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  • 1.
    Alaie, Iman
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Philipson, Anna
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hagberg, Lars
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Moller, Margareta
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    Arinell, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Päären, Aivar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Olsson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    von Knorring, Anne-Liis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Bohman, Hannes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Jonsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Karolinska Inst, Karolinska Inst KIND, Dept Womens & Childrens Hlth, Ctr Neurodev Disorders,Pediat Neuropsychiat Unit, Stockholm, Sweden;Stockholm Cty Council, Stockholm Hlth Care Serv, Ctr Psychiat Res, Stockholm, Sweden.
    Uppsala Longitudinal Adolescent Depression Study (ULADS)2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 3, article id e024939Article in journal (Refereed)
    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.

  • 2.
    Feldman, Inna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Eurenius, E.
    Umea Univ, Dept Publ Hlth & Clin Med, Epidemiol & Global Hlth, Umea, Sweden..
    Häggström, J.
    Umea Univ, Dept Stat, USBE, Umea, Sweden..
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Lindkvist, M.
    Umea Univ, Dept Publ Hlth & Clin Med, Epidemiol & Global Hlth, Umea, Sweden..
    Pulkki-Brännström, A. M.
    Umea Univ, Dept Publ Hlth & Clin Med, Epidemiol & Global Hlth, Umea, Sweden..
    Ivarsson, A.
    Umea Univ, Dept Publ Hlth & Clin Med, Epidemiol & Global Hlth, Umea, Sweden..
    Effectiveness of the Salut Program: a universal health promotion intervention for parents & children2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26Article in journal (Refereed)
  • 3.
    Feldman, Inna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hellstrand, Mats
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Health promotion or health care – a profitable interaction?2013Conference paper (Refereed)
    Abstract [en]

    Background: The possibility to estimate health care savings given a change in population lifestyles may be of interest to health promotion specialists and decision-makers. A macro model entitled Risk factors, Health and Societal Costs (RHS) was developed to estimate changes in incidence and health care costs of ten common diseases during five years. The estimations were based on four common risk factors for disease: obesity (BMI>30), daily tobacco smoking, lack of exercise and risk alcohol consumption.

    Material and methods: The RHS model is based on relative risks that define the relation between disease incidence and risk factors. Relative risks were collected from Swedish and international publications and are age- and gender-specific. Swedish national registers were used to retrieve incident cases. Changes in risk factor prevalence lead to changes in new cases of disease. Disease-specific health care costs were retrieved from Stockholm Council. The following parameters were imputed in the model: population data, current risk factor prevalence and potential changes.

    Results: The RHS model is able to predict future cases of illness and related costs. By creating scenarios with different changes in risk factors, the model can thus estimate the potential gains/losses in health in monetary units. The different scenarios, where it is assumed a 1% reduction in risk factor prevalence, show that significant savings in health care costs can arise from modest changes in population lifestyle habits. Lower levels of risk factors generate greater impact in regards to disease prevalence.      

    Discussion: The model can be used to simulate the effects of different scenarios in regards to how risk factors can change in different population areas. To build scenarios requires two types of data available: age- and gender- stratified population data and the prevalence of risk factors. The results of the model can be used as relevant arguments in discussions with decision-makers for a more health promoting health care system.   

  • 4.
    Feldman, Inna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Kelly, Michael P
    Response to Invited Commentary: Methods to address control for confounding and nonperfect randomization when using outcome distribution curves to estimate the population-level impact of a public health intervention.2014In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 67, no 11, p. 1286-1288Article in journal (Refereed)
  • 5. Finnes, Anna
    et al.
    Enebrink, Pia
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sorjonen, Kimmo
    Dahl, JoAnne
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Ghaderi, Ata
    Nager, Anna
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Cost-Effectiveness of Acceptance and Commitment Therapy and a Workplace Intervention for Employees on Sickness Absence due to Mental Disorders.2017In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 59, no 12, p. 1211-1220Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to evaluate cost-effectiveness of Acceptance and Commitment Therapy (ACT) and workplace dialogue intervention (WDI), both as stand-alone interventions and in combination, compared with treatment as usual (TAU), for employees on sickness absence with mental disorders.

    METHODS: Employees (n = 352, 78.4% females) on sickness absence were randomized to one of four groups. Cost-utility analyses were conducted from a health care perspective and a limited societal perspective.

