[Show abstract][Hide abstract] ABSTRACT: Background:
Bipolar disorder is often underdiagnosed and undertreated. Its detection and correct diagnosis highly relies on the report of past hypomanic or manic episodes. We investigated the recognition and awareness of past hypomanic and manic episodes in a sample of respondents with bipolar disorder selected from a general population study.
In a reappraisal study from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), we further investigated 40 respondents with lifetime bipolar disorder confirmed by the structured clinical interview for DSM-IV (SCID). Respondents were asked about awareness of past depressive, manic and hypomanic episodes, illness characteristics and treatment history.
Most respondents (82.5 %) recognized that they had experienced a depressive episode while 75 % had consulted a health professional for a depressive episode. Only a minority (22.5 %) recognized that they had experienced a (hypo)manic episode and only 17.5 % had consulted a health professional for a (hypo)manic episode. Only 12.5 % of the respondents reported having received a diagnosis of bipolar disorder. Recognition of previous (hypo)manic episodes was not related to severity of bipolar disorder.
In routine clinical practice history-taking on a syndromal level, i.e., only inquiring whether a patient presenting with depression ever experienced a hypomanic or manic episode or received treatment for such an episode, is not sufficient to confirm or exclude a diagnosis of bipolar disorder. Other efforts, such as an interview with a significant other and the use of self report questionnaires or (semi-)structured interviews may be needed to recognize previous manic symptoms in patients with depression.
[Show abstract][Hide abstract] ABSTRACT: Objectives: One explanation for the increase in delinquency in adolescence is that young people are trapped in the so-called maturity gap: the discrepancy between biological and social maturation, which motivates them to engage in delinquency as a temporary means to bridge this gap by emphasizing their maturity. In the current study, we investigated to what extent the discrepancy between pubertal status (i.e., biological maturation) and autonomy in decision making (i.e., social maturation) is related to conflict with parents, which in turn predicts increasing levels of delinquency as well as substance use.
Full-text · Article · Aug 2015 · Journal of Research in Crime and Delinquency
[Show abstract][Hide abstract] ABSTRACT: Peer cliques form an important context for the social development of adolescents. Although clique members are often similar in social status, also within cliques, status differences exist. How differences in social status between clique members are related to behaviors of its individual members is rather unknown. This study examined to what extent the relationship of individual social status (i.e., perceived popularity) with aggression and prosocial behavior depends on the level of internal clique hierarchy. The sample consists of 2674 adolescents (49.8 % boys), with a mean age of 14.02. We focused specifically on physical and relational aggression, and practical and emotional support, because these behaviors have shown to be of great importance for social relationships and social standing among adolescents. The internal status hierarchy of cliques was based on the variation in individual social status between clique members (i.e., clique hierarchization) and the structure of status scores within a clique (pyramid shape, inverted pyramid, or equal distribution of social status scores) (i.e., clique status structure). The results showed that differences in aggressive and prosocial behaviors were particularly moderated by clique status structure: aggression was stronger related to individual social status in (girls') cliques where the clique status structure reflected an inverted pyramid with relatively more high status adolescents within the clique than low status peers, and prosocial behavior showed a significant relationship with individual social status, again predominantly in inverted pyramid structured (boys' and girls') cliques. Furthermore, these effects differed by types of gender cliques: the associations were found in same gender but not mixed-gender cliques. The findings stress the importance of taking into account internal clique characteristics when studying adolescent social status in relationship to aggression and prosociality.
Full-text · Article · Jun 2015 · Journal of Youth and Adolescence
[Show abstract][Hide abstract] ABSTRACT: Background
Several studies have shown that substance use levels among adolescents living in residential youth care are high. However, it is not clear to what extent adolescents initiate (heavy) substance during their stay and to what extent these rates are higher than would be expected based on their risk profile.
The aim of the present study is to examine the initiation of (heavy) substance use among adolescents in residential care and to compare these initiation rates with a reference group of non-institutionalized youth, while taking differences in the risk profiles between both groups into account.
Self-report questionnaires were completed by 241 adolescents in residential care (42 % boys; mean age 15.4 years) and 359 adolescents attending mainstream education (54 % boys; mean age 14.8 years).
A substantial proportion of adolescents first started to use substances (heavily) during their stay in residential care (1 year incidence of daily tobacco use: 22.6 %, drunkenness: 38.5 %, cannabis use: 27.3 %, hard drug use: 9.4 %. Except for drunkenness, these rates were significantly higher compared to those in mainstream education. Adjusting the analyses for the risk profile showed that the elevated risk for hard drug use remained significant and substantial (IRR = 13.09).
