| 1. |
- Andersson, Erik, et al.
(författare)
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Cost-effectiveness of internet-based cognitive behavior therapy for irritable bowel syndrome: results from a randomized controlled trial
- 2011
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 11:215
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Tidskriftsartikel (refereegranskat)abstract
- Background: Irritable Bowel Syndrome (IBS) is highly prevalent and is associated with a substantial economic burden. Cognitive behavior therapy (CBT) has been shown to be effective in treating IBS. The aim of this study was to evaluate the cost-effectiveness of a new treatment alternative, internet-delivered CBT based on exposure and mindfulness exercises. Methods: Participants (N = 85) with IBS were recruited through self-referral and were assessed via a telephone interview and self-report measures on the internet. Participants were randomized to internet-delivered CBT or to a discussion forum. Economic data was assessed at pre-, post- and at 3-month and 1 year follow-up. Results: Significant cost reductions were found for the treatment group at $16,806 per successfully treated case. The cost reductions were mainly driven by reduced work loss in the treatment group. Results were sustained at 3-month and 1 year follow-up. Conclusions: Internet-delivered CBT appears to generate health gains in IBS treatment and is associated with cost-savings from a societal perspective.
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| 2. |
- Bower, Peter, et al.
(författare)
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Influence of initial severity of depression on effectiveness of low intensity interventions : meta-analysis of individual patient data
- 2013
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Ingår i: BMJ (Clinical Research Edition). - : BMJ Publishing Group: BMJ. - 0959-8138 .- 1756-1833. ; 346
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Tidskriftsartikel (refereegranskat)abstract
- Objective To assess how initial severity of depression affects the benefit derived from low intensity interventions for depression.Design Meta-analysis of individual patient data from 16 datasets comparing low intensity interventions with usual care.Setting Primary care and community settings.Participants 2470 patients with depression.Interventions Low intensity interventions for depression (such as guided self help by means of written materials and limited professional support, and internet delivered interventions).Main outcome measures Depression outcomes (measured with the Beck Depression Inventory or Center for Epidemiologic Studies Depression Scale), and the effect of initial depression severity on the effects of low intensity interventions.Results Although patients were referred for low intensity interventions, many had moderate to severe depression at baseline. We found a significant interaction between baseline severity and treatment effect (coefficient −0.1 (95% CI −0.19 to −0.002)), suggesting that patients who are more severely depressed at baseline demonstrate larger treatment effects than those who are less severely depressed. However, the magnitude of the interaction (equivalent to an additional drop of around one point on the Beck Depression Inventory for a one standard deviation increase in initial severity) was small and may not be clinically significant.Conclusions The data suggest that patients with more severe depression at baseline show at least as much clinical benefit from low intensity interventions as less severely depressed patients and could usefully be offered these interventions as part of a stepped care model.
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| 3. |
- Carlbring, Per, et al.
(författare)
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Randomized Trial of Internet-Delivered Self-Help With Telephone Support for Pathological Gamblers
- 2008
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Ingår i: JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY. - : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 76:6, s. 1090-1094
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Tidskriftsartikel (refereegranskat)abstract
- Although effective therapies for pathological gambling exist, their uptake is limited to 10% of the target population. To lower the barriers for help seeking, the authors tested all online alternative in a randomized trial (N = 66). The participants were pathological gamblers not presenting with severe comorbid depression. A wait-list control was compared with an 8-week Internet-based cognitive behavior therapy program with minimal therapist contact via e-mail and weekly telephone calls of less than 15 min. Average time spent on each participant, including phone conversations, e-mail, and administration. was 4 hr. The Internet-based intervention resulted in favorable changes in pathological gambling, anxiety. depression, and quality of life. Composite between-group effect size (Cohens d) at posttreatment was 0.83. Follow-ups carried out in the treatment group at 6, 18, and 36 months indicated that treatment effects were sustained (ds = 2.58, 1.96, and 1.98). This evidence is in support of Internet-delivered treatment for pathological gamblers. However, it is not clear how effective the treatment is for more severely depressed individuals.
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| 4. |
- Cuijpers, Pim, et al.
(författare)
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Continuous and dichotomous outcomes in studies of psychotherapy for adult depression: A meta-analytic comparison
- 2010
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Ingår i: JOURNAL OF AFFECTIVE DISORDERS. - : Elsevier Science B.V., Amsterdam.. - 0165-0327 .- 1573-2517. ; 126:3, s. 349-357
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Forskningsöversikt (refereegranskat)abstract
- Background: In treatment research on depressive disorders, outcomes can be based on continuous outcomes but also on dichotomous outcomes. Although it is possible to convert the two types of outcomes to each other, it has not been tested whether this results in systematic differences. Method: We selected studies on psychotherapy for adult depression from an existing database, in which both continuous and dichotomous outcomes were presented. We calculated effect sizes using both types of outcomes, and compared the results. Results: Although there were considerable differences between the two types of outcomes in individual studies, both types of outcomes resulted in very similar pooled effect sizes. The pooled effect size based on the continuous outcome were somewhat more conservative (d = 0.59: OR = 2.92) than the one based on the dichotomous outcome (d = 0.64; OR = 3.17). Heterogeneity was higher in the analyses based on the continuous outcomes than in those based on the dichotomous outcomes. Sensitivity analyses and subgroup analyses confirmed that the pooled effect sizes were very similar, that the effect sizes were somewhat smaller when the continuous outcomes are used, and that heterogeneity was higher in the analyses based on the continuous outcomes. Conclusion: Overall, the two types of outcomes result in comparable pooled effect sizes and can both be used in meta-analyses. However, the results of the two types of outcomes should not be used interchangeably, because there may be systematic differences in heterogeneity and subgroup analyses.
