TY - JOUR
T1 - Healthcare use and costs associated with children's behavior problems
AU - Kohlboeck, Gabriele
AU - Romanos, Marcel
AU - Teuner, Christina M.
AU - Holle, Rolf
AU - Tiesler, Carla M.T.
AU - Hoffmann, Barbara
AU - Schaaf, Beate
AU - Lehmann, Irina
AU - Herbarth, Olf
AU - Koletzko, Sibylle
AU - Bauer, Carl Peter
AU - Von Berg, Andrea
AU - Berdel, Dietrich
AU - Heinrich, Joachim
N1 - Funding Information:
This research was funded by Grants 01 EG 9732 and 01 EG 9705/2 (LISA Study) and 01 EE 9401-4 (GINI Study) from the Federal Ministry for Education, Science, Research, and Technology, FKZ 20462296 from the Federal Ministry of Environment, and Ludwig-Maximilians-Universitaet’s innovative research priority Project MC-Health.
PY - 2014/8
Y1 - 2014/8
N2 - The objective of the study was to investigate associations between severity of behavior problems, specific symptom domains with healthcare use and costs in school-aged children. A cross-sectional study using data from the 10-year follow-up of two population-based birth cohorts was conducted on four rural and urban communities in Germany. There were 3,579 participants [1,834 boys (51%), 1,745 girls (49%)] on average aged 10.4 years. The severity levels (normal, at risk, abnormal) and symptom domains of behavioral problems were assessed by parent-reported strengths and difficulties questionnaire (SDQ).The outcomes were medical use categories (physicians, therapists, hospital, and rehabilitation), medical costs categories and total direct medical use and costs (calculated from parent-reported utilization of healthcare services during the last 12 months). Total direct medical costs showed a graded relationship with severity level (adjusted p < 0.0001). Average annual cost difference in total direct medical costs between at risk and normal total difficulties was Euro (€) 271 (SD 858), and € 1,237 (SD 2,528) between abnormal and normal total difficulties. A significant increase in physician costs showed between children with normal and at risk total difficulties (1.30), and between normal and abnormal total difficulties (1.29; p < 0.0001). Between specific symptom domains, children with emotional symptoms showed highest costs for physicians, psychotherapist, and hospitalization as well as total direct medical costs. Children with hyperactivity/inattention showed highest costs for therapists and emergency room costs. Healthcare use and costs are related to the severity of child behavior problems. In general, children's costs for psychotherapy treatments have been low relative to general medical treatments which may indicate that some children with behavioral problems did not get appropriate care. To some degree, medical conditions may be attributable to some of the high hospitalization costs found in children with emotional symptom.
AB - The objective of the study was to investigate associations between severity of behavior problems, specific symptom domains with healthcare use and costs in school-aged children. A cross-sectional study using data from the 10-year follow-up of two population-based birth cohorts was conducted on four rural and urban communities in Germany. There were 3,579 participants [1,834 boys (51%), 1,745 girls (49%)] on average aged 10.4 years. The severity levels (normal, at risk, abnormal) and symptom domains of behavioral problems were assessed by parent-reported strengths and difficulties questionnaire (SDQ).The outcomes were medical use categories (physicians, therapists, hospital, and rehabilitation), medical costs categories and total direct medical use and costs (calculated from parent-reported utilization of healthcare services during the last 12 months). Total direct medical costs showed a graded relationship with severity level (adjusted p < 0.0001). Average annual cost difference in total direct medical costs between at risk and normal total difficulties was Euro (€) 271 (SD 858), and € 1,237 (SD 2,528) between abnormal and normal total difficulties. A significant increase in physician costs showed between children with normal and at risk total difficulties (1.30), and between normal and abnormal total difficulties (1.29; p < 0.0001). Between specific symptom domains, children with emotional symptoms showed highest costs for physicians, psychotherapist, and hospitalization as well as total direct medical costs. Children with hyperactivity/inattention showed highest costs for therapists and emergency room costs. Healthcare use and costs are related to the severity of child behavior problems. In general, children's costs for psychotherapy treatments have been low relative to general medical treatments which may indicate that some children with behavioral problems did not get appropriate care. To some degree, medical conditions may be attributable to some of the high hospitalization costs found in children with emotional symptom.
KW - Behavior problems
KW - Depression
KW - Epidemiology
KW - Healthcare utilization
KW - Medical costs
KW - Mental health
UR - http://www.scopus.com/inward/record.url?scp=84906791046&partnerID=8YFLogxK
U2 - 10.1007/s00787-013-0504-9
DO - 10.1007/s00787-013-0504-9
M3 - Article
C2 - 24327267
AN - SCOPUS:84906791046
SN - 1018-8827
VL - 23
SP - 701
EP - 714
JO - European Child and Adolescent Psychiatry
JF - European Child and Adolescent Psychiatry
IS - 8
ER -