A substantial proportion of adolescents started using substances (heavily) during their stay in residential care. Although rates may have been even higher if these adolescents were not placed in residential care, these findings highlight the need for effective preventive interventions and policies in these settings, especially with regard to the use of hard drugs.
Full-text · Article · Dec 2014 · Child and Youth Care Forum
[Show abstract][Hide abstract] ABSTRACT: This study investigated the age of onset of substance use among 536 students with mild academic disabilities and 906 students without academic disabilities, and the extent to which emotional, conduct, and hyperactivity problems explain the differences between these two groups. Using discrete-time survival analysis, the results of this study showed that students with a mild academic disability were not at higher risk for the onset of daily smoking, and were at a significantly lower risk for the onset of weekly alcohol use and cannabis use. Though students with a mild academic disability displayed higher scores on conduct, emotional, and hyperactivity problems compared with their counterparts without an academic disability, this was not reflected in an increased risk for early onset substance use.
Full-text · Article · Nov 2014 · Learning Disabilities Research and Practice
[Show abstract][Hide abstract] ABSTRACT: Background
Alcohol consumption levels and alcohol use disorder (AUD) symptoms may serve as easily quantifiable markers for AUD relapse after remission and might help prevention workers identify at-risk individuals. We investigated the predictive value of alcohol consumption and AUD symptoms on relapse.
Data are from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). We selected 506 people in ≥12-month DSM-5 AUD remission at baseline and assessed their status at 3-year follow-up. AUD symptoms and drinking patterns were assessed using the Composite International Diagnostic Interview 3.0. Time since remission was assessed retrospectively at baseline and ranged from 1 to 48 years. Predictors for relapse were examined using Cox regression analysis.
Cumulative AUD relapse rate was 5.6% at 5 years, 9.1% at 10 years and 12.0% at 20 years. Relapse was predicted by both medium [15-28/22-42 drinks weekly for women/men] and high [≥29/43] past alcohol intake, 6+ lifetime AUD symptoms, ‘impaired control over use’, and at-risk [≥8/15] current intake. The risk of relapse was especially high when medium or high past intake or 6+ lifetime symptoms coincided with current at-risk drinking.
Only a minority of people in DSM-5 AUD remission relapsed, but the risk of relapse increased substantially with the presence of at least one of the risk factors. Moreover, at-risk current drinking coupled with other risk factors substantially increased the likelihood of relapse. Therefore, current drinking may provide an adequate reference point for relapse prevention.
No preview · Article · Jul 2014 · Drug and alcohol dependence
[Show abstract][Hide abstract] ABSTRACT: To examine cross-national changes in frequent adolescent cannabis use (40+ times consumed over life-time at age 15) over time and relate these trends to societal wealth, family affluence and gender.
Data from three cycles (2002, 2006, 2010) of the Health Behaviour in School-aged Children (HBSC) Study were used for cross-sectional and trend analyses of adolescent cannabis use.
Representative surveys in 30 European and North American countries.
A total of 160 606 15-year-old students.
Respondents' life-time cannabis use, demographics, family affluence (FAS) and frequency of peer contacts were measured individually. Indicators of wealth (gross domestic product per capita, GDP) and perceived availability of cannabis were obtained from national public data bases.
The frequency of life-time cannabis use decreased over time among adolescents in Europe and North America, particularly in western European countries and the United States (relative risk (RR) = 0.86: confidence interval (CI) 0.79-0.93). This trend was not observed consistently in rapidly developing countries in eastern, central and southern Europe. Over time (2002-10), cannabis use became: (i) less characteristic of high GDP countries in contrast to lower GDP countries (RR = 0.74: CI 0.57-0.95); (ii) less characteristic of youth from high FAS families in contrast to youth from low FAS families (RR = 0.83: CI 0.72-0.96); and (iii) characterized by an increasing gender gap, i.e. consumption was higher among males (RR 1.26: CI 1.04-1.53). Perceived availability of cannabis and peer contacts remained strong predictors of frequent cannabis use.
Among 30 European and North American countries, cannabis use appears to have 'trickled down' over time, with developing countries taking on the former (heavier) use pattern of richer countries, and less affluent youth taking on the former (heavier) use pattern of more affluent youth. Cannabis use continues to be more common among adolescent males than females.
