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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
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: 2019-09-30Bibliographically 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: 2019-02-04Bibliographically approved
Alaie, I., Philipson, A., Ssegonja, R., Hagberg, L., Feldman, I., Sampaio, F., . . . Jonsson, U. (2019). Uppsala Longitudinal Adolescent Depression Study (ULADS). BMJ Open, 9(3), Article ID e024939.
Open this publication in new window or tab >>Uppsala Longitudinal Adolescent Depression Study (ULADS)
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 3, article id e024939Article in journal (Refereed) Published
Abstract [en]

Purpose: To present the Uppsala Longitudinal Adolescent Depression Study, initiated in Uppsala, Sweden, in the early 1990s. The initial aim of this epidemiological investigation was to study the prevalence, characteristics and correlates of adolescent depression, and has subsequently expanded to include a broad range of social, economic and health-related long-term outcomes and cost-of-illness analyses.

Participants: The source population was first-year students (aged 16-17) in upper-secondary schools in Uppsala during 1991-1992, of which 2300 (93%) were screened for depression. Adolescents with positive screening and sex/age-matched peers were invited to a comprehensive assessment. A total of 631 adolescents (78% females) completed this assessment, and 409 subsequently completed a 15year follow-up assessment. At both occasions, extensive information was collected on mental disorders, personality and psychosocial situation. Detailed social, economic and health-related data from 1993 onwards have recently been obtained from the Swedish national registries for 576 of the original participants and an age-matched reference population (N=200 000).

Findings to date: The adolescent lifetime prevalence of a major depressive episode was estimated to be 11.4%. Recurrence in young adulthood was reported by the majority, with a particularly poor prognosis for those with a persistent depressive disorder or multiple somatic symptoms. Adolescent depression was also associated with an increased risk of other adversities in adulthood, including additional mental health conditions, low educational attainment and problems related to intimate relationships.

Future plans: Longitudinal studies of adolescent depression are rare and must be responsibly managed and utilised. We therefore intend to follow the cohort continuously by means of registries. Currently, the participants are approaching mid-adulthood. At this stage, we are focusing on the overall long-term burden of adolescent depression. For this purpose, the research group has incorporated expertise in health economics. We would also welcome extended collaboration with researchers managing similar datasets.

National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-389609 (URN)10.1136/bmjopen-2018-024939 (DOI)000471144900167 ()30826765 (PubMedID)
Funder
Swedish Research Council, 2014-10092Forte, Swedish Research Council for Health, Working Life and WelfareStiftelsen Söderström - Königska sjukhemmet
Available from: 2019-07-22 Created: 2019-07-22 Last updated: 2019-07-22Bibliographically approved
Ssegonja, R., Feldman, I., Lalouni, M., Ljotsson, B., Bonnert, M., Benninga, M., . . . Olen, O. (2018). Cost-Effectiveness of Cognitive Behavioral Therapy Delivered Via Internet for Children with Functional Abdominal Pain Disorders: Evaluation Alongside A Randomized Controlled Trial. Value in Health, 21, S85-S85
Open this publication in new window or tab >>Cost-Effectiveness of Cognitive Behavioral Therapy Delivered Via Internet for Children with Functional Abdominal Pain Disorders: Evaluation Alongside A Randomized Controlled Trial
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2018 (English)In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 21, p. S85-S85Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-366685 (URN)10.1016/j.jval.2018.04.574 (DOI)000437739100459 ()
Available from: 2018-11-23 Created: 2018-11-23 Last updated: 2018-11-23Bibliographically approved
Sampaio, F., Bonnert, M., Olen, O., Hedman, E., Lalouni, M., Lenhard, F., . . . Feldman, I. (2018). Cost-Effectiveness of Internet-Delivered Cognitive Behaviour Therapy for Adolescents with Irritable Bowel Syndrome. Value in Health, 21, S42-S42
Open this publication in new window or tab >>Cost-Effectiveness of Internet-Delivered Cognitive Behaviour Therapy for Adolescents with Irritable Bowel Syndrome
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2018 (English)In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 21, p. S42-S42Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-378248 (URN)10.1016/j.jval.2018.07.321 (DOI)000458697200226 ()
Available from: 2019-03-08 Created: 2019-03-08 Last updated: 2019-03-08Bibliographically approved
Sarkadi, A., Ådahl, K., Ssegonja, R., Fängström, K. & Salari, R. (2018). Evaluation of a group intervention for unaccompanied refugee minors with PTSD symptoms in Sweden. Paper presented at 1st World Congress on Migration, Ethnicity, Race and Health, 17-19 May 2018, Edinburgh, UK.. European Journal of Public Health, 28(Supplement: 1), 105-105
Open this publication in new window or tab >>Evaluation of a group intervention for unaccompanied refugee minors with PTSD symptoms in Sweden
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2018 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no Supplement: 1, p. 105-105Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Oxford University Press, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-359391 (URN)10.1093/eurpub/cky047.255a (DOI)000432430700300 ()
Conference
1st World Congress on Migration, Ethnicity, Race and Health, 17-19 May 2018, Edinburgh, UK.
Note

Oral Presentations

Meeting Abstract: 7.4-O1

Available from: 2018-09-25 Created: 2018-09-25 Last updated: 2018-09-25Bibliographically approved
Ssegonja, R., Nystrand, C., Feldman, I., Sarkadi, A., Langenskiöld, S. & Jonsson, U. (2018). Indicated Preventive Interventions for Depression in Children and Adolescents: A Meta-Analysis And Meta-Regression. Value in Health, 21, S181-S181
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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2018 (English)In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 21, p. S181-S181Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-366684 (URN)10.1016/j.jval.2018.04.1234 (DOI)000438630000353 ()
Available from: 2018-11-23 Created: 2018-11-23 Last updated: 2018-11-23Bibliographically approved
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