The Efficacy and Cost-Effectiveness of Stepped Care Prevention and Treatment for Depressive and/or Anxiety Disorders: A Systematic Review and Meta-Analysis

Ho, Fiona Yan Yee; Yeung, Wing‐Fai; Ng, Tommy H.; Chan, Christian S.

doi:10.1038/srep29281

Cited by 123 publications

(107 citation statements)

References 48 publications

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“…An issue related to better use of resources, especially highly skilled specialist human resources, is the cost‐effectiveness of stepped care or (stepped) collaborative care. These have recently been reviewed, although evidence remains inconclusive, due partly to methodological issues (e.g., use of QALY as outcome measure, and a wide range of time horizons, from 6 to 24 months) and partly to the heterogeneity of these models.…”

Section: Current Economic Evidence and Key Events In Mental Health Carementioning

confidence: 99%

Economics and mental health: the current scenario

2020

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Economics and mental health are intertwined. Apart from the accumulating evidence of the huge economic impacts of mental ill‐health, and the growing recognition of the effects that economic circumstances can exert on mental health, governments and other budget‐holders are putting increasing emphasis on economic data to support their decisions. Here we consider how economic evaluation (including cost‐effectiveness analysis, cost‐utility analysis and related techniques) can contribute evidence to inform the development of mental health policy strategies, and to identify some consequences at the treatment or care level that are of relevance to service providers and funding bodies. We provide an update and reflection on economic evidence relating to mental health using a lifespan perspective, analyzing costs and outcomes to shed light on a range of pressing issues. The past 30 years have witnessed a rapid growth in mental health economics, but major knowledge gaps remain. Across the lifespan, clearer evidence exists in the areas of perinatal depression identification‐plus‐treatment; risk‐reduction of mental health problems in childhood and adolescence; scaling up treatment, particularly psychotherapy, for depression; community‐based early intervention and employment support for psychosis; and cognitive stimulation and multicomponent carer interventions for dementia. From this discussion, we pull out the main challenges that are faced when trying to take evidence from research and translating it into policy or practice recommendations, and from there to actual implementation in terms of better treatment and care.

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Section: Current Economic Evidence and Key Events In Mental Health Carementioning

confidence: 99%

Economics and mental health: the current scenario

2020

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“…interventions are unlikely to be successful (Johnson, Giannotti, & Cortesi, 2009). This brief, low-cost intervention fits with current trends in the mental healthcare arena focused on the urgent need to increase access to behavioral therapies to manage common problems (Ho, Yeung, Ng, & Chan, 2016). While a small percentage of children may require an intensive personalized therapy with a highly qualified behavioral sleep specialist, most children with behavioral sleep problems will benefit from a less intensive, general intervention approach.…”

Section: Pretreatmentmentioning

confidence: 90%

Nurse‐led brief sleep education intervention aimed at parents of school‐aged children with neurodevelopmental and mental health disorders: Results from a pilot study

Bastida-Pozuelo¹,

Sánchez‐Ortuño

Meltzer

2018

Specialist Pediatric Nursing

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Purpose To test the effects of a single‐session parent sleep educational intervention, led by a pediatric nurse, on sleep in a group of school‐aged children attending a National Health Service mental health clinic in Murcia, Spain. Design and Methods Parents/caregivers of 26 children (mean age = 8.58 years; standard deviation = 0.58; 80.8% male) with neurodevelopmental or mental health disorders (84.6% pervasive developmental disorder), and with a suspicion of a behavioral sleep problem, participated in a 45‐min group educational session about healthy sleep practices, supplemented by a written handout. The main outcome measures were derived from items of the Pediatric Sleep Questionnaire and included an insomnia composite score, a daytime sleepiness composite score, average sleep onset latency, and sleep duration on both weekdays and weekends. Outcome variables were assessed before and 3 months after the intervention. Results After the educational intervention, the insomnia and daytime composite scores decreased significantly (ps < 0.03). Weekday and weekend sleep duration significantly increased ( ps < 0.01). No statistically significant difference was observed in sleep onset latency before and after the intervention. Practice Implications A brief and relatively inexpensive single sleep educational session can positively impact sleep in children with neurodevelopmental and mental health disorders. Thus, this intervention meets the characteristics of a successful “entry level” treatment in a stepped‐care approach. The stepped‐care model places nurses in a pivotal position to ensure that their patients will receive the least complex and most accessible intervention, from which they are likely to get some benefit, and that a sizeable number of patients who need treatment may receive it. Thus, it is important for nurses in all types of practice settings to have an understanding of healthy sleep patterns, as well as sleep disorders in children. Pediatric nurses, regardless of their setting, are in a unique position to screen children and adolescents for sleep behavior problems or sleep disorders, to educate families about healthy sleep practices, provide guidance and feedback, and recommend referral to pediatric specialized care for more complex assessment and management.

