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Philipsson, A., Alaie, I., Ssegonja, R., Imberg, H., Copeland, W., Möller, M., . . . Jonsson, U. (2020). Adolescent depression and subsequent earnings across early to middle adulthood: a 25-year longitudinal cohort study. Epidemiology and Psychiatric Sciences, 29, Article ID e123.
Open this publication in new window or tab >>Adolescent depression and subsequent earnings across early to middle adulthood: a 25-year longitudinal cohort study
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2020 (English)In: Epidemiology and Psychiatric Sciences, ISSN 2045-7960, E-ISSN 1827-4331, Vol. 29, article id e123Article in journal (Refereed) Published
Abstract [en]

AIMS: The few available studies on early-onset depression and future earnings offer ambiguous findings, and potential sources of heterogeneity are poorly understood. We examined the differences in adult earnings of males and females with and without a history of depressive disorder in adolescence, with specific focuses on (1) future earnings in clinical subtypes of adolescent depression; (2) the growth and distribution of earnings over time within these subgroups and (3) the mediating role of subsequent depressive episodes occurring in early adulthood.

METHODS: Data were drawn from the Uppsala Longitudinal Adolescent Depression Study, a community-based cohort study initiated in Uppsala, Sweden, in the early 1990s. Comprehensive diagnostic assessments were conducted at age 16-17 and in follow-up interviews 15 years later, while consecutive data on earnings for the years 1996 to 2016 (ages 20-40) were drawn from population-based registries. The current study included participants with a history of persistent depressive disorder (PDD) (n = 175), episodic major depressive disorder (MDD) (n = 82), subthreshold depression (n = 64) or no depression (n = 218) in adolescence. The association of adolescent depression with earnings in adulthood was analysed using generalised estimating equations. Estimates were adjusted for major child and adolescent psychiatric comorbidities and parental socioeconomic status. The indirect (mediated) effect of depression in early adulthood (ages 19-30) on earnings in mid-adulthood (31-40) was estimated in mediation analysis. The study followed the 'STrengthening the Reporting of OBservational studies in Epidemiology' (STROBE) guidelines.

RESULTS: Earnings across early to middle adulthood were lower for participants with a history of a PDD in adolescence than for their non-depressed peers, with an adjusted ratio of mean earnings of 0.85 (0.77-0.95) for females and 0.76 (0.60-0.95) for males. The differences were consistent over time, and more pronounced in the lower percentiles of the earnings distributions. The association was partially mediated by recurrent depression in early adulthood (48% in total; 61% for females, 29% for males). No reduction in earnings was observed among participants with episodic MDD in adolescence, while results for subthreshold depression were inconclusive.

CONCLUSIONS: Our findings suggest that future earnings of adolescents with depressive disorders are contingent on the duration and natural long-term course of early-onset depression, emphasising the need for timely and effective interventions to avoid loss of human capital.

Place, publisher, year, edition, pages
Cambridge University Press, 2020
Keywords
Adolescents, depression, economic issues, epidemiology, mental health
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-81455 (URN)10.1017/S2045796020000360 (DOI)000529152600001 ()32345393 (PubMedID)2-s2.0-85084107314 (Scopus ID)
Funder
Swedish Research CouncilVinnova, 2014-10092Swedish Research Council FormasForte, Swedish Research Council for Health, Working Life and Welfare
Note

Funding Agencies:

Uppsala-Örebro Regional Research Council  RFR-652841 RFR-738411 RFR-840891

Uppsala County Council's Funds for Clinical Research  LUL-713161 LUL-828241

Available from: 2020-05-04 Created: 2020-05-04 Last updated: 2020-05-12Bibliographically approved
Ssegonja, R., Alaie, I., Philipsson, A., Hagberg, L., Sampaio, F., Möller, M., . . . Feldman, I. (2019). Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood: A longitudinal cost-of-illness study. Journal of Affective Disorders, 258, 33-41
Open this publication in new window or tab >>Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood: A longitudinal cost-of-illness study
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2019 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 258, p. 33-41Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Depression in adolescence is associated with increased healthcare consumption in adulthood, but prior research has not recognized the heterogeneity of depressive disorders. This paper investigated the additional healthcare usage and related costs in mid-adulthood for individuals with adolescent depression, and examined the mediating role of subsequent depression in early adulthood.

