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Prevention and Treatment of Externalizing Behaviour Problems in Children through Parenting Interventions: An Application of Health Economic Methods
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. (CHAP)
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The early onset of externalizing behaviour problems (EBP) is associated with negative outcomes later in life, such as poor mental health, substance use, crime, and unemployment. Some children also develop conduct disorder (CD), entailing a high disease and economic burden for both individuals and society.

Most studies on the effectiveness and cost-effectiveness of parenting interventions targeting EBP among children have evaluated selective or indicated preventive interventions, or treatment strategies. Evidence on the effectiveness of universally delivered parenting programmes is controversial, partly due to methodological difficulties.

The overall aim of this thesis was to 1) address the methodological challenges of evaluating universal parenting programmes, and to 2) employ different health economic methods to evaluate parenting interventions for EBP and CD in children.

Study I indicated that offering low intensity levels of Triple P universally, with limited intervention attendance, does not result in improved outcomes, and may not be a worthwhile use of public resources. Study II showed that using the distribution of an outcome variable makes it possible to estimate the impact of public health interventions at the population level. Study III supports offering bibliotherapy to initially target CP in children, whereas Comet could be offered to achieve greater effects based on decision-makers’ willingness to make larger investments. Cope could be offered when targeting symptom improvement, rather than clinical caseness. The economic decision model in Study IV demonstrated that Triple P for the treatment of CD appears to represent good value for money, when delivered in a Group format, but less likely, when delivered in an Individual format.

To reduce the burden of mental health problems in childhood, cost-effective and evidence-based interventions should be provided on a continuum from prevention through early intervention to treatment. We believe our results can assist decision-makers in resource allocation to this field.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. , 72 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1203
Keyword [en]
parenting interventions, externalizing behaviour problems, conduct problems, conduct disorder, health economics, cost-effectiveness, prevention, treatment
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Child and Youth Psychiatry; Health Care Research; Economics
Identifiers
URN: urn:nbn:se:uu:diva-281349ISBN: 978-91-554-9530-5 (print)OAI: oai:DiVA.org:uu-281349DiVA: diva2:915262
Public defence
2016-05-17, Eva Netzeliussalen (BH/10:K102), Kraemers Allé 1, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2016-04-25 Created: 2016-03-22 Last updated: 2016-04-29
List of papers
1. Cost and effects of a universal parenting programme delivered to parents of preschoolers
Open this publication in new window or tab >>Cost and effects of a universal parenting programme delivered to parents of preschoolers
Show others...
2015 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no 6, 1035-1042 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Parenting programmes are effective in improving child behaviour and parental well-being, but long follow-up studies of universally offered programmes are scarce.

METHODS:

A cluster randomized controlled trial was conducted to assess the costs and effects of Triple P levels 2-3 on child externalizing behaviours and parental mental health. The programme was offered universally to parents of preschoolers (self-selection allowed). Preschools were randomized to Triple P or a waitlist control. Health outcomes were reduction in externalizing behaviours measured on the Eyberg Child Behaviour Inventory-22 and improvement in parental mental health measured on the Depression Anxiety Stress Scales collected at baseline, 6-, 12- and 18-month follow-up. Child outcomes were based on 355 children aged 3-5 years (child sample) and parental outcomes on 759 parents (parental sample) with baseline data. Costs were collected from a municipality perspective, including 312 children and 488 parents with baseline data in the intervention preschools.

RESULTS:

Sixty-seven (29%) parents attended the intervention. Triple P showed no significant improvement in child externalizing behaviours or parental mental health at either of the follow-up points. Triple P had an average yearly total cost of 3007 Swedish Krona (SEK) (€323) per child or 1922 SEK (€207) per parent. Running Triple P cost 227 SEK (€24) per child or 145 SEK (€16) per parent yearly.

CONCLUSION:

Offering low intensity levels of Triple P with 29% attendance may not be a reasonable use of public resources, as no evidence of improvement in child externalizing behaviours or parental mental health was found.

National Category
Health Sciences Health Care Service and Management, Health Policy and Services and Health Economy Pediatrics
Identifiers
urn:nbn:se:uu:diva-269208 (URN)10.1093/eurpub/ckv106 (DOI)000367163900024 ()26063699 (PubMedID)
Funder
Swedish Research Council Formas, 259 - 2012-68Public Health Agency of Sweden
Available from: 2015-12-14 Created: 2015-12-14 Last updated: 2017-12-01
2. A novel approach used outcome distribution curves to estimate the population-level impact of a public health intervention
Open this publication in new window or tab >>A novel approach used outcome distribution curves to estimate the population-level impact of a public health intervention
2014 (English)In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 67, no 7, 785-792 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To provide an analytical framework within which public health interventions can be evaluated, present its mathematical proof, and demonstrate its use using real trial data. Study Design and Setting: This article describes a method to assess population-level effects by describing change using the distribution curve. The area between the two overlapping distribution curves at baseline and follow-up represents the impact of the intervention, that is, the proportion of the target population that benefited from the intervention. Results: Using trial data from a parenting program, empirical proof of the idea is demonstrated on a measure of behavioral problems in 355 preschoolers using the Gaussian distribution curve. The intervention group had a 12% [9%-17%] health gain, whereas the control group had 3% [1%-7%]. In addition, for the subgroup of parents with lower education, the intervention produced a 15% [6%-25%] improvement, whereas for the group of parents with higher education the net health gain was 6% [4%-16%]. Conclusion: It is possible to calculate the impact of public health interventions by using the distribution curve of a variable, which requires knowing the distribution function. The method can be used to assess the differential impact of population interventions and their potential to improve health inequities. 

Keyword
Public health, Intervention studies, Normal distribution, Area under the curve, Primary prevention, Parenting education
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-228973 (URN)10.1016/j.jclinepi.2013.12.012 (DOI)000337983600009 ()
Available from: 2014-07-25 Created: 2014-07-24 Last updated: 2017-12-05Bibliographically approved
3. Cost-effectiveness of four parenting programs and bibliotherapy for parents of children with conduct problems: a multicentre randomized controlled trial
Open this publication in new window or tab >>Cost-effectiveness of four parenting programs and bibliotherapy for parents of children with conduct problems: a multicentre randomized controlled trial
(English)In: Journal of Mental Health Policy and Economics, ISSN 1091-4358, E-ISSN 1099-176XArticle in journal (Refereed) Submitted
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Economics
Identifiers
urn:nbn:se:uu:diva-281347 (URN)
Funder
Swedish National Board of Health and Welfare
Available from: 2016-03-22 Created: 2016-03-22 Last updated: 2017-11-30
4. Population cost-effectiveness of the Triple P parenting programme for the treatment of Conduct Disorder: an economic modelling study
Open this publication in new window or tab >>Population cost-effectiveness of the Triple P parenting programme for the treatment of Conduct Disorder: an economic modelling study
(English)Manuscript (preprint) (Other academic)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Economics
Identifiers
urn:nbn:se:uu:diva-281348 (URN)
Available from: 2016-03-22 Created: 2016-03-22 Last updated: 2016-04-29

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