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ABSTRACT: It has been hypothesized that hypovitaminosis D is associated with depression but epidemiological evidence is limited. We investigated the association between depressive disorders and related clinical characteristics with blood concentrations of 25-hydroxyvitamin D [25(OH)D] in a large cohort. The sample consisted of participants (aged 18-65 years) from the Netherlands Study of Depression and Anxiety (NESDA) with a current (N=1102) or remitted (N=790) depressive disorder (major depressive disorder, dysthymia) defined according to DSM-IV criteria, and healthy controls (N=494). Serum levels of 25(OH)D measured and analyzed in multivariate analyses adjusting for sociodemographics, sunlight, urbanization, lifestyle and health. Of the sample, 33.6% had deficient or insufficient serum 25(OH)D (<50 nmol l(-1)). As compared with controls, lower 25(OH)D levels were found in participants with current depression (P=0.001, Cohen's d=0.21), particularly in those with the most severe symptoms (P=0.001, Cohen's d=0.44). In currently depressed persons, 25(OH)D was inversely associated with symptom severity (β=-0.19, s.e.=0.07, P=0.003) suggesting a dose-response gradient, and with risk (relative risk=0.90, 95% confidence interval=0.82-0.99, P=0.03) of having a depressive disorders at 2-year follow-up. This large cohort study indicates that low levels of 25(OH)D were associated to the presence and severity of depressive disorder suggesting that hypovitaminosis D may represent an underlying biological vulnerability for depression. Future studies should elucidate whether-the highly prevalent-hypovitaminosis D could be cost-effectively treated as part of preventive or treatment interventions for depression.Molecular Psychiatry advance online publication, 9 April 2013; doi:10.1038/mp.2013.36.
Molecular psychiatry 04/2013; · 15.05 Impact Factor
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ABSTRACT: OBJECTIVE: Theory of Mind (ToM) is considered an essential element of social cognition. In younger schizophrenia patients, ToM impairments have extensively been demonstrated. It is not clear whether similar impairments can be found in older schizophrenia patients and if these impairments differ between older patients with early-onset and late-onset schizophrenia. METHODS: Theory of Mind abilities were assessed using the Hinting Task in 15 older patients (age 60 years and older) with early-onset paranoid schizophrenia, 15 older patients with late-onset paranoid schizophrenia and 30 healthy controls. ANCOVA was performed to test differences between groups. Analyses were adjusted for level of education. Effect sizes, partial eta squared (ε(2) ), were computed as an indication of the clinical relevance of the findings. RESULTS: Patients with early-onset schizophrenia scored significantly lower on the Hinting Task (mean 16.1; SD 4.3) compared with patients with late-onset schizophrenia (mean 18.6; SD 1.5) and with healthy controls (mean 19.0; SD 1.4). The effect size of this difference was large (ε(2) = 0.2). CONCLUSIONS: These results suggest that ToM functioning may be a protective factor modulating the age at onset of psychosis. Further studies into the relationship between social cognition and onset age of psychosis are warranted. Copyright © 2013 John Wiley & Sons, Ltd.
International Journal of Geriatric Psychiatry 01/2013; · 2.42 Impact Factor
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ABSTRACT: Although anxiety disorders, like depression, are increasingly being associated with metabolic and cardiovascular burden, in contrast with depression, the role of inflammation in anxiety has sparsely been examined. This large cohort study examines the association between anxiety disorders and anxiety characteristics with several inflammatory markers. For this purpose, persons (18-65 years) with a current (N=1273) or remitted (N=459) anxiety disorder (generalized anxiety disorder, social phobia, panic disorder, agoraphobia) according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and healthy controls (N=556) were selected from the Netherlands Study of Depression and Anxiety. In addition, severity, duration, age of onset, anxiety subtype and co-morbid depression were assessed. Inflammatory markers included C-reactive protein (CRP), interleukin (IL)-6 and tumor-necrosis factor (TNF)-α. Results show that after adjustment for sociodemographics, lifestyle and disease, elevated levels of CRP were found in men, but not in women, with a current anxiety disorder compared with controls (1.18 (s.e.=1.05) versus 0.98 (s.e.=1.07) mg l(-1), P=0.04, Cohen's d=0.18). No associations were found with IL-6 or TNF-α. Among persons with a current anxiety disorder, those with social phobia, in particular women, had lower levels of CRP and IL-6, whereas highest CRP levels were found in those with an older age of anxiety disorder onset. Especially in persons with an age of onset after 50 years, CRP levels were increased compared with controls (1.95 (s.e.=1.18) versus 1.27 (s.e.=1.05) mg l(-1), P=0.01, Cohen's d=0.37). In conclusion, elevated inflammation is present in men with current anxiety disorders. Immune dysregulation is especially found in persons with a late-onset anxiety disorder, suggesting the existence of a specific late-onset anxiety subtype with a distinct etiology, which could possibly benefit from alternative treatments.
