Cost-effectiveness of implementing a digital psychosocial intervention for patients with psychotic spectrum disorders in low- and middle-income countries in Southeast Europe: Economic evaluation alongside a cluster randomised trial.

BACKGROUND: DIALOG+ is a digital psychosocial intervention aimed at making routine meetings between patients and clinicians therapeutically effective. This study aimed to evaluate the cost-effectiveness of implementing DIALOG+ treatment for patients with psychotic disorders in five low- and middle-income countries in Southeast Europe alongside a cluster randomised trial. METHODS: Resource use and quality of life data were collected alongside the multi-country cluster randomised trial of 468 participants with psychotic disorders. Due to COVID-19 interruptions of the trial's original 12-month intervention period, adjusted costs and quality-adjusted life years (QALYs) were estimated at the participant level using a mixed-effects model over the first 6 months only. We estimated the incremental cost-effectiveness ratio (ICER) with uncertainty presented using a cost-effectiveness plane and a cost-effectiveness acceptability curve. Seven sensitivity analyses were conducted to check the robustness of the findings. RESULTS: The average cost of delivering DIALOG+ was €91.11 per participant. DIALOG+ was associated with an incremental health gain of 0.0032 QALYs (95% CI -0.0015, 0.0079), incremental costs of €84.17 (95% CI -8.18, 176.52), and an estimated ICER of €26,347.61. The probability of DIALOG+ being cost-effective against three times the weighted gross domestic product (GDP) per capita for the five participating countries was 18.9%. CONCLUSION: Evidence from the cost-effectiveness analyses in this study suggested that DIALOG+ involved relatively low costs. However, it is not likely to be cost-effective in the five participating countries compared with standard care against a willingness-to-pay threshold of three times the weighted GDP per capita per QALY gained.

The need for regular screening of postpartum depression.

AIM: The aim of this study was to examine the level of depression during the first week of the postpartum period in a sample of women hospitalized for childbirth at the University Obstetric Clinic in Skopje and correlate it with some demographic characteristics. METHOD AND SAMPLE: The sample comprised 150 randomly selected women with a mean age of 29.23 years (SD±5.11). As a psychometric test the Beck Depression Inventory was used. It is a multiple choice, self-report inventory for measuring the severity of depression. For statistic evaluation (descriptive analysis and correlations) software Statistica 7 was used. RESULTS: The random study showed that 68% of postpartum women have minimal, 25% mild and 5% moderate depression. Fortunately only 2% manifested severe depression. Our findings showed that depression is negatively correlated with the level of education (r=-0.17), as well as with age (r=-0.15). The comparison of the level of depression with a group of chronic dialyzed patients showed that PPD is not so serious a problem. However, this study shows that PPD is under diagnosed. CONCLUSION: As a common mental health problem PPD is not systematically screened in our country. The study showed the presence of minimal (68%) and mild (25%) depression in the examined women. The age of the woman is important for PPD; younger women are more susceptible to depressive reactions. The level of education is negatively correlated with depression. It was pointed out that PPD must be recognized, treated and followed for a long period because it is a risk not only to the mental health of the mother but also for the development of child.

Comparison of visual and emotional continuous performance test related to sequence of presentation, gender and age.

(Full text is available at http://www.manu.edu.mk/prilozi). Continous Performance Tests (CPTs) form a group of paradigms for the evaluation of attention and, to a lesser degree, the response inhibition (or disinhibition) component of executive control. The object of this study was to compare performance on a CPT using both visual and emotional tasks in 46 normal adult subjects. In particular, it was to examine the effects of the type of task (VCPT or ECPT), sequence of presentation, and gender/age influence on performance as measured errors of omission, errors of commission, reaction time and variation of reaction time. From the results we can assume that there are significantly worse performance parameters for ECPT than VCPT tasks, with a probable explanation of the influence of emotional stimuli on attention and information-processing and no significant effect of order of presentation and gender on performance. Significant differences with more omission errors for older groups were obtained, showing better attention in younger subjects. Key words: VCPT, ECPT, omission errors, commission errors, reaction time, variation of reaction time, normal adults.

Neurofeedback treatment of children with attention deficit hyperactivity disorder.

BACKGROUND: Biofeedback is a modern computer-related technique used for assessment and therapy of many psychophysiological disorders, especially stress-related ones. After a short overview of the basic concepts of biofeedback, in this study the application of EEG biofeedback (neurofeedback) in the assessment of and therapy for attention deficit hyperactivity disorders (ADHD) is presented and discussed. METHODS: The study comprised 12 children diagnosed as ADHD, selected according to ICD-10, and assessed by WISC-R, Q-EEG, neurofeedback and Conner's questionnaire for parents and teachers. The mean age was 9.5 years (7 to 13), both sexes. Each of them participated in a five-month programme of neurofeedback training, performed two times weekly with Biograph/ProComp 2.0 protocols. RESULTS: Post-treatment results showed an improved EEG pattern expressed in increased 16-20 Hz (beta) activity and decreased 4-8 Hz (theta) activity. In parallel, higher scores on WISC-R, better school notes and improved social adaptability and self-esteem were obtained. CONCLUSIONS: EEG biofeedback operant conditioning is a good choice for treatment of ADHD children. The method is non-invasive and has high cost-benefit. Optimal results are obtained in children of higher age. Cooperation with family members and teachers is crucial.