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Feldman, Inna, DocentORCID iD iconorcid.org/0000-0003-3329-6066
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Publications (10 of 59) Show all publications
Sarkadi, A., Warner, G., Salari, R., Fängström, K., Durbeej, N., Lampa, E., . . . Keeshin, B. (2020). Evaluation of the Teaching Recovery Techniques community-based intervention for unaccompanied refugee youth experiencing post-traumatic stress symptoms (Swedish UnaccomPanied yOuth Refugee Trial; SUPpORT): study protocol for a randomised controlled trial.. Trials, 21(1), Article ID 63.
Open this publication in new window or tab >>Evaluation of the Teaching Recovery Techniques community-based intervention for unaccompanied refugee youth experiencing post-traumatic stress symptoms (Swedish UnaccomPanied yOuth Refugee Trial; SUPpORT): study protocol for a randomised controlled trial.
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2020 (English)In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 21, no 1, article id 63Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In 2015, 162,877 persons sought asylum in Sweden, 35,369 of whom were unaccompanied refugee minors (URMs). Refugee children, especially URMs, have often experienced traumas and are at significant risk of developing mental health problems, such as symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, which can continue years after resettlement. The Swedish UnaccomPanied yOuth Refugee Trial (SUPpORT) aims to evaluate a community-based intervention, called Teaching Recovery Techniques (TRT), for refugee youth experiencing PTSD symptoms.

METHODS/DESIGN: A randomised controlled trial will be conducted in which participants will be randomly allocated to one of two possible arms: the intervention arm (n = 109) will be offered the TRT programme, and the waitlist-control arm (n = 109) will receive services as usual, followed by the TRT programme around 20 weeks later. Outcome data will be collected at three points: pre-intervention (T1), post-intervention (T2; about 8 weeks after randomisation) and follow-up (T3; about 20 weeks after randomisation).

DISCUSSION: This study will provide knowledge about the effect and efficiency of a group intervention for URMs reporting symptoms of PTSD in Sweden.

TRIAL REGISTRATION: ISRCTN, ISRCTN47820795. Prospectively registered on 20 December 2018.

Keywords
Post-traumatic stress disorder, Randomised controlled trial, Teaching Recovery Techniques, Unaccompanied refugee minors
National Category
Health Sciences
Identifiers
urn:nbn:se:uu:diva-402288 (URN)10.1186/s13063-019-3814-5 (DOI)31924247 (PubMedID)
Available from: 2020-01-13 Created: 2020-01-13 Last updated: 2020-01-20Bibliographically approved
Jangmo, A., Stålhandske, A., Chang, Z., Chen, Q., Almqvist, C., Feldman, I., . . . Larsson, H. (2019). Attention-Deficit/Hyperactivity Disorder, School Performance, and Effect of Medication. Journal of the American Academy of Child and Adolescent Psychiatry, 58(4), 423-432
Open this publication in new window or tab >>Attention-Deficit/Hyperactivity Disorder, School Performance, and Effect of Medication
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2019 (English)In: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 58, no 4, p. 423-432Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) are at increased risk of poor school performance and pharmacological treatment of ADHD may have beneficial effects on school performance. Conclusions from previous research have been limited by small sample sizes, outcome measures, and treatment follow-up. The current study analyzed school performance in students with ADHD compared to students without ADHD, and the association between pharmacological treatment of ADHD and school performance.

METHOD: A linkage of Swedish national registers covering 657,720 students graduating from year 9 of compulsory school provided measures of school performance, electronically recorded dispensations of ADHD medication, and potentially confounding background factors such as parental socioeconomic status. Primary measures of school performance included student eligibility to upper secondary school and grade point sum.

RESULTS: ADHD was associated with substantially lower school performance independent of socioeconomic background factors. Treatment with ADHD medication for 3 months was positively associated with all primary outcomes, including a decreased risk of no eligibility to upper secondary school, odds ratio of 0.80, 95% confidence interval (CI) 0.76-0.84, and a higher grade point sum (range 0.0-320.0) of 9.35 points, 95% CI=7.88-10.82; standardized coefficient of 0.20.

