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Reducing suicidal ideation via the internet: Cost-effectiveness analysis alongside a randomised trial into unguided self-help

van Spijker, Bregje; Majo, Cristina; Smit, Filip; van Straten, Annemieke; Kerkhof, Ad

Description

Background: Suicidal ideation is highly prevalent, but often remains untreated. The Internet can be used to provide accessible interventions. Objective: To evaluate the cost-effectiveness of an online, unguided, self-help intervention for reducing suicidal ideation. Methods: A total of 236 adults with mild to moderate suicidal thoughts, defined as scores between 1-26 on the Beck Scale for Suicide Ideation (BSS), were recruited in the general population and randomized to the intervention (n =...[Show more]

dc.contributor.authorvan Spijker, Bregje
dc.contributor.authorMajo, Cristina
dc.contributor.authorSmit, Filip
dc.contributor.authorvan Straten, Annemieke
dc.contributor.authorKerkhof, Ad
dc.date.accessioned2015-12-07T22:14:23Z
dc.identifier.issn1438-8871
dc.identifier.urihttp://hdl.handle.net/1885/17394
dc.description.abstractBackground: Suicidal ideation is highly prevalent, but often remains untreated. The Internet can be used to provide accessible interventions. Objective: To evaluate the cost-effectiveness of an online, unguided, self-help intervention for reducing suicidal ideation. Methods: A total of 236 adults with mild to moderate suicidal thoughts, defined as scores between 1-26 on the Beck Scale for Suicide Ideation (BSS), were recruited in the general population and randomized to the intervention (n = 116) or to a waitlist, information-only, control group (n = 120). The intervention aimed to decrease the frequency and intensity of suicidal ideation and consisted of 6 modules based on cognitive behavioral techniques. Participants in both groups had unrestricted access to care as usual. Assessments took place at baseline and 6 weeks later (post-test). All questionnaires were self-report and administered via the Internet. Treatment response was defined as a clinically significant decrease in suicidal ideation on the BSS. Total per-participant costs encompassed costs of health service uptake, participants' out-of-pocket expenses, costs stemming from production losses, and intervention costs. These were expressed in Euros (€) for the reference year 2009. Results: At post-test, treatment response was 35.3% and 20.8% in the experimental and control conditions, respectively. The incremental effectiveness was 0.35 - 0.21 = 0.15 (SE 0.06, P = .01). The annualized incremental costs were -€5039 per participant. Therefore, the mean incremental cost-effectiveness ratio (ICER) was estimated to be -€5039/0.15 = -€34,727 after rounding (US -$41,325) for an additional treatment response, indicating annual cost savings per treatment responder. Conclusions: This is the first trial to indicate that online self-help to reduce suicidal ideation is feasible, effective, and cost saving. Limitations included reliance on self-report and a short timeframe (6 weeks). Therefore, replication with a longer follow-up period is recommended.
dc.publisherJournal of medical Internet Research
dc.sourceJournal of Medical Internet Research
dc.subjectKeywords: adult; article; controlled clinical trial; controlled study; cost benefit analysis; female; human; Internet; male; Netherlands; questionnaire; randomized controlled trial; suicidal ideation; Adult; Cost-Benefit Analysis; Female; Humans; Internet; Male; Ne Cognitive behavior therapy; Cost-effectiveness; Internet; Randomized controlled trial; Suicidal ideation
dc.titleReducing suicidal ideation via the internet: Cost-effectiveness analysis alongside a randomised trial into unguided self-help
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume14
dc.date.issued2012
local.identifier.absfor111700 - PUBLIC HEALTH AND HEALTH SERVICES
local.identifier.ariespublicationu5036076xPUB1
local.type.statusPublished Version
local.contributor.affiliationvan Spijker, Bregje, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationMajo, Cristina, Trimbos Institute, Netherlands Institute of Mental Health and Addiction
local.contributor.affiliationSmit, Filip, Trimbos Institute, Netherlands Institute of Mental Health and Addiction
local.contributor.affiliationvan Straten, Annemieke, VU University
local.contributor.affiliationKerkhof, Ad, VU University Amsterdam
local.description.embargo2037-12-31
local.bibliographicCitation.issue5
local.bibliographicCitation.startpagee141
local.identifier.doi10.2196/jmir.1966
dc.date.updated2016-02-24T11:33:49Z
local.identifier.scopusID2-s2.0-84872453506
local.identifier.thomsonID000315108100023
CollectionsANU Research Publications

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