Economic evaluation of Be a Mom, a web-based intervention to prevent postpartum depression in high-risk women alongside a randomized controlled trial.

BACKGROUND: Postpartum depression (PPD) poses significant challenges, affecting both mothers and children, with substantial societal and economic implications. Internet-based cognitive behavioral therapy interventions (iCBT) offer promise in addressing PPD, but their economic impact remains unexplored. This study aimed to evaluate the cost-utility of Be a Mom, a self-guided iCBT intervention, compared with a waiting-list control among postpartum women at high risk of PPD. METHODS: This economic evaluation was conducted alongside a 14-month randomized controlled trial adopting a societal perspective. Participants were randomized to Be a Mom (n = 542) or a waitlisted control group (n = 511). Self-report data on healthcare utilization, productivity losses, and quality-adjusted life years (QALYs) were collected at baseline, post-intervention, and 4 and 12 months post-intervention. Incremental cost-effectiveness ratios (ICERs) were calculated, and cost-effectiveness acceptability curves were generated using nonparametric bootstrapping. Sensitivity analyses were conducted to assess result robustness. RESULTS: Over 14 months, Be a Mom generated a QALY gain of 0.0184 (0.0022, 0.0346), and cost savings of EUR 34.06 (-176.16, 108.04) compared to the control group. At a willingness to pay of EUR 20,000, Be a Mom had a 97.6 % probability of cost-effectiveness. LIMITATIONS: Results have limitations due to self-selected sample, potential recall bias in self-reporting, missing data, limited follow-up, and the use of a waiting-list control group. CONCLUSIONS: This study addresses a critical gap by providing evidence on the cost-utility of an iCBT intervention tailored for PPD prevention. Further research is essential to identify scalable and cost-effective interventions for reducing the burden of PPD.

Establishing priorities for psychological interventions in pediatric settings: A decision-tree approach using the DISABKIDS-10 Index as a screening instrument.

Most children and adolescents with chronic health conditions have impaired health-related quality of life and are at high risk of internalizing and externalizing problems. However, few patients present clinically significant symptoms. Using a decision-tree approach, this study aimed to identify risk profiles for psychological problems based on measures that can be easily scored and interpreted by healthcare professionals in pediatric settings. The participants were 736 children and adolescents between 8-18 years of age with asthma, epilepsy, cerebral palsy, type-1diabetes or obesity. The children and adolescents completed self-report measures of health-related quality of life (DISABKIDS-10) and psychological problems (Strengths and Difficulties Questionnaire). Sociodemographic and clinical data were collected from their parents/ physicians. Children and adolescents were classified into the normal (78.5%) or borderline/clinical range (21.5%) according to the Strengths and Difficulties Questionnaire cut-off values for psychological problems. The overall accuracy of the decision-tree model was 78.1% (sensitivity = 71.5%; specificity = 79.9%), with 4 profiles predicting 71.5% of borderline/clinical cases. The strongest predictor of psychological problems was a health-related quality of life standardized score below the threshold of 57.5 for patients with cerebral palsy, epilepsy or obesity and below 70.0 for patients with asthma or diabetes. Other significant predictors were low socio-economic status, single-parent household, medication intake and younger age. The model showed adequate validity (risk = .28, SE = .02) and accuracy (area under the Receiver Operating Characteristic curve = .84; CI = .80/.87). The identification of pediatric patients at high risk for psychological problems may contribute to a more efficient allocation of health resources, particularly with regard to their referral to specialized psychological assessment and intervention.

Caregiving burden and uplifts: a contradiction or a protective partnership for the quality of life of parents and their children with asthma?

Parental caregiving in the context of pediatric chronic conditions is a multifaceted experience that encompasses negative (burdens) and positive dimensions (uplifts), which may support risk and protective processes that influence family adaptation. This study aimed to examine the caregiving experience of parents caring for a child with asthma and the moderating role of caregiving uplifts on the associations between caregiving burden and quality of life (QoL) of parents and their children. Participants were 180 dyads of children/adolescents with asthma between 8 and 18 years of age and one of their parents. The parents reported on caregiving burden and uplifts and on their QoL, and the children/adolescents completed a self-report measure of generic QoL. Results showed that although parents of children with intermittent asthma and parents of younger children presented higher levels of caregiving burden, noncontrolled asthma was the only clinical variable representing a significant risk factor for decreased QoL in children. Significant negative and positive associations were found between burden dimensions and QoL and between caregiving uplifts and QoL, respectively, in parents and children. Additionally, caregiving uplifts moderated the negative link between relationship burden and parents' QoL. These results suggest that, far from being contradictory, caregiving uplifts may co-occur with high levels of burden and may constitute a protective factor against the deleterious effect of the caregiving burden on parents' QoL and a resource that directly contributes to children's QoL. This risk-resistance approach to family caregiving may contribute to operationalizing strength-based interventions in the context of pediatric asthma.

Mapping the caregiving process in paediatric asthma: Parental burden, acceptance and denial coping strategies and quality of life.

