and translating it into policy or practice recommendations, and from there to actual implementation in terms of better treatment and care.
Collapse
Affiliation(s)
- Martin Knapp
- Care Policy and Evaluation Centre (CPEC), London School of Economics and Political ScienceLondonUK,School for Social Care Research, National Institute for Health ResearchUK
| | - Gloria Wong
- Department of Social Work and Social Administration, University of Hong KongHong Kong
| |
Collapse
|
36
|
Pereira JA, Sepulveda P, Rana M, Montalba C, Tejos C, Torres R, Sitaram R, Ruiz S. Self-Regulation of the Fusiform Face Area in Autism Spectrum: A Feasibility Study With Real-Time fMRI Neurofeedback. Front Hum Neurosci 2019; 13:446. [PMID: 31920602 PMCID: PMC6933482 DOI: 10.3389/fnhum.2019.00446] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/04/2019] [Indexed: 12/27/2022] Open
Abstract
One of the most important and early impairments in autism spectrum disorder (ASD) is the abnormal visual processing of human faces. This deficit has been associated with hypoactivation of the fusiform face area (FFA), one of the main hubs of the face-processing network. Neurofeedback based on real-time fMRI (rtfMRI-NF) is a technique that allows the self-regulation of circumscribed brain regions, leading to specific neural modulation and behavioral changes. The aim of the present study was to train participants with ASD to achieve up-regulation of the FFA using rtfMRI-NF, to investigate the neural effects of FFA up-regulation in ASD. For this purpose, three groups of volunteers with normal I.Q. and fluent language were recruited to participate in a rtfMRI-NF protocol of eight training runs in 2 days. Five subjects with ASD participated as part of the experimental group and received contingent feedback to up-regulate bilateral FFA. Two control groups, each one with three participants with typical development (TD), underwent the same protocol: one group with contingent feedback and the other with sham feedback. Whole-brain and functional connectivity analysis using each fusiform gyrus as independent seeds were carried out. The results show that individuals with TD and ASD can achieve FFA up-regulation with contingent feedback. RtfMRI-NF in ASD produced more numerous and stronger short-range connections among brain areas of the ventral visual stream and an absence of the long-range connections to insula and inferior frontal gyrus, as observed in TD subjects. Recruitment of inferior frontal gyrus was observed in both groups during FAA up-regulation. However, insula and caudate nucleus were only recruited in subjects with TD. These results could be explained from a neurodevelopment perspective as a lack of the normal specialization of visual processing areas, and a compensatory mechanism to process visual information of faces. RtfMRI-NF emerges as a potential tool to study visual processing network in ASD, and to explore its clinical potential.
Collapse
Affiliation(s)
- Jaime A. Pereira
- Laboratory for Brain Machine Interfaces and Neuromodulation, Pontifical Catholic University of Chile, Santiago, Chile
- Department of Psychiatry, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Pradyumna Sepulveda
- Laboratory for Brain Machine Interfaces and Neuromodulation, Pontifical Catholic University of Chile, Santiago, Chile
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Mohit Rana
- Laboratory for Brain Machine Interfaces and Neuromodulation, Pontifical Catholic University of Chile, Santiago, Chile
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Cristian Montalba
- Biomedical Imaging Center, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Cristian Tejos
- Biomedical Imaging Center, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
- Department of Electrical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile
| | - Rafael Torres
- Department of Psychiatry, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Ranganatha Sitaram
- Laboratory for Brain Machine Interfaces and Neuromodulation, Pontifical Catholic University of Chile, Santiago, Chile
- Department of Psychiatry, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
- Department of Electrical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Institute for Biological and Medical Engineering, Faculty of Engineering, Pontifical Catholic University of Chile, Santiago, Chile
| | - Sergio Ruiz
- Laboratory for Brain Machine Interfaces and Neuromodulation, Pontifical Catholic University of Chile, Santiago, Chile
- Department of Psychiatry, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| |
Collapse
|
37
|