CONCLUSION: ADHD has a substantial negative impact on school performance while pharmacological treatment for ADHD is associated with higher levels in several measures of school performance. Our findings emphasize the importance of detection and treatment of ADHD at an early stage to reduce the negative impact on school performance.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
ADHD, medication, school performance, treatment
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-377391 (URN)10.1016/j.jaac.2018.11.014 (DOI)000471838200008 ()30768391 (PubMedID)
Funder
Swedish Research Council, 2013-2280Swedish Research Council, 538-2013-8864
Available from: 2019-02-19 Created: 2019-02-19 Last updated: 2019-08-05Bibliographically approved
Lalouni, M., Ljótsson, B., Bonnert, M., Ssegonja, R., Benninga, M., Bjureberg, J., . . . Olén, O. (2019). Clinical and Cost Effectiveness of Online Cognitive Behavioral Therapy in Children with Functional Abdominal Pain Disorders. Clinical Gastroenterology and Hepatology, 17(11), 2236-2244
Open this publication in new window or tab >>Clinical and Cost Effectiveness of Online Cognitive Behavioral Therapy in Children with Functional Abdominal Pain Disorders
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2019 (English)In: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 17, no 11, p. 2236-2244Article in journal (Refereed) Published
Abstract [en]

BACKGROUND & AIMS: Scalable and effective treatments are needed for children with functional abdominal pain disorders (FAPDs). We performed a randomized controlled trial of the efficacy and cost effectiveness of cognitive behavioral therapy delivered online (internet CBT) compared to usual therapy.

METHODS: We studied children (8-12 years old) diagnosed with FAPDs, based on the Rome IV criteria, in Sweden from September 2016 through April 2017. The patients were randomly assigned to groups that received 10 weeks of therapist-guided, internet-delivered cognitive behavioral therapy (internet CBT, n=46) or usual treatment (treatments within the healthcare and school systems, including medications and visits to doctors and other healthcare professionals; n=44). The primary outcome was Global child-rated gastrointestinal symptom severity assessed using the Pediatric Quality of Life Gastrointestinal Symptom scale. All outcomes were collected from September 2016 through January 2018. Secondary outcomes included quality of life, gastrointestinal-specific anxiety, avoidance behaviors, and parental responses to children's symptoms. Societal costs and costs for healthcare consumption were collected during the treatment.

RESULTS: Children who received internet CBT had a significantly larger improvement in gastrointestinal symptom severity with a medium effect size (Cohen's d=0.46; 95% CI, 0.05-0.88; number needed to treat, 3.8) compared with children who received the usual treatment. The children's quality of life, gastrointestinal-specific anxiety, avoidance behaviors, and parental responses to children's symptoms also improved significantly in the internet CBT group compared with the usual treatment group. The effects of internet CBT persisted through 36 weeks of follow up. Children who received internet CBT had significantly less healthcare use than children who received usual treatment, with an average cost difference of US $137 (P=.011). We calculated a cost saving of US $1050 for every child treated with internet CBT compared with usual treatment.

CONCLUSION: In a randomized trial of pediatric patients with FAPDs, we found internet CBT to be clinically and cost effective compared with usual treatment. Internet CBT has the potential to increase the availability of treatment for a number of patients and reduce healthcare costs. ClinicalTrials.gov no.: NCT02873078.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
IBS, dyspepsia, irritable bowel syndrome, remote access to therapy
National Category
Applied Psychology Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-375602 (URN)10.1016/j.cgh.2018.11.043 (DOI)000486630000023 ()30502501 (PubMedID)
Funder
Swedish Research Council, 521-2013-2846Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4052
Available from: 2019-01-31 Created: 2019-01-31 Last updated: 2019-10-31Bibliographically approved
Feldman, I., Helgason, A. R., Johansson, P., Tegelberg, Å. & Nohlert, E. (2019). Cost-effectiveness of a high-intensity versus a low-intensity smoking cessation intervention in a dental setting: long-term follow-up. BMJ Open, 9, Article ID e030934.
Open this publication in new window or tab >>Cost-effectiveness of a high-intensity versus a low-intensity smoking cessation intervention in a dental setting: long-term follow-up
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, article id e030934Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of this study was to conduct a cost-effectiveness analysis (CEA) of a high-intensity and a low-intensity smoking cessation treatment programme (HIT and LIT) using long-term follow-up effectiveness data and to validate the cost-effectiveness results based on short-term follow-up.