    RESULTS: All groups reported significant improvements in health-related quality-of-life (HRQoL) and there were no significant differences in HRQoL or costs between groups. The probability of cost-effectiveness for ACT+WDI was 50% compared with ACT, indicating that both treatment alternatives could be considered equally favorable for decision-makers. TAU and WDI were rejected due to less economic efficiency.

    CONCLUSION: Adding WDI to ACT cannot be recommended on the basis of our study results.

  • 6.
    Häggström, Jenny
    et al.
    Umeå University, Umeå School of Business and Economics, Department of Statistics.
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Eurenius, Eva
    Umeå University, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Pulkki-Brännström, Anni-Maria
    Umeå University, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ivarsson, Anneli
    Umeå University, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindkvist, Marie
    Umeå University, Umeå School of Business and Economics, Department of Statistics; Umeå University, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Is the Salut Programme an effective and cost-effective universal health promotion intervention for parents and their children?: A register-based retrospective observational study2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 9, article id e016732Article in journal (Refereed)
    Abstract [en]

    Objectives: This study investigates the effectiveness and cost-effectiveness of the Salut Programme, a universal health promotion intervention, compared with care-as-usual, over the periods of pregnancy, delivery and the child's first 2 years of life.

    Method: We adopted a register-based retrospective observational design using existing data sources with respect to both exposures and outcomes. Health outcomes and costs were compared between geographical areas that received care-as-usual (non-Salut area) and areas where the programme was implemented (Salut area). We included mothers and their children from both the Salut and non-Salut areas if: (1) the child was born 2002-2004 (premeasure period) or (2) the child was born 2006-2008 (postmeasure period). The effectiveness study adopted two strategies: (1) a matched difference-in-difference analysis using data from all participants and (2) a longitudinal analysis restricted to mothers who had given birth twice, that is, both in the premeasure and postmeasure periods. The economic evaluation was performed from a healthcare and a limited societal perspective. Outcomes were clustered during pregnancy, delivery and birth and the child's first 2 years.

    Results: Difference-in-difference analyses did not yield any significant effect on the outcomes. Longitudinal analyses resulted in significant positive improvement in Apgar scores, reflecting the newborn's physical condition, with more children having a normal Apgar score (1 min + 3%, 5 min + 1%). The cost of the programme was international dollar (INT$)308/child. From both costing perspectives, the programme yielded higher effects and lower costs than care-as-usual, being thus cost-saving (probability of around 50%).

    Conclusions: Our findings suggest that the Salut Programme is an effective universal intervention to improve maternal and child health, and it may be good value for money; however, there is large uncertainty around the cost estimates.

  • 7.
    Nystrand, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Enebrink, P.
    Karolinska Inst, Div Psychol, Dept Clin Neurosci, Stockholm, Sweden..
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Cost-offset analysis of parenting interventions to prevent externalizing behavior problems2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, p. 332-332Article in journal (Other academic)
  • 8.
    Nystrand, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hultkrantz, L.
    Orebro Univ, Orebro, Sweden.
    Vimefall, E.
    Orebro Univ, Orebro, Sweden.
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Indicated Parenting Interventions and Long Term Outcomes: A Health Economic Modeling Study2018In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 21, p. S76-S76Article in journal (Other academic)
  • 9.
    Nystrand, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Cost-Offset Analysis Of Social And Emotional Learning Programs For The Prevention Of Externalizing Behavior Problems: An Economic Modeling Study2017In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 20, no 5, p. A297-A297Article in journal (Other academic)
    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.

  • 10.
    Nystrand, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Quality of life and service use amongst parents of young children: Results from the Children and Parents in Focus trial2018In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed)
    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.

  • 11.
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Prevention and Treatment of Externalizing Behaviour Problems in Children through Parenting Interventions: An Application of Health Economic Methods2016Doctoral 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.

    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
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    2015 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no 6, p. 1035-1042Article 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, p. 785-792Article 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. 