Bachmann CJ, Beecham J, O'Connor TG, Scott A, Briskman J, Scott S. The cost of love: financial consequences of insecure attachment in antisocial youth. J Child Psychol Psychiatry 2019; 60:1343-1350. [PMID: 31495929 DOI: 10.1111/jcpp.13103] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Knowing that your parent or caregiver will be there for you in times of emotional need and distress is a core aspect of the human experience of feeling loved and being securely attached. In contrast, an insecure attachment pattern is found in many antisocial youth and is related to less sensitive caregiving. Such youth are often distrustful of adults and authority figures, and are at high risk of poor outcomes. As they become adults, they require extensive health, social and economic support, costing society ten times more than their well-adjusted peers. However, it is not known whether insecure attachment itself is associated with higher costs in at-risk youth, independently of potential confounders, nor whether cost differences are already beginning to emerge early in adolescence. METHODS Sample: A total of 174 young people followed up aged 9-17 years (mean 12.1, SD 1.8): 85 recruited with moderate antisocial behaviour (80th percentile) from a school screen aged 4-6 years; 89 clinically referred with very high antisocial behaviour (98th percentile) aged 3-7 years. MEASURES Costs by detailed health economic and service-use interview; attachment security to mother and father from interview; diagnostic interviews for oppositional and conduct problems; self-reported delinquent behaviour. RESULTS Costs were greater for youth insecurely attached to their mothers (secure £6,743, insecure £10,199, p = .001) and more so to fathers (secure £1,353, insecure £13,978, p < .001). These differences remained significant (mother p = .019, father p < .001) after adjusting for confounders, notably family income and education, intelligence and antisocial behaviour severity. CONCLUSIONS Attachment insecurity is a significant predictor of public cost in at-risk youth, even after accounting for covariates. Since adolescent attachment security is influenced by caregiving quality earlier in childhood, these findings add support to the public health case for early parenting interventions to improve child outcomes and reduce the financial burden on society.
Collapse
Affiliation(s)
| | - Jennifer Beecham
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK.,Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Thomas G O'Connor
- Department of Psychiatry, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Adam Scott
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Jackie Briskman
- National Academy for Parenting Research, King's College London, London, UK
| | - Stephen Scott
- National Academy for Parenting Research, King's College London, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
38
|
König U, Heinzel-Gutenbrunner M, Meinlschmidt G, Maier W, Bachmann CJ. [Socioeconomic status and health insurance expenditures for children and adolescents with conduct disorder : An analysis of statutory health insurance data]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1057-1066. [PMID: 31410523 DOI: 10.1007/s00103-019-02991-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND For various psychiatric and somatic disorders, there is evidence of an association between patients' socioeconomic status (SES), healthcare utilisation, and the resulting costs. In the field of child and adolescent psychiatric disorders, studies on this topic are lacking. OBJECTIVES To exploratively analyse the association of healthcare expenditures for children and adolescents with conduct disorder (including oppositional-defiant disorder) - one of the most prevalent child and adolescent psychiatric disorders - and SES. MATERIALS AND METHODS The analysis is based on routine data from the German statutory health insurance company AOK Nordost for the calendar year 2011, covering 6461 children and adolescents (age 5-18 years) with an ICD-10 diagnosis of conduct disorder. The insureds' SES was estimated indirectly, based on the social structure of the postcode area, using the German Index of Multiple Deprivation (Mecklenburg-Vorpommern, Brandenburg), and the Berliner Sozialindex I (Berlin), respectively. From the two indices, quintiles were derived. Based on these quintiles, average costs per case for the following cost types were analysed: inpatient healthcare, outpatient healthcare (general practitioners, paediatricians, child and adolescent psychiatrists, child and adolescent psychotherapists), and prescribed medication. RESULTS There was no significant functional association between SES and healthcare costs for any of the analysed cost types. CONCLUSIONS In contrast to findings in adults, this study on children and adolescents with conduct disorders did not reveal an association between SES and healthcare costs. Within this group of patients, social inequality does not seem to have a significant influence on healthcare utilisation in Germany.
