Cost-effectiveness of classroom-based cognitive behaviour therapy in reducing symptoms of depression in adolescents: a trial-based analysis
Open accessAbstract
Background: A substantial minority of adolescents suffer from depression and it is associated with increased risk of suicide, social and educational impairment, and mental health problems in adulthood. A recently conducted randomized controlled trial in England evaluated the effectiveness of a manualized universally delivered age‐appropriate CBT programme in school classrooms. The cost‐effectiveness of the programme for preventing low mood and depression for all participants from a health and social care sector perspective needs to be determined. Methods: A trial‐based cost‐effectiveness analysis based on a cluster‐randomized controlled trial (trial registration – ISRCTN 19083628) comparing classroom‐based CBT with usual school provision of Personal Social and Health Education. Per‐student cost of intervention was estimated from programme records. The study was undertaken in eight mixed‐sex UK secondary schools, and included 3,357 school children aged 12 to 16 years (in the two trial arms evaluated in the cost‐effectiveness analysis). The main outcome measures were individual self‐reported data on care costs, Quality‐Adjusted Life‐Years ( QALY s, based on the EQ ‐5D health‐related quality‐of‐life instrument) and symptoms of depression (Short Mood and Feelings Questionnaire) at baseline, 6 and 12 months. Results: Although there was lower quality‐adjusted life‐years over 12 months (−.05 QALY s per person, 95% confidence interval −.09 to −.005, p = .03) with CBT , this is a ‘clinically’ negligible difference, which was not found in the complete case analyses. There was little evidence of any between‐arm differences in SMFQ scores (0.19, 95% CI −0.57 to 0.95, p = .62), or costs (£142, 95% CI −£132 to £415, p = .31) per person for CBT versus usual school provision. Conclusions: Our analysis suggests that the universal provision of classroom‐based CBT is unlikely to be either more effective or less costly than usual school provision.
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Trial-based economic evaluations found that school-based CBT was more costly and less effective than usual care for indicated prevention of major depressive disorder over a 1-year period.
“In contrast, trial-based economic evaluations found that school-based CBT was more costly and less effective than usual care for indicated prevention of major depressive disorder over a 1-year period.”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [410]
The Results (Table 4 discussion) say that over 12 months, point estimates made classroom-based CBT more costly and less effective than usual school provision, although the differences were small and uncertain. The Discussion describes this as a universally delivered programme targeting symptoms of low mood or depression, not indicated prevention of major depressive disorder. (LLM, conf=0.89)
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Mental health interventions in schools in high-income countries
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The Lancet Psychiatry Commission on youth mental health
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Hamilton, M. P., Hetrick, S. E., Mihalopoulos, C., Baker, D., Browne, V., Chanen, A. M., Pennell, K., Purcell, R., Stavely, H., & McGorry, P. D. (2017) · Medical Journal of Australia · doi:10.5694/mja17.00972 · Cited by 30 · see citing works
- Authors
- Anderson, R., Ukoumunne, O. C., Sayal, K., Phillips, R., Taylor, J. A., Spears, M., Araya, R., Lewis, G., Millings, A., Montgomery, A. A., & Stallard, P.
- Affiliations
- University of Exeter (GB)
- University of Nottingham (GB)
- Cardiff University (GB)
- University of Bristol (GB)
- University of Bath (GB)
- Corresponding author
- Anderson, Rob
- ORCID
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2014-05-12
- Volume
- 55
- Issue
- 12
- Pages
- 1390-1397
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- OpenAlex
- W2134333595
- Cited by
- 34
- References
- 6
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 7 · 2023: 1 · 2022: 2 · 2021: 6 · 2020: 4 · 2019: 1 · 2018: 1 · 2017: 2 · 2016: 4 · 2015: 1 · 2014: 1
- FWCI
- 6.63
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- Repository@Nottingham (University of Nottingham) (acceptedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion)
- Cardiff Metropolitan Research Repository (Cardiff Metropolitan University) (submittedVersion)
- Funders
- National Institute for Health Research Health Technology Assessment (06/37/04)
- CLAHRC
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- cost-effectiveness, adolescent depression, universal prevention, school-based mental health programs, quality-adjusted life years, depressive mood, personal, social and health education, high school students
- MeSH terms
- Adolescent, Child, Cost-Benefit Analysis, Female, Health Education, Humans, Male, School Health Services, Schools, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Quality-Adjusted Life Years
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