Design and outcome measures: Intervention effectiveness was estimated in a randomised controlled trial as numbers of abstinent participants after 1 and 5-8 years of follow-up. The economic evaluation was performed from a societal perspective using a Markov model by estimating future disease-related costs (in Euro (Euro) 2018) and health effects (in quality-adjusted life-years (QALYs)). Programmes were explicitly compared in an incremental analysis, and the results were presented as an incremental cost-effectiveness ratio.

Setting: The study was conducted in dental clinics in Sweden.

Participants: 294 smokers aged 19-71 years were included in the study.

Interventions: Behaviour therapy, coaching and pharmacological advice (HIT) was compared with one counselling session introducing a conventional self-help programme (LIT).

Results: The more costly HIT led to higher number of 6-month continuous abstinent participants after 1 year and higher number of sustained abstinent participants after 5-8 years, which translates into larger societal costs avoided and health gains than LIT. The incremental cost/QALY of HIT compared with LIT amounted to Euro918 and Euro3786 using short-term and long-term effectiveness, respectively, which is considered very cost-effective in Sweden.

Conclusion: CEA favours the more costly HIT if decision makers are willing to spend at least Euro4000/QALY for tobacco cessation treatment.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2019
Keywords
smoking cessation, cost-effectivenes, long-term sustainability
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-402227 (URN)10.1136/bmjopen-2019-030934 (DOI)000502537200371 ()31420398 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-1399
Available from: 2020-01-17 Created: 2020-01-17 Last updated: 2020-01-17Bibliographically approved
Sampaio, F., Bonnert, M., Olén, O., Hedman, E., Lalouni, M., Lenhard, F., . . . Feldman, I. (2019). Cost-effectiveness of internet-delivered cognitive-behavioural therapy for adolescents with irritable bowel syndrome. BMJ Open, 9(1), Article ID e023881.
Open this publication in new window or tab >>Cost-effectiveness of internet-delivered cognitive-behavioural therapy for adolescents with irritable bowel syndrome
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 1, article id e023881Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

To assess whether exposure-based internet-delivered cognitive-behavioural therapy (internet-CBT) is a cost-effective treatment for adolescents with irritable bowel syndrome (IBS) compared with a waitlist control, from a societal perspective, based on data from a randomised trial.

DESIGN:

Within-trial cost-effectiveness analysis.

SETTING:

Participants were recruited from the whole of Sweden via primary, secondary and tertiary care clinics reached through news media and advertising.

PARTICIPANTS:

Adolescents (aged 13-17) with a diagnosis of IBS.

INTERVENTIONS:

Participants were randomised to either an exposure-based internet-CBT, including 10 weekly modules for adolescents and five modules for parents, or a waitlist.

OUTCOME MEASURES:

The main health outcome was the quality-adjusted life-year (QALY) estimated by mapping Pediatric Quality-of-Life Inventory (PedsQL) scores onto EQ-5D-3L utilities. The secondary outcome was the point improvement on the PedsQL scale. Data on health outcomes and resource use were collected at baseline and 10 weeks post-treatment. Resource use was measured using the Trimbos and Institute of Medical Technology Assessment Cost Questionnaire for Psychiatry (TIC-P) . Incremental cost-effectiveness ratios (ICER) were calculated as the difference in average costs by the difference in average outcomes between groups.

RESULTS:

The base-case results showed that internet-CBT costs were on average US$170.24 (95% CI 63.14 to 315.04) more per participant than the waitlist. Adolescents in the internet-CBT group showed small QALY gains (0.0031; 95% CI 0.0003 to 0.0061), and an average improvement of 5.647 points (95% CI 1.82 to 9.46) on the PedsQL compared with the waitlist. Internet-CBT yielded an ICER of $54 916/QALY gained and a probability of cost-effectiveness of 74% given the Swedish willingness-to-pay threshold. The ICER for the outcome PedsQL was US$85.29/point improvement.

