Cost-effectiveness of dialectical behaviour therapy vs. enhanced usual care in the treatment of adolescents with self-harm

Haga, Egil; Aas, Eline; Grøholt, Berit; Tørmoen, Anita Johanna; Mehlum, Lars

doi:10.1186/s13034-018-0227-2

Cited by 16 publications

(21 citation statements)

References 25 publications

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“…We have previously shown that a comparatively brief course of Dialectical Behavior Therapy adapted for adolescents (DBT‐A) (Miller, Rathus, & Linehan, ) is superior to enhanced usual care (EUC) in reducing self‐harming behavior, suicidal ideation and depressive symptoms (Mehlum et al., , ), and that this treatment is cost‐effective (Haga, Aas, Groholt, Tormoen, & Mehlum, ). In the present study, based on data from more than 90% of the originally included sample of adolescents, our aim was to investigate the long‐term treatment effectiveness of DBT‐A compared to EUC at follow‐up 3 years post‐randomization with respect to frequency of self‐harm episodes, severity of suicidal ideation and depressive symptoms, frequency of subsequent emergency room visits, hospitalizations and use of additional treatments due to risk of self‐harm behavior.…”

Section: Introductionmentioning

confidence: 99%

Long term effectiveness of dialectical behavior therapy versus enhanced usual care for adolescents with self‐harming and suicidal behavior

Mehlum

Ramleth

Tørmoen

et al. 2019

Child Psychology Psychiatry

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Background Knowledge is lacking on the long‐term outcomes of treatment for adolescents with repetitive suicidal and self‐harming behavior. Furthermore, the pathways through which treatment effects may operate are poorly understood. Our aims were to investigate enduring treatment effects of dialectical behavior therapy adapted for adolescents (DBT‐A) compared to enhanced usual care (EUC) through a prospective 3‐year follow‐up and to analyze possible mediators of treatment effects. Methods Interview and self‐report data covering the follow‐up interval were collected from 92% of the adolescents who participated in the original randomized trial. Trial registration number: NCT01593202 (http://www.ClinicalTrials.gov). Results At the 3‐year follow‐up DBT‐A remained superior to EUC in reducing the frequency of self‐harm, whereas for suicidal ideation, hopelessness and depressive and borderline symptoms and global level of functioning there were no inter‐group differences, with no sign of symptom relapse in either of the participant groups. A substantial proportion (70.8%) of the effect of DBT‐A on self‐harm frequency over the long‐term was mediated through a reduction in participants’ experience of hopelessness during the trial treatment phase. Receiving more than 3 months follow‐up treatment after completion of the trial treatment was associated with further enhanced outcomes in patients who had received DBT‐A. Conclusions There were on average no between‐group differences at the 3‐year follow‐up in clinical outcomes such as suicidal ideation, hopelessness, depressive and borderline symptoms. The significantly and consistently larger long‐term reduction in self‐harm behavior for adolescents having received DBT‐A compared with enhanced usual care, however, suggests that DBT‐A may be a favorable treatment alternative for adolescents with repetitive self‐harming behavior.

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Section: Introductionmentioning

confidence: 99%

Long term effectiveness of dialectical behavior therapy versus enhanced usual care for adolescents with self‐harming and suicidal behavior

Mehlum

Ramleth

Tørmoen

et al. 2019

Child Psychology Psychiatry

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“…Additionally, in the transitional period into young adulthood, BPD symptoms can lead to romantic dysfunction such as unwanted pregnancy and partner discontentment [ 30 ]. Research has suggested the role early intervention can play in mitigating these potential problems [ 31 ] and can be considered a cost-effective intervention for this population in the long-term [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

A Qualitative Evaluation of Young People’s, Parents’ and Carers’ Experiences of a National and Specialist CAMHS Dialectical Behaviour Therapy Outpatient Service

