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Mindfulness therapy for somatization disorder and functional somatic syndromes: economic analysis

Tom Kindlon

Senior Member
Messages
1,734
Full text is available here for free: http://funktionellelidelser.dk/file...ationer/Economic_analysis_alongside_a_RCT.pdf

Mindfulness therapy for somatization disorder and functional somatic syndromes: analysis of economic consequences alongside a randomized trial.

J Psychosom Res. 2013 Jan;74(1):41-8. doi: 10.1016/j.jpsychores.2012.09.010. Epub 2012 Oct 11.

Fjorback LO1, Carstensen T, Arendt M, Ornbøl E, Walach H, Rehfeld E, Fink P.

Author information

Abstract

OBJECTIVE:

The objective of the present study is to estimate the economic consequences of somatization disorder and functional somatic syndromes such as fibromyalgia and chronic fatigue syndrome, defined as bodily distress syndrome (BDS), when mindfulness therapy is compared with enhanced treatment as usual.

METHODS:

A total of 119 BDS patients were randomized to mindfulness therapy or enhanced treatment as usual and compared with 5950 matched controls.

Register data were analyzed from 10years before their inclusion to 15-month follow-up.

The main outcome measures were disability pension at the 15-month follow-up and a reduction in total health care costs.

Unemployment and sickness benefit prior to inclusion were tested as possible risk factors.

RESULTS:

At 15-month follow-up, 25% from the mindfulness therapy group received disability pension compared with 45% from the specialized treatment group (p=.025).

The total health care utilization was reduced over time in both groups from the year before inclusion (mean $5325, median $2971) to the year after inclusion (mean $3644, median $1593) (p=.0001).

This overall decline was seen in spite of elevated costs due to assessment and mindfulness therapy or enhanced treatment as usual.

The BDS patients accumulated significantly more weeks of unemployment and sickness benefit 5 and 10years before inclusion (p<.0001) than the population controls.

CONCLUSIONS:

Mindfulness therapy may prevent disability pension and it may have a potential to significantly reduce societal costs and increase the effectiveness of care.

Accumulated weeks of unemployment and sickness benefit are possible risk factors for BDS.

Copyright © 2012 Elsevier Inc. All rights reserved.

PMID: 23272987 [PubMed - indexed for MEDLINE]
 

Tom Kindlon

Senior Member
Messages
1,734
71% of the patients had CFS.

I don't think the abstract give a good reflection of what was found:

Point 1:
They have collapsed the healthcare costs from the two groups, one of which is "enhanced treatment as usual" which would usually be seen as more like a control group.

With the Mindfulness therapy:
One year prior to baseline: $4643
Baseline and one year ahead: $3937

"Enhanced treatment as usual"
One year prior to baseline: $5996
Baseline and one year ahead: $3355

The baseline figures may not be average figures for a typical year: this figure was in the year in the lead up to be referred to the clinic so these were likely in the period when the patients, and indeed health professionals, were looking for answers to do with their health problems.
 
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Tom Kindlon

Senior Member
Messages
1,734
I don't think the abstract give a good reflection of what was found:

Point 2:
The percentages receiving disability pension increase quite dramatically from baseline:

Mindfulness therapy:
Baseline: 4
Follow-up at 15 months: 15

"Enhanced treatment as usual"
Baseline: 7
Follow-up at 15 months: 27

-----
Also, the focus on disability pension ignores the fact that most people were still getting some sort of support from the state.

DREAM contains weekly information on transfer payments for all citizens in Denmark since 1991. Transfer payments include sickness benefit, disability pension, unemployment benefit, flexible work (jobs created for persons with limited working capacity), etc.

Transfer payments were divided into five categories: 1: disability pension; 2: flexiblework (jobs created for personswith limitedworking capacity); 3: sickness benefit; 4: unemployed; and 5: self-supporting. Which of these five categories each patient fit into was determined at two time points: a 12-week period immediately before baseline and a 12-week period 15 months after baseline. We chose a 12-week period over a one-week period to obtain an estimate as precise as possible of the transfer payments received during the two time periods.

We used the transfer payment categories proposed by Hjollund et al. [18] and Carstensen [19]. Carstensen [19] grouped sickness benefit and vocational rehabilitation as temporary health-related benefits, whereas flexible work and disability pension were grouped as permanent health-related benefits.