CONCLUSIONS:

Offering internet-CBT to adolescents with IBS improves health-related quality of life and generates small QALY gains at a higher cost than a waitlist control. Internet-CBT is thus likely to be cost-effective given the strong efficacy evidence, small QALY gains and low cost.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-375730 (URN)10.1136/bmjopen-2018-023881 (DOI)000471116800132 ()30679293 (PubMedID)
Funder
Swedish Research Council, 521-2013-2846Swedish Society of Medicine, SLS331681Swedish Society of Medicine, SLS-410501Stockholm County CouncilForte, Swedish Research Council for Health, Working Life and Welfare, 2014-4052
Available from: 2019-01-31 Created: 2019-01-31 Last updated: 2019-08-28Bibliographically approved
Ssegonja, R., Alaie, I., Philipson, A., Hagberg, L., Sampaio, F., Möller, M., . . . Feldman, I. (2019). Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood: A longitudinal cost-of-illness study. Journal of Affective Disorders, 258, 33-41
Open this publication in new window or tab >>Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood: A longitudinal cost-of-illness study
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2019 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 258, p. 33-41Article in journal (Refereed) Published
Abstract [en]

Background: Depression in adolescence is associated with increased healthcare consumption in adulthood, but prior research has not recognized the heterogeneity of depressive disorders. This paper investigated the additional healthcare usage and related costs in mid-adulthood for individuals with adolescent depression, and examined the mediating role of subsequent depression in early adulthood.

Methods: This study was based on the Uppsala Longitudinal Adolescent Depression Study, initiated in Sweden in the early 1990s. Depressive disorders were assessed in adolescence (age 16-17) and early adulthood (age 19-30). Healthcare usage and related costs in mid-adulthood (age 31-40) were estimated using nationwide population-based registries. Participants with specific subtypes of adolescent depression (n = 306) were compared with matched non-depressed peers (n = 213).

Results: Women with persistent depressive disorder (PDD) in adolescence utilized significantly more healthcare resources in mid-adulthood. The association was not limited to psychiatric care, and remained after adjustment for individual and parental characteristics. The total additional annual cost for a single age group of females with a history of PDD at a population level was estimated at 3.10 million USD. Depression recurrence in early adulthood mediated the added costs for psychiatric care, but not for somatic care.

Limitations: Primary health care data were not available, presumably resulting in an underestimation of the true healthcare consumption. Estimates for males had limited precision due to a relatively small male proportion.

Conclusions: On a population level, the additional healthcare costs incurred in mid-adulthood in females with a history of adolescent PDD are considerable. Early treatment and prevention should be prioritized.

Place, publisher, year, edition, pages
ELSEVIER, 2019
Keywords
Adolescence, Depression, Direct costs, Adulthood, Psychiatric healthcare, Non-psychiatric healthcare
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-393715 (URN)10.1016/j.jad.2019.07.077 (DOI)000482176400004 ()31382102 (PubMedID)
Funder
Swedish Research Council, 2014-10092Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Research Council FormasVinnova
Available from: 2019-09-30 Created: 2019-09-30 Last updated: 2020-02-22Bibliographically approved
Sampaio, F., Ssegonja, R., Nystrand, C. & Feldman, I. (2019). Health, public sector service use and related costs of Swedish preschool children: results from the Children and Parents in Focus trial. European Child and Adolescent Psychiatry, 28(1), 43-56
Open this publication in new window or tab >>Health, public sector service use and related costs of Swedish preschool children: results from the Children and Parents in Focus trial
2019 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 28, no 1, p. 43-56Article in journal (Refereed) Published
Abstract [en]

Despite Sweden's good child health statistics, data on the mental health and wellbeing of Swedish preschool children is scarce and not routinely collected in healthcare. The study aimed to: identify the proportion of preschool children with mental health and somatic problems, the public sector services used by these children and whether they differ by type of problems, investigate whether other factors affect service use, and estimate the costs associated with these services. This study used cross-sectional data on a sample of 3175 children aged 3-5 from the "Children and Parents in Focus trial". Data on service use, child health and demographics were obtained from primary caregivers. Child mental health was assessed by both primary caregivers and teachers. 8.9% of the sample reported mental health problems, and approximately 1% had comorbid somatic and mental health problems. Over 50% of the preschoolers used any service, with school assistant being the most frequently used. The average annual cost per child, regardless of health status, was US$921, with 75% of the costs accruing at school. The presence of both somatic and mental health problems predicted higher service use, in particular extra services used at school and at home (mean annual cost US$13826 and US$1583, respectively). Children with comorbid problems accounted for the highest mean costs. Mental health problems among preschool children were particularly high compared to studies from other countries. There is a need to strengthen school mental health services to engage in proactive early identification of children with mental health problems so that appropriate care is provided.