[Show abstract][Hide abstract] ABSTRACT: Adolescents who attend special education for behavioural problems (SEB) and adolescents who live in a residential youth care institution (RYC) are characterised by behavioural disorders and problematic family backgrounds and have an increased risk for substance use. Though it is likely that the high rates of substance use in SEB/RYC settings might be inherent to the risk profile of these adolescents, little is known about the actual role the risk profile has in explaining substance use. The present study examined the extent to which the elevated risk of substance use in SEB/RYC can be explained by high levels of individual, family, and peer risk indicators that are known to characterise their risk profile. Self-report questionnaires from 531 adolescents in RYC (50 % male; mean age 14.7) and 603 adolescents in SEB (81 % male; mean age 14.1) were compared with information from 1,905 adolescents attending special education for students with learning disabilities (SEL) (56 % male; mean age 14.1). Results show that adolescents in SEB/RYC reported higher levels of daily smoking, weekly alcohol consumption, cannabis and hard drug use, as well as greater prevalence of individual, family and peer factors. Though individual, family and in particular peer risk indicators all explain some of the variance in substance use, the differences between adolescents in SEB/RYC compared with SEL remained significant and substantial, with the exception of heavy alcohol consumption. These findings suggest that deviant peer affiliation, in particular, plays a role in explaining high substance use levels in SEB/RYC and those factors relevant to the residential settings and special education schools might also contribute to substance use in these high-risk groups.
No preview · Article · Sep 2013 · European Child & Adolescent Psychiatry
[Show abstract][Hide abstract] ABSTRACT: Neighbourhood research hitherto has suggested that the neighbourhood in which youth grow up affects their educational achievement. However, the mechanisms though which the neighbourhood reaches these effects are still unclear. Family and individual characteristics seem important in explaining educational outcomes. We therefore propose two related mediating factors: parenting strategies and problematic behaviour. We test this mediation using the 2009 Health Behaviour in School-aged Children data for the Netherlands (N = 2683), in which adolescents are surveyed about their behaviour and relationships and, additionally, their parents are interviewed about their child and their parenting. These data are combined with data from Statistics Netherlands, which include neighbourhood-level information about real-estate value and ethnic variation of the neighbourhood population. The results show that the effects of the proportion of immigrant groups and the mean property values in the neighbourhood are unlikely to be mediated by parenting behaviours and problematic behaviour. The results also show that parents are likely to adapt their parenting behaviours to demographic neighbourhood characteristics. For example, parents in neighbourhoods with higher ethnic heterogeneity apply more protective parenting strategies.
Full-text · Article · Sep 2013 · Environment and Planning A
[Show abstract][Hide abstract] ABSTRACT: Although it seems intuitive that alcohol use disorders (AUDs) include excessive alcohol consumption (EAC), this notion is not well established. This study investigates to which degree EAC (defined as >14/21 drinks weekly for women/men and at least three 5+ drinking days per week) and AUD overlap and whether problematic alcohol use groups (EAC-only, AUD-only, and EAC + AUD) differ from each other and from nonproblematic alcohol users regarding sociodemographics, mental health problems, functioning, and service utilization.
Data were derived from the Netherlands Mental Health Survey and Incidence Study-2, a population-based study including 5,443 current drinkers (aged 18 to 64) interviewed with the Composite International Diagnostic Interview 3.0. Both DSM-IV AUDs and a proxy of DSM-5 AUD are considered.
Of the current drinkers, 3.8% reported 12-month EAC. Twelve-month prevalence of DSM-IV and DSM-5 AUD were 5.4 and 4.4%, respectively. Regarding DSM-IV, only 17.7% of subjects with AUD reported EAC and 25.3% of those with EAC had an AUD. Compared with nonproblematic alcohol users, the 3 groups of problematic alcohol use (EAC-only, AUD-only, and EAC + AUD) were more often associated with mental health problems, poorer functioning, and service utilization. There were few differences between EAC-only and AUD-only regarding these correlates. However, EAC + AUD had strongest associations with above-mentioned correlates compared with the other 3 groups. Compared with DSM-IV findings, DSM-5 AUDs had slightly larger overlap with EAC, but correlates were similarly associated with problematic alcohol use groups.
Findings indicate limited overlap between EAC and AUD. Yet, both dimensions were similarly associated with other problems suggesting that both should be included in future epidemiological research to detect the total group of problematic alcohol users.
No preview · Article · Aug 2013 · Alcoholism Clinical and Experimental Research
[Show abstract][Hide abstract] ABSTRACT: To establish the 3-year persistency rate of alcohol use disorder (AUD) and its predictors, and to examine drinking patterns of recently remitted persons.
The Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2) surveyed a nationally representative sample of adults (aged 18-64) at baseline (response=65.1%) and 3-year follow-up (response=80.4%).
People with AUD at baseline, as defined by DSM-5 (n=198).
AUD, drinking patterns and mental disorders were assessed using the Composite International Diagnostic Interview 3.0. Other predictors were assessed with an additional questionnaire. Predictors of persistency were examined with univariable and multivariable logistic regression analyses.