Ratnaweera

Hunt

Camp

2021

IJERPH

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(1) Background: Dialectical Behaviour Therapy (DBT) is the recommended treatment for Borderline Personality Disorder (BPD) symptoms in adults, however, research investigating the effectiveness of DBT for adolescents is limited. The present study explores the experiences of young people and their parents/carers of a DBT service using qualitative methodology. (2) Methods: Young people and their parents/carers, who completed DBT within the National and Specialist Child and Adolescent Mental Health DBT Service based at the Maudsley Hospital in London, were asked questions regarding their experience of the service. Data was collected from young people who completed treatment between July 2019 and July 2020 (n = 18) and their parents and carers (n = 7). (3) Results: Amongst young people, the themes identified were: a new way of living, better understanding of self, new skills, person-centred approach, and relationships with others. Parent and carer interviews revealed themes of improved relationships, feeling supported, improved quality of life, and time/timing. (4) Conclusions: Young people reported improvements in emerging BPD symptomology after completing DBT. Parents and carers reported improvements in their young person and families since starting DBT. A longer DBT programme, earlier DBT intervention, and the time-consuming nature of DBT were highlighted as areas for improvement.

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“…Costs of ICT treatment were estimated as €5293 per patient. The cost of Dialectical Behavior Therapy for adolescents (DBT-A), and enhanced usual care (EUC) was investigated by Haga and colleagues [ 36 ]. The treatments extended over approximately the equivalent time as ICT (19 weeks), but were associated with higher total treatment costs; €16,199 and €13,217, respectively [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…The cost of Dialectical Behavior Therapy for adolescents (DBT-A), and enhanced usual care (EUC) was investigated by Haga and colleagues [ 36 ]. The treatments extended over approximately the equivalent time as ICT (19 weeks), but were associated with higher total treatment costs; €16,199 and €13,217, respectively [ 36 ]. In another study by Ougrin and colleagues [ 37 ], the mean total cost for supported discharge service (SDS), and usual care (UC) was £64,355 (€72,721), and £63,463 (€69,809) per patient respectively.…”

Section: Discussionmentioning

confidence: 99%

A pilot study of the impact of an integrated individual- and family therapy model for self-harming adolescents on overall healthcare consumption

et al. 2021

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Background Self-harming behaviors in adolescents cause great suffering and can lead to considerable costs to the healthcare system. The aim of the current study was to investigate the cost of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) and to compare the adolescent’s healthcare consumption 1 year before and 1 year after treatment. Method The study had a within group design with repeated measures. The clinical outcomes and the cost of ICT treatment are based on a sample of 49 participants who were previously enrolled in an intervention trial. Participants with significantly improved clinical outcomes (self-harm behavior, or general mental health symptoms) were defined as treatment responders. Calculation of changes in healthcare consumption is based on 25 participants who gave their consent to participate in a retrospective collection of healthcare data from medical records, including inpatient and outpatient care, and prescribed medication. Results The average estimated cost of ICT per person was €5293. There were no significant differences between the cost of healthcare consumption 1 year before and after ICT, but the results suggested that the adolescents consumed less inpatient and specialized care after treatment. There was a significantly higher cost of psychotropic medication after treatment explained by a higher consumption of central stimulants. Treatment responders (general mental health problems) reduced their consumption of healthcare resources significantly more than non-responders, especially regarding hospital visits and total health care costs. Conclusions Good response to the ICT in terms of improved general mental health symptoms seems to be associated with reduced healthcare consumption during the post-treatment period. However, controlled studies with larger sample sizes are needed to draw causal conclusions. The results of this study should be interpreted with caution as it is based on a small sample and attrition rate was high. Trial registration This study has been registered with the ISRCTN: 15885573.

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Cost-effectiveness of dialectical behaviour therapy vs. enhanced usual care in the treatment of adolescents with self-harm

Cited by 16 publications

References 25 publications

Long term effectiveness of dialectical behavior therapy versus enhanced usual care for adolescents with self‐harming and suicidal behavior

Long term effectiveness of dialectical behavior therapy versus enhanced usual care for adolescents with self‐harming and suicidal behavior

A Qualitative Evaluation of Young People’s, Parents’ and Carers’ Experiences of a National and Specialist CAMHS Dialectical Behaviour Therapy Outpatient Service

A pilot study of the impact of an integrated individual- and family therapy model for self-harming adolescents on overall healthcare consumption

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