    Keywords
    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: 2018-01-08
    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
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    2018 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 27, no 7, p. 933-944Article in journal (Refereed) Published
    Abstract [en]

    Parenting programmes are the recommended treatments of conduct disorders (CD) in children, but little is known about their longer term cost-effectiveness. This study aimed to evaluate the population cost-effectiveness of one of the most researched evidence-based parenting programmes, the Triple P—Positive Parenting Programme, delivered in a group and individual format, for the treatment of CD in children. A population-based multiple cohort decision analytic model was developed to estimate the cost per disability-adjusted life year (DALY) averted of Triple P compared with a ‘no intervention’ scenario, using a health sector perspective. The model targeted a cohort of 5–9-year-old children with CD in Australia currently seeking treatment, and followed them until they reached adulthood (i.e., 18 years). Multivariate probabilistic and univariate sensitivity analyses were conducted to incorporate uncertainty in the model parameters. Triple P was cost-effective compared to no intervention at a threshold of AU$50,000 per DALY averted when delivered in a group format [incremental cost-effectiveness ratio (ICER) = $1013 per DALY averted; 95% uncertainty interval (UI) 471–1956] and in an individual format (ICER = $20,498 per DALY averted; 95% UI 11,146–39,470). Evidence-based parenting programmes, such as the Triple P, for the treatment of CD among children appear to represent good value for money, when delivered in a group or an individual face-to-face format, with the group format being the most cost-effective option. The current model can be used for economic evaluations of other interventions targeting CD and in other settings.

    Keywords
    Population model, Conduct disorder, Children and adolescents, Cost-effectiveness, Parenting programme
    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)10.1007/s00787-017-1100-1 (DOI)000435956400012 ()29288334 (PubMedID)
    Funder
    Swedish Research Council Formas, 259-2012-68
    Available from: 2016-03-22 Created: 2016-03-22 Last updated: 2019-07-02Bibliographically approved
  • 12.
    Sampaio, Filipa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Barendregt, Jan J.
    Epigear International, Sunrise Beach, Australia; School of Public Health, University of Queensland, Brisbane, Australia.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Lee, Yong Yi
    Sawyer, Michael G.
    Dadds, Mark R.
    Scott, James G.
    Mihalopoulos, Cathrine
    Population cost-effectiveness of the Triple P parenting programme for the treatment of Conduct Disorder: an economic modelling study2018In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 27, no 7, p. 933-944Article in journal (Refereed)
    Abstract [en]

    Parenting programmes are the recommended treatments of conduct disorders (CD) in children, but little is known about their longer term cost-effectiveness. This study aimed to evaluate the population cost-effectiveness of one of the most researched evidence-based parenting programmes, the Triple P—Positive Parenting Programme, delivered in a group and individual format, for the treatment of CD in children. A population-based multiple cohort decision analytic model was developed to estimate the cost per disability-adjusted life year (DALY) averted of Triple P compared with a ‘no intervention’ scenario, using a health sector perspective. The model targeted a cohort of 5–9-year-old children with CD in Australia currently seeking treatment, and followed them until they reached adulthood (i.e., 18 years). Multivariate probabilistic and univariate sensitivity analyses were conducted to incorporate uncertainty in the model parameters. Triple P was cost-effective compared to no intervention at a threshold of AU$50,000 per DALY averted when delivered in a group format [incremental cost-effectiveness ratio (ICER) = $1013 per DALY averted; 95% uncertainty interval (UI) 471–1956] and in an individual format (ICER = $20,498 per DALY averted; 95% UI 11,146–39,470). Evidence-based parenting programmes, such as the Triple P, for the treatment of CD among children appear to represent good value for money, when delivered in a group or an individual face-to-face format, with the group format being the most cost-effective option. The current model can be used for economic evaluations of other interventions targeting CD and in other settings.

  • 13.
    Sampaio, Filipa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Bonnert, M.
    Karolinska Inst, Stockholm, Sweden.
    Olen, O.
    Karolinska Inst, Stockholm, Sweden.
    Hedman, E.
    Karolinska Inst, Stockholm, Sweden.
    Lalouni, M.
    Karolinska Inst, Stockholm, Sweden.
    Lenhard, F.
    Karolinska Inst, Stockholm, Sweden.
    Ljotsson, B.
    Karolinska Inst, Stockholm, Sweden.
    Nystrand, Camilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Serlachius, E.
    Karolinska Inst, Stockholm, Sweden.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Cost-Effectiveness of Internet-Delivered Cognitive Behaviour Therapy for Adolescents with Irritable Bowel Syndrome2018In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 21, p. S42-S42Article in journal (Other academic)
  • 14.
    Sampaio, Filipa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Bonnert, Marianne
    Olén, Ola
    Hedman, Erik
    Lalouni, Maria
    Lenhard, Fabian
    Ljótsson, Brjánn
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Serlachius, Eva
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Cost-effectiveness of internet-delivered cognitive-behavioural therapy for adolescents with irritable bowel syndrome2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 1, article id e023881Article in journal (Refereed)
    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.