Collapse
Affiliation(s)
- Udo König
- Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin, Philipps-Universität Marburg, Karl-von-Frisch-Straße 4, 35043, Marburg, Deutschland.
| | | | - Gerhard Meinlschmidt
- Berlin School of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Werner Maier
- Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Neuherberg, Deutschland
| | - Christian J Bachmann
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm, Ulm, Deutschland
| |
Collapse
|
39
|
Daley D, Jacobsen RH, Lange AM, Sørensen A, Walldorf J. The economic burden of adult attention deficit hyperactivity disorder: A sibling comparison cost analysis. Eur Psychiatry 2019; 61:41-48. [PMID: 31288209 DOI: 10.1016/j.eurpsy.2019.06.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 02/05/2023] Open
Abstract
AIM Attention Deficit Hyperactivity Disorder (ADHD) is a lifespan disorder associated with considerable economic cost. While the economic burden of ADHD has been widely estimated, there is considerable variation in reported costs between studies, which typically focus on health outcomes only, lack adequate control and fail to correct for the influence of genetic and shared environmental factors. The aim of this study is to overcome these limitations to reach a fuller understanding of the economic burden of ADHD. METHOD Using the Danish National Registers 5269 adults with a diagnosis of ADHD in adulthood who had not received a diagnosis in childhood were identified. Excluding cases with missing data, comorbid diagnoses, and cases without a same sex sibling free of any diagnosed psychiatric diagnoses, a final cohort was formed consisting of 460 sibling dyads. Using a cross-sectional method focusing on the year 2010, cost differences between each adult with ADHD and their sibling were calculated from data retrieved from health, education, crime, employment and social care registers. RESULTS Adults with ADHD had considerably lower disposable income and paid less tax than their siblings. They also received more state benefits, had higher costs for health, social care, and crime than their siblings. The total average costs difference for the year 2010 was 20,134 euros more than their sibling for each adult with ADHD. CONCLUSION ADHD is associated with considerable costs which are borne by both the individual and the state and underlines the need to consider the wider economic impact of ADHD beyond income and healthcare utilisation costs.
Collapse
Affiliation(s)
- D Daley
- Division of Psychiatry and Applied Psychology, School of Medicine & Centre for ADHD and Neurodevelopmental Disorders across the Lifespan & NIHR MindTech Health Care Technology Cooperative, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.
| | - R H Jacobsen
- VIVE, The Danish Centre for Applied Social Science, Copenhagen, Denmark
| | - A-M Lange
- Aarhus University Hospital, Department of Child & Adolescent Psychiatry, Skejby, Denmark
| | - A Sørensen
- Department of Economics, Copenhagen Business School, Porcelaenshaven, Copenhagen, Denmark
| | - J Walldorf
- Department of Economics, Copenhagen Business School, Porcelaenshaven, Copenhagen, Denmark
| |
Collapse
|
40
|
Tougas AM, Rassy J, Frenette-Bergeron É, Marcil K. “Lost in Transition”: A Systematic Mixed Studies Review of Problems and Needs Associated with School Reintegration After Psychiatric Hospitalization. SCHOOL MENTAL HEALTH 2019. [DOI: 10.1007/s12310-019-09323-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
41
|
Powell L, Parker J, Harpin V, Mawson S. Guideline Development for Technological Interventions for Children and Young People to Self-Manage Attention Deficit Hyperactivity Disorder: Realist Evaluation. J Med Internet Res 2019; 21:e12831. [PMID: 30942692 PMCID: PMC6468334 DOI: 10.2196/12831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. ADHD can affect the individual, the individual's family, and the community. ADHD is managed using pharmacological and nonpharmacological treatments, which principally involves others helping children and young people (CAYP) manage their ADHD rather than learning self-management strategies themselves. Over recent