The AUD persistency rate was 29.5% (95% CI=20.0-39.0). In the multivariable model, the older (25-34 and 35-44) age groups had lower AUD persistency (odds ratio (OR)=0.05; p=.014 and OR=0.14; p=.028, respectively) than the youngest age group (18-24). A higher number of weekly drinks and a comorbid anxiety disorder predicted AUD persistency (OR=1.03; p=.043 and OR=4.56; p=.046, respectively). Furthermore, remission was associated with a reduction of 6 drinks per week between T0 and T1 . It should be noted however that 35.8% (95% CI=22.4-49.2) of persons in diagnostic remission still drank more than the recommended maximum (>7/14 drinks weekly for women/men).
Only a minority of people in the Netherlands with alcohol use disorder (AUD) as defined by DSM-5 still have the disorder 3 years later. Factors that help identify people at risk of AUD persistence are: younger age, a higher number of weekly drinks and a comorbid anxiety disorder. A substantial number of people recently in diagnostic remission still drink above the maximum recommended level.
[Show abstract][Hide abstract] ABSTRACT: Background:
Across Europe, tobacco use is more prevalent among secondary school students attending vocational tracks compared with students attending academic tracks. The purpose of the present study is to describe trends in social inequality in daily smoking among adolescents between 2002 and 2010 by addressing both absolute social inequality (prevalence difference between vocational and academic tracks) and relative social inequality (prevalence ratio) in seven European countries.
Analyses were based on data from 15-year-olds who participated in the Health Behaviour in School-aged Children study in 2002, 2006 and 2010 in Belgium, Croatia, France, Germany, Hungary, Italy and The Netherlands (total N = 32 867).
Overall, daily smoking decreased between 2002 and 2010 in Belgium, France, Germany and The Netherlands, increased in Croatia and remained stable in Hungary and Italy. Considerable differences in daily smoking according to educational track existed in all countries. Absolute educational inequalities increased dramatically in Croatia and Italy, while relative inequalities showed a tendency to increase in all countries (significant in Belgium and The Netherlands).
Conclusions on social inequality in adolescent smoking may appear differently when described by absolute and relative measures. Especially the large increase in absolute educational inequalities in daily smoking in Croatia and Italy are worrisome and warrant attention from the public health domain. The findings underline the need for appropriate smoking policies and interventions in vocational schools across Europe.
No preview · Article · Mar 2013 · The European Journal of Public Health
[Show abstract][Hide abstract] ABSTRACT: More physical activity is associated with fewer mental health problems among adolescents, but the underlying mechanisms are not clear. The aim of this article is to investigate whether the association between physical activity and mental health is mediated by body-weight perception (self-image) or the social aspects of participation in organized sports (social interaction). Data from 7,304 adolescents were drawn from the Dutch Health Behaviour in School-Aged Children survey. Logistic regression analyses showed that, compared with respondents who were physically active, inactive respondents were at higher risk for both internalizing (odds ratio [OR] = 1.52, p < .001) and externalizing (OR = 1.34, p < .05) problems. The inclusion of body-weight perception and sports-club membership variables reduced the strength of the association to an OR of 1.35 (p < .05) for internalizing problems and an OR of 1.20 (p = .132) for externalizing problems. This study found some support for the self-image and social interaction hypotheses and thereby confirms the importance of the psychological and sociological aspects of physical activity.
[Show abstract][Hide abstract] ABSTRACT: Previous research has provided considerable support for idea that increased parental support and control are strong determinants of lower prevalence levels of adolescent risk behavior. Much less is known on the association between specific parenting practices, such as concrete rules with respect to smoking and drinking and adolescent risk behavior. The present paper examined whether such concrete parental rules (1) have an effect on the targeted behaviors and (2) predict other, frequently co-occurring, risk behaviors (i.e., cannabis use and early sexual intercourse). These hypotheses were tested in a nationally representative sample of 12- to 16-year-old adolescents in the Netherlands. We found that both types of rules were associated with a lower prevalence of the targeted behaviors (i.e., smoking and drinking). In addition, independent of adolescent smoking and drinking behaviors, parental rules on smoking predicted a lower prevalence of cannabis use and early sexual intercourse, and parental rules on alcohol use also predicted a lower prevalence of early sexual intercourse. This study showed that concrete parental rule setting is more strongly related to lower levels of risk behaviors in adolescents compared to the more general parenting practices (i.e., support and control). Additionally, the effects of such rules do not only apply to the targeted behavior but extend to related behaviors as well. These findings are relevant to the public health domain and suggest that a single intervention program that addresses a limited number of concrete parenting practices, in combination with traditional support and control practices, may be effective in reducing risk behaviors in adolescence.