Trial registration number: ISRCTN16513449. Registered 23 July 2013.

Keywords
Children, Costs, Mental health, Physical health, Service use, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-375594 (URN)10.1007/s00787-018-1185-1 (DOI)000456945300005 ()29926252 (PubMedID)
Funder
Swedish Research Council Formas, 259-2012-68Swedish Research Council, 259-2012-68Forte, Swedish Research Council for Health, Working Life and Welfare, 259-2012-68VINNOVA, 259-2012-68
Available from: 2019-01-31 Created: 2019-01-31 Last updated: 2019-03-05Bibliographically approved
Ssegonja, R., Nystrand, C., Feldman, I., Sarkadi, A., Langenskiöld, S. & Jonsson, U. (2019). Indicated preventive interventions for depression in children and adolescents: A meta-analysis and meta-regression. Preventive Medicine, 118, 7-15
Open this publication in new window or tab >>Indicated preventive interventions for depression in children and adolescents: A meta-analysis and meta-regression
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2019 (English)In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 118, p. 7-15Article, review/survey (Refereed) Published
Abstract [en]

Depression contributes about 2% to the global burden of disease. A first onset of depressive disorder or subsyndromal depressive symptoms is common in adolescence, indicating that early prevention is a priority. However, trials of preventive interventions for depression in youths show conflicting results. This systematic review and meta-analysis investigated the effectiveness of group-based cognitive behavioral therapy (GB-CBT) as a preventive intervention targeting subsyndromal depression in children and adolescents. In addition, the impact of different covariates (type of comparator and use of booster sessions) was assessed. Relevant articles were identified from previous systematic reviews, and supplemented with an electronic search spanning from 01/09/2014 to 28/02/2018. The retrieved articles were assessed for eligibility and risk of bias. Relevant data were extracted. Intervention effectiveness was pooled using a random-effects model and the impact of covariates assessed using meta-regression. 38 eligible articles (34 trials) were obtained. The analysis showed GB-CBT to significantly reduce the incidence (relative risk 0.43, 95% CI 0.21-0.87) and symptoms (Cohen's d -0.22, 95% CI -0.32 to -0.11) of depression at post-test compared to all controls. Comparisons with passive comparators suggested that the effect decayed over time. However, compared to active controls, a significant intervention effect was evident only after 12 month or more. Our results suggest that the preventive effect of GB-CBT wears off, but still lasts longer than the effect of active comparators. Only a few studies included booster sessions, precluding firm conclusions. Future studies should clarify to what extent maintenance strategies can prolong the preventive effect of GB-CBT.

Keywords
Depression, Dysthymia, Cognitive-behavioral therapy, Meta-analysis, Meta-regression, Indicated prevention interventions
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-375899 (URN)10.1016/j.ypmed.2018.09.021 (DOI)000454933300002 ()30287331 (PubMedID)
Funder
Swedish Research Council, 2014-10092Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Research Council FormasVINNOVA
Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2020-02-22Bibliographically approved
Skokauskas, N., Fung, D., Flaherty, L. T., von Klitzing, K., Puras, D., Servili, C., . . . Guerrero, A. (2019). Shaping the future of child and adolescent psychiatry. Child and Adolescent Psychiatry and Mental Health, 13, Article ID 19.
Open this publication in new window or tab >>Shaping the future of child and adolescent psychiatry
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2019 (English)In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 13, article id 19Article in journal, Editorial material (Other academic) Published
Abstract [en]