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| 5. |
- Cuijpers, Pim, et al.
(författare)
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Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias
- 2010
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Ingår i: British Journal of Psychiatry. - : Royal College of Psychiatrists. - 0007-1250 .- 1472-1465. ; 196:3, s. 173-178
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Forskningsöversikt (refereegranskat)abstract
- Background: It is not clear whether the effects of cognitive-behavioural therapy and other psychotherapies have been overestimated because of publication bias. Aims: To examine indicators of publication bias in randomised controlled trials of psychotherapy for adult depression. Method: We examined effect sizes of 117 trials with 175 comparisons between psychotherapy and control conditions. As indicators of publication bias we examined funnel plots, calculated adjusted effect sizes after publication had been taken into account using Duval & Tweedies procedure, and tested the symmetry of the funnel plots using the Begg & Mazumdar rank correlation test and Eggers test. Results The mean effect size was 0.67, which was reduced after adjustment for publication bias to 0.42 (51 imputed studies). Both Begg & Mazumbars test and Eggers test were highly significant (Pandlt;0.001). Conclusions: The effects of psychotherapy for adult depression seem to be overestimated considerably because of publication bias. Declaration of interest: None.
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| 6. |
- Cuijpers, Pim, et al.
(författare)
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Is psychotherapy for depression equally effective in younger and older adults? A meta-regression analysis
- 2009
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Ingår i: International psychogeriatrics. - 1041-6102 .- 1741-203X. ; 21:1, s. 16-24
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Forskningsöversikt (refereegranskat)abstract
- Background: It is well established that psychotherapy is effective in the treatment of depression in younger as well as in older adults. Whether these psychotherapies are equally effective in younger and older age groups has not been examined in meta-analytic research. Methods: We conducted a systematic literature search and included 112 studies with 170 comparisons between a psychotherapy and a control group (with a total of 7,845 participants). Twenty studies with 26 comparisons were aimed at older adults. Results: We found no indication that psychotherapies were more or less effective for older adults compared to younger adults. The effect sizes of both groups of comparisons did not differ significantly from each other (older adults: d = 0.74; 95% CI: 0.49 similar to 0.99; younger adults: d = 0.67; 95% CI: 0.58 similar to 0.76). In a multivariate metaregression analysis, in which we controlled for major characteristics of the participants, the interventions and the study designs, no indication of a difference between psychotherapy in younger and older adults was found. Conclusions: There appears to be no significant difference between psychotherapy in younger and older adults, although it is not clear whether this is also true for clinical samples, patients with more severe depression, and the older old.
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| 7. |
- Koning, Ina M., et al.
(författare)
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Preventing Heavy Alcohol Use in Adolescents (PAS) : Cluster Randomized Trial of a Parent and Student Intervention offered Separately and Simultaneously
- 2009
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Ingår i: Addiction. - : Wiley-Blackwell. - 0965-2140 .- 1360-0443. ; 104:10, s. 1669-1678
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To evaluate the effectiveness of two preventive interventions to reduce heavy drinking in first- and second-year high school students.Design and setting: Cluster randomized controlled trial using four conditions for comparing two active interventions with a control group from 152 classes of 19 high schools in the Netherlands.Participants: A total of 3490 first-year high school students (mean 12.68 years, SD = 0.51) and their parents.Intervention conditions: (i) Parent intervention (modelled on the Swedish Örebro Prevention Program) aimed at encouraging parental rule-setting concerning their children's alcohol consumption; (ii) student intervention consisting of four digital lessons based on the principles of the theory of planned behaviour and social cognitive theory; (iii) interventions 1 and 2 combined; and (iv) the regular curriculum as control condition.Main outcome measures: Incidence of (heavy) weekly alcohol use and frequency of monthly drinking at 10 and 22 months after baseline measurement.Findings: A total of 2937 students were eligible for analyses in this study. At first follow-up, only the combined student–parent intervention showed substantial and statistically significant effects on heavy weekly drinking, weekly drinking and frequency of drinking. At second follow-up these results were replicated, except for the effects of the combined intervention on heavy weekly drinking. These findings were consistent across intention-to-treat and completers-only analyses.Conclusions: Results suggest that adolescents as well as their parents should be targeted in order to delay the onset of drinking, preferably prior to onset of weekly drinking.
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