Translational psychiatry. 01/2013; 3:e249.
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ABSTRACT: BACKGROUND: Knowledge of the risk of recurrence after recovery from major depressive disorder (MDD) in the general population is scarce. Method Data were derived from 687 subjects in the general population with a lifetime DSM-III-R diagnosis of MDD but without a current major depressive episode (MDE) or dysthymia. Participants had to be at least 6 months in remission, and were recruited from The Netherlands Mental Health Survey and Incidence Study (NEMESIS), using the Composite International Diagnostic Interview (CIDI). Recency and severity of the last MDE were assessed retrospectively at baseline. Recurrence of MDD was measured prospectively during the 3-year follow-up. Kaplan-Meier survival curves were used to measure time to recurrence. Determinants of time to recurrence were analyzed using proportional hazard models. RESULTS: The estimated cumulative recurrence of MDD was 13.2% at 5 years, 23.2% at 10 years and 42.0% at 20 years. In bivariate analysis, the following variables predicted a shorter time to recurrence: younger age, younger age of onset, higher number of previous episodes, a severe last depressive episode, negative youth experiences, ongoing difficulties before recurrence and high neuroticism. Multivariably, younger age, a higher number of previous episodes, a severe last depressive episode, negative youth experiences and ongoing difficulties remained significant. CONCLUSIONS: In this community sample, the long-term risk of recurrence was high, but lower than that found in clinical samples. Subjects who had had an MDE had a long-term vulnerability for recurrence. Factors predicting recurrence included illness- and stress-related factors.
Psychological Medicine 10/2012; · 6.16 Impact Factor
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ABSTRACT: The hypothalamic-pituitary-adrenal (HPA) axis and the inflammatory response system have been suggested as pathophysiological mechanisms implicated in the etiology of major depressive disorder (MDD). Although meta-analyses do confirm associations between depression and these biological systems, effect sizes vary greatly among individual studies. A potentially important factor explaining variability is heterogeneity of MDD. Aim of this study was to evaluate the association between depressive subtypes (based on latent class analysis) and biological measures. Data from 776 persons from the Netherlands Study of Depression and Anxiety, including 111 chronic depressed persons with melancholic depression, 122 with atypical depression and 543 controls were analyzed. Inflammatory markers (C-reactive protein, interleukin-6, tumor necrosis factor-α), metabolic syndrome components, body mass index (BMI), saliva cortisol awakening curves (area under the curve with respect to the ground (AUCg) and with respect to the increase (AUCi)), and diurnal cortisol slope were compared among groups. Persons with melancholic depression had a higher AUCg and higher diurnal slope compared with persons with atypical depression and with controls. Persons with atypical depression had significantly higher levels of inflammatory markers, BMI, waist circumference and triglycerides, and lower high-density lipid cholesterol than persons with melancholic depression and controls. This study confirms that chronic forms of the two major subtypes of depression are associated with different biological correlates with inflammatory and metabolic dysregulation in atypical depression and HPA-axis hyperactivity in melancholic depression. The data provide further evidence that chronic forms of depressive subtypes differ not only in their symptom presentation, but also in their biological correlates. These findings have important implications for future research on pathophysiological pathways of depression and treatment.Molecular Psychiatry advance online publication, 23 October 2012; doi:10.1038/mp.2012.144.