Flexible work and disability pension are permanent health-related benefits

Here are the results:

Mindfulness therapy (n=59):

Baseline:
Self-support: 19
Unemployed: 6
Sickness benefit: 21
Flexible work: 9
Disability pension: 4

Follow-up:
Self-support: 17
Unemployed: 9
Sickness benefit: 2
Flexible work: 16
Disability pension: 15

-------

"Enhanced treatment as usual"
Baseline:
Self-support: 17
Unemployed: 6
Sickness benefit: 23
Flexible work: 7
Disability pension: 7

Follow-up:
Self-support: 13
Unemployed: 4
Sickness benefit: 3
Flexible work: 13
Disability pension: 27

So if one just looks at self-support, the only one that doesn't involve transfers, there is little difference:

Mindfulness therapy (n=59):
Baseline: 19
Follow-up: 17

"Enhanced treatment as usual" (n=60)
Baseline: 17
Follow-up: 13
 
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Tom Kindlon

Senior Member
Messages
1,734
"bodily distress syndrome (BDS)"

That's a new one for me. I can't remember having come across that term before.
Bodily distress syndrome (BDS) is a diagnosis developed from empirical research that may unite different functional somatic syndromes and somatization disorder [13,14]. Multi-organ BDS requires functional somatic symptoms from at least three out of four bodily systems: cardiopulmonary, gastrointestinal, musculoskeletal, or general symptoms andwithmoderate to severe impairment in daily life [15].

71% had CFS.

This involves Peter Fink from Denmark.
 

Bob

Senior Member
Messages
16,455
Location
England (south coast)
Bodily distress syndrome (BDS) is a diagnosis developed from empirical research that may unite different functional somatic syndromes and somatization disorder [13,14]. Multi-organ BDS requires functional somatic symptoms from at least three out of four bodily systems: cardiopulmonary, gastrointestinal, musculoskeletal, or general symptoms andwithmoderate to severe impairment in daily life [15].

@Tom Kindlon, thank you. I've added it to my (ever-growing) reference list:
http://forums.phoenixrising.me/index.php?threads/psychosomatic-disorders-synonyms.23109/
 

Esther12

Senior Member
Messages
13,774
Here are the results:

Mindfulness therapy (n=59):

Baseline:
Self-support: 19
Unemployed: 6
Sickness benefit: 21
Flexible work: 9
Disability pension: 4



Follow-up:
Self-support: 17
Unemployed: 9
Sickness benefit: 23
Flexible work: 16
Disability pension: 15

? There are 80 in the follow up group. How did they get more participants at follow up?

edit: Typo there - Sickness benefit: 2 not 23
 
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john66

Senior Member
Messages
159
I took the mindfullness meditation course last year. It does help to quiet the mind down and helps sleep overall. You can try some of the mediations on youtube. The key is that you have to do it for at least six weeks. After a while it became tedious to do it and I stopped, for no particular reason. I recently started again, hoping my sleep will improve. J
 

A.B.

Senior Member
Messages
3,780
I did meditation for years. It helps feeling better, but didn't change the underlying illness, which continued to progress.
 

Cheshire

Senior Member
Messages
1,129
At 15-month follow-up, 25% from the mindfulness therapy group received disability pension compared with 45% from the specialized treatment group (p=.025).

Ok, but the number of people receiving disability pension from the 2 groups at the beginning were slightly different.

Mindfulness therapy (n=59):
Baseline:

Disability pension: 4

Follow-up:

Disability pension: 15

which makes an increase of 3.75

"Enhanced treatment as usual"

Baseline:

Disability pension: 7

Follow-up:

Disability pension: 27

which makes an increase of 3.85


The difference is really very subtle!! You can manipulate the numbers to make them mean very different things...
 

A.B.

Senior Member
Messages
3,780
Both forms of treatment resulted in increased disability at the followup. Since there is no control group (of patients not receiving treatment), it's not even clear whether the treatments are helping at all. For all we know, they could be harmful. The paper acknowledges this:

The rate of disability pension increased significantly in both groups from baseline to the 15-month follow-up, which substantiates the severity of somatization disorder and functional somatic syndromes. It may raise the question of whether the treatments made people more ill.

In addition, we do not have any information on the rate of disability pension in a similar untreated patient population.

Since no treatment costs less than some treatment, for a proper economic analysis it would be crucial to check whether the treatments are actually useful. Since the nutters are not interested in reality, this was of course not done. The goal is, as usual, to promote their pet theory.
 
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Cheshire

Senior Member
Messages
1,129
It may raise the question of whether the treatments made people more ill.

Oh!!! Just a small sentence for an obviously so important question... So patients could be right? Let us forget this unhelpfull matter quickly.
Do these people have a brain?
 

A.B.

Senior Member
Messages
3,780
According to table 2:

Pension/no-pension ratios at baseline and at 15 month followup:
Mindfulness: 11/44 and 15/44 (in percentages 25% and 34%)
Treatment as usual: 20/33 and 27/33 (in percentages 60% and 81%)

The percentages suggest that the mindfulness patients are very different from the treatment as usual ones.

Furthermore, assuming that the difference in reduced health care costs between the two patient groups is actually attributable to the therapy, one cannot conclude anything about the cause. The paper wants to suggest it's because the therapy is somehow working (despite patients getting worse), but it could also be attributable to patients losing faith in the health care system and chosing to use it less, or being told their problem is psychological and that they should not go to the doctor, etc.

Edit: nevermind about the table, I figured it out.
 
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