Mara Violato Hi, my name is Mara Violato, and I am a Health Economist at the University of Oxford. My colleague, Jack Pollard, and I, are going to talk about a systematic review and meta-analysis on the “Consequences of Child Anxiety Problems,” which we have recently completed and published. This was a collaborative research with other colleagues at the University of Oxford and other UK universities, and it was funded by the UK National Institute for Health and Care Research. To give you a bit of background, anxiety problems are very common. For example, over a quarter of people experience an anxiety disorder at some time in their life, and very often, difficulties emerge during childhood and adolescence. Despite being such a common mental health disorders, a gap still exist in the current evidence base of the multiple consequences of child anxiety problems and their costs. For example, existing literature reviews have explored the relationship between child anxiety problems and specific outcomes, and they have focused mainly on consequences for the child. We, instead, produce a holistic overview of the impact of child anxiety problems at the child, family, soci – and societal level and their associated costs. And we do this because we believe that this approach is very important for informing multidisciplinary policies and intervention to tackle anxiety problems and their multifaceted consequences. So, now Jack will explain the methods that we used and the results that we obtained. Jack Pollard Thanks for the introduction, Mara. I’m Jack Pollard, another Health Economist at the University of Oxford. So, with respect to the methods, we searched four databases to identify longitudinal and economic studies reporting on the association between childhood anxiety problems and at least one individual family or societal level outcome or cost. After the title abstract and full text screening and reviewing the reference lists of included studies, 83 papers were included in the narrative synthesis. For longitudinal studies, effect direction was used as a common metric, where each association was categorised as an improvement, worsening or no clear change in the outcome of interest. 13 studies were included in 13 separate meta-analyses, which required two or more studies to have a similar exposure and outcome, as well as other similar study characteristics. Of the 83 studies included in our systematic review, 71 were longitudinal studies, including 788 separate analyses that were extracted and grouped into 15 mutually exclusive outcome domains. 12 studies were economic based, six of which were costing studies, five trial-based economic evaluations and one burden of disease study. 41 studies were of strong quality and 31 were of moderate quality, with quality assessed using the Effective Public Health Practice Project quality assessment tool for quantitative studies. In summary, anxiety problems were associated with worse outcomes in each of the 15 outcome domains. However, the strength and quality of evidence varied. Figure one shows the 15 outcome domains. The colour shows the quality of evidence in a traffic light system, while the arrows show the strength of evidence. The results of the meta-analysis, shown with the bold solid line, show that anxiety problems were associated with anxiety, mood, behaviour and substance use problems. The unbolded solid line shows the results of the sign test, where we tested whether there were significantly more worse outcomes than improved outcomes in the domain of interest. There were worse outcomes in anxiety, mood, substance use and physical health. Finally, the dashed line shows evidence that exposure to anxiety problems in pre-teenage years was associated with worse outcomes in the narrative review, while the dash and dotted line shows evidence of worse outcomes associated with teenage anxiety problems. With respect to economic costs, they varied among the costing studies. Direct costs, such as healthcare costs, varied from £965 to £3,610 per year per child, with societal costs up to £4,040 annually per child, which were mostly made up of non-healthcare costs. I’ll now pass you back to Mara to summarise our conclusions. Mara Violato Thank you, Jack. So, to conclude, our findings suggest that the child anxiety problems persist in later childhood, teenage years and early adulthood, and they are also associated with the various long-lasting adverse outcomes that cover several domains of everyday life. Furthermore, our holistic overview of the consequences of child anxiety problems provide very important evidence that can be used for modelling the long-term clinical and economic outcomes of child anxiety problems. And finally, the finding that child anxiety disorders are associated with substantial child, family and societal level economic costs also highlights the urgent need for cost effective, preventative and interventional policies to address this very common mental health disorder. We’d like to thank our funder, the UK NIHR and to remind that the views expressed are ours and not those of the funders. And finally, we hope that you find reading our article both useful and interesting. So, thank you very much for listening to us.