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Publications (10 of 11) Show all publications
Nystrand, C., Feldman, I., Enebrink, P. & Sampaio, F. (2019). Cost-effectiveness analysis of parenting interventions for the prevention of behaviour problems in children. PLoS ONE, 14(12), Article ID e0225503.
Open this publication in new window or tab >>Cost-effectiveness analysis of parenting interventions for the prevention of behaviour problems in children
2019 (English)In: PLoS ONE, E-ISSN 1932-6203, Vol. 14, no 12, article id e0225503Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Behavior problems are common among children and place a high disease and financial burden on individuals and society. Parenting interventions are commonly used to prevent such problems, but little is known about their possible longer-term economic benefits. This study modelled the longer-term cost-effectiveness of five parenting interventions delivered in a Swedish context: Comet, Connect, the Incredible Years (IY), COPE, bibliotherapy, and a waitlist control, for the prevention of persistent behavior problems.

METHODS: A decision analytic model was developed and used to forecast the cost per averted disability-adjusted life-year (DALY) by each parenting intervention and the waitlist control, for children aged 5-12 years. Age-specific cohorts were modelled until the age of 18. Educational and health care sector costs related to behavior problems were included. Active interventions were compared to the waitlist control as well as to each other.

RESULTS: Intervention costs ranged between US$ 14 (bibliotherapy) to US$ 1,300 (IY) per child, with effects of up to 0.23 averted DALYs per child (IY). All parenting interventions were cost-effective at a threshold of US$ 15,000 per DALY in relation to the waitlist control. COPE and bibliotherapy strongly dominated the other options, and an additional US$ 2,629 would have to be invested in COPE to avert one extra DALY, in comparison to bibliotherapy.

CONCLUSIONS: Parenting interventions are cost-effective in the longer run in comparison to a waitlist control. Bibliotherapy or COPE are the most efficient options when comparing interventions to one another. Optimal decision for investment should to be based on budget considerations and priority settings.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-404248 (URN)10.1371/journal.pone.0225503 (DOI)31790442 (PubMedID)
Available from: 2020-02-16 Created: 2020-02-16 Last updated: 2020-02-25Bibliographically 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
Nystrand, C., Ssegonja, R. & Sampaio, F. (2019). Quality of life and service use amongst parents of young children: Results from the Children and Parents in Focus trial. Scandinavian Journal of Public Health, 47(7), 774-781
Open this publication in new window or tab >>Quality of life and service use amongst parents of young children: Results from the Children and Parents in Focus trial
2019 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 7, p. 774-781Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to assess the quality of life (QoL) and service use of parents who have preschool-aged children, and whether the mental-health problems of parents and their children predict these outcomes. 

Methods: Cross-sectional data were gathered in 2015–2016 in Uppsala County in Sweden where 3164 parents of children aged three- to five-years-old were asked to self-report their own and their children’s mental-health status and service use in the past 12 months. Data from the General Health Questionnaire were used to derive health-related quality of life (HRQoL) measures for adults. 

Results: Very few parents reported mental-health problems, while approximately 15% of the sample used any type of parental support and/or psychological health-care service. Families without problems used the least amount of resources. Parents’ own mental-health problems predicted usage of both psychotherapy and couples’ therapy, while child problems predicted the former but also the use of a parenting program. Parental HRQoL was predicted by mental-health problems, and all families with at least one individual experiencing problems rated their QoL lower than families without problems. 

Conclusions: Parental service use and HRQoL is associated not only with their own mental-health status but also with their children’s mental-health problems.

Keywords
Mental health, parents, service use, costs, preschool children
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Child and Youth Psychiatry
Identifiers
urn:nbn:se:uu:diva-375728 (URN)10.1177/1403494818801640 (DOI)000503081200012 ()30253689 (PubMedID)
Funder
Swedish Research Council FormasSwedish Research CouncilForte, Swedish Research Council for Health, Working Life and WelfareVinnova, 259-2012-68
Available from: 2019-01-31 Created: 2019-01-31 Last updated: 2020-02-25Bibliographically 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
Nystrand, C., Hultkrantz, L., Vimefall, E., Sampaio, F. & Feldman, I. (2018). Indicated Parenting Interventions and Long Term Outcomes: A Health Economic Modeling Study. Value in Health, 21, S76-S76
Open this publication in new window or tab >>Indicated Parenting Interventions and Long Term Outcomes: A Health Economic Modeling Study
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2018 (English)In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 21, p. S76-S76Article 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-378247 (URN)10.1016/j.jval.2018.07.571 (DOI)000458697200419 ()
Available from: 2019-03-08 Created: 2019-03-08 Last updated: 2019-03-08Bibliographically 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
Skokauskas, N., Lavelle, T. A., Munir, K., Sampaio, F., Nystrand, C., McCrone, P., . . . Belfer, M. (2018). The cost of child and adolescent mental health services [Letter to the editor]. Lancet psychiatry, 5, 299-300
Open this publication in new window or tab >>The cost of child and adolescent mental health services
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2018 (English)In: Lancet psychiatry, ISSN 2215-0374, E-ISSN 2215-0366, Vol. 5, p. 299-300Article in journal, Letter (Other academic) Published
Abstract [en]

