Cost-effectiveness of psychological interventions for children and young people with post-traumatic stress disorder / Ifigeneia MAVRANEZOULI in Journal of Child Psychology and Psychiatry, 61-6 (June 2020)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 61-6 (June 2020) . - p.699-710 Titre : Cost-effectiveness of psychological interventions for children and young people with post-traumatic stress disorder Type de document : texte imprimé Auteurs : Ifigeneia MAVRANEZOULI, Auteur ; Odette MEGNIN-VIGGARS, Auteur ; David TRICKEY, Auteur ; Richard MEISER-STEDMAN, Auteur ; Caitlin DALY, Auteur ; Sofia DIAS, Auteur ; Sarah STOCKTON, Auteur ; Stephen PILLING, Auteur Article en page(s) : p.699-710 Langues : Anglais (eng) Mots-clés : Post-traumatic stress disorder  decision-analytic modelling  economic evaluation  intervention Index. décimale : PER Périodiques Résumé : BACKGROUND: PTSD in youth may lead to long-lasting psychological implications, educational difficulties and increased healthcare costs. Psychological interventions have been shown to be effective in its management. The objective of this study was to assess the cost-effectiveness of a range of psychological interventions for children and young people with PTSD. METHODS: A decision-analytic model was constructed to compare costs and quality-adjusted life years (QALYs) of 10 psychological interventions and no treatment for children and young people with PTSD, from the perspective of the National Health Service and personal social services in England. Effectiveness data were derived from a systematic review and network meta-analysis. Other model input parameters were based on published sources, supplemented by expert opinion. RESULTS: Cognitive therapy for PTSD, a form of individual trauma-focused cognitive behavioural therapy (TF-CBT), appeared to be the most cost-effective intervention for children and young people with PTSD (with a probability of .78 amongst the 11 evaluated options at a cost-effectiveness threshold of £20,000/QALY), followed by narrative exposure (another form of individual TF-CBT), play therapy, and other forms of individual TF-CBT. After excluding cognitive therapy from the analysis, narrative exposure appeared to be the most cost-effective option with a .40 probability of being cost-effective amongst the remaining 10 options. EMDR, parent training and group TF-CBT occupied middle cost-effectiveness rankings. Family therapy and supportive counselling were less cost-effective than other active interventions. There was limited evidence for some interventions, in particular cognitive therapy for PTSD and parent training. CONCLUSIONS: Individual forms of TF-CBT and, to a lesser degree, play therapy appear to be cost-effective in the treatment of children and young people with PTSD. Family therapy and supportive counselling are unlikely to be cost-effective relative to other interventions. There is a need for well-conducted studies that examine the long-term clinical and cost-effectiveness of a range of psychological treatments for children and young people with PTSD. En ligne : http://dx.doi.org/10.1111/jcpp.13142 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=426 [article] Cost-effectiveness of psychological interventions for children and young people with post-traumatic stress disorder [texte imprimé] / Ifigeneia MAVRANEZOULI, Auteur ; Odette MEGNIN-VIGGARS, Auteur ; David TRICKEY, Auteur ; Richard MEISER-STEDMAN, Auteur ; Caitlin DALY, Auteur ; Sofia DIAS, Auteur ; Sarah STOCKTON, Auteur ; Stephen PILLING, Auteur . - p.699-710. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 61-6 (June 2020) . - p.699-710 Mots-clés : Post-traumatic stress disorder  decision-analytic modelling  economic evaluation  intervention Index. décimale : PER Périodiques Résumé : BACKGROUND: PTSD in youth may lead to long-lasting psychological implications, educational difficulties and increased healthcare costs. Psychological interventions have been shown to be effective in its management. The objective of this study was to assess the cost-effectiveness of a range of psychological interventions for children and young people with PTSD. METHODS: A decision-analytic model was constructed to compare costs and quality-adjusted life years (QALYs) of 10 psychological interventions and no treatment for children and young people with PTSD, from the perspective of the National Health Service and personal social services in England. Effectiveness data were derived from a systematic review and network meta-analysis. Other model input parameters were based on published sources, supplemented by expert opinion. RESULTS: Cognitive therapy for PTSD, a form of individual trauma-focused cognitive behavioural therapy (TF-CBT), appeared to be the most cost-effective intervention for children and young people with PTSD (with a probability of .78 amongst the 11 evaluated options at a cost-effectiveness threshold of £20,000/QALY), followed by narrative exposure (another form of individual TF-CBT), play therapy, and other forms of individual TF-CBT. After excluding cognitive therapy from the analysis, narrative exposure appeared to be the most cost-effective option with a .40 probability of being cost-effective amongst the remaining 10 options. EMDR, parent training and group TF-CBT occupied middle cost-effectiveness rankings. Family therapy and supportive counselling were less cost-effective than other active interventions. There was limited evidence for some interventions, in particular cognitive therapy for PTSD and parent training. CONCLUSIONS: Individual forms of TF-CBT and, to a lesser degree, play therapy appear to be cost-effective in the treatment of children and young people with PTSD. Family therapy and supportive counselling are unlikely to be cost-effective relative to other interventions. There is a need for well-conducted studies that examine the long-term clinical and cost-effectiveness of a range of psychological treatments for children and young people with PTSD. En ligne : http://dx.doi.org/10.1111/jcpp.13142 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=426

