The clinical and cost effectiveness of a STAndardised DIagnostic Assessment for children and adolescents with emotional difficulties: the STADIA multi-centre randomised controlled trial / Laura WYATT ; Christopher PARTLETT ; Colleen EWART ; Anupam BHARDWAJ ; Bernadka DUBICKA ; Tamsin MARSHALL ; Julia GLEDHILL ; Alexandra LANG ; Kirsty SPRANGE ; Louise THOMSON ; Sebastian MOODY ; Grace HOLT ; Helen BOULD ; Clare UPTON ; Matthew KEANE ; Edward COX ; Marilyn JAMES ; Alan MONTGOMERY in Journal of Child Psychology and Psychiatry, 66-6 (June 2025)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 66-6 (June 2025) . - p.805-820 Titre : The clinical and cost effectiveness of a STAndardised DIagnostic Assessment for children and adolescents with emotional difficulties: the STADIA multi-centre randomised controlled trial Type de document : Texte imprimé et/ou numérique Auteurs : Laura WYATT, Auteur ; Christopher PARTLETT, Auteur ; Colleen EWART, Auteur ; Anupam BHARDWAJ, Auteur ; Bernadka DUBICKA, Auteur ; Tamsin MARSHALL, Auteur ; Julia GLEDHILL, Auteur ; Alexandra LANG, Auteur ; Kirsty SPRANGE, Auteur ; Louise THOMSON, Auteur ; Sebastian MOODY, Auteur ; Grace HOLT, Auteur ; Helen BOULD, Auteur ; Clare UPTON, Auteur ; Matthew KEANE, Auteur ; Edward COX, Auteur ; Marilyn JAMES, Auteur ; Alan MONTGOMERY, Auteur Article en page(s) : p.805-820 Langues : Anglais (eng) Mots-clés : RCT  standardised diagnostic assessment  diagnosis  emotional disorders  health economic evaluation  STADIA  Child and Adolescent Mental Health Services (CAMHS) Index. décimale : PER Périodiques Résumé : Background Standardised Diagnostic Assessment tools, such as the Development and Well-Being Assessment (DAWBA), may aid detection and diagnosis of emotional disorders but there is limited real-world evidence of their clinical or cost effectiveness. Methods We conducted a multicentre, two-arm parallel group randomised controlled trial in eight large National Health Service Trusts in England providing multidisciplinary specialist Child and Adolescent Mental Health Services (CAMHS). Participants (5?17?year-olds with emotional difficulties referred to CAMHS) were randomly assigned (1:1), following referral receipt, to either receive the DAWBA and assessment-as-usual (intervention group) or assessment-as-usual (control group). Data were self-reported by participants (parents and/or young person, depending on age) at baseline, 6- and 12-month post-randomisation and collected from clinical records up to 18?months post-randomisation. The primary outcome was a clinician-made diagnosis decision about the presence of an emotional disorder within 12?months of randomisation. Trial registration: ISRCTN15748675. Results In total, 1,225 children and young people (58% female sex) were randomised (615 intervention; 610 control). Adherence to the intervention (full/partial completion) was 80% (494/615). At 12?months, 68 (11%) participants in the intervention group received an emotional disorder diagnosis versus 72 (12%) in the control group (adjusted risk ratio (RR) 0.94 [95% CI 0.70, 1.28]). The intervention was not cost effective. There was no evidence of any differences between groups for service-related or participant-reported secondary outcomes, for example, CAMHS acceptance of the index referral (intervention 277 (45%) versus control 262 (43%); RR: 1.06 [95% CI: 0.94, 1.19]) was similar between groups. Conclusions As delivered in this pragmatic trial, we found no evidence for the effectiveness or cost effectiveness of using a Standardised Diagnostic Assessment tool in aiding the detection of emotional disorders or clinical outcomes in clinically referred children and young people. Despite regular efforts to encourage clinicians to view the DAWBA report and consider its findings as part of assessment and diagnosis, we did not collect data on usage and therefore cannot confirm the extent to which clinicians did this. As a pragmatic trial that aimed to test the effectiveness of incorporating the DAWBA into usual practice and clinical care, our study found that, in the format as delivered in this trial, there was no impact on diagnosis or clinical outcomes. En ligne : https://doi.org/10.1111/jcpp.14090 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=556 [article] The clinical and cost effectiveness of a STAndardised DIagnostic Assessment for children and adolescents with emotional difficulties: the STADIA multi-centre randomised controlled trial [Texte imprimé et/ou numérique] / Laura WYATT, Auteur ; Christopher PARTLETT, Auteur ; Colleen EWART, Auteur ; Anupam BHARDWAJ, Auteur ; Bernadka DUBICKA, Auteur ; Tamsin MARSHALL, Auteur ; Julia GLEDHILL, Auteur ; Alexandra LANG, Auteur ; Kirsty SPRANGE, Auteur ; Louise THOMSON, Auteur ; Sebastian MOODY, Auteur ; Grace HOLT, Auteur ; Helen BOULD, Auteur ; Clare UPTON, Auteur ; Matthew KEANE, Auteur ; Edward COX, Auteur ; Marilyn JAMES, Auteur ; Alan MONTGOMERY, Auteur . - p.805-820. