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      Cost-effectiveness of a preferred intensity exercise programme for young people with depression compared with treatment as usual: an economic evaluation alongside a clinical trial in the UK

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          To assess the cost-effectiveness of preferred intensity exercise programme for young people with depression compared with a treatment as usual control group.


          A ‘within trial’ cost-effectiveness and cost-utility analysis conducted alongside a randomised controlled trial. The perspective of the analysis was the UK National Health Service and social services.


          The intervention was provided in a community leisure centre setting.


          86 young people aged 14–17 years attending Tier 2 and Tier 3 CAMHS (Child and Adolescent Mental Health Services) outpatient services presenting with depression.


          The intervention comprised 12 separate sessions of circuit training over a 6-week period. Sessions were supervised by a qualified exercise therapist. Participants also received treatment as usual. The comparator group received treatment as usual.


          We found improvements in the Children’s Depression Inventory-2 (CDI-2) and estimated cost-effectiveness at £61 per point improvement in CDI-2 for the exercise group compared with control. We found no evidence that the exercise intervention led to differences in quality-adjusted life years (QALY). QALYs were estimated using the EQ-5D-5L (5-level version of EuroQol-5 dimension).


          There is evidence that exercise can be an effective intervention for adolescents with depression and the current study shows that preferred intensity exercise could also represent a cost-effective intervention in terms of the CDI-2.

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          Most cited references 23

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          EuroQol: the current state of play.

          The EuroQol Group first met in 1987 to test the feasibility of jointly developing a standardised non-disease-specific instrument for describing and valuing health-related quality of life. From the outset the Group has been multi-country, multi-centre, and multi-disciplinary. The EuroQol instrument is intended to complement other forms of quality of life measures, and it has been purposefully developed to generate a cardinal index of health, thus giving it considerable potential for use in economic evaluation. Considerable effort has been invested by the Group in the development and valuation aspects of health status measurement. Earlier work was reported upon in 1990; this paper is a second 'corporate' effort detailing subsequent developments. The concepts underlying the EuroQol framework are explored with particular reference to the generic nature of the instrument. The valuation task is reviewed and some evidence on the methodological requirements for measurement is presented. A number of special issues of considerable interest and concern to the Group are discussed: the modelling of data, the duration of health states and the problems surrounding the state 'dead'. An outline of some of the applications of the EuroQol instrument is presented and a brief commentary on the Group's ongoing programme of work concludes the paper.
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            Sports participation as a protective factor against depression and suicidal ideation in adolescents as mediated by self-esteem and social support.

            Participation in sports has been shown to be protective against depression and suicidal ideation, but little is known about what factors mediate these relationships. No previous studies examined potential mediators between sports participation and suicidal ideation and only one study explored possible mediators between sports participation and depression. Increased sports participation could protect against depression and suicidal ideation by increasing endogenous endorphin levels, boosting self-esteem, improving body image, increasing social support, and affecting substance abuse. Multivariate hierarchical logistic regression analyses of Add Health data to explore whether increased participation in sports (none, 1-2, 3-4, or 5 or more times per week) is associated with depression and suicidal ideation and whether exercise, self-esteem, body weight, social support, and substance abuse mediate these relationships. As sports participation increases, the odds of suffering from depression decreases by 25% (OR: 0.75; 95% CI: 0.70-0.82) and the odds of having suicidal ideation decreases by 12% (OR: 0.88; 95% CI: 0.83-0.93) after controlling for sex, age, race/ethnicity, public assistance, and physical limitations. Substance abuse, body weight, and exercise did not mediate these associations. Consistent with self-esteem and social support acting as mediators of these relationships, the inclusion of these variables in the multivariate models attenuated the associations for depression (OR: 0.83; 95% CI: 0.75-0.91) and suicidal ideation (OR: 0.93; 95% CI: 0.88-0.99). Adolescents should be offered ample opportunity and encouragement to participate in sports, which can protect against depression and suicidal ideation by boosting self-esteem and increasing social support.
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              Prospective reciprocal relations between physical activity and depression in female adolescents.

              Although an inverse correlation between physical activity and depression among adolescents has been found in research, this relation has seldom been examined prospectively. Thus, we tested whether physical activity reduces risk for future escalations in depression and whether depression decreases likelihood of future change in physical activity. Data from a longitudinal study involving annual assessments of 496 adolescent girls (mean age = 13 years, SD = 0.73) followed over a 6-year period were analyzed to address these questions. Using analyses that controlled for several covariates, we found that physical activity significantly reduced risk for future increases in depressive symptoms and risk for onset of major-minor depression. Further, depressive symptoms and major-minor depression significantly reduced future physical activity. However, predictive effects were modest for both. Results support a bidirectional relation between exercise and depression and imply that interventions that increase physical activity may reduce risk for depression among this high-risk population. (c) 2010 APA, all rights reserved

                Author and article information

                BMJ Open
                BMJ Open
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                26 November 2017
                : 7
                : 11
                [1 ] departmentNorwich Medical School , University of East Anglia , Norwich, UK
                [2 ] departmentSchool of Health Sciences , University of Nottingham , Nottingham, UK
                [3 ] departmentDivision of Psychiatry and Applied Psychology , University of Nottingham , Nottingham, UK
                Author notes
                [Correspondence to ] David Turner; David.A.Turner@ 123456uea.ac.uk
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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