-
[show abstract]
[hide abstract]
ABSTRACT: To investigate associations between different indices of family socioeconomic position (SEP) and the use of specialty mental health services (SMHS) and whether the associations exist after adjusting for severity of mental problems.
Using data from a large longitudinal study of adolescents (N = 2,149; mean age = 13.6 years [SD = 0.53, range = 12 to 15 years]; 51% girls), we assessed the relations of family SEP indices with SMHS use while accounting for severity of mental problems in logistic regression models. Multiple informants (parent, self, and teachers) assessed severity of mental health problems using the Achenbach scales. A parent questionnaire was used to assess family SEP (parents' education, parents' occupation, and family income) and SMHS use. Baseline response rate was 76%, and 96.4% of responders were reassessed at a 2.5-year follow-up visit. Baseline assessments ran from March 2001 through July 2002 and follow-up from September 2003 to December 2004.
Overall, 6.7% of the total sample and 42.9% of those with mental problems accessed SMHS. Univariable analyses yielded no significant associations between SMHS and all the indices of SEP. Adjustment for the severity of mental problems resulted in substantial and statistically significant associations of indices of SEP with SMHS use. Adolescents were particularly more likely to use SMHS with increasing levels of maternal education. Compared to mothers with elementary education, those with university education were three times more likely to consult SMHS independent of severity of their offspring's mental health problems (odds ratio [OR] = 3.18, confidence interval [CI] = 1.22, 8.30). For the aggregate measure of SEP, high SEP was associated with increased use of SMHS compared with low SEP (OR = 1.63, CI = 1.04, 2.55).
Higher levels of maternal education and overall SEP predict more SMHS use when the severity of mental problems was accounted for. Without correcting for the severity of mental problems, the true association between SEP and SMHS use is obscured in early adolescents.
Journal of the American Academy of Child and Adolescent Psychiatry 07/2010; 49(7):647-55. · 4.98 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Inflammatory processes may play a role in the pathophysiology of schizophrenia. The aim of this study was to determine the efficacy of adjuvant treatment with aspirin (acetylsalicylic acid) in schizophrenia spectrum disorders.
This randomized, double-blind, placebo-controlled study was conducted between May 2004 and August 2007. Seventy antipsychotic-treated inpatients and outpatients from 10 psychiatric hospitals in The Netherlands with a DSM-IV-diagnosed schizophrenia spectrum disorder were included. Patients were randomized to adjuvant treatment with aspirin 1000 mg/d or placebo. During a 3-month follow-up, psychopathology was assessed with the Positive and Negative Syndrome Scale (PANSS). Other assessments included cognitive tests and immune function. The primary efficacy outcome was the change in total PANSS score. Secondary outcomes were changes in the PANSS subscales and cognitive test results.
Mixed-effect models showed a 4.86-point (95% CI, 0.91 to 8.80) and 1.57-point (95% CI, 0.06 to 3.07) larger decrease in the aspirin group compared to the placebo group on the total and positive PANSS score, respectively. Similar but not statistically significant results were observed for the other PANSS subscale scores. Treatment efficacy on total PANSS score was substantially larger in patients with the more altered immune function (P = .018). Aspirin did not significantly affect cognitive function. No substantial side effects were recorded.
Aspirin given as adjuvant therapy to regular antipsychotic treatment reduces the symptoms of schizophrenia spectrum disorders. The reduction is more pronounced in those with the more altered immune function. Inflammation may constitute a potential new target for antipsychotic drug development.
controlled-trials.com Identifier: ISRCTN27745631.
The Journal of Clinical Psychiatry 05/2010; 71(5):520-7. · 5.80 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Cognitive dysfunction is clearly recognized in bipolar patients, but the degree of impairment varies due to methodological factors as well as heterogeneity in patient populations. The goal of this study was to evaluate cognitive functioning in bipolar patients and to assess its association with depressive symptoms. Post hoc the relationship with lifetime alcohol use disorder was explored.