METHODS: This study was based on the Uppsala Longitudinal Adolescent Depression Study, initiated in Sweden in the early 1990s. Depressive disorders were assessed in adolescence (age 16-17) and early adulthood (age 19-30). Healthcare usage and related costs in mid-adulthood (age 31-40) were estimated using nationwide population-based registries. Participants with specific subtypes of adolescent depression (n = 306) were compared with matched non-depressed peers (n = 213).

RESULTS: Women with persistent depressive disorder (PDD) in adolescence utilized significantly more healthcare resources in mid-adulthood. The association was not limited to psychiatric care, and remained after adjustment for individual and parental characteristics. The total additional annual cost for a single age group of females with a history of PDD at a population level was estimated at 3.10 million USD. Depression recurrence in early adulthood mediated the added costs for psychiatric care, but not for somatic care.

LIMITATIONS: Primary health care data were not available, presumably resulting in an underestimation of the true healthcare consumption. Estimates for males had limited precision due to a relatively small male proportion.

CONCLUSIONS: On a population level, the additional healthcare costs incurred in mid-adulthood in females with a history of adolescent PDD are considerable. Early treatment and prevention should be prioritized.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Adolescence, Adulthood, Depression, Direct costs, Non-psychiatric healthcare, Psychiatric healthcare
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-75560 (URN)10.1016/j.jad.2019.07.077 (DOI)000482176400004 ()31382102 (PubMedID)2-s2.0-85071708904 (Scopus ID)
Funder
Swedish Research Council, 2014-10092Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Research Council FormasVinnova
Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-11-15Bibliographically approved
Philipsson, A., Sandberg, E., Högström, S., Eriksson, M., Särnblad, S., Ekstav, L., . . . Duberg, A. (2019). ”Just in TIME” - Intervention med dans och yoga för flickor med funktionell magsmärta och IBS. In: : . Paper presented at Barnveckan, Örebro, Sweden, April 1-4, 2019.
Open this publication in new window or tab >>”Just in TIME” - Intervention med dans och yoga för flickor med funktionell magsmärta och IBS
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2019 (Swedish)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [sv]

Bakgrund och syfte

Funktionell magsmärta drabbar många barn i skolåldern, mestadels flickor. Det kan leda till minskad livskvalitet, skolfrånvaro, sämre sömn, försämrade kamratkontakter och ökad vårdkonsumtion. Det vetenskapliga underlaget för interventioner vid långvarig smärta hos barn är begränsat. Dans kan öka rörelseglädje och förbättra kroppskännedom, vilket i sin tur påverkar självtillit och kan öka psykiskt välbefinnande. Yoga kan ge mental avslappning och reducera stressreaktioner. Syftet med studien är att utvärdera effekten av en intervention med dans och yoga på återkommande magsmärta, stress och depressiva symtom samt på funktion i vardagen hos flickor 9-13 år som har funktionell buksmärta och IBS.

Metod

En randomiserad kontrollerad studie genomförs med forskningspersoner som identifieras via diagnosregister samt barnmottagningarna i Västerås och Örebro, samt från primärvården. Interventionen består av dans och yoga med fokus på rörelseglädje, gemenskap och kravlöshet, och utförs som gruppaktivitet två ggr/veckan under 8 månader. Primärt utfall är förändring av magsmärta efter 8 mån. Flickorna följs upp under fem år avseende magsmärta, självskattad hälsa, stress och psykiskt välmående, fysisk aktivitet och skolfunktioner. Vidare studeras kostnad i relation till nytta.

Resultat/(Planerade studier)

Projektet pågår och de första resultaten beräknas publiceras hösten 2019. Projektet utvärderas både kvalitativt, genom intervjuer med flickor och vårdnadshavare, och kvantitativt, genom bland annat analys av smärtdagböcker, upplevd hälsa, stress samt med en hälsoekonomisk analys. Därutöver utvärderas salivkortisol och faeces som objektiva mått. 

Konklusion

Studien förväntas leda till ökad kunskap om icke-farmakologiska insatser för barn samt hur behandlingsinsatser för målgruppen kan breddas med ett kostnadseffektivt alternativ till ”standard care”.

