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Healthcare use and costs associated with children’s behavior problems

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Abstract

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.

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Abbreviations

ADHD:

Attention deficit hyperactivity disorder

AG MEG:

AG Methoden der gesundheitsökonomischen Evaluation

aOR:

Adjusted odds ratio

ENT:

Ear, nose and throat specialist

€:

Euro

CI:

Confidence interval

GINI:

German Infant Nutritional Intervention study

LISA:

Influences of lifestyle-related factors on the immune system and the development of allergies in childhood study

MCMC:

Markov chain Monte Carlo methods

OECD:

Organization for Economic Cooperation and Development

p :

p Value

PROC MI:

Procedure Multiple imputation

SAS:

Statistical analysis system

SD:

Standard deviation

SDQ:

Strengths and difficulties questionnaire

SES:

Socioeconomic status

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Acknowledgments

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.

Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Institute of Epidemiology I, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany

    Gabriele Kohlboeck & Carla M. T. Tiesler

  2. Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Wuerzburg, Würzburg, Germany

    Marcel Romanos

  3. Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany

    Christina M. Teuner & Rolf Holle

  4. Chair of Epidemiology, Institute of Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-University of Munich, Munich, Germany

    Gabriele Kohlboeck, Carla M. T. Tiesler & Joachim Heinrich

  5. Dr von Hauner Children’s Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany

    Sibylle Koletzko

  6. IUF Leibniz Research Institute for Environmental Medicine and Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany

    Barbara Hoffmann

  7. Medical Practice for Pediatrics, Bad Honnef, Germany

    Beate Schaaf

  8. UFZ-Center for Environmental Research, Leipzig, Germany

    Irina Lehmann

  9. Faculty of Medicine, Institute of Environmental Medicine and Hygiene, University of Leipzig, Leipzig, Germany

    Olf Herbarth

  10. Department of Pediatrics, Technical University of Munich, Munich, Germany

    Carl-Peter Bauer

  11. Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany

    Andrea von Berg & Dietrich Berdel

  12. Institute of Applied Psychology, Private University of Health Sciences, Medical Informatics and Technology (UMIT), Hall in Tyrol, Austria

    Gabriele Kohlboeck

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  1. Gabriele Kohlboeck
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  2. Marcel Romanos
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  3. Christina M. Teuner
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  6. Barbara Hoffmann
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  7. Beate Schaaf
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  14. Joachim Heinrich
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Corresponding author

Correspondence to Gabriele Kohlboeck.

Additional information

For the study of GINI-plus and LISA-plus study group. The members of GINI-plus and LISA-plus Study Group are listed in Appendix S1 in online repository.

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Kohlboeck, G., Romanos, M., Teuner, C.M. et al. Healthcare use and costs associated with children’s behavior problems. Eur Child Adolesc Psychiatry 23, 701–714 (2014). https://doi.org/10.1007/s00787-013-0504-9

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