The study included 110 bipolar patients and 75 healthy controls. Patients with severe depressive symptoms, (hypo)manic symptoms and current severe alcohol use disorder were excluded. Diagnoses were evaluated via the Mini-International Neuropsychiatric Interview. Cognitive functioning was measured in domains of psychomotor speed, speed of information processing, attentional switching, verbal memory, visual memory, executive functioning and an overall mean score. Severity of depression was assessed by the Inventory of Depressive Symptomatology-self rating. Patients were euthymic (n = 46) or with current mild (n = 38) or moderate (n = 26) depressive symptoms. Cognitive impairment was found in 26% (z-score 2 or more above reference control group for at least one domain) of patients, most prominent in executive functioning (effect size; ES 0.49) and speed of information processing (ES 0.47). Depressive symptoms were associated with dysfunction in psychomotor speed (adjusted beta 0.43; R(2) 7%), speed of information processing (adjusted beta 0.36; R(2) 20%), attentional switching (adjusted beta 0.24; R(2) 16%) and the mean score (adjusted beta 0.23; R(2) 24%), but not with verbal and visual memory and executive functioning. Depressive symptoms explained 24% of the variance in the mean z-score of all 6 cognitive domains. Comorbid lifetime alcohol use (n = 21) was not associated with cognitive dysfunction.
Cognitive dysfunction in bipolar disorder is more severe in patients with depressive symptoms, especially regarding speed and attention. Therefore, interpretation of cognitive functioning in patients with depressive symptoms should be cautious. No association was found between cognitive functioning and lifetime comorbid alcohol use disorder.
PLoS ONE 01/2010; 5(9). · 4.09 Impact Factor
-
Mariken E Stegmann,
Johan Ormel,
Ron de Graaf,
Josep-Maria Haro,
Giovanni de Girolamo,
Koen Demyttenaere,
Vivianne Kovess,
Herbert Matschinger,
Gemma Vilagut,
Jordi Alonso, Huibert Burger
[show abstract]
[hide abstract]
ABSTRACT: The link between physical conditions and mental health is poorly understood. Functional disability could explain the association of physical conditions with major depressive episode (MDE) as an intermediary factor.
Data was analyzed from a subsample (N=8796) of the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional general population survey. MDE during the last 12 months was assessed using a revision of the Composite International Diagnostic Interview (CIDI 3.0). Lifetime chronic physical conditions were assessed by self-report. Functional disability was measured using a version of the World Health Organization Disability Assessment Schedule (WHODAS). The associations of physical conditions with MDE and explanation by functional disability were quantified using logistic regression.
All physical conditions were significantly associated with MDE. The increases in risk of MDE ranged from 30% for allergy to amply 100% for arthritis and heart disease. When adjusted for physical comorbidity, associations decreased and were no longer statistically significant for allergy and diabetes. Functional disability explained between 17 and 64% of these associations, most substantially for stomach or duodenum ulcer, arthritis and heart disease.
Due to the cross-sectional nature of the study the temporal relationship of the variables could not be assessed and the amount of explanation cannot simply be interpreted as the amount of mediation.
Our findings suggest that the association of chronic physical conditions with MDE is partly explained by functional disability. Such explanation is more pronounced for pain causing conditions and heart disease. Health professionals should be particularly aware of the increased risk of depressive disorder when patients experience disability from these conditions.
Journal of affective disorders 11/2009; 124(1-2):38-44. · 3.76 Impact Factor
-
Jaap Wijkstra, Huibert Burger,
Walter W van den Broek,
Tom K Birkenhäger,
Joost G E Janzing,
Marco P M Boks,
Jan A Bruijn,
Marc L M van der Loos,
Leonie M T Breteler,
Robbert J Verkes,
Willem A Nolen
[show abstract]
[hide abstract]
ABSTRACT: Data about follow-up after acute pharmacological treatment of psychotic depression are scarce.
A 4 month open follow-up was done, preferentially with same medication as during acute treatment, of patients (n=59) with DSM-IV-TR major depressive disorder with psychotic features, aged 18 to 65 years, who had completed as responders an acute double-blind 7 week trial with imipramine, venlafaxine or venlafaxine plus quetiapine. Main outcome measures were Hamilton Rating Scale for Depression and Clinical Global Impression Scale.