Molecular psychiatry 10/2012; · 15.05 Impact Factor
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ABSTRACT: Background: Hardly any reliable data are available relating to the course of late-life depression. Aim: To trace the course of late-life depression in the community; to determine whether the outlook/or depressed persons deteriorates with age; and to find out whether failure to satisfy
DSM criteria for affective disorders when the depression first manifests itself predicts the course of the depression. Method: The study was part of the Longitudinal Aging Study Amsterdam. Reliable data relating to 277 depressed elderly persons are available (on average9.8 observations per respondent]. Results: During a 6-year period the mean severity of symptoms in the study group was remained higher than the 85th percentile score for elderly persons in the general population. Fewer than 15% of the respondents were depressed/or less than 20% of the time. Of the respondents 23% went into remission, 12% went into remission but experienced recurrence, 32% fell into the chronic intermittent category and 32% fell into the chronic category. Both age at baseline and age-related risk/actors predicted that the depression would take a rather less favourable course. Respondents fulfilling the
DSM-criteria/or depression or dysthymic disorder had the least favourable prognosis. In most cases the course of the depression in those diagnosed as having subthreshold depression at baseline was highly unfavourable and certainly far less favourable than in a control group of non-depressed elderly persons who were followed/or 3 years. Conclusion: The outlook/or most persons with late-life depression in the community as a whole is not promising and is probably less promising than for younger adults. The
DSM-criteria for depression disorders are a helpful tool/or identifying the group whose depression will take the worst course. However, most of the elderly persons with symptoms of depression do not meet formal
DSM-criteria. This 'grey area' in the classification of affective disorders is highly relevant, both clinically and from the point of view of public health, and therefore requires further research. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Tijdschrift voor psychiatrie 10/2012;
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ABSTRACT: BACKGROUND: Much is still unclear about the role of personality in the structure of common psychiatric disorders such as depressive/anxiety disorders and alcohol dependence. This study will therefore examine whether various traits of negative emotionality and impulsivity showed shared or specific associations with these disorders. Method Cross-sectional data were used from the Netherlands Study of Depression and Anxiety (NESDA), including individuals with no DSM-IV psychiatric disorder (n = 460), depressive/anxiety disorder only (i.e. depressive and/or anxiety disorder; n = 1398), alcohol dependence only (n = 32) and co-morbid depressive/anxiety disorder plus alcohol dependence (n = 358). Aspects of negative emotionality were neuroticism, hopelessness, rumination, worry and anxiety sensitivity, whereas aspects of impulsivity included disinhibition, thrill/adventure seeking, experience seeking and boredom susceptibility. RESULTS: Aspects of negative emotionality formed a homogeneous dimension, which was unrelated to the more heterogeneous construct of impulsivity. Although all aspects of negative emotionality were associated with alcohol dependence only, associations were much stronger for depressive/anxiety disorder only and co-morbid depressive/anxiety disorder with alcohol dependence. The results for impulsivity traits were less profound and more variable, with disinhibition and boredom susceptibility showing modest associations with both depressive/anxiety disorder and alcohol dependence, whereas low thrill/adventure seeking and high disinhibition were more strongly related with the first and the latter, respectively. CONCLUSIONS: Our results suggest that depressive/anxiety disorder and alcohol dependence result from shared as well as specific aetiological pathways as they showed the same associations with all aspects of negative emotionality, disinhibition and boredom susceptibility as well as specific associations with thrill/adventure seeking and disinhibition.
Psychological Medicine 10/2012; · 6.16 Impact Factor
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ABSTRACT: ABSTRACT Background: Prevalence of depression is twice as high in women as in men, also in older adults. Lack of social support is a risk factor for late-life depression. The relation between depression and social support may be different for men and women. Methods: Data from the Longitudinal Aging Study Amsterdam were used to investigate gender differences in the relation between social support and depression in a population-based sample aged 55-85 years, with n = 2,823 at baseline and using the 13-year follow-up data on onset of depression. Results: Respondents without a partner in the household, with a small network, and with low emotional support were more often depressed, with men showing higher rates of depression than women. A high need for affiliation was associated with depression in women but not in men. Lack of a partner in the household and having a small network predicted onset of depression in men but not in women. In respondents with high affiliation need and low social support, depression rates were higher, with men being more often depressed than women. Conclusions: Low social support and a high need for affiliation were related to depression in later life, with men being more vulnerable for depression than women. Considering the serious consequences of depression, especially in older people, it is important to identify the persons with low social support and a high need for affiliation, and to help them to increase their social support or to adjust their needs.