Research Review: Psychological and psychosocial treatments for children and young people with post-traumatic stress disorder: a network meta-analysis / Ifigeneia MAVRANEZOULI in Journal of Child Psychology and Psychiatry, 61-1 (January 2020)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 61-1 (January 2020) . - p.18-29 Titre : Research Review: Psychological and psychosocial treatments for children and young people with post-traumatic stress disorder: a network meta-analysis Type de document : texte imprimé Auteurs : Ifigeneia MAVRANEZOULI, Auteur ; Odette MEGNIN-VIGGARS, Auteur ; Caitlin DALY, Auteur ; Sofia DIAS, Auteur ; Sarah STOCKTON, Auteur ; Richard MEISER-STEDMAN, Auteur ; David TRICKEY, Auteur ; Stephen PILLING, Auteur Article en page(s) : p.18-29 Langues : Anglais (eng) Mots-clés : Post-traumatic stress disorder  intervention  network meta-analysis Index. décimale : PER Périodiques Résumé : BACKGROUND: Post-traumatic stress disorder (PTSD) is a potentially chronic and disabling disorder that affects a significant minority of youth exposed to trauma. Previous studies have concluded that trauma-focused cognitive behavioural therapy (TF-CBT) is an effective treatment for PTSD in youth, but the relative strengths of different psychological therapies are poorly understood. METHODS: We undertook a systematic review and network meta-analyses of psychological and psychosocial interventions for children and young people with PTSD. Outcomes included PTSD symptom change scores post-treatment and at 1-4-month follow-up, and remission post-treatment. RESULTS: We included 32 trials of 17 interventions and 2,260 participants. Overall, the evidence was of moderate-to-low quality. No inconsistency was detected between direct and indirect evidence. Individual forms of TF-CBT showed consistently large effects in reducing PTSD symptoms post-treatment compared with waitlist. The order of interventions by descending magnitude of effect versus waitlist was as follows: cognitive therapy for PTSD (SMD -2.94, 95%CrI -3.94 to -1.95), combined somatic/cognitive therapies, child-parent psychotherapy, combined TF-CBT/parent training, meditation, narrative exposure, exposure/prolonged exposure, play therapy, Cohen TF-CBT/cognitive processing therapy (CPT), eye movement desensitisation and reprocessing (EMDR), parent training, group TF-CBT, supportive counselling and family therapy (SMD -0.37, 95%CrI -1.60 to 0.84). Results for parent training, supportive counselling and family therapy were inconclusive. Cohen TF-CBT/CPT, group TF-CBT and supportive counselling had the largest evidence base. Results regarding changes in PTSD symptoms at follow-up and remission post-treatment were uncertain due to limited evidence. CONCLUSIONS: Trauma-focused cognitive behavioural therapy, in particular individual forms, appears to be most effective in the management of PTSD in youth. EMDR is effective but to a lesser extent. Supportive counselling does not appear to be effective. Results suggest a large positive effect for emotional freedom technique, child-parent psychotherapy, combined TF-CBT/parent training, and meditation, but further research is needed to confirm these findings as they were based on very limited evidence. En ligne : http://dx.doi.org/10.1111/jcpp.13094 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=413 [article] Research Review: Psychological and psychosocial treatments for children and young people with post-traumatic stress disorder: a network meta-analysis [texte imprimé] / Ifigeneia MAVRANEZOULI, Auteur ; Odette MEGNIN-VIGGARS, Auteur ; Caitlin DALY, Auteur ; Sofia DIAS, Auteur ; Sarah STOCKTON, Auteur ; Richard MEISER-STEDMAN, Auteur ; David TRICKEY, Auteur ; Stephen PILLING, Auteur . - p.18-29. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 61-1 (January 2020) . - p.18-29 Mots-clés : Post-traumatic stress disorder  intervention  network meta-analysis Index. décimale : PER Périodiques Résumé : BACKGROUND: Post-traumatic stress disorder (PTSD) is a potentially chronic and disabling disorder that affects a significant minority of youth exposed to trauma. Previous studies have concluded that trauma-focused cognitive behavioural therapy (TF-CBT) is an effective treatment for PTSD in youth, but the relative strengths of different psychological therapies are poorly understood. METHODS: We undertook a systematic review and network meta-analyses of psychological and psychosocial interventions for children and young people with PTSD. Outcomes included PTSD symptom change scores post-treatment and at 1-4-month follow-up, and remission post-treatment. RESULTS: We included 32 trials