Six patients dropped out during the 4 month follow-up. Almost all patients (86.4%; 51/59) remained responder while remission rate increased from 59.3% (35/59) to 86.8% (46/53), independent of treatment. Relapse rate was low (3.8%; 2/53). Tolerability was good. Weight increased with all treatments.
Limitations were the limited sample size and consequent limited statistical power. The treatment during follow-up was not double-blind.
Continuation treatment with the same medication that was effective in the acute treatment trial, remained effective during the 4 month follow-up in many patients leading to further improvement, and was well tolerated.
Journal of affective disorders 10/2009; 123(1-3):238-42. · 3.76 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Familial risk factors have been implicated in the development of mental health problems in adolescents. Whether the associations between parental loading, as assessed by lifetime psychopathology, and offspring internalising and externalising problems were moderated by family socioeconomic position (SEP) was investigated. Two hypotheses of moderation were tested: (1) the "social push" hypothesis in which parental loading effects are stronger in contexts with low environmental risks and (2) the "vulnerability" hypothesis in which parental loading effects are stronger in high-risk environments.
In a population-based sample of 2149, familial loading and family SEP were assessed at baseline by parent reports. Offspring psychopathology was assessed by reports from multiple informants (parent, self and teachers). Multiple linear regression was used to assess the independent associations of parental loading and family SEP on offspring psychopathology and their potential interaction.
Both family SEP and familial loading had significant independent main effects on offspring internalising and externalising problems. However, the interaction terms were not significant and did not add any explanatory power to the model.
Lower levels of family SEP appear not to confer additional risks for mental health problems in offspring of parents with high loading on psychopathology. During early adolescence, parental psychopathology and low family SEP seem independent risk factors for offspring mental health problems. Results do not support either the social push or vulnerability hypothesis as no evidence of interactions between parental loading and family SEP were found.
Journal of epidemiology and community health 10/2009; 65(1):57-63. · 3.04 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Life stressors and family socioeconomic position have often been associated with mental health status. The aim of the present study is to contribute to the understanding of the pathways from low socioeconomic position and life stressors to mental problems.
In a cross-sectional analysis using data from a longitudinal study of early adolescents (N = 2,149, 51% girls; mean age 13.6 years, SD 0.53, range 12-15), we assessed the extent of mediation of the association between family socioeconomic position and mental health problems by different types of life stressors in multiple regression models. Stressors were rated as environment related or person related. Information on socioeconomic position was obtained directly from parents, and internalizing and externalizing problem behaviors were assessed by reports from multiple informants (parents, self, and teachers).
Low socioeconomic position was associated with more mental health problems and more life stressors. Both environment-related and person-related stressors predicted mental health problems independently of socioeconomic position. The associations between socioeconomic position and all mental health outcomes were partly mediated by environment-related life stressors. Mediation by environment-related and person-related stressors as assessed by linear regression amounted to 56% (95% confidence interval [CI] 35%-78%) and 7% (95% CI -25% to 38%) for internalizing problems and 13% (95% CI 7%-19%) and 5% (95% CI -2% to 13%) for externalizing problems, respectively.
Environment-related, but not person-related, stressors partly mediated the association between socio economic position and adolescent mental problems. The extent of mediation was larger for internalizing than for externalizing problems. Because the effect sizes of the associations were relatively small, targeted interventions to prevent impaired mental health may have only modest benefits to adolescents from low socioeconomic background.
Journal of the American Academy of Child and Adolescent Psychiatry 09/2009; 48(10):1031-8. · 4.98 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Relatives who are bereaved by suicide likely consult their GP when they feel the need for professional help. GPs may play a key role in establishing who is at risk for adverse consequences of the loss as they are familiar with relatives' possible psychiatric vulnerabilities. The availability of evidence-based services for relatives of suicide victims is limited. Successful implementation of services needs analysis of key factors considered critical in the achievement of changes. We investigated GPs' management of help requests of relatives bereaved by suicide and examined determinants of GPs willingness to refer for evidence-based follow-up care.
A cross-sectional survey among 488 GPs in the northern part of The Netherlands.