years, technological developments have meant that technology has been harnessed to create interventions to facilitate the self-management of ADHD in CAYP. Despite a clear potential to improve the effectiveness and personalization of interventions, there are currently no guidelines based on existing evidence or theories to underpin the development of technologies that aim to help CAYP self-manage their ADHD. OBJECTIVE The aim of this study was to create evidence-based guidelines with key stakeholders who will provide recommendations for the future development of technological interventions, which aim to specifically facilitate the self-management of ADHD. METHODS A realist evaluation (RE) approach was adopted over 5 phases. Phase 1 involved identifying propositions (or hypotheses) outlining what could work for such an intervention. Phase 2 involved the identification of existing middle-range theories of behavior change to underpin the propositions. Phase 3 involved the identification and development of context mechanism outcome configurations (CMOCs), which essentially state which elements of the intervention could be affected by which contexts and what the outcome of these could be. Phase 4 involved the validation and refinement of the propositions from phase 1 via interviews with key stakeholders (CAYP with ADHD, their parents and specialist clinicians). Phase 5 involved using information gathered during phases 1 to 4 to develop the guidelines. RESULTS A total of 6 specialist clinicians, 8 parents, and 7 CAYP were recruited to this study. Overall, 7 key themes were identified: (1) positive rewarding feedback, (2) downloadable gaming resources, (3) personalizable and adaptable components, (4) psychoeducation component, (5) integration of self-management strategies, (6) goal setting, and (7) context (environmental and personal). The identified mechanisms interacted with the variable contexts in which a complex technological intervention of this nature could be delivered. CONCLUSIONS Complex intervention development for complex populations such as CAYP with ADHD should adopt methods such as RE, to account for the context it is delivered in, and co-design, which involves developing the intervention in partnership with key stakeholders to increase the likelihood that the intervention will succeed. The development of the guidelines outlined in this paper could be used for the future development of technologies that aim to facilitate self-management in CAYP with ADHD.
Collapse
Affiliation(s)
| | - Jack Parker
- University of Sheffield, Sheffield, United Kingdom
| | - Val Harpin
- Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Susan Mawson
- University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
42
|
Stewart SL, Poss JW, Thornley E, Hirdes JP. Resource Intensity for Children and Youth: The Development of an Algorithm to Identify High Service Users in Children's Mental Health. Health Serv Insights 2019; 12:1178632919827930. [PMID: 30828248 PMCID: PMC6390227 DOI: 10.1177/1178632919827930] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/27/2018] [Indexed: 11/25/2022] Open
Abstract
Children’s mental health care plays a vital role in many social, health care, and
education systems, but there is evidence that appropriate targeting strategies
are needed to allocate limited mental health care resources effectively. The aim
of this study was to develop and validate a methodology for identifying children
who require access to more intense facility-based or community resources.
Ontario data based on the interRAI Child and Youth Mental Health instruments
were analysed to identify predictors of service complexity in children’s mental
health. The Resource Intensity for Children and Youth (RIChY) algorithm was a
good predictor of service complexity in the derivation sample. The algorithm was
validated with additional data from 61 agencies. The RIChY algorithm provides a
psychometrically sound decision-support tool that may be used to inform the
choices related to allocation of children’s mental health resources and
prioritisation of clients needing community- and facility-based resources.