International Psychogeriatrics 07/2012; · 2.24 Impact Factor
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ABSTRACT: The relation of aging and the stability of personality in late life is evaluated by a literature review. The findings of six
longitudinal studies reveal that rank-order consistency continues into old age. The mean-level stability reveals a concave
curve for ‘neuroticism’ with an increase after age 80, a decrease for ‘extraversion’, and an increase for ‘agreeableness’.
The methodological and conceptual issues of personality assessment with old adults can be resolved by using a self report
scale which corresponds to the capacities and the lifestyle of older adults and by involving age related variables into analyses.
Door middel van literatuuronderzoek wordt onderzocht wat bekend is over de invloed van veroudering op de stabiliteit van persoonlijkheid
op hoge leeftijd. De resultaten van 6 longitudinale onderzoeken wijzen op voortzetting van de relatieve stabiliteit tot op
hoge leeftijd. De absolute stabiliteit laat een U-vormig beloop van ‘neuroticisme’ zien met een stijging na het 80e jaar, een afname van ‘extraversie’ en een toename van ‘altruïsme’. De methodologische en conceptuele problemen bij onderzoek
naar de ontwikkeling van persoonlijkheid op latere leeftijd kunnen grotendeels ondervangen worden door een persoonlijkheidsvragenlijst
te ontwikkelen die aansluit bij de levensfase van ouderen en door de aan veroudering gerelateerde kenmerken als co-variabelen
in de onderzoeksopzet te betrekken.
persoonlijkheid-ouderen-stabiliteit
Tijdschrift voor gerontologie en geriatrie 05/2012; 37(4):151-157.
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Tijdschrift voor gerontologie en geriatrie 04/2012; 2010(3):126-135.
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ABSTRACT: The GDS-8; a short, client- and user-friendly shortened version of the Geriatric Depression Scale for nursing homes The objective of this study was to construct a patient- and user-friendly shortened version of the Geriatric Depression Scale
(GDS) that is especially suitable for nursing home patients. The study was carried out on two different data bases including
23 Dutch nursing homes. Data on the GDS (n=410), the Mini Mental State Examination (n=410) and a diagnostic interview (SCAN;
n=333), were collected by trained clinicians. Firstly, the items of the GDS-15 were judged on their clinical applicability
by three clinical experts. Subsequently, seven items that were identified as unsuitable were removed using the GDS-data of
the Assess-project (n=77), and internal consistency was calculated. Secondly, with respect to criterion validity (sensitivity,
specificity, area under ROC and positive and negative predictive values), the newly constructed 8-item version of the GDS
was validated in the AGED data set (n=333), using DSM-IV diagnosis for depression as measured by the SCAN as ‘gold standard’.
In the AGED dataset, the GDS-8 was internally consistent (a=.80) and high sensitivity rates of 96.3% for major depression
and 83.0% for minor depression were found, with a specificity rate of 71.7% at a cut-off point of 2/3. The GDS-8 has good
psychometric properties. Given that the GDS-8 is less burdening for the patient, more comfortable to use and less time consuming,
it may be a more feasible screening test for the frail nursing home population.
Tijdschr Gerontol Geriatr 2007; 38: 298-304
De Geriatrische Depressie Schaal heeft als screeningsinstrument zijn sporen verdiend, maar heeft veel items en is belastend
voor de fragiele verpleeghuispopulatie. Een veelgebruikte verkorte versie, de GDS-15, bevat items die niet geschikt zijn voor
gebruik in verpleeghuizen. Doel van deze studie was het construeren van een verkorte verpleeghuisversie. Voor twee onderzoeksprojecten
werd bij 410 cliënten de GDS afgenomen. Uit GDS-data van het Assess-project (N=77) werden zeven items verwijderd die volgens
drie deskundigen niet van toepassing, onbegrijpelijk of ergerniswekkend waren. Van de resterende acht items werd berekend
of zij een intern consistente schaal vormden. Vervolgens werden betrouwbaarheid en criteriumvaliditeit van deze acht-itemversie
bepaald in de AGED dataset (N=333). Hierbij werd de DSM-IV diagnose voor depressie (gemeten met de SCAN) gebruikt als gouden
standaard. In de AGED-dataset had de GDS-8 een goede interne consistentie (?=0,80) en een hoge sensitiviteit voor een depressieve
stoornis (major depression) (96,3%) en een iets minder hoge sensitiviteit (83,0%) voor een lichte depressieve stoornis (minor
depression) bij een specificiteit van 71,7% (cut-off 2/3).