A 44% response was achieved (n = 214) during the last 3 years, 38 (18%) were exposed to suicide, 21 (10%) to help requests without being exposed to suicide and 52 (24%) to both suicide and help requests. Out of 106 requests, 69 (65%) were handled by the GP; 60 (57%) were either directly or additionally referred, principally for mental health care. Suicide exposure and female gender were associated with the doctor's perception that follow-up care following a loss through suicide is useful. The perception that help is useful increased the likelihood of GPs' referral for evidence-based follow-up care.
GPs support the availability of evidence-based follow-up care for relatives of suicide victims. To modify GPs' key role in referring relatives for it, GPs should be well informed of its usefulness and to whom.
Family Practice 08/2009; 26(5):372-6. · 1.50 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The hypothesis that chronic inflammation may play a role in psychosis receives increasing attention. In this study, we aim to investigate whether the use of steroidal anti-inflammatory drugs is associated with a decreased risk of psychosis.A longitudinal nested case-control study was performed investigating the association of glucocorticosteroid (GCS) consumption with a new diagnosis of a psychotic disorder. Significantly reduced odds ratios of 0.52 (95% confidence interval, 0.36-0.75) were found for GCS in men only (odds ratio in women, 0.84 [95% confidence interval, 0.590-1.20]). Similar risk reductions were present for the inhaled and systemic GCSs. A dose-response relationship was present. Our finding of an inverse relation between GCS consumption and new psychotic episodes may promote further research into inflammation in schizophrenia.
Journal of clinical psychopharmacology 07/2009; 29(3):288-90. · 5.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine whether the association between non-right-handedness and mental problems among adolescents is specific for psychotic symptoms, we included a group of 2096 adolescents with a mean age of 14 years from the general population. Mental health problems were assessed using the parent, self-report, and teacher versions of the Child Behavior Checklist. Internalising problems comprised anxious and depressed, withdrawn and depressed, and somatic complaints. Externalising problems consisted of delinquent behaviour and aggressive behaviour. The remaining problems consisted of social problems, attention problems, and thought problems. The latter were divided into psychotic and non-psychotic items. A total of 14.3% of the adolescents were non-right-handed. We observed positive associations of non-right-handedness with thought problems, social problems, and being withdrawn and depressed. Externalising problems showed no associations with handedness. Within the thought problems subscale, the effect sizes associated with non-right-handedness for psychotic and non-psychotic items were 0.18 (p = .005) and 0.04 (p = .459), respectively. In conclusion, non-right-handedness is predominantly associated with psychosis-related mental problems as early as in adolescence. Handedness could be taken into account when identifying adolescents at risk for psychosis.
Laterality 04/2009; 15(3):304-16. · 1.13 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Many depressed patients have negative beliefs about antidepressants, leading to poor adherence, unfavorable depression outcome, and low perceived well-being, role functioning, and quality of life. Interventions to ameliorate beliefs are therefore needed.
In a cluster-randomized controlled trial conducted from September 1999 to January 2001, 2 interventions to improve management of major depressive disorder in primary care were compared: (1) a depression care program (DCP), providing enhanced patient education, stimulation of active participation of general practitioners and patients in the treatment process, discussion of benefits and costs of taking antidepressant medication, and systematic follow-up and (2) a systematic follow-up program (SFP). Thirty general practitioners were randomly assigned, and 211 patients with current major depressive disorder (diagnosed according to DSM-IV) were included. All patients were prescribed a selective serotonin reuptake inhibitor. Beliefs were assessed at baseline, at week 10, and at week 26. Differences in change of beliefs between DCP and SFP groups were analyzed.
Changes in patients' beliefs were more favorable in the DCP condition at week 10 and week 26, compared with SFP only (beliefs concerning appropriate medication-taking, week 10: effect size = 0.39, p = .012; week 26: effect size = 0.55, p = .001; beliefs concerning harmfulness, week 10: effect size = 0.45, p = .011; week 26: effect size = 0.62, p = .002).