Keywords
Buksmärta, dans, yoga
National Category
Health Sciences Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:oru:diva-73177 (URN)
Conference
Barnveckan, Örebro, Sweden, April 1-4, 2019
Available from: 2019-03-18 Created: 2019-03-18 Last updated: 2019-04-17Bibliographically approved
Alaie, I., Philipsson, A., Ssegonja, R., Hagberg, L., Feldman, I., Sampaio, F., . . . Jonsson, U. (2019). Uppsala Longitudinal Adolescent Depression Study (ULADS). BMJ Open, 9(3), Article ID e024939.
Open this publication in new window or tab >>Uppsala Longitudinal Adolescent Depression Study (ULADS)
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 3, article id e024939Article in journal (Refereed) Published
Abstract [en]

Purpose: To present the Uppsala Longitudinal Adolescent Depression Study, initiated in Uppsala, Sweden, in the early 1990s. The initial aim of this epidemiological investigation was to study the prevalence, characteristics and correlates of adolescent depression, and has subsequently expanded to include a broad range of social, economic and health-related long-term outcomes and cost-of-illness analyses.

Participants: The source population was first-year students (aged 16-17) in upper-secondary schools in Uppsala during 1991-1992, of which 2300 (93%) were screened for depression. Adolescents with positive screening and sex/age-matched peers were invited to a comprehensive assessment. A total of 631 adolescents (78% females) completed this assessment, and 409 subsequently completed a 15year follow-up assessment. At both occasions, extensive information was collected on mental disorders, personality and psychosocial situation. Detailed social, economic and health-related data from 1993 onwards have recently been obtained from the Swedish national registries for 576 of the original participants and an age-matched reference population (N=200 000).

Findings to date: The adolescent lifetime prevalence of a major depressive episode was estimated to be 11.4%. Recurrence in young adulthood was reported by the majority, with a particularly poor prognosis for those with a persistent depressive disorder or multiple somatic symptoms. Adolescent depression was also associated with an increased risk of other adversities in adulthood, including additional mental health conditions, low educational attainment and problems related to intimate relationships.

Future plans: Longitudinal studies of adolescent depression are rare and must be responsibly managed and utilised. We therefore intend to follow the cohort continuously by means of registries. Currently, the participants are approaching mid-adulthood. At this stage, we are focusing on the overall long-term burden of adolescent depression. For this purpose, the research group has incorporated expertise in health economics. We would also welcome extended collaboration with researchers managing similar datasets.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
General Practice Psychiatry
Identifiers
urn:nbn:se:oru:diva-75243 (URN)10.1136/bmjopen-2018-024939 (DOI)000471144900167 ()30826765 (PubMedID)2-s2.0-85062413050 (Scopus ID)
Funder
Swedish Research Council, 2014-10092Forte, Swedish Research Council for Health, Working Life and Welfare
Note

Funding Agencies:

Uppsala-Orebro Regional Research Council  RFR-738411  RFR-652841 

Uppsala County Council's Funds for Clinical Research  LUL-713161 

Medical Training and Research Agreement Funds (ALF) from Uppsala University Hospital 

Märta and Nicke Nasvell Foundation  

Clas Groschinsky Memorial Fund  

Söderström-Königska Foundation  

Foundation in Memory of Professor Bror Gadelius 

Available from: 2019-07-25 Created: 2019-07-25 Last updated: 2019-07-25Bibliographically approved
Dahlberg, K., Philipsson, A., Hagberg, L., Jaensson, M., Hälleberg Nyman, M. & Nilsson, U. (2017). Cost-effectiveness of a systematic e-assessed follow up of postoperative recovery after day surgery: a multicentre randomized controlled trial. In: : . Paper presented at 4th International Conference for PeriAnaesthesia Nurses, Sydney, Australia, November 1-4, 2017.
Open this publication in new window or tab >>Cost-effectiveness of a systematic e-assessed follow up of postoperative recovery after day surgery: a multicentre randomized controlled trial
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2017 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-57059 (URN)
Conference
4th International Conference for PeriAnaesthesia Nurses, Sydney, Australia, November 1-4, 2017
Available from: 2017-04-18 Created: 2017-04-18 Last updated: 2019-04-05Bibliographically approved
Dahlberg, K., Philipsson, A., Hagberg, L., Jaensson, M., Hälleberg Nyman, M. & Nilsson, U. (2017). Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial. British Journal of Anaesthesia, 119(5), 1039-1046
Open this publication in new window or tab >>Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial
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2017 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 119, no 5, p. 1039-1046Article in journal (Refereed) Published
Abstract [en]

Background: Most surgeries are done on a day-stay basis. Recovery assessment by phone points (RAPP) is a smartphonebased application (app) to evaluate patients after day surgery. The aim of this study was to estimate the cost-effectiveness of using RAPP for follow-up on postoperative recovery compared with standard care.