Based on a multidimensional model of the caregiving process, the main goal of this study was to examine the direct and indirect links, via acceptance and denial coping, between the caregiving burden and the quality of life (QoL) in parents of children with asthma. The sample was composed of 182 parents of a child/adolescent between 8 and 18 years of age with a clinical diagnosis of asthma. Data were obtained via self-report questionnaires assessing the caregiving burden, acceptance and denial coping strategies and QoL. Results from structural equation modelling indicated a good fit for the mediation model, which explained 30% of the variability of the parents' QoL. Higher levels of caregiving burden were negatively and indirectly associated with the parents' QoL, via less use of acceptance and greater use of denial coping strategies. Multigroup analyses ascertained the invariance of these links across the children's asthma severity, age and socio-economic groups. These findings emphasise acceptance and denial as important coping mechanisms in the caregiving process. Thus, broad-spectrum family-centred interventions in paediatric asthma settings can target the development of the parents' coping tendencies characterised by greater acceptance and less denial as a way of reappraising caregiving demands as less burdensome and improving their QoL.

Applying a developmental approach to quality of life assessment in children and adolescents with psychological disorders: challenges and guidelines.

Research on the quality of life (QL) of children/adolescents with psychological disorders has flourished over the last few decades. Given the developmental challenges of QL measurements in pediatric populations, the aim of this study was to ascertain the extent to which a developmental approach to QL assessment has been applied to pedopsychiatric QL research. A systematic literature search was conducted in three electronic databases (PubMed, PsycINFO, SocINDEX) from 1994 to May 2014. Quantitative studies were included if they assessed the self- or proxy-reported QL of children/adolescents with a psychological disorder. Data were extracted for study design, participants, QL instruments and informants, and statistical approach to age-related specificities. The systematic review revealed widespread utilization of developmentally appropriate QL instruments but less frequent use of both self and proxy reports and an inconsistent approach to age group specificities. Methodological guidelines are discussed to improve the developmental validity of QL research for children/adolescents with mental disorders.

Does the small fit them all? The utility of Disabkids-10 Index for the assessment of pediatric health-related quality of life across age-groups, genders, and informants.

The objective of this study was twofold: First, to conduct a confirmatory factor analysis of the Portuguese versions of Disabkids-10; and second, to examine potential differences in factor structures between age-groups, genders, and informants. The sample included 293 school-aged children and adolescents with chronic health conditions and 197 parents. Both family members (whenever possible) completed the self- and proxy-report versions of Disabkids-10. The factorial model of Disabkids-10 had good fit for self-reported data and minimally acceptable fit for proxy-reported data. The multigroup analyses confirmed the model invariance across age-groups (children vs. adolescents), genders (boys vs. girls), and informants (children vs. parents). The generic developmental applicability of these questionnaires makes them recommended for health care routine assessments on pediatric intervention needs and outcomes.

Caregiving burden and parent-child quality of life outcomes in neurodevelopmental conditions: the mediating role of behavioral disengagement.

The aim of this study was to analyze the direct and indirect effects, via parents' behavioral disengagement coping, of caregiving burden on the quality of life (QL) of parents and their children with neurodevelopmental conditions. Self-completion questionnaires on the target variables were administered to a sample of 156 parents who had a child with a neurodevelopmental condition, namely epilepsy (n = 65) and cerebral palsy (n = 91). Structural equation modeling was used to test a mediation model and ascertain direct and indirect effects among study variables. Significant direct effects of caregiving burden on parents' and their children's QL were found. Additionally, caregiving burden had a significant indirect effect on parents' QL, via behavioral disengagement, but not on their children's QL. Finally, this model was found to be invariant across conditions and patients' age groups. Caregiving burden may be elected as a strategic intervention target to improve parent-child QL outcomes in neuropediatric settings. Parents should be encouraged to avoid or reduce behavioral disengagement coping in relation to their caregiving stress, and alternatively adopt active coping strategies that may positively affect their children's QL and impede or attenuate the deleterious effects of caregiving burden on their own QL.

Development and psychometric properties of the World Health Organization Quality of Life Assessment Instrument (WHOQOL-100) in Portugal.

BACKGROUND: At the beginning of the 1990s, the World Health Organization (WHO) developed a project in order to create a cross-cultural instrument of quality of life assessment: the World Health Organization Quality of Life (WHOQOL). PURPOSE: This paper describes the development of the European Portuguese version of the WHOQOL-100, according to the methodology recommended by the WHO. METHOD: Special attention is given to the qualitative pilot study, which led to the development of the Portuguese Facet [Political P], and to the empirical pilot study and the psychometric studies, based on the application of the Portuguese version of the instrument to a sample of 315 subjects from the general population and 289 patients. The assessment protocol also included the Beck Depression Inventory and the Brief Symptom Inventory. RESULTS: The Portuguese version of WHOQOL-100 showed acceptable internal consistency (alpha range 0.84-0.94) and test-retest reliability in all domains (r range 0.67-0.86). Discriminant validity was significant for all domains, except in Spirituality. Convergent validity with the Beck Depression Inventory and the Brief Symptom Inventory was satisfactory for most domains. CONCLUSION: The WHOQOL showed good psychometric characteristics, suggesting that the Portuguese version of WHOQOL is valid and reliable in the assessment of quality of life in Portugal.