The depression care program ameliorates beliefs about antidepressants in primary care patients with major depressive disorder. The study results encourage the implementation of a depression care program in order to improve beliefs about antidepressant medication in primary care patients diagnosed with major depressive disorder.
The Primary Care Companion to The Journal of Clinical Psychiatry 02/2009; 11(2):48-52.
-
[show abstract]
[hide abstract]
ABSTRACT: Risperidone long-acting injectable (RLAI), the first second-generation depot antipsychotic, has extensively been studied before introduction. Thereafter, questions about the type of patients actually treated with RLAI in daily practice remain to be answered for making valid antipsychotic treatment comparisons involving RLAI in observational studies.
We aimed to determine in chronic antipsychotic users who switched treatment, predictors for the prescription of (1) depot versus oral antipsychotics and (2) RLAI versus first-generation antipsychotics (FGAs) depot.
We used pharmacy dispensing data from 53 community pharmacies in the northeast of the Netherlands containing approximately 500,000 persons. Chronic antipsychotic users were defined and followed up for a switch in antipsychotic treatment within the first period that RLAI was on the market. Multivariable analysis was performed to relate patient, prescriber, and medication characteristics to prescription of a new antipsychotic drug.
Predictors for switching to depot versus oral antipsychotics were male sex, previous use of depot antipsychotics, recent anticholinergic drug use, and a gap in antipsychotic dispensation history. Predictors for switching to RLAI versus FGA depot were previous use of depot and consulting a specialist.
The results suggest that, compared with oral antipsychotics, patients receiving a depot are less compliant users, with more extrapyramidal side effects. Compared with FGA depot, patients receiving RLAI tend to be more severely ill patients. We conclude that RLAI may be partly channeled to patients as a last resort, which may have important consequences for the interpretation of observational effectiveness comparisons between RLAI and other antipsychotics in daily practice.
Journal of clinical psychopharmacology 01/2009; 28(6):625-30. · 5.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Family socioeconomic position (SEP) is known to be associated with adolescent mental health. Whether the relationship is different for different mental health dimensions is unknown.
Using a cross-sectional design, we investigated the differential effects of family SEP on multiple mental health dimensions in preadolescents (N = 2230, baseline age 10-12, 49% boys) using reports from multiple informants (parent, self, and teachers). A score equal to or higher than the 85th percentile (averaged across informants) defined mental health problems.
SEP was inversely associated with all dimensions. Compared to high SEP, the odds ratios (OR) for externalizing problems were 3.88 (95% confidence interval (CI): 2.56, 5.90) and 2.05 (CI: 1.34, 3.14) for low and intermediate SEP, respectively. For internalizing problems, they were 1.86 (CI: 1.28, 2.70) and 1.37 (CI: 0.94, 2.00), respectively. When adjusted for externalizing problems, SEP effects on internalizing problems materially attenuated (OR: 1.47, CI: 0.78, 1.68 and OR: 1.34, CI: 0.91, 1.96) while the converse was less pronounced (OR: 3.39, CI: 2.24, 5.15) and (OR: 1.91, CI: 1.25, 2.94).
In early adolescence, the risk of mental health problems increases with decreasing SEP, particularly for externalizing problems. Further, the SEP-internalizing problems relationship is partly explained by shared aspects with externalizing problems.
Social Psychiatry 09/2008; 44(3):231-8. · 2.05 Impact Factor
-
Johan Ormel,
Maria Petukhova,
Somnath Chatterji,
Sergio Aguilar-Gaxiola,
Jordi Alonso,
Matthias C Angermeyer,
Evelyn J Bromet, Huibert Burger,
Koen Demyttenaere,
Giovanni de Girolamo, [......],
Jean Pierre Lépine,
María Elena Medina-Mora,
José Posada-Villa,
Nancy Sampson,
Kate Scott,
T Bedirhan Ustün,
Michael Von Korff,
David R Williams,
Mingyuan Zhang,
Ronald C Kessler
[show abstract]
[hide abstract]
ABSTRACT: Advocates of expanded mental health treatment assert that mental disorders are as disabling as physical disorders, but little evidence supports this assertion.
To establish the disability and treatment of specific mental and physical disorders in high-income and low- and middle-income countries.