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 66-6 (June 2025) . - p.805-820 Mots-clés : RCT  standardised diagnostic assessment  diagnosis  emotional disorders  health economic evaluation  STADIA  Child and Adolescent Mental Health Services (CAMHS) Index. décimale : PER Périodiques Résumé : Background Standardised Diagnostic Assessment tools, such as the Development and Well-Being Assessment (DAWBA), may aid detection and diagnosis of emotional disorders but there is limited real-world evidence of their clinical or cost effectiveness. Methods We conducted a multicentre, two-arm parallel group randomised controlled trial in eight large National Health Service Trusts in England providing multidisciplinary specialist Child and Adolescent Mental Health Services (CAMHS). Participants (5?17?year-olds with emotional difficulties referred to CAMHS) were randomly assigned (1:1), following referral receipt, to either receive the DAWBA and assessment-as-usual (intervention group) or assessment-as-usual (control group). Data were self-reported by participants (parents and/or young person, depending on age) at baseline, 6- and 12-month post-randomisation and collected from clinical records up to 18?months post-randomisation. The primary outcome was a clinician-made diagnosis decision about the presence of an emotional disorder within 12?months of randomisation. Trial registration: ISRCTN15748675. Results In total, 1,225 children and young people (58% female sex) were randomised (615 intervention; 610 control). Adherence to the intervention (full/partial completion) was 80% (494/615). At 12?months, 68 (11%) participants in the intervention group received an emotional disorder diagnosis versus 72 (12%) in the control group (adjusted risk ratio (RR) 0.94 [95% CI 0.70, 1.28]). The intervention was not cost effective. There was no evidence of any differences between groups for service-related or participant-reported secondary outcomes, for example, CAMHS acceptance of the index referral (intervention 277 (45%) versus control 262 (43%); RR: 1.06 [95% CI: 0.94, 1.19]) was similar between groups. Conclusions As delivered in this pragmatic trial, we found no evidence for the effectiveness or cost effectiveness of using a Standardised Diagnostic Assessment tool in aiding the detection of emotional disorders or clinical outcomes in clinically referred children and young people. Despite regular efforts to encourage clinicians to view the DAWBA report and consider its findings as part of assessment and diagnosis, we did not collect data on usage and therefore cannot confirm the extent to which clinicians did this. As a pragmatic trial that aimed to test the effectiveness of incorporating the DAWBA into usual practice and clinical care, our study found that, in the format as delivered in this trial, there was no impact on diagnosis or clinical outcomes. En ligne : https://doi.org/10.1111/jcpp.14090 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=556

Toward precision therapeutics: general and specific factors differentiate symptom change in depressed adolescents / Madison AITKEN in Journal of Child Psychology and Psychiatry, 61-9 (September 2020)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 61-9 (September 2020) . - p.998-1008 Titre : Toward precision therapeutics: general and specific factors differentiate symptom change in depressed adolescents Type de document : Texte imprimé et/ou numérique Auteurs : Madison AITKEN, Auteur ; John D. HALTIGAN, Auteur ; Peter SZATMARI, Auteur ; Bernadka DUBICKA, Auteur ; Peter FONAGY, Auteur ; Raphael KELVIN, Auteur ; Nick MIDGLEY, Auteur ; Shirley REYNOLDS, Auteur ; Paul O. WILKINSON, Auteur ; Ian M. GOODYER, Auteur Année de publication : 2020 Article en page(s) : p.998-1008 Langues : Anglais (eng) Mots-clés : Bifactor models  adolescent  depression  psychopathology  psychotherapy Index. décimale : PER Périodiques Résumé : BACKGROUND: The longitudinal course of multiple symptom domains in adolescents treated for major depression is not known. Revealing the temporal course of general and specific psychopathology factors, including potential differences between psychotherapies, may aid therapeutic decision-making. METHODS: Participants were adolescents with major depressive disorder (aged 11-17; 75% female; N = 465) who were part of the IMPACT trial, a randomized controlled trial comparing cognitive behavioral therapy, short-term psychoanalytic psychotherapy, and brief psychosocial intervention. Self-reported symptoms at baseline and 6, 12, 36, 