More than 2·5 billion children and adolescents exist worldwide, with most individuals living in low-income and middle-income countries (LMICs).1 For these children and adolescents, mental health and neurodevelopmental disorders remain one of the leading causes of the global burden of disease and years lived with disability.2 Although the importance of child and adolescent mental health (CAMH) has been widely acknowledged by organisations such as the UN,3 the development of an inclusive cross-sectorial mental health system for children and adolescents has not gained adequate traction.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-348571 (URN)10.1016/S2215-0366(18)30089-0 (DOI)000428249900011 ()29580605 (PubMedID)
Available from: 2018-04-16 Created: 2018-04-16 Last updated: 2018-08-09Bibliographically approved
Nystrand, C., Feldman, I., Enebrink, P. & Sampaio, F. (2017). Cost-offset analysis of parenting interventions to prevent externalizing behavior problems. European Journal of Public Health, 27, 332-332
Open this publication in new window or tab >>Cost-offset analysis of parenting interventions to prevent externalizing behavior problems
2017 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, p. 332-332Article in journal, Meeting abstract (Other academic) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-345669 (URN)000414389803181 ()
Available from: 2018-03-19 Created: 2018-03-19 Last updated: 2018-03-19Bibliographically approved
Nystrand, C., Sampaio, F. & Feldman, I. (2017). Cost-Offset Analysis Of Social And Emotional Learning Programs For The Prevention Of Externalizing Behavior Problems: An Economic Modeling Study. Paper presented at ISPOR 22nd Annual International Meeting. Value in Health, 20(5), A297-A297
Open this publication in new window or tab >>Cost-Offset Analysis Of Social And Emotional Learning Programs For The Prevention Of Externalizing Behavior Problems: An Economic Modeling Study
2017 (English)In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 20, no 5, p. A297-A297Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

OBJECTIVES: Externalizing behavior problems are common among children,and place a high disease and financial burden on individuals and society. Social and Emotional Learning (SEL) programs are commonly used to prevent such problems, but little is known about their possible longer-term cost-offsets. This study estimates the costs and longer term savings of the two evidence based SEL programs currently available in Sweden, Good Behavior Game and Second Step, for the reduction of externalizing behavior problems in children.

METHODS: A population-based Markov model was developed to estimate the cost-savings of the two SEL programs compared to a no intervention scenario, achieved by a reduction in clinical cases of attention-deficit/hyperactivity disorder (ADHD), Conduct disorder (CD) and comorbid ADHD/CD. Epidemiological data were collected from the 2015 Global Burden of Disease Study. Intervention effectiveness parameters were estimated from a meta-analysis of relevant studies, where effects assumed to reduce to zero after one year. This study adopted a limited societal perspective including costs accruing to the healthcare and education sectors while intervention costs were based on intervention descriptions. The target population was a cohort of 8-10-year-old healthy children in the 2015 Swedish population followed through to the age of 15 years, assuming 100% intervention coverage. Multivariate probabilistic and univariate sensitivity analyses were conducted to test model assumptions.

RESULTS: Intervention cost per child amounted to 70 USD and total cost-savings per child over the modeling period were estimated at 330 USD. The cost-offset relationship for prevention was 1.49, implying that for 1 USD invested, 1.49 USD can be gained over the modeling period.

CONCLUSIONS: Our results suggest that these two evidence based SEL programs are likely to yield cost-savings to society. Further research is needed to investigate cost-savings accruing to other sectors of the society, as well as the cost-effectiveness of such interventions.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-333342 (URN)10.1016/j.jval.2017.05.005 (DOI)000405448004084 ()
Conference
ISPOR 22nd Annual International Meeting
Available from: 2017-11-14 Created: 2017-11-14 Last updated: 2017-11-14Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9866-1100

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