  • 15.
    Sampaio, Filipa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Enebrink, P.
    Mihalopoulos, C.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    COST EFFECTIVENESS OF GROUP-BASED PARENTING PROGRAMS AND BIBLIOTHERAPY FOR PARENTS OF CHILDREN AT RISK OF DEVELOPING CONDUCT DISORDER: A MULTICENTER RANDOMIZED CONTROLLED TRIAL2015In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 18, no 3, p. A258-A258, article id PHS65Article in journal (Other academic)
  • 16.
    Sampaio, Filipa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Enebrink, Pia
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Mihalopoulos, Cathrine
    Deakin Univ, Melbourne, Vic, Australia.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Cost-Effectiveness of Four Parenting Programs and Bibliotherapy for Parents of Children with Conduct Problems2016In: Journal of Mental Health Policy and Economics, ISSN 1091-4358, E-ISSN 1099-176X, Vol. 19, no 4, p. 201-212Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Parenting programs and self-help parenting interventions employing written materials are effective in reducing child conduct problems (CP) in the short-term compared to control groups, however evidence on the cost-effectiveness of such interventions is insufficient. Few studies have looked at the differences in effects between interventions in the same study design.

    AIM: This study aimed to determine the cost-effectiveness of four parenting programs: Comet, Incredible Years (IY), Cope and Connect, and bibliotherapy, compared to a waitlist control (WC), with a time horizon of 4 months, targeting CP in children aged 3-12 years.

    METHODS: This economic evaluation was conducted alongside an RCT of the four parenting interventions and bibliotherapy compared to a WC. The study sample consisted of 961 parents of 3-12 year-old children with CP. CP was measured by the Eyberg Child Behavior Inventory. Effectiveness was expressed as the proportion of "recovered" cases of CP. The time horizon of the study was four months with a limited health sector perspective, including parents' time costs. We performed an initial comparative cost analysis for interventions whose outcomes differed significantly from the WC, and later a cost-effectiveness analysis of interventions whose outcomes differed significantly from both the WC and each other. Secondary analyses were performed: (i) joint outcome "recovered and improved", (ii) intervention completers, (iii) exclusion of parents' time costs, (iv) exclusion of training costs.

    RESULTS: All interventions apart from Connect significantly reduced CP compared to the WC. Of the other interventions Comet resulted in a significantly higher proportion of recovered cases compared to bibliotherapy. A comparative cost analysis of the effective interventions rendered an average cost per recovered case for bibliotherapy of USD 483, Cope USD 1972, Comet USD 3741, and IY USD 6668. Furthermore, Comet had an ICER of USD 8375 compared to bibliotherapy. Secondary analyses of "recovered and improved" and of intervention completers held Cope as the cheapest alternative. Exclusion of parents' time and training costs did not change the cost-effectiveness results.

    DISCUSSION: The time horizon for this evaluation is very short. This study also had a limited costing perspective. Results may be interpreted with caution when considering decision-making about value for money. The inclusion of a multi-attribute utility instrument sensitive to domains of quality-of-life impacted by CP in children would be valuable so that pragmatic value for money estimations can be made.

    IMPLICATIONS FOR FUTURE RESEARCH: Further studies are needed with longer follow-up periods to ascertain on the sustainability of the effects, and fuller economic evaluations and economic modeling to provide insights on longer-term cost-effectiveness. These results also raise the need to investigate the cost-effectiveness of the provision of these interventions as a "stepped care" approach.

    CONCLUSIONS: The results suggest the delivery of different programs according to budget constraints and the outcome desired. In the absence of a WTP threshold, bibliotherapy could be a cheap and effective option to initially target CP within a limited budget, whereas Comet could be offered to achieve greater effects based on decision-makers' willingness to make larger investments. In its turn, Cope could be offered when targeting broader outcomes, such as symptom improvement, rather than clinical caseness.

