Public health consequences of different thresholds for the diagnosis of mental disorders
ABSTRACT The acceptance of subthreshold disorders in psychiatry is a controversial topic with multiple implications for public health policy. Using subthreshold depression as an example, we provide documentation based on data from epidemiologic and clinical studies suggesting that subthreshold conditions are not uncommon, there is significant associated disability (with significant societal costs), and the course of illness often leads to the development of the full-blown disorder. The potential societal benefits of developing and testing low-cost, low-risk, and nontraditional treatments are considered. The recommendations are to match treatment intensity and cost with severity level in a staged approach.
SourceAvailable from: Jeroen Ruwaard[Show abstract] [Hide abstract]
ABSTRACT: In 1997, researchers at the University of Amsterdam developed one of the first psychotherapeutic applications of the World Wide Web. They implemented a standardized cognitive behavioural treatment (CBT) of posttraumatic stress symptoms in a website, and used this site to treat a small number of students with matching symptoms. To the surprise of the research team, the results of what they called Interapy were very encouraging. Subsequently, controlled trials confirmed the value of this pilot study, and showed that a large part of these improvements could be attributed to the intervention. In this dissertation, we explore the wider applicability of online CBT, in four randomized controlled trials (Chapter 2 to 5) and a practice study (Chapter 6). In the controlled studies (N = 456), we assess the efficacy of online CBT for work-related stress, mild to moderate depression, and symptoms of panic disorder and bulimia nervosa. In the fifth study, we examine the effectiveness of online CBT in routine clinical practice (N = 1500).08/2013, Degree: PHD, Supervisor: Prof. dr. A. Lange, Prof. dr. Conor Dolan, Prof. dr. P. Emmelkamp
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ABSTRACT: Depressive symptoms are related to a host of negative individual and family outcomes; therefore, it is important to establish risk factors for depressive symptoms in order to design prevention efforts. Following studies in the marital and psychiatric literatures regarding marital factors associated with depression, we tested two potential predictors of depressive symptoms: marital adjustment and perceived spousal criticism. We assessed 249 spouses from 132 married couples from the community during their first year of marriage and at three time points over the next ten years. Initial marital adjustment significantly predicted depressive symptoms for husbands and wives at all follow-ups. Further, perceived criticism significantly predicted depressive symptoms at the five- and ten-year follow-ups. However, at the one-year follow-up, this association was significant for men but not for women. Finally, a model where the contributions of marital adjustment and perceived criticism were tested together suggested that both play independent roles in predicting future depressive symptoms. These findings highlight the potential importance of increasing marital adjustment and reducing perceived criticism at the outset of marriage as a way to reduce depressive symptoms during the course of marriage.Behavior Therapy 07/2014; DOI:10.1016/j.beth.2014.03.002 · 2.43 Impact Factor