of 17 interventions and 2,260 participants. Overall, the evidence was of moderate-to-low quality. No inconsistency was detected between direct and indirect evidence. Individual forms of TF-CBT showed consistently large effects in reducing PTSD symptoms post-treatment compared with waitlist. The order of interventions by descending magnitude of effect versus waitlist was as follows: cognitive therapy for PTSD (SMD -2.94, 95%CrI -3.94 to -1.95), combined somatic/cognitive therapies, child-parent psychotherapy, combined TF-CBT/parent training, meditation, narrative exposure, exposure/prolonged exposure, play therapy, Cohen TF-CBT/cognitive processing therapy (CPT), eye movement desensitisation and reprocessing (EMDR), parent training, group TF-CBT, supportive counselling and family therapy (SMD -0.37, 95%CrI -1.60 to 0.84). Results for parent training, supportive counselling and family therapy were inconclusive. Cohen TF-CBT/CPT, group TF-CBT and supportive counselling had the largest evidence base. Results regarding changes in PTSD symptoms at follow-up and remission post-treatment were uncertain due to limited evidence. CONCLUSIONS: Trauma-focused cognitive behavioural therapy, in particular individual forms, appears to be most effective in the management of PTSD in youth. EMDR is effective but to a lesser extent. Supportive counselling does not appear to be effective. Results suggest a large positive effect for emotional freedom technique, child-parent psychotherapy, combined TF-CBT/parent training, and meditation, but further research is needed to confirm these findings as they were based on very limited evidence. En ligne : http://dx.doi.org/10.1111/jcpp.13094 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=413

The cost-effectiveness of supported employment for adults with autism in the United Kingdom / Ifigeneia MAVRANEZOULI in Autism, 18-8 (November 2014)  

Public ISBD [article]  inAutism > 18-8 (November 2014) . - p.975-984 Titre : The cost-effectiveness of supported employment for adults with autism in the United Kingdom Type de document : texte imprimé Auteurs : Ifigeneia MAVRANEZOULI, Auteur ; Odette MEGNIN-VIGGARS, Auteur ; Nadir CHEEMA, Auteur ; Patricia HOWLIN, Auteur ; Simon BARON-COHEN, Auteur ; Stephen PILLING, Auteur Article en page(s) : p.975-984 Langues : Anglais (eng) Mots-clés : autism  cost-effectiveness  economics  supported employment Index. décimale : PER Périodiques Résumé : Adults with autism face high rates of unemployment. Supported employment enables individuals with autism to secure and maintain a paid job in a regular work environment. The objective of this study was to assess the cost-effectiveness of supported employment compared with standard care (day services) for adults with autism in the United Kingdom. Thus, a decision-analytic economic model was developed, which used outcome data from the only trial that has evaluated supported employment for adults with autism in the United Kingdom. The main analysis considered intervention costs, while cost-savings associated with changes in accommodation status and National Health Service and personal social service resource use were examined in secondary analyses. Two outcome measures were used: the number of weeks in employment and the quality-adjusted life year. Supported employment resulted in better outcomes compared with standard care, at an extra cost of £18 per additional week in employment or £5600 per quality-adjusted life year. In secondary analyses that incorporated potential cost-savings, supported employment dominated standard care (i.e. it produced better outcomes at a lower total cost). The analysis suggests that supported employment schemes for adults with autism in the United Kingdom are cost-effective compared with standard care. Further research needs to confirm these findings. En ligne : http://dx.doi.org/10.1177/1362361313505720 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=242 [article] The cost-effectiveness of supported employment for adults with autism in the United Kingdom [texte imprimé] / Ifigeneia MAVRANEZOULI, Auteur ; Odette MEGNIN-VIGGARS, Auteur ; Nadir CHEEMA, Auteur ; Patricia HOWLIN, Auteur ; Simon BARON-COHEN, Auteur ; Stephen PILLING, Auteur . - p.975-984. Langues : Anglais (eng) in Autism > 18-8 (November 2014) . - p.975-984 Mots-clés : autism  cost-effectiveness  economics  supported employment Index. décimale : PER Périodiques Résumé : Adults with autism face high rates of unemployment. Supported employment enables individuals with autism to secure and maintain a paid job in a regular work environment. The objective of this study was to assess the cost-effectiveness of supported employment compared with standard care (day services) for adults with autism in the United Kingdom. Thus, a decision-analytic economic model was developed, which used outcome data from the only trial that has evaluated supported employment for adults with autism in the United Kingdom. The main analysis considered intervention costs, while cost-savings associated with changes in accommodation status and National Health Service and personal social service resource use were examined in secondary analyses. Two outcome measures were used: the number of weeks in employment and the quality-adjusted life year. Supported employment resulted in better outcomes compared with standard care, at an extra cost of £18 per additional week in employment or £5600 per quality-adjusted life year. In secondary analyses that incorporated potential cost-savings, supported employment dominated standard care (i.e. it produced better outcomes at a lower total cost). The analysis suggests that supported employment schemes for adults with autism in the United Kingdom are cost-effective compared with standard care. Further research needs to confirm these findings. En ligne : http://dx.doi.org/10.1177/1362361313505720 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=242