  • 17.
    Sampaio, Filipa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Enebrink, Pia
    Mihalopoulos, Cathy
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Cost-effectiveness of four parenting programs and bibliotherapy for parents of children with conduct problems: a multicentre randomized controlled trialIn: Journal of Mental Health Policy and Economics, ISSN 1091-4358, E-ISSN 1099-176XArticle in journal (Refereed)
  • 18.
    Sampaio, Filipa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Health Economic Evaluation of Four Parenting Programmes and a Book on Parent Management Techniques for Parents of Children with Conduct Problems: A Multicentre Randomised Controlled Trial2015In: Journal of Mental Health Policy and Economics, ISSN 1091-4358, E-ISSN 1099-176X, Vol. 18, no S1, p. S34-S35Article in journal (Other academic)
  • 19.
    Sampaio, Filipa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Eurenius, E.
    Umea Univ, Umea, Sweden..
    Häggström, J.
    Umea Univ, Umea, Sweden..
    Lindkvist, M.
    Umea Univ, Umea, Sweden..
    Pulkki-Brännström, A.
    Umea Univ, Umea, Sweden..
    Ivarsson, A.
    Umea Univ, Umea, Sweden..
    Effectiveness And Cost-Effectiveness Of The Salut Programme - A Universal Health Promotion Intervention For Parents And Children2016In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 19, no 7, p. A604-A605Article in journal (Refereed)
  • 20.
    Sampaio, Filipa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    A Cost-Effectiveness Analysis of the Triple P Program in Uppsala Municipality, Sweden2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no S2, p. 101-101Article in journal (Other academic)
  • 21.
    Sampaio, Filipa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Zethraeus, Niklas
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Cost and effects of a universal parenting programme delivered to parents of preschoolers2015In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no 6, p. 1035-1042Article in journal (Refereed)
    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.

  • 22.
    Sampaio, Filipa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Nystrand, Camilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Health, public sector service use and related costs of Swedish preschool children: results from the Children and Parents in Focus trial2019In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 28, no 1, p. 43-56Article in journal (Refereed)
    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.

  • 23.
    Sarkadi, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Kelly, Michael P.
    National Institute of Health and Care Excellence, Centre for Public Health, London, UK.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    A novel approach used outcome distribution curves to estimate the population-level impact of a public health intervention2014In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 67, no 7, p. 785-792Article in journal (Refereed)
    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. 

  • 24.
    Sarkadi, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Warner, Georgina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Fängström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Durbeej, Natalie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Lampa, Elin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Baghdasaryan, Zaruhi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Osman, Fatumo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Gupta Löfving, Sandra
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Perez Aronsson, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Calam, Rachel
    Bjärtå, Anna
    Leiler, Anna
    Rondung, Elisabet
    Wasteson, Elisabet
    Oppedal, Brit
    Keeshin, Brooks
    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.2020In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 21, no 1, article id 63Article in journal (Refereed)
    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.

  • 25.
    Skokauskas, Norbert
    et al.
    Regional Centre for Child and Youth Mental Health and Child Welfare, Trondheim, Norway.
    Lavelle, Tara A
    Tuft University School of Medicine, Boston, MA, USA.
    Munir, Kerim
    Boston Children’s Hospital, Boston, MA, USA.
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Nystrand, Camilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    McCrone, Paul
    King’s College London, London, UK.
    McDaid, David
    London School of Economics and Political Science, London, UK.
    Chrisholm, Dan
    WHO Regional Office for Europe, Copenhagen, Denmark.
    Byford, Sarah
    King’s College London, London, UK.
    Ganguli, Poushali
    King’s College London, London, UK.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Belfer, Myron
    Boston Children’s Hospital, Boston, MA, USA.
    The cost of child and adolescent mental health services2018In: Lancet psychiatry, ISSN 2215-0374, E-ISSN 2215-0366, Vol. 5, p. 299-300Article in journal (Other academic)
    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.

  • 26.
    Ssegonja, Richard
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Alaie, Iman
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Philipson, Anna
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    Hagberg, Lars
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Möller, Margareta
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. Murdoch Childrens Res Inst, Melbourne, Vic, Australia.
    Langenskiöld, Sophie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Karolinska Inst, Dept Learning Informat Management & Eth LIME, Stockholm, Sweden.
    von Knorring, Anne-Liis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Bohman, Hannes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Jonsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Karolinska Inst Kind, Ctr Neurodev Disorders, Pediat Neuropsychiat Unit, Stockholm, Sweden;Stockholm Cty Council, Ctr Psychiat Res, Stockholm Hlth Care Serv, Stockholm, Sweden.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood: A longitudinal cost-of-illness study2019In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 258, p. 33-41Article in journal (Refereed)
    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.

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