Collapse
Affiliation(s)
| | - Jeff W Poss
- University of Waterloo, Faculty of Applied Health Sciences, Waterloo, ON, Canada
| | | | - John P Hirdes
- University of Waterloo, Faculty of Applied Health Sciences, Waterloo, ON, Canada
| |
Collapse
|
43
|
Beecham J, Pearce P, Sewell R, Osman S. Support and costs for students with emotional problems referred to school-based counselling: findings from the ALIGN study. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2018. [DOI: 10.1080/03069885.2018.1552777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
44
|
Gerhardt H, Heinzel-Gutenbrunner M, Bachmann CJ. Differences in healthcare costs in youths with conduct disorders in rural vs. urban regions: an analysis of German health insurance data. BMC Health Serv Res 2018; 18:714. [PMID: 30217151 PMCID: PMC6137893 DOI: 10.1186/s12913-018-3520-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 09/03/2018] [Indexed: 11/23/2022] Open
Abstract
Background For children and adolescents with mental health problems, there is a lack of data as to whether the type of residential area (urban vs. rural) influences healthcare costs for affected individuals. The aim of this study was therefore to explore potential urban vs. rural healthcare cost differences in children and adolescents with conduct disorder (CD), one of the most frequent and cost-intensive child and adolescent psychiatric disorders. Additionally, we aimed to compare healthcare costs of youths with CD, and of youths without this diagnosis. Methods We analysed data from a German health insurance company, extracting all youths with a CD diagnosis in 2011 (CD group; N = 6337), and an age- and sex-matched group without this diagnosis (control group). For both groups, annual costs per person for outpatient and inpatient healthcare were aggregated, stratified by area of residence (urban vs. rural). Results While mean annual overall costs in the CD group did not differ significantly between urban and rural areas of residence (2785 EUR vs. 3557 EUR, p = 0.253), inpatient treatment costs were significantly higher in rural areas (2166 EUR (60.9% of overall costs) vs. 1199 EUR (43.1% of overall costs), p < 0.0005). For outpatient healthcare costs, the reverse effect was found, with significantly higher costs in individuals from urban areas of residence (901 EUR (32.3% of overall costs) vs. 581 EUR (16.3% of overall costs), p < 0.0005). In the control group, no significant rural vs. urban difference was found for either overall health costs, inpatient or outpatient costs. Mean overall costs in the CD group were four times higher than in the control group (3162 (±5934) EUR vs. 795 (±4425) EUR). Conclusions This study is the first to demonstrate urban vs. rural differences in healthcare costs among youths with CD. The higher costs of inpatient treatment in rural regions may indicate a need for alternative forms of service provision and delivery in rural settings.
Collapse
Affiliation(s)
- Heike Gerhardt
- Department of Child and Adolescent Psychiatry, Philipps-University Marburg, Hans-Sachs-Str. 4-6, DE-35039, Marburg, Germany
| | - Monika Heinzel-Gutenbrunner
- Department of Child and Adolescent Psychiatry, Philipps-University Marburg, Hans-Sachs-Str. 4-6, DE-35039, Marburg, Germany
| | - Christian J Bachmann
- Department of Child and Adolescent Psychiatry, Philipps-University Marburg, Hans-Sachs-Str. 4-6, DE-35039, Marburg, Germany. .,Department of Child and Adolescent Psychiatry, LVR-Klinikum Düsseldorf/ Kliniken der Heinrich-Heine-Universität Düsseldorf, Bergische Landstraße 2, DE-40629, Düsseldorf, Germany.
| |
Collapse
|
45
|
Young S, González RA, Fridman M, Hodgkins P, Kim K, Gudjonsson GH. The economic consequences of attention-deficit hyperactivity disorder in the Scottish prison system. BMC Psychiatry 2018; 18:210. [PMID: 29940897 PMCID: PMC6019793 DOI: 10.1186/s12888-018-1792-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 06/13/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is highly prevalent amongst prison inmates and the criminal justice system (CJS) likely bears considerable costs for offenders with ADHD. We aimed to examine the relationship between ADHD and health-related quality of life (HRQoL) and quality-adjusted life years (QALY) amongst imprisoned adults; and to estimate the annual expenditure associated with ADHD status in prison. METHODS An observational study was performed in 2011-2013, at Porterfield Prison, Inverness, United Kingdom (UK). The all male sample included 390 adult prison inmates with capacity to consent and no history of moderate or severe intellectual disability. Participants were interviewed using the Diagnostic Interview for ADHD in Adults 2.0. The Health Utilities Index Mark 3 (HUI3) was used to measure health status, and to calculate attribute specific HRQoL scores and QALY. Health service utilisation was obtained through inspection of medical prison records. Inmates with ADHD were compared with inmates without ADHD. RESULTS Inmates with ADHD had significantly lower QALYs, with a clinically significant adjusted difference of 0.13. Psychiatric co-morbidity accounted for the variation of ADHD on the HUI3 emotion domain only. Medical costs for inmates with ADHD were significantly higher; and behaviour-related prison costs were similar to prisoners without ADHD, reflecting a low frequency of recorded critical incidents. CONCLUSIONS ADHD may directly contribute to adverse health and quality of life through cognitive and executive function deficits, and co-morbid disorders. The extrapolation of conservative cost estimates suggests that the financial burden of medical and behavior-related prison care for inmates with ADHD in the UK is approximately £11.7 million annually. The reported cost estimates are conservative as there is great variability in recorded critical incidents in prisons. In turn, for some prison establishments the prison care costs associated with prisoners with ADHD may be considerably greater.
