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Pediatric Anxiety Disorders: A Cost of Illness Analysis

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Abstract

Few studies provide information about the clinical correlates of economic costs in pediatric anxiety disorders. This study uses baseline data from a randomized trial involving 209 children and adolescents with clinical anxiety to examine clinical and demographic correlates of direct and indirect costs. Measured costs included the direct costs of mental health services and the indirect costs resulting from children’s missed school and parents’ missed work. Validated measures of anxiety and depression severity and of internalizing and externalizing behaviors were reported by youth, their parents, and independent evaluators. Seventy-two percent of youth (n = 150) had positive costs. Among these youth, the mean annual total cost was $6405 (sd = $11,674), of which $5890 represented direct cost and $4658 represented indirect cost. Higher average costs were correlated with greater child anxiety and depression severity (p < 0.001). Most pediatric anxiety disorders result in substantial individual and family costs, and costs may increase rapidly with elevated anxiety severity and depressed mood.

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References

  • Achenbach, T. M., & Rescorla, L. (2001). Manual for the ASEBA school-age forms & profiles: An integrated system of multi-informant assessment. Burlington: Aseba.

    Google Scholar 

  • Achenbach, T. M., Dumenci, L., & Rescorla, L. A. (2003). DSM-oriented and empirically based approaches to constructing scales from the same item pools. Journal of Clinical Child and Adolescent Psychology, 32(3), 328–340.

    Article  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

  • Ascher, B. H. Z., Farmer, E. M., Burns, B. J., & Angold, A. (1996). The child and adolescent services assessment (CASA) description and psychometrics. Journal of Emotional and Behavioral Disorders, 4(1), 12–20.

    Article  Google Scholar 

  • Blue Cross and Blue Shield of Massachusetts, Inc. (2015). Typical Cost of Common Medical Services. https://www.bluecrossma.com/blue-iq/pdfs/TypicalCosts_89717_042709.pdf. Published 2019. Accessed 7 Jan 2019.

  • Bodden, D. H., Dirksen, C. D., & Bögels, S. M. (2008). Societal burden of clinically anxious youth referred for treatment: A cost-of-illness study. Journal of Abnormal Child Psychology, 36(4), 487–497.

    Article  Google Scholar 

  • Bodner, T. E. (2008). What Improves with Increased Missing Data Imputations? Structural Equation Modeling, 15(4), 651–675.

    Article  Google Scholar 

  • Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: A revised child anxiety and depression scale. Behaviour Research and Therapy, 38(8), 835–855.

    Article  Google Scholar 

  • Chorpita, B. F., Moffitt, C. E., & Gray, J. (2005). Psychometric properties of the revised child anxiety and depression scale in a clinical sample. Behaviour Research and Therapy, 43(3), 309–322.

    Article  Google Scholar 

  • Connecticut State Department of Education. (2015). 2014–15 Net Current Expenditures (NCE) per Pupil and 2014–15 Special Education Excess Cost Grant Basic Contributions for the May Payment. http://ctschoolfinance.org/assets/uploads/files/NCEP-2014-15.pdf. Published January 2016. Accessed January 17, 2019.

  • Foster, M. E., & Jones, D. E. (2005). The high costs of aggression: Public expenditures resulting from conduct disorder. American Journal of Public Health, 95(10), 1767–1772.

    Article  Google Scholar 

  • Gilleskie, D. B., & Mroz, T. A. (2004). A flexible approach for estimating the effects of covariates on health expenditures. Journal of Health Economics, 23(2), 391–418.

    Article  Google Scholar 

  • Ginsburg, G. S., Pella, J. E., Pikulski, P. J., Tein, J. Y., & Drake, K. L. (2019). School-based treatment for anxiety research study (STARS): a randomized controlled effectiveness trial. Journal of Abnormal Child Psychology, 1-11.

  • Guy, W. (1976). ECDEU assessment manual for psychopharmacology. US Department of Health, and Welfare, 534–537.

  • Howell, E., & McFeeters, J. (2008). Children's mental health care: Differences by race/ethnicity in urban/rural areas. Journal of Health Care for the Poor and Underserved, 19(1), 237–247.

    Article  Google Scholar 

  • Lee, S. W., Lohmeier, J. H., Niileksela, C., & Oeth, J. (2009). Rural schools' mental health needs: Educators' perceptions of mental health needs and services in rural schools. Journal of Rural Mental Health, 33(1), 26.

    Article  Google Scholar 

  • Maryland Department of Health. (2015) Behavioral Health Administration. Public Mental Health System Rates. https://bha.health.maryland.gov/Documents/PMHS-Reimbursement-Schedule.pdf. Published 1 Jan 2015. Accessed 7 Jan 2019.