Community epidemiological surveys were administered in 15 countries through the World Health Organization World Mental Health (WMH) Survey Initiative.
Respondents in both high-income and low- and middle-income countries attributed higher disability to mental disorders than to the commonly occurring physical disorders included in the surveys. This pattern held for all disorders and also for treated disorders. Disaggregation showed that the higher disability of mental than physical disorders was limited to disability in social and personal role functioning, whereas disability in productive role functioning was generally comparable for mental and physical disorders.
Despite often higher disability, mental disorders are under-treated compared with physical disorders in both high-income and in low- and middle-income countries.
The British Journal of Psychiatry 06/2008; 192(5):368-75. · 6.62 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Most screening instruments for externalizing disorders have been developed and validated in Western children. We developed and validated a brief screening instrument for predicting externalizing disorders in native Dutch children as well as in non-Dutch immigrant children, using predictors that can be easily obtained from teachers.
Teachers completed the Strengths and Difficulties Questionnaire for an ethnic diverse sample of 2,185 children ages 6 to 10 years. In a stratified subsample, 254 children and their parents were additionally interviewed regarding psychiatric disorders and sociodemographic data. In this group, stepwise logistic regression was used to derive a score from sex and all items of the Hyperactivity and Conduct Problems Scale of the Strengths and Difficulties Questionnaire, for predicting a best-estimate diagnosis of any externalizing disorder. The accuracy of the score was compared between native Dutch and non-Dutch immigrant children.
Ninety-one cases of externalizing disorders were identified. An externalizing disorder could be predicted by the items restless, obeys, lies, and concentrates. Sex and ethnicity did not contribute to a prediction of an externalizing disorder. The area under the receiver operating characteristic was 0.84 (95% confidence interval 0.79-0.89), indicating good discriminatory power with no substantial differences between native Dutch and non-Dutch immigrant children.
Externalizing disorders in both native Dutch and non-Dutch immigrant children can be predicted with a scoring rule, based on only four items that can be easily assessed by teachers. Before this internally validated prediction tool can be implemented, external validation in another sample is necessary.
Journal of the American Academy of Child & Adolescent Psychiatry 04/2008; 47(3):309-16. · 6.44 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The present study assesses the population prevalence of DSM-IV disorders among native and immigrant children living in low socio-economic status (SES) inner-city neighborhoods in the Netherlands. In the first phase of a two-phase epidemiological design, teachers screened an ethnically diverse sample of 2041 children aged 6-10 years using the Strengths and Difficulties Questionnaire (SDQ). In the second phase, a subsample of 253 children was psychiatrically examined, while their parents were interviewed. In addition, teachers completed a short questionnaire about 10 DSM-IV items. Prevalence was estimated using the best-estimate diagnosis based on parent, child and teacher information. Projected to the total population, 11% of the children had one or more impairing psychiatric disorders, which did not differ between native and non-native children. In the total group a clear relationship was observed between the prevalence of psychiatric disorders and gender, parental psychopathology, peer problems and school problems, but not among all ethnic groups separately. This study suggests that the prevalence of psychiatric disorders among non-treated minority and native children in low SES inner-city neighborhoods does not materially differ. However, associated mechanisms may be influenced by ethnicity.
Journal of Abnormal Child Psychology 09/2007; 35(4):556-66. · 3.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To examine the effectiveness of a family based grief counselling programme to prevent complicated grief among first degree relatives and spouses of someone who had committed suicide.
Cluster randomised controlled trial with follow-up at 13 months after the suicide.
General practices in the Netherlands.
122 first degree relatives and spouses of 70 people who committed suicide; 39 families (68 participants) were allocated to intervention, 31 families (54 participants) to control.
A family based, cognitive behaviour counselling programme of four sessions with a trained psychiatric nurse counsellor between three to six months after the suicide. Control participants received usual care.
Self report complicated grief. Secondary outcomes were the presence of maladaptive grief reactions, depression, suicidal ideation, and perceptions of being to blame for the suicide.