udiovisual speech integration in autism spectrum disorders: ERP evidence for atypicalities in lexical-semantic processing / Odette MEGNIN in Autism Research, 5-1 (February 2012)  

Public ISBD [article]  inAutism Research > 5-1 (February 2012) . - p.39-48 Titre : udiovisual speech integration in autism spectrum disorders: ERP evidence for atypicalities in lexical-semantic processing Type de document : texte imprimé Auteurs : Odette MEGNIN, Auteur ; Atlanta FLITTON, Auteur ; Catherine R.G. JONES, Auteur ; Michelle DE HAAN, Auteur ; Torsten BALDEWEG, Auteur ; Tony CHARMAN, Auteur Année de publication : 2012 Article en page(s) : p.39-48 Langues : Anglais (eng) Mots-clés : auditory  ASD  ERP  language  multisensory  visual Index. décimale : PER Périodiques Résumé : In typically developing (TD) individuals, behavioral and event-related potential (ERP) studies suggest that audiovisual (AV) integration enables faster and more efficient processing of speech. However, little is known about AV speech processing in individuals with autism spectrum disorders (ASD). This study examined ERP responses to spoken words to elucidate the effects of visual speech (the lip movements accompanying a spoken word) on the range of auditory speech processing stages from sound onset detection to semantic integration. The study also included an AV condition, which paired spoken words with a dynamic scrambled face in order to highlight AV effects specific to visual speech. Fourteen adolescent boys with ASD (15–17 years old) and 14 age- and verbal IQ-matched TD boys participated. The ERP of the TD group showed a pattern and topography of AV interaction effects consistent with activity within the superior temporal plane, with two dissociable effects over frontocentral and centroparietal regions. The posterior effect (200–300 ms interval) was specifically sensitive to lip movements in TD boys, and no AV modulation was observed in this region for the ASD group. Moreover, the magnitude of the posterior AV effect to visual speech correlated inversely with ASD symptomatology. In addition, the ASD boys showed an unexpected effect (P2 time window) over the frontocentral region (pooled electrodes F3, Fz, F4, FC1, FC2, FC3, FC4), which was sensitive to scrambled face stimuli. These results suggest that the neural networks facilitating processing of spoken words by visual speech are altered in individuals with ASD. En ligne : http://dx.doi.org/10.1002/aur.231 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=153 [article] udiovisual speech integration in autism spectrum disorders: ERP evidence for atypicalities in lexical-semantic processing [texte imprimé] / Odette MEGNIN, Auteur ; Atlanta FLITTON, Auteur ; Catherine R.G. JONES, Auteur ; Michelle DE HAAN, Auteur ; Torsten BALDEWEG, Auteur ; Tony CHARMAN, Auteur . - 2012 . - p.39-48. Langues : Anglais (eng) in Autism Research > 5-1 (February 2012) . - p.39-48 Mots-clés : auditory  ASD  ERP  language  multisensory  visual Index. décimale : PER Périodiques Résumé : In typically developing (TD) individuals, behavioral and event-related potential (ERP) studies suggest that audiovisual (AV) integration enables faster and more efficient processing of speech. However, little is known about AV speech processing in individuals with autism spectrum disorders (ASD). This study examined ERP responses to spoken words to elucidate the effects of visual speech (the lip movements accompanying a spoken word) on the range of auditory speech processing stages from sound onset detection to semantic integration. The study also included an AV condition, which paired spoken words with a dynamic scrambled face in order to highlight AV effects specific to visual speech. Fourteen adolescent boys with ASD (15–17 years old) and 14 age- and verbal IQ-matched TD boys participated. The ERP of the TD group showed a pattern and topography of AV interaction effects consistent with activity within the superior temporal plane, with two dissociable effects over frontocentral and centroparietal regions. The posterior effect (200–300 ms interval) was specifically sensitive to lip movements in TD boys, and no AV modulation was observed in this region for the ASD group. Moreover, the magnitude of the posterior AV effect to visual speech correlated inversely with ASD symptomatology. In addition, the ASD boys showed an unexpected effect (P2 time window) over the frontocentral region (pooled electrodes F3, Fz, F4, FC1, FC2, FC3, FC4), which was sensitive to scrambled face stimuli. These results suggest that the neural networks facilitating processing of spoken words by visual speech are altered in individuals with ASD. En ligne : http://dx.doi.org/10.1002/aur.231 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=153

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