  • Maryland State Department of Education. (2015). Selected Financial Data Maryland Public Schools 2014–2015 Part 3 – Analysis of costs. http://www.marylandpublicschools.org/about/Documents/DBS/SFD/2014-2015/SFD20142015Part3.pdf. Published January 2017. Accessed 17 Jul 2018.

  • Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., et al. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989.

    Article  Google Scholar 

  • Merikangas, K. R., He, J. P., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., et al. (2011). Service utilization for lifetime mental disorders in US adolescents: Results of the National Comorbidity Survey–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 50(1), 32–45.

    Article  Google Scholar 

  • PayScale.com. (2019). https://www.payscale.com/research/US/Job=Crisis_Counselor/Hourly_Rate. Published January 2019. Accessed January 30, 2019.

  • Rosenheck, R., Leslie, D., Sint, K., Lin, H., Robinson, D. G., Schooler, N. R., ... & Correll, C. U. (2016). Cost-effectiveness of comprehensive, integrated care for first episode psychosis in the NIMH RAISE early treatment program. Schizophrenia Bulletin, 42(4), 896–906.

  • Rubin, D. B. (1987). Multiple imputation for nonresponse in surveys. New York: Wiley.

    Book  Google Scholar 

  • Silverman, W. K., & Albano, A. M. (1996). The anxiety disorders interview schedule for children for DSMIV (child and parent versions). San Antonio: Psychological Corporation.

    Google Scholar 

  • Silverman, W. K., Saavedra, L. M., & Pina, A. A. (2001). Test-retest reliability of anxiety symptoms and diagnoses with the anxiety disorders interview schedule for DSM-IV: Child and parent versions. Journal of the American Academy of Child & Adolescent Psychiatry, 40(8), 937–944.

    Article  Google Scholar 

  • Swan, A. J., & Kendall, P. C. (2016). Fear and missing out: Youth anxiety and functional outcomes. Clinical Psychology: Science and Practice, 23(4), 417–435.

    Google Scholar 

  • Swensen, A. R., Birnbaum, H. G., Secnik, K., Marynchenko, M., Greenberg, P., & Claxton, A. M. I. (2003). Attention-deficit/hyperactivity disorder: Increased costs for patients and their families. Journal of the American Academy of Child & Adolescent Psychiatry, 42(12), 1415–1423.

    Article  Google Scholar 

  • Taouali, W., Benvenuti, G., Wallisch, P., Chavane, F. F., & Perrinet, L. U. (2015). Testing the Odds of Inherent versus Observed Over-dispersion in Neural Spike Counts. J Neurophysiol: jn, 194.

  • United States Department of Labor. Bureau of Labor Statistics. (2015). National Occupational Employment and Wage Estimates United States. https://www.bls.gov/oes/current/oes_nat.htm. Published May 2018. Accessed July 17, 2018.

  • van Steensel, F. J., Dirksen, C. D., & Bögels, S. M. (2013). A cost of illness study of children with high-functioning autism spectrum disorders and comorbid anxiety disorders as compared to clinically anxious and typically developing children. Journal of Autism and Developmental Disorders, 43(12), 2878–2890.

    Article  Google Scholar 

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Funding

The research reported here was supported by the Institute ofEducation Sciences, U.S. Department of Education, through GrantR324A120405 to Dr. Ginsburg. The opinions expressed are those of theauthors and do not represent views of the Institute or the U.S. Departmentof Education.

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Authors and Affiliations

  1. Department of Psychiatry, University of Connecticut School of Medicine, 65 Kane Street, West Hartford, CT, 06119, USA

    Jeffrey E. Pella, Paige J. Pikulski & Golda S. Ginsburg

  2. The Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA

    Eric P. Slade

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  1. Jeffrey E. Pella
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  2. Eric P. Slade
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  3. Paige J. Pikulski
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  4. Golda S. Ginsburg
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Correspondence to Jeffrey E. Pella.

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The authors declare they have no financial or non-financial conflicts of interest to report.

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The study was approved by the UConn Health Institutional Review Board.

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written informed consent was completed with all participants prior to commencing with study procedures.

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Pella, J.E., Slade, E.P., Pikulski, P.J. et al. Pediatric Anxiety Disorders: A Cost of Illness Analysis. J Abnorm Child Psychol 48, 551–559 (2020). https://doi.org/10.1007/s10802-020-00626-7

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  • DOI: https://doi.org/10.1007/s10802-020-00626-7

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