Methods: This study was a prospective parallel single-blind multicentre randomized controlled trial. Participants were randomly allocated to the intervention group using RAPP or the control group receiving standard care. A cost-effectiveness analysis was performed based on individual data and included costs for the intervention, health effect [quality-adjusted life-years (QALYs)], and costs or savings in health-care use.

Results: The mean cost for health-care consumption during 2 weeks after surgery was estimated at e37.29 for the intervention group and e60.96 for the control group. The mean difference was e23.66 (99% confidence interval 46.57 to0.76; P¼0.008). When including the costs of the intervention, the cost-effectiveness analysis showed net savings of e4.77 per patient in favour of the intervention. No difference in QALYs gained was seen between the groups (P¼0.75). The probability of the intervention being cost-effective was 71%.

Conclusions: This study shows that RAPP can be cost-effective but had no effect on QALY. RAPP can be a cost-effective toolin providing low-cost health-care contacts and in systematically assessing the quality of postoperative recovery.

Clinical trial registration:NCT02492191

Place, publisher, year, edition, pages
Oxford University Press, 2017
Keywords
Ambulatory surgery, cost effectiveness, mobile applications, postoperative period
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-61954 (URN)10.1093/bja/aex332 (DOI)000413642900027 ()29077819 (PubMedID)2-s2.0-85034731856 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-4765Swedish Research Council, 2015-02273
Available from: 2017-10-25 Created: 2017-10-25 Last updated: 2019-03-26Bibliographically approved
Philipsson, A., Duberg, A., Möller, M. & Hagberg, L. (2013). Cost-utility analysis of a dance intervention for adolescent girls with internalizing problems. Cost Effectiveness and Resource Allocation, 11(1), 4
Open this publication in new window or tab >>Cost-utility analysis of a dance intervention for adolescent girls with internalizing problems
2013 (English)In: Cost Effectiveness and Resource Allocation, ISSN 1478-7547, E-ISSN 1478-7547, Vol. 11, no 1, p. 4-Article in journal (Refereed) Published
Abstract [en]

Background: The increasing prevalence of psychological health problems among adolescent girls is alarming. Knowledge of beneficial effects of physical activity on psychological health is widespread. Dance is a popular formof exercise that could be a protective factor in preventing and treating symptoms of depression. The aim of thisstudy was to assess the cost-effectiveness of a dance intervention in addition to usual school health services foradolescent girls with internalizing problems, compared with usual school health services alone.

Methods: A cost-utility analysis from a societal perspective based on a randomized controlled intervention trial wasperformed. The setting was a city in central Sweden with a population of 130 000. A total of 112 adolescent girls, 13–18 years old, with internalizing problems participated in the study. They were randomly assigned to intervention (n =59) or control (n = 53) group. The intervention comprised dance twice weekly during eight months in addition to usualschool health services. Costs for the stakeholder of the intervention, treatment effect and healthcare costs wereconsidered. Gained quality-adjusted life-years (QALYs) were used to measure the effects. Quality of life was measuredwith the Health Utility Index Mark 3. Cost-effectiveness ratios were based on the changes in QALYs and net costs forthe intervention group compared with the control group. Likelihood of cost-effectiveness was calculated.

Results: At 20 months, quality of life had increased by 0.08 units more in the intervention group than in the controlgroup (P = .04), translating to 0.10 gained QALYs. The incremental cost-effectiveness ratio was USD $3,830 per QALYand the likelihood of cost-effectiveness was 95%.

Conclusions: Intervention with dance twice weekly in addition to usual school health services may be consideredcost-effective compared with usual school health services alone, for adolescent girls with internalizing problems.

Keywords
Internalizing problems, Adolescent girls, Physical activity, Dance, Cost-utility analysis
National Category
Business Administration Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Business Studies
Identifiers
urn:nbn:se:oru:diva-38723 (URN)10.1186/1478-7547-11-4 (DOI)23425608 (PubMedID)2-s2.0-84873979104 (Scopus ID)
Note

Trial registration:

Name of the trial registry: “Influencing Adolescent Girls’ With Creative Dance Twice Weekly”

Trial registration number: NCT01523561

Available from: 2014-11-18 Created: 2014-11-18 Last updated: 2018-05-22Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8433-6529

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