De GDS-8 heeft goede psychometrische eigenschappen en is bovendien minder belastend voor de cliënt, prettiger af te nemen
en minder tijdsintensief. Gebruik van de GDS-8 zou de opsporing van depressie in verpleeghuizen kunnen verbeteren.
depressie-screening-Geriatrische Depressie Schaal-verpleeghuizen
Tijdschrift voor gerontologie en geriatrie 04/2012; 38(6):264-269.
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ABSTRACT: Growing evidence suggests that immune dysregulation may be involved in depressive disorders, but the exact nature of this association is still unknown and may be restricted to specific subgroups. This study examines the association between depressive disorders, depression characteristics and antidepressant medication with inflammation in a large cohort of controls and depressed persons, taking possible sex differences and important confounding factors into account. Persons (18-65 years) with a current (N = 1132) or remitted (N = 789) depressive disorder according to DSM-IV criteria and healthy controls (N = 494) were selected from the Netherlands Study of Depression and Anxiety. Assessments included clinical characteristics (severity, duration and age of onset), use of antidepressant medication and inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α)). After adjustment for sociodemographics, currently depressed men, but not women, had higher levels of CRP (1.33 versus 0.92 mg l(-1), P<0.001, Cohen's d = 0.32) and IL-6 (0.88 versus 0.72 pg ml(-1), P = 0.01, Cohen's d = 0.23) than non-depressed peers. Associations reduced after considering lifestyle and disease indicators--especially body mass index--but remained significant for CRP. After full adjustment, highest inflammation levels were found in depressed men with an older age of depression onset (CRP, TNF-α). Furthermore, inflammation was increased in men using serotonin-norepinephrine reuptake inhibitors (CRP, IL-6) and in men and women using tri- or tetracyclic antidepressants (CRP), but decreased among men using selective serotonin reuptake inhibitors (IL-6). In conclusion, elevated inflammation was confirmed in depressed men, especially those with a late-onset depression. Specific antidepressants may differ in their effects on inflammation.
Translational psychiatry. 02/2012; 2:e79.
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ABSTRACT: BACKGROUND: Identifying depressive subtypes is an important tool in reducing the heterogeneity of major depressive disorder. However, few studies have examined the stability of putative subtypes of depression over time.MethodThe sample included 488 persons from the Netherlands Study of Depression and Anxiety (NESDA) who had major depressive disorder at baseline and at the 2-year follow-up assessment. A latent transition analysis (LTA) was applied to examine the stability of depressive subtypes across time-points. Differences in demographic, clinical, psychosocial and health correlates between subtypes were evaluated in a subsample of persons with stable subtypes. RESULTS: Three subtypes were identified at each time-point: a moderate subtype (prevalence T0 39%, T1 42%), a severe typical subtype (T0 30%, T1 25%), and a severe atypical subtype (T0 31%, T1 34%). The LTA showed 76% stability across the 2-year follow-up, with the greatest stability in the severe atypical class (79%). Analyses of correlates in the stable subtypes showed a predominance of women and more overweight and obesity in the severe atypical subtype, and a greater number of negative life events and higher neuroticism and functioning scores in the severe typical subtype. CONCLUSIONS: Subtypes of major depressive disorder were found to be stable across a 2-year follow-up and to have distinct determinants, supporting the notion that the identified subtypes are clinically meaningful.
Psychological Medicine 02/2012; · 6.16 Impact Factor
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ABSTRACT: To examine which factors are associated with the duration of sick leave in employees who had been sick-listed for at least 4 weeks for any cause.
Prospective cohort study.