52, and 86 weeks postrandomization were analyzed with bifactor modeling. RESULTS: General psychopathology factor scores decreased across treatment and one-year follow-up. Specific melancholic features and depressive cognitions factors decreased from baseline to 6 weeks. Conduct problems decreased across treatment and follow-up. Anxiety increased by 6 weeks and then reverted to baseline levels. Obsessions-compulsions did not change. Changes in general and specific factors were not significantly different between the three psychotherapies during treatment. During follow-up, however, conduct problems decreased more in brief psychosocial intervention versus cognitive behavioral therapy (1.02, 95% Bayes credible interval 0.25, 1.96), but not versus short-term psychoanalytic psychotherapy. CONCLUSIONS: The clinical response signature in this trial is best revealed by rapid reductions in depression symptoms and general psychopathology. Protracted improvements in general psychopathology and conduct problems subsequently occur. Psychosocial treatments for adolescent depression have comparable effects on general and specific psychopathology, although a psychoeducational, goal-focused approach may be indicated for youth with comorbid conduct problems. En ligne : http://dx.doi.org/10.1111/jcpp.13194 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=430 [article] Toward precision therapeutics: general and specific factors differentiate symptom change in depressed adolescents [Texte imprimé et/ou numérique] / Madison AITKEN, Auteur ; John D. HALTIGAN, Auteur ; Peter SZATMARI, Auteur ; Bernadka DUBICKA, Auteur ; Peter FONAGY, Auteur ; Raphael KELVIN, Auteur ; Nick MIDGLEY, Auteur ; Shirley REYNOLDS, Auteur ; Paul O. WILKINSON, Auteur ; Ian M. GOODYER, Auteur . - 2020 . - p.998-1008. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 61-9 (September 2020) . - p.998-1008 Mots-clés : Bifactor models  adolescent  depression  psychopathology  psychotherapy Index. décimale : PER Périodiques Résumé : BACKGROUND: The longitudinal course of multiple symptom domains in adolescents treated for major depression is not known. Revealing the temporal course of general and specific psychopathology factors, including potential differences between psychotherapies, may aid therapeutic decision-making. METHODS: Participants were adolescents with major depressive disorder (aged 11-17; 75% female; N = 465) who were part of the IMPACT trial, a randomized controlled trial comparing cognitive behavioral therapy, short-term psychoanalytic psychotherapy, and brief psychosocial intervention. Self-reported symptoms at baseline and 6, 12, 36, 52, and 86 weeks postrandomization were analyzed with bifactor modeling. RESULTS: General psychopathology factor scores decreased across treatment and one-year follow-up. Specific melancholic features and depressive cognitions factors decreased from baseline to 6 weeks. Conduct problems decreased across treatment and follow-up. Anxiety increased by 6 weeks and then reverted to baseline levels. Obsessions-compulsions did not change. Changes in general and specific factors were not significantly different between the three psychotherapies during treatment. During follow-up, however, conduct problems decreased more in brief psychosocial intervention versus cognitive behavioral therapy (1.02, 95% Bayes credible interval 0.25, 1.96), but not versus short-term psychoanalytic psychotherapy. CONCLUSIONS: The clinical response signature in this trial is best revealed by rapid reductions in depression symptoms and general psychopathology. Protracted improvements in general psychopathology and conduct problems subsequently occur. Psychosocial treatments for adolescent depression have comparable effects on general and specific psychopathology, although a psychoeducational, goal-focused approach may be indicated for youth with comorbid conduct problems. En ligne : http://dx.doi.org/10.1111/jcpp.13194 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=430

Trajectories of depression symptom change during and following treatment in adolescents with unipolar major depression / Sian Emma DAVIES in Journal of Child Psychology and Psychiatry, 61-5 (May 2020)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 61-5 (May 2020) . - p.565-574 Titre : Trajectories of depression symptom change during and following treatment in adolescents with unipolar major depression Type de document : Texte imprimé et/ou numérique Auteurs : Sian Emma DAVIES, Auteur ; Sharon A. S. NEUFELD, Auteur ; Eleonore VAN SPRANG, Auteur ; Lizanne SCHWEREN, Auteur ; Rogier KEIVIT, Auteur ; Peter FONAGY, Auteur ; Bernadka DUBICKA, Auteur ; Raphael KELVIN, Auteur ; Nick MIDGLEY, Auteur ; Shirley REYNOLDS, Auteur ; Mary TARGET, Auteur ; Paul WILKINSON, Auteur ; Anne Laura VAN HARMELEN, Auteur ; Ian Michael GOODYER, Auteur Article en page(s) : p.565-574 Langues : Anglais (eng) Mots-clés : Depression  longitudinal studies  outcome  therapy Index. décimale : PER Périodiques Résumé : OBJECTIVE: To classify a cohort of depressed adolescents recruited to the UK IMPACT trial, according to trajectories of symptom change. We examined for predictors and compared the data-driven categories of patients with a priori operational definitions of treatment response. METHOD: Secondary data analysis using growth mixture modelling (GMM). Missing data were imputed. Trajectories of self-reported depressive symptoms were plotted using scores taken at six nominal time points over 86 weeks from randomisation in all 465 patients. RESULTS: A piecewise GMM categorised patients into two classes with initially similar and subsequently distinct trajectories. Both groups had a significant decline in depressive symptoms over the first 18 weeks. Eighty-four per cent (84.1%, n = 391) of patients were classed as 'continued-improvers' with symptoms reducing over the duration of the study. A further class of 15.9% (n = 74) of patients were termed 'halted-improvers' with higher baseline depression scores, faster early recovery but no further improvement after 18 weeks. Presence of baseline comorbidity somewhat increased membership to the halted-improvers class (OR = 1.40, CI: 1.00-1.96). By end of study, compared with classes, a clinical remission cut-off score (/=50%) indexing treatment response misclassified 15% and 31% of cases, respectively. CONCLUSIONS: A fast reduction in depressive symptoms in the first few weeks of treatment may not indicate a good prognosis. Halted improvement is only seen after 18 weeks of treatment. Longitudinal modelling may improve the precision of revealing differential responses to treatment. Improvement in depressive symptoms may be somewhat better in the year after treatment than previously considered. En ligne : http://dx.doi.org/10.1111/jcpp.13145 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=422 [article] Trajectories of depression symptom change during and following treatment in adolescents with unipolar major depression [Texte imprimé et/ou numérique] / Sian Emma DAVIES, Auteur ; Sharon A. S. NEUFELD, Auteur ; Eleonore VAN SPRANG, Auteur ; Lizanne SCHWEREN, Auteur ; Rogier KEIVIT, Auteur ; Peter FONAGY, Auteur ; Bernadka DUBICKA, Auteur ; Raphael KELVIN, Auteur ; Nick MIDGLEY, Auteur ; Shirley REYNOLDS, Auteur ; Mary TARGET, Auteur ; Paul WILKINSON, Auteur ; Anne Laura VAN HARMELEN, Auteur ; Ian Michael GOODYER, Auteur . - p.565-574. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 61-5 (May 2020) . - p.565-574 Mots-clés : Depression  longitudinal studies  outcome  therapy Index. décimale : PER Périodiques Résumé : OBJECTIVE: To classify a cohort of depressed adolescents recruited to the UK IMPACT trial, according to trajectories of symptom change. We examined for predictors and compared the data-driven categories of patients with a priori operational definitions of treatment response. METHOD: Secondary data analysis using growth mixture modelling (GMM). Missing data were imputed. Trajectories of self-reported depressive symptoms were plotted using scores taken at six nominal time points over 86 weeks from randomisation in all 465 patients. RESULTS: A piecewise GMM categorised patients into two classes with initially similar and subsequently distinct trajectories. Both groups had a significant decline in depressive symptoms over the first 18 weeks. Eighty-four per cent (84.1%, n = 391) of patients were classed as 'continued-improvers' with symptoms reducing over the duration of the study. A further class of 15.9% (n = 74) of patients were termed 'halted-improvers' with higher baseline depression scores, faster early recovery but no further improvement after 18 weeks. Presence of baseline comorbidity somewhat increased membership to the halted-improvers class (OR = 1.40, CI: 1.00-1.96). By end of study, compared with classes, a clinical remission cut-off score (/=50%) indexing treatment response misclassified 15% and 31% of cases, respectively. CONCLUSIONS: A fast reduction in depressive symptoms in the first few weeks of treatment may not indicate a good prognosis. Halted improvement is only seen after 18 weeks of treatment. Longitudinal modelling may improve the precision of revealing differential responses to treatment. Improvement in depressive symptoms may be somewhat better in the year after treatment than previously considered. En ligne : http://dx.doi.org/10.1111/jcpp.13145 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=422

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