Collapse
Affiliation(s)
- Susan Young
- Psychology Services Limited, PO Box 1735, Croydon, CR97AE, UK. .,Reykjavik University, Reykjavik, Iceland.
| | - Rafael A. González
- 0000 0004 0426 7183grid.450709.fEast London NHS Foundation Trust, London, UK
| | | | - Paul Hodgkins
- 0000 0004 5913 664Xgrid.476678.cSage Therapeutics, Cambridge, MA USA
| | - Keira Kim
- Indedpendent Medical Writer, San Diego, CA USA
| | - Gisli H. Gudjonsson
- 0000 0004 0643 5232grid.9580.4Reykjavik University, Reykjavik, Iceland ,0000 0001 2322 6764grid.13097.3cInstitute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| |
Collapse
|
46
|
León-Del-Barco B, Fajardo-Bullón F, Mendo-Lázaro S, Rasskin-Gutman I, Iglesias-Gallego D. Impact of the Familiar Environment in 11⁻14-Year-Old Minors' Mental Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1314. [PMID: 29937491 PMCID: PMC6069230 DOI: 10.3390/ijerph15071314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/09/2018] [Accepted: 06/20/2018] [Indexed: 12/22/2022]
Abstract
The analysis of the mental health in children under 14 years has become a research topic of global interest where the family can be a key factor for protection or risk against mental health problems. With this work, we intend to determine, employing binary logistic regression analysis, whether parental acceptance-rejection perceived by boys and girls can predict their mental health. Seven hundred sixty-two students participated, the average age was 12.23 years; 53.8% (n = 410) girls and 46.2% (n = 352) boys. We have used the Strengths and Difficulties Questionnaire (SDQ), self-reported version and the Affection Scale children version (EA-H) for parental acceptance-rejection to assess mental health. The odds ratio (OR) of the logistic models reports that there is a greater probability of having mental health problems in boys and girls when they perceive that they are highly criticized and rejected by their parents. With our work, we highlight the importance of the environment and family affection on mental health. The perception of the children about the rejection, aversion, and criticism of their parents constitutes a risk factor in the manifestation of mental health problems.
Collapse
Affiliation(s)
- Benito León-Del-Barco
- Department of Psychology, Teacher Training College, University of Extremadura, 10071 Cáceres, Spain.
| | - Fernando Fajardo-Bullón
- Department of Psychology, Faculty of Education and Psychology, University of Extremadura, 06006 Badajoz, Spain.
| | - Santiago Mendo-Lázaro
- Department of Psychology, Teacher Training College, University of Extremadura, 10071 Cáceres, Spain.
| | - Irina Rasskin-Gutman
- Department of Psychology, Teacher Training College, University of Extremadura, 10071 Cáceres, Spain.
| | - Damián Iglesias-Gallego
- Department of Didactics of Music, Plastic and Body Expression. Teacher Training College, University of Extremadura, 10071 Cáceres, Spain.