Data were collected from employees who had been on sick leave for at least 4 weeks. Possible predictors of absenteeism were collected by means of a questionnaire upon study inclusion. The dependent variable, duration until full return to work, was extracted from the Dutch Occupational Health and Safety Services' database at 1 year after the start of sick leave. The Cox proportional hazards regression model was used to calculate the factors predicting the duration of sick leave.
We analysed data from 562 employees. During the first year of sick leave, 71% of the employees had fully returned to work, 9.1% had resigned during this period and 19.9% had not yet returned to work. Predictors for a longer period of absence were: Physically demanding work (HR (hazard ratio): 0.562; 95% CI: 0.348-0.908), contact with medical specialists (HR: 0.691; 95% CI: 0.560-0.854), many physical symptoms (HR: 0.744; 95% CI: 0.583-0.950), moderate to severe symptoms of depression (HR: 0.748; 95% CI: 0.569-0.984) and older age (HR: 0.776; 95% CI: 0.628-0.958).
Sick-listed employees with physically demanding jobs, contact with medical specialists, many physical symptoms, symptoms of moderate to severe depression and older age are at an increased risk for longer absenteeism. Awareness of these predictors of long-term sick leave by occupational physicians helps to identify those employees at high risk.
Nederlands tijdschrift voor geneeskunde 01/2012; 156(8):A4243.
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ABSTRACT: To investigate which percentage of elderly schizophrenia patients show remission of psychotic symptoms, and to determine which clinical and social characteristics are associated with this symptomatic remission.
Descriptive cohort study.
All patients aged 60 years and over who were diagnosed with schizophrenia or schizoaffective disorder and who were being treated within a psychiatric catchment area in Amsterdam were asked to provide consent for study participation. The presence and intensity of psychotic symptoms was documented using the international criteria for symptomatic remission. In addition, we collected a number of clinical and social characteristics concerning the research group.
29.4% of the 109 participants demonstrated symptomatic remission. These patients had more often been diagnosed with schizoaffective disorder and scored higher on measures of social functioning and collaboration with treatment. Being in remission was not related to age at onset of the disorder, a better mood or a subjectively higher quality of life.
Only a minority of elderly schizophrenia patients showed symptomatic remission. The relation between remission and social functioning and collaboration with treatment offers possibilities for intervention.
Nederlands tijdschrift voor geneeskunde 01/2012; 156(32):A4701.
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ABSTRACT: This article presents initial data from the Amsterdam Study of Acute Psychiatry (ASAP) which investigated the factors that play a role in the decision to admit a patient compulsorily to a psychiatric clinic in the Amsterdam area.
To find out how socio-demographic factors, a patient’s psychiatric history and pathway to care influence a patient’s chance of being served with an emergency compulsory admission order during emergency consultation.
We conducted a prospective cohort study of 1970 consecutive patients who consecutively came into contact with the Psychiatric Emergency Service Amsterdam (PESA) in the period September 2004 to September 2006.
A patient who had been admitted compulsorily once in the previous five years ran an increased risk of compulsorily admission (or 3.9). Referral by the police or by the mental health services also implied a high risk of a compulsorily admission (or 2.2 and or 2.6 respectively).
A previous compulsorily admission and referral by the police or mental health services were found to be predictors of emergency compulsory admission, irrespective of possible danger to the patient himself and others and irrespective of the patient’s lack of motivation for treatment.
Tijdschrift voor psychiatrie 01/2012; 54(4):317-27.
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ABSTRACT: Clergy members (CMS) frequently provide support and counselling for people with psychological and psychiatric disorders. There is evidence in the literature that CMS consider themselves to be inadequately trained to recognise psychiatric disorders.
To investigate to what extent CMS are able to recognise psychiatric symptoms.
CMS were recruited in the south-west of the Netherlands among various denominations (Roman Catholic, strict (orthodox) Protestant, moderate Protestant and Evangelical; n = 143) by means of a regional sampling method. The participating CMS (n = 143) and a control group consisting of mental health care professionals MPHS; n = 73) evaluated four vignettes of psychiatric problems with a religious content: two were about a psychiatric disorder (a psychotic state and a psychotic depression/melancholic state), and two concerned non-psychiatric states (a spiritual/religious experience and a mourning reaction with a religious dilemma). For each vignette the respondents scored the suitability of psychiatric medication, the desirability of mental health care, the severity of the disorder and whether there was a religious or spiritual aetiology.