The intervention was not associated with a reduction in complicated grief (mean difference -0.61, 95% confidence interval -6.05 to 4.83; P=0.82). Secondary outcomes were not affected either. When adjusted for baseline inequalities, the intervention reduced the risk of perceptions of being to blame (odds ratio 0.18, 0.05 to 0.67; P=0.01) and maladaptive grief reactions (0.39, 0.15 to 1.01; P=0.06).
A cognitive behaviour grief counselling programme for families bereaved by suicide did not reduce the risk of complicated grief or suicidal ideation or the level of depression. The programme may help to prevent maladaptive grief reactions and perceptions of blame among first degree relatives and spouses.
Current Controlled Trials ISRCTN66473618.
BMJ (Clinical research ed.). 06/2007; 334(7601):994.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate if disturbed glucose homeostasis or known diagnosis of diabetes was associated with depressive symptoms. The reason for the increased prevalence of depression in patients with Type 2 diabetes mellitus (DM2) is unknown.
Within the Utrecht Health Project, an ongoing longitudinal study among inhabitants of a residential area of a large city in The Netherlands, 4747 subjects (age: 39.4 +/- 12.5 years) were classified into four mutually exclusive categories: normal fasting plasma glucose (FPG) (<5.6 mmol/l), impaired FPG (> or =5.6 and <7.0 mmol/l), undiagnosed DM2 (FPG > or =7.0 mmol/l), and diagnosed DM2. Presence of depressive symptoms was defined as a score of > or =25 on the depression subscale of the Symptom Check List (SCL-90) or self-reported use of antidepressants.
Diagnosed DM2 was associated with an increased risk of depressive symptoms (odds ratio (OR) = 1.69; 95% confidence interval (CI) 1.06-2.72) after adjustment for demographic and lifestyle variables. Additional adjustment for number of chronic diseases reduced the OR to 1.36 (95% CI 0.83-2.23). Impaired fasting glucose and undiagnosed DM2 were not associated with depressive symptoms.
Our findings suggest that disturbed glucose homeostasis is not associated with depressive symptoms. The increased prevalence of depressive symptoms among patients with diagnosed DM2 suggests that depressive symptoms might be a consequence of the burden of diabetes. The number of chronic diseases seems to explain part of the association between DM2 and depressive symptoms.
Psychosomatic Medicine 06/2007; 69(4):300-5. · 3.97 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We compared risks of first contact with services for an alcohol use disorder (AUD) or drug use disorder (DUD) between the largest immigrant groups to the Netherlands and Dutch nationals. We tested the hypothesis that the ethnic pattern for DUD is similar to the previously demonstrated pattern for schizophrenia.
Retrospective, population-based cohort study of First Admissions to Dutch psychiatric hospitals during the period 1990-1996 (national data) and First Contacts with inpatient or outpatient centres in Rotterdam for treatment of AUD or DUD during the period 1992-2001 (Rotterdam data).
In both datasets the risk of service contact for AUD was significantly lower in immigrants from Surinam, Turkey and Morocco than in Dutch nationals. The risk was lower or moderately higher in immigrants from western countries. Analysis of the national data showed that, compared with Dutch males, the risk of first hospital admission for DUD was higher for male immigrants from the Dutch Antilles (RR = 4.6; 95% CI: 4.0-5.3), Surinam (RR = 4.3; 3.9-4.7) and Morocco (RR = 2.3; 2.0-2.6), but not for male immigrants from Turkey (RR = 0.9; 0.7-1.1). A similar pattern was found with the Rotterdam data. Female immigrants from Surinam and the Dutch Antilles had a higher risk for DUD according to the national data, but a lower risk according to the Rotterdam data. Female immigrants from Turkey and Morocco had a lower risk (both datasets). Immigrants from western countries had a higher risk for DUD, but many had developed the disorder before emigrating.
Those immigrant groups in the Netherlands that are at increased risk of schizophrenia appear also at increased risk of developing DUD, but not AUD.
Social Psychiatry 05/2007; 42(4):301-6. · 2.05 Impact Factor
-
Journal of Epidemiology & Community Health 04/2007; 61(3):185-9. · 3.19 Impact Factor
