基于课堂的认知行为疗法对减轻青少年抑郁症状的成本效益：一项基于试验的分析。

Cost-effectiveness of classroom-based cognitive behaviour therapy in reducing symptoms of depression in adolescents: a trial-based analysis.

作者信息

Anderson Rob, Ukoumunne Obioha C, Sayal Kapil, Phillips Rhiannon, Taylor John A, Spears Melissa, Araya Ricardo, Lewis Glyn, Millings Abigail, Montgomery Alan A, Stallard Paul

机构信息

PenTAG, University of Exeter Medical School, Exeter, UK.

出版信息

J Child Psychol Psychiatry. 2014 Dec;55(12):1390-7. doi: 10.1111/jcpp.12248. Epub 2014 May 12.

DOI:10.1111/jcpp.12248

PMID:24813670

Abstract

BACKGROUND

A substantial minority of adolescents suffer from depression and it is associated with increased risk of suicide, social and educational impairment, and mental health problems in adulthood. A recently conducted randomized controlled trial in England evaluated the effectiveness of a manualized universally delivered age-appropriate CBT programme in school classrooms. The cost-effectiveness of the programme for preventing low mood and depression for all participants from a health and social care sector perspective needs to be determined.

METHODS

A trial-based cost-effectiveness analysis based on a cluster-randomized controlled trial (trial registration--ISRCTN 19083628) comparing classroom-based CBT with usual school provision of Personal Social and Health Education. Per-student cost of intervention was estimated from programme records. The study was undertaken in eight mixed-sex U.K. secondary schools, and included 3,357 school children aged 12 to 16 years (in the two trial arms evaluated in the cost-effectiveness analysis). The main outcome measures were individual self-reported data on care costs, Quality-Adjusted Life-Years (QALYs, based on the EQ-5D health-related quality-of-life instrument) and symptoms of depression (Short Mood and Feelings Questionnaire) at baseline, 6 and 12 months.

RESULTS

Although there was lower quality-adjusted life-years over 12 months (-.05 QALYs per person, 95% confidence interval -.09 to -.005, p = .03) with CBT, this is a 'clinically' negligible difference, which was not found in the complete case analyses. There was little evidence of any between-arm differences in SMFQ scores (0.19, 95% CI -0.57 to 0.95, p = .62), or costs (£142, 95% CI -£132 to £415, p = .31) per person for CBT versus usual school provision.

CONCLUSIONS

Our analysis suggests that the universal provision of classroom-based CBT is unlikely to be either more effective or less costly than usual school provision.

摘要

背景

相当一部分青少年患有抑郁症，这与自杀风险增加、社交和教育障碍以及成年后的心理健康问题有关。最近在英国进行的一项随机对照试验评估了在学校教室中普遍提供的适合年龄的手册化认知行为疗法（CBT）项目的有效性。需要从卫生和社会护理部门的角度确定该项目预防所有参与者情绪低落和抑郁症的成本效益。

方法

基于一项整群随机对照试验（试验注册号——ISRCTN 19083628）进行基于试验的成本效益分析，将课堂认知行为疗法与学校常规提供的个人社会和健康教育进行比较。干预的人均成本根据项目记录估算。该研究在英国八所男女混合的中学进行，纳入了3357名12至16岁的学童（成本效益分析中评估的两个试验组）。主要结局指标为基线、6个月和12个月时关于护理成本、质量调整生命年（QALYs，基于EQ-5D健康相关生活质量量表）以及抑郁症状（简短情绪与感受问卷）的个体自我报告数据。

结果

尽管认知行为疗法在12个月内的质量调整生命年较低（每人-0.05 QALYs，95%置信区间为-0.09至-0.005，p = 0.03），但这是一个“临床上”可忽略不计的差异，在完整病例分析中未发现。几乎没有证据表明认知行为疗法与学校常规提供相比，在简短情绪与感受问卷（SMFQ）评分（0.19，95%置信区间为-0.57至0.95，p = 0.62）或人均成本（142英镑，95%置信区间为-132英镑至415英镑，p = 0.31）方面存在组间差异。