| |
Collapse
|
47
|
Fatori D, Salum G, Itria A, Pan P, Alvarenga P, Rohde LA, Bressan R, Gadelha A, de Jesus Mari J, Conceição do Rosário M, Manfro G, Polanczyk G, Miguel EC, Graeff-Martins AS. The economic impact of subthreshold and clinical childhood mental disorders. J Ment Health 2018; 27:588-594. [DOI: 10.1080/09638237.2018.1466041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Daniel Fatori
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil,
| | - Giovanni Salum
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil,
| | - Alexander Itria
- Department of Collective Health, Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiania, Brazil, and
| | - Pedro Pan
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Pedro Alvarenga
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil,
| | - Luis Augusto Rohde
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil,
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil,
| | - Rodrigo Bressan
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Ary Gadelha
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Gisele Manfro
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil,
| | - Guilherme Polanczyk
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil,
| | | | | |
Collapse
|
48
|
School-Based Interventions for Aggression and Defiance in Youth: A Framework for Evidence-Based Practice. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-018-9269-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
49
|
Deidda M, Boyd KA, Minnis H, Donaldson J, Brown K, Boyer NRS, McIntosh E. Protocol for the economic evaluation of a complex intervention to improve the mental health of maltreated infants and children in foster care in the UK (The BeST? services trial). BMJ Open 2018. [PMID: 29540420 PMCID: PMC5857651 DOI: 10.1136/bmjopen-2017-020066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Children who have experienced abuse and neglect are at increased risk of mental and physical health problems throughout life. This places an enormous burden on individuals, families and society in terms of health services, education, social care and judiciary sectors. Evidence suggests that early intervention can mitigate the negative consequences of child maltreatment, exerting long-term positive effects on the health of maltreated children entering foster care. However, evidence on cost-effectiveness of such complex interventions is limited. This protocol describes the first economic evaluation of its kind in the UK. METHODS AND ANALYSIS An economic evaluation alongside the Best Services Trial (BeST?) has been prospectively designed to identify, measure and value key resource and outcome impacts arising from the New Orleans intervention model (NIM) (an infant mental health service) compared with case management (CM) (enhanced social work services as usual). A within-trial economic evaluation and long-term model from a National Health Service/Personal Social Service and a broader societal perspective will be undertaken alongside the National Institute for Health Research (NIHR)-Public Health Research Unit (PHRU)-funded randomised multicentre BeST?. BeST? aims to evaluate NIM compared with CM for maltreated children entering foster care in a UK context. Collection of Paediatric Quality of Life Inventory (PedsQL) and the recent mapping of PedsQL to EuroQol-5-Dimensions (EQ-5D) will facilitate the estimation of quality-adjusted life years specific to the infant population for a cost-utility analysis. Other effectiveness outcomes will be incorporated into a cost-effectiveness analysis (CEA) and cost-consequences analysis (CCA). A long-term economic model and multiple economic evaluation frameworks will provide decision-makers with a comprehensive, multiperspective guide regarding cost-effectiveness of NIM. The long-term population health economic model will be developed to synthesise trial data with routine linked data and key government sector parameters informed by literature. Methods guidance for population health economic evaluation will be adopted (lifetime horizon, 1.5% discount rate for costs and benefits, CCA framework, multisector perspective). ETHICS AND DISSEMINATION Ethics approval was obtained by the West of Scotland Ethics Committee. Results of the main trial and economic evaluation will be submitted for publication in a peer-reviewed journal as well as published in the peer-reviewed NIHR journals library (Public Health Research Programme). TRIAL REGISTRATION NUMBER NCT02653716; Pre-results.
Collapse
Affiliation(s)
- Manuela Deidda
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Kathleen Anne Boyd
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Helen Minnis
- Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Kevin Brown
- Family Assessment and Contact Service, Glasgow, UK
| | - Nicole R S Boyer
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| |
Collapse
|
50
|
Hamilton MP, Hetrick SE, Mihalopoulos C, Baker D, Browne V, Chanen AM, Pennell K, Purcell R, Stavely H, McGorry PD. Identifying attributes of care that may improve cost‐effectiveness in the youth mental health service system. Med J Aust 2017; 207:S27-S37. [DOI: 10.5694/mja17.00972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/17/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Matthew P Hamilton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | | | - David Baker
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Vivienne Browne
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Kerryn Pennell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Rosemary Purcell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Heather Stavely
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| |
Collapse
|