Child and adolescent psychiatry is in a unique position to respond to the growing public health challenges associated with the large number of mental disorders arising early in life, but some changes may be necessary to meet these challenges. In this context, the future of child and adolescent psychiatry was considered by the Section on Child and Adolescent Psychiatry of the World Psychiatric Association (WPA CAP), the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP), the World Association for Infant Mental Health (WAIMH), the International Society for Adolescent Psychiatry and Psychology (ISAPP), the UN Special Rapporteur on the Right to Health, representatives of the WHO Department of Mental Health and Substance Abuse, and other experts. We take this opportunity to outline four consensus priorities for child and adolescent psychiatry over the next decade: increase the workforce necessary for providing care for children, adolescents and families facing mental disorders; reorienting child and adolescent mental health services to be more responsive to broader public health needs; increasing research and research training while also integrating new research finding promptly and efficiently into clinical practice and research training; Increasing efforts in advocacy.

Place, publisher, year, edition, pages
BMC, 2019
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-383050 (URN)10.1186/s13034-019-0279-y (DOI)000464850500001 ()31007713 (PubMedID)
Available from: 2019-05-13 Created: 2019-05-13 Last updated: 2019-05-13Bibliographically approved
Aspvall, K., Andersson, E., Lenhard, F., Melin, K., Norlin, L., Wallin, L., . . . Serlachius, E. (2019). Stepped Care Internet-Delivered vs Face-to-Face Cognitive-Behavior Therapy for Pediatric Obsessive-Compulsive Disorder A Trial Protocol for a Randomized Noninferiority Trial. JAMA NETWORK OPEN, 2(10), Article ID e1913810.
Open this publication in new window or tab >>Stepped Care Internet-Delivered vs Face-to-Face Cognitive-Behavior Therapy for Pediatric Obsessive-Compulsive Disorder A Trial Protocol for a Randomized Noninferiority Trial
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2019 (English)In: JAMA NETWORK OPEN, ISSN 2574-3805, Vol. 2, no 10, article id e1913810Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE Internet-delivered cognitive behavior therapy is an effective treatment for children and adolescents with obsessive-compulsive disorder and has the potential to markedly increase access to treatment for patients while being cost-effective for health care organizations. OBJECTIVE To investigate whether internet-delivered cognitive behavior therapy implemented within a stepped care model is noninferior to, and cost-effective compared with, the gold standard of face-to-face cognitive behavior therapy for pediatric obsessive-compulsive disorder. DESIGN, SETTING, AND PARTICIPANTS Multicenter, single-blind, randomized clinical noninferiority trial implemented at 2 specialist pediatric obsessive-compulsive disorder clinics in Stockholm and Gothenburg, Sweden. Participants are 152 children and adolescents aged 7 to 17 years with obsessive compulsive disorder, recruited through the 2 clinics and online self-referral. Patients will be randomized 1:1 to the stepped care intervention or face-to-face therapy. Blind evaluations will be conducted after treatment and at 3-month and 6-month follow-ups. At the 6-month follow-up (primary end point), noninferiority will be tested and resource use will be compared between the 2 treatment groups. Data will be analyzed according to intention-to-treat principles. INTERVENTION Patients randomized to stepped care will first receive internet-delivered cognitive behavior therapy for 16 weeks; patients who are classified as nonresponders 3 months after treatment completion will receive additional face-to-face therapy. The control group will receive 16 weeks of face-to-face cognitive behavior therapy immediately following randomization and nonresponders at the 3-month follow-up will, as in the stepped care group, receive additional face-to-face therapy. MAIN OUTCOMES AND MEASURES Noninferiority is defined as a 4-point difference on the primary outcome measure (Children's Yale-Brown Obsessive Compulsive Scale). DISCUSSION Recruitment started October 6, 2017, and was completed May 24, 2019. Results from the primary end point will be available by May 2020. The naturalistic follow-ups (1, 2, and 5 years after the end of treatment) will continue to 2025. There are no interim analyses planned or stopping rules for the trial.

Place, publisher, year, edition, pages
AMER MEDICAL ASSOC, 2019
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-400042 (URN)10.1001/jamanetworkopen.2019.13810 (DOI)000497997100078 ()31642928 (PubMedID)
Available from: 2019-12-18 Created: 2019-12-18 Last updated: 2019-12-18Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0003-3329-6066

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