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“…TTT Summit attendees recognized that some CBIT formats have lower access barriers, which led to interest in testing the delivery of CBIT in a stepped care model. "Stepped care" is a treatment model that aims to solve access problems by distributing evidence-based treatments in graded steps based on intensity, cost, and time demand (Ho et al, 2016). In this model, the "least restrictive" interventions are used as the first-line treatment, such as self-help or internet-based treatments.…”

Section: How Does Cbit Compare To Other Treatments For Tics?mentioning

confidence: 99%

“…Stepped care models have been tested for a number of psychiatric disorders, including anxiety, depression, and OCD, and results generally show improved outcomes for patients and better cost effectiveness (Ho et al, 2016). There is no research to date testing the stepped care model in TDs.…”

Section: How Does Cbit Compare To Other Treatments For Tics?mentioning

confidence: 99%

Treating Tourette Together: An Agenda for Patient-Centered Research Focused on Comprehensive Behavior Therapy for Tics

Conelea¹,

Bennett²,

Capriotti³

et al. 2020

Preprint

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After the Summit, we organized this input into 4 Key Research Areas that described the general types of research that attendees felt passionately about.Here, we list these domains, as well as specific Research Questions within each domain. Even though we number these below, each is considered equally important (for example, #3 isn't a lower priority than #1). Key Research Domains and Sample Questions Domain 1: Increasing Access to CBIT Representative research questions include:1. Children spend a lot of time in school. Can we train school-based providers (e.g., guidance counselors, school OTs) to provide CBIT effectively in school settings?2. Currently, there are not enough CBIT providers for all of the people with TDs who want CBIT. What are the most effective ways to train more providers in CBIT?3. Many people with TDs have to see more than one doctor, or wait a long time to get diagnosed and connected to quality care. What is the best way to train general doctors (such as pediatricians and family doctors) to recognize TDs and provide appropriate education, resources, treatment recommendations, and referrals? Domain 2: Increasing CBIT's EffectivenessRepresentative research questions include:1. CBIT in its current form does not work for everyone. Can we improve CBIT outcomes by figuring out what makes it work more, or less, well for some people? This would include looking at numerical information from studies, and also talking with people who have received CBIT about ways to improve it.2. CBIT involves a number of different parts. Can we make CBIT more efficient by identifying its most "active ingredients"?3. Many people with TDs do not feel that CBIT is a good fit for them. Can we create a "CBIT Readiness Interview" to explain what CBIT is, discuss concerns, and possibly increase patients' desire to do CBIT? Domain 3: Optimizing How CBIT Fits into Individuals' Broader Care for TDsRepresentative research questions include:1. People with TDs are likely to use multiple kinds of treatments, such as medications and CBIT. What are the best sequences of treatment for TDs (for example, CBIT followed by medication, or vice versa)? And, can we identify who will benefit from one treatment sequence instead of another?2. Many patients who want CBIT have to wait a long time on waitlists to get it. Can we help people with TDs find relief more quickly by having them start with an online,selfhelp version of CBIT, and then move on to CBIT with a therapist if self-help is not effective for them?3. Many patients live too far from CBIT providers for weekly visits. Can we evaluate whether other CBIT formats work just as well, such as doing CBIT over videochat or doing a short, intensive "CBIT Bootcamp" (called "intensive outpatient treatment" by healthcare providers)?4. Many people with TDs take tic-reducing medications but wish they did not have to. Can CBIT be used as a tool to get off of these medications?5. How well does CBIT work compared to medication alone, and the combination of CBIT and medication used simultaneously? Full ...

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The Efficacy and Cost-Effectiveness of Stepped Care Prevention and Treatment for Depressive and/or Anxiety Disorders: A Systematic Review and Meta-Analysis

Cited by 123 publications

References 48 publications

Economics and mental health: the current scenario

Economics and mental health: the current scenario

Nurse‐led brief sleep education intervention aimed at parents of school‐aged children with neurodevelopmental and mental health disorders: Results from a pilot study

Treating Tourette Together: An Agenda for Patient-Centered Research Focused on Comprehensive Behavior Therapy for Tics

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