Some CMS were able to recognise psychiatric problems almost as well as the MHPS, but among the CMS the degree of recognition varied according to the denomination. Recognition was relatively poor among Evangelical CMS, but was best among the strict Protestant CMS. Evangelical pastors and strict Protestant CMS tended to interpret the non-psychiatric states as pathological.
The findings of this study emphasise the need for collaboration between MHPS and CMS and stress the importance of consultation.
Tijdschrift voor psychiatrie 01/2012; 54(9):785-95.
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ABSTRACT: Randomised controlled trial to evaluate the effectiveness of collaborative care in a Dutch occupational healthcare setting: 126 workers on sick leave with major depressive disorder were randomised to usual care (n = 61) or collaborative care (n = 65). After 3 months, collaborative care was more effective on the primary outcome measure of treatment response (i.e. reduction in symptoms of ≥50%) on the Patient Health Questionnaire-9 (PHQ-9). However, the groups did not differ on the PHQ-9 as a continuous outcome measure. Implications of these results are discussed.
The British journal of psychiatry: the journal of mental science 11/2011; 200(6):510-1. · 6.62 Impact Factor
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ABSTRACT: Although there are many forms of effective, evidence-based treatments available to patients with mood and anxiety disorders, many do not seek any help. Certain personality characteristics are associated with increased use of mental health services. The objective of this study is to examine whether personality traits are also related to patients' perceived need for (specific types of) mental health care.
Cross-sectional data were derived from the Netherlands Study of Depression and Anxiety (NESDA). A total of 762 patients recruited from general practices, and who had been diagnosed with one or more DSM-IV diagnoses of anxiety and/or depression were included. Perceived need for mental health care was assessed with the Perceived Need for Care Questionnaire (PNCQ) and personality traits were assessed with the NEO-Five Factor Inventory (NEO-FFI).
We found indications that personality traits, in particular neuroticism and openness to experience, have an impact on care needs. Patients with higher scores on these traits were more likely to have a perceived need for care, irrespective of whether or not this need was met. Extraversion, agreeableness and conscientiousness were largely unrelated to perceived need for care.
Regardless of the severity of anxiety and depression, personality is associated with need for care. This seems to be true for neuroticism, openness to experience, agreeableness and conscientiousness. Associations with these domains were found for various types of treatment. These findings suggest that patients with different levels of personality traits need different treatments.
Journal of affective disorders 11/2011; 136(3):666-74. · 3.76 Impact Factor
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ABSTRACT: Current classification of unipolar depression reflects the idea that prognosis is essential. However, do DSM categories of major depressive disorder (MDD), dysthymic disorder (Dysth) and double depression (DD=MDD+Dysth) indeed adequately represent clinically relevant course trajectories of unipolar depression? Our aim was to test DSM categories (MDD, Dysth and DD) in comparison with empirically derived prognostic categories, using a prospectively followed cohort of depressed patients.
A large sample (n=804) of out-patients with unipolar depression were derived from a prospective cohort study, the Netherlands Study of Depression and Anxiety (NESDA). Using latent class growth analysis (LCGA), empirically derived 2-year course trajectories were constructed. These were compared with DSM diagnoses and a wider set of putative predictors for class membership.
Five course trajectories were identified, ranging from mild severity and rapid remission to high severity and chronic course trajectory. Contrary to expectations, more than 50% of Dysth and DD were allocated to classes with favorable course trajectories, suggesting that current DSM categories do not adequately represent course trajectories. The class with the most favorable course trajectory differed on several characteristics from other classes (younger age, more females, less childhood adversity, less somatic illnesses, lower neuroticism, higher extraversion). Older age, earlier age of onset and lower extraversion predicted poorest course trajectory.
MDD, Dysth and DD did not adequately match empirically derived course trajectories for unipolar depression. For the future classification of unipolar depression, it may be wise to retain the larger, heterogeneous category of unipolar depression, adopting cross-cutting dimensions of severity and duration to further characterize patients.
Psychological Medicine 11/2011; 42(7):1383-96. · 6.16 Impact Factor
