The main aim of this thesis is to explore risk factors associated to an increased risk of adverse outcomes for heart failure (HF) patients and improve the early re-admission or mortality prediction... Show moreThe main aim of this thesis is to explore risk factors associated to an increased risk of adverse outcomes for heart failure (HF) patients and improve the early re-admission or mortality prediction in HF. Data from two studies (OPERA-HF study in the UK and SAPHIRE study in US) has been used to explore a wide range of variables as potential risk factors. We found that depression is a significant and independent predictor of all-cause mortality among HF patients. Depression was also significantly associated with recurrent events: unplanned readmission or mortality. Other psychosocial or non-clinical variables independently associated with increasing risk of recurrent events in the year following discharge after a HF hospital admission were: presence of frailty, moderate-to-severe anxiety, living alone and the presence of cognitive impairment. We then used data from the OPERA-HF study to develop a 30-day composite outcome model and to explore the added predictive value of non-clinical predictors to early outcomes: 30-day unplanned readmission or mortality. The performance of the model improved by including physical frailty and social support next to clinical variables. The transportability of the model to a different geography was proved in the external validation of the model on the SAPHIRE study data. Show less
Luenen, S. van; Kraaij, V.; Garnefski, N.; Spinhoven, P.; Akker-van Marie, M.E. van den 2019
Objective: The aim of this study was to evaluate the cost-utility of a guided Internet-based intervention for people living with HIV and depressive symptoms, compared to attention only (control... Show moreObjective: The aim of this study was to evaluate the cost-utility of a guided Internet-based intervention for people living with HIV and depressive symptoms, compared to attention only (control condition). It was previously found that the intervention was effective in decreasing depressive symptoms, compared to the control group.Methods: This economic evaluation was conducted alongside a randomized controlled trial. The control group received attention only and was put on a waiting list. Quality adjusted life years were calculated over six months. The study was conducted from a societal perspective and included intervention costs, healthcare costs, and non healthcare costs. Participants completed a pretest, a post-test after two to three months, and a second post-test after six months. Cost-utility acceptability curves were constructed and two sensitivity analyses were conducted.Results: No differences between the intervention and the control group were found in quality adjusted life years and total societal costs. The results indicate that the intervention is likely to be cost-effective, compared to attention only. The findings of the sensitivity analyses point in the same direction.Conclusion: More research with larger samples is necessary to confirm the findings. The outcomes of this study may inform policy makers to decide which interventions will be included in policies. The guided Internet intervention may improve psychological care for people living with HIV and depressive symptoms, against low costs. Show less
Background: Depressive and anxiety disorders have been linked to a dysregulated hypothalamus-pituitary adrenal (HPA)-axis. Hair cortisol levels (HairF) reflect integrated long-term cortisol... Show moreBackground: Depressive and anxiety disorders have been linked to a dysregulated hypothalamus-pituitary adrenal (HPA)-axis. Hair cortisol levels (HairF) reflect integrated long-term cortisol regulation and are therefore promising endocrine markers of chronic (psychological and physical) stress.Our aim was to assess hair cortisol levels in persons with a depressive and/or anxiety disorder and to compare their levels with that of persons in remission and healthy controls.Methods: Data from 1166 participants of the Netherlands Study of Depression and Anxiety (NESDA) were used, including 266 participants with a recent (1-month) diagnosis of a depressive and/or anxiety disorder, 655 participants with a diagnosis in remission, and 245 healthy controls. HairF was measured in the proximal three cm of scalp hair, using LC-MS/MS.Results: Compared to the healthy controls no differences on HairF or HairE levels were found for depressive and anxiety disorders alone. However the presence of a comorbid depressive and anxiety disorder was significantly associated with increased HairF levels (beta = 0.07; p = .031), as was the severity of depressive symptoms (beta = 0.06; p = .029), but no differences were found on HairE nor the HairF:HairE ratio.Conclusions: Persons with current diagnosis of comorbid depression and anxiety show moderately higher levels of cortisol than patients with only depression or anxiety, or patients in remission and healthy controls, which may be indicative of a chronic state of hyperactivation of the HPA axis. Show less
Background: : Psychiatric disorders are associated with overweight/obesity. Obsessive-compulsive disorder(OCD) may be an exception, as anecdotal evidence suggests lower BMI in OCD. Additionally,... Show moreBackground: : Psychiatric disorders are associated with overweight/obesity. Obsessive-compulsive disorder(OCD) may be an exception, as anecdotal evidence suggests lower BMI in OCD. Additionally, depression isassociated with elevated BMI, but effects of comorbid secondary depression are unknown. The aim of the presentstudy was to assess BMI and risk for overweight/obesity in OCD and to assess the effect of comorbid depressionon BMI.Methods: : BMI, demographics, and clinical status were assessed in large samples of individuals with OCD,anxiety disorders, depressive disorders, comorbid anxiety/depressive disorders, and non-clinical controls (NCC).Results: : Although no initial differences were found between the samples on BMI, the non-depressed OCDsubsample had significantly lower BMI and risk for overweight/obesity compared to all other clinical samples.NCC were nearly twice as likely to be overweight compared to non-depressed OCD.Limitations: : Eating disorders were excluded in the OCD sample, but BMI < 17 was used as an exclusion cri-terion in the clinical control groups in lieu of screening for Anorexia. Group differences on demographics werecontrolled for. Recruitment methodology differed between samples.Conclusions: : OCD is associated with significantly lower rates of obesity and overweight, but this relationshipwas not found when comorbid depression was present. This suggests that the purer the phenotype of OCD, themore substantial protective factor against overweight/obesity emerges compared to other clinical samples andNCC. An OCD-specific reward/anhedonia model, previously offered to elucidate lower smoking rates in OCD,may account for lower BMI in OCD. These results warrant careful clinical attention to the negative impact ofcomorbid depression on OCD that spans from increasing risk for obesity and cigarette smoking, to hinderingtreatment response. Show less
Henstra, M.J.; Feenstra, T.C.; Velde, N. van der; Mast, R.C. van der; Comijs, H.; Stek, M.L.; Rhebergen, D. 2019
Background In older people, both apathy and depression (which frequently co-occurs with apathy) have been associated with poor physical functioning, a major health concern. We investigated the... Show moreBackground In older people, both apathy and depression (which frequently co-occurs with apathy) have been associated with poor physical functioning, a major health concern. We investigated the association between apathy and physical functioning in older people without dementia and whether this association is modified by depression.Methods We used the data from 380 older participants (with and without depression) taking part in the Netherlands Study of Depression in Older Persons, with baseline scores on the Apathy Scale and baseline and 2-year follow-up scores on at least one measure of physical functioning. These included the International Physical Activities Questionnaire (IPAQ, self-reported), WHO Disability Assessment Schedule (WHO-DASII mobility subset, self-reported), walking speed, or handgrip strength. Multivariable linear regression analyses were performed to examine the association between apathy at baseline and physical functioning at 2-year follow-up. We also investigated effect modification by sex, age, and depression.Results Cross-sectionally, participants with higher baseline Apathy Scale scores performed significantly worse on all measures of physical functioning. Longitudinally, higher baseline Apathy Scale scores were associated with higher delta scores on the IPAQ (B = -59.81) in the basic model, and higher delta scores on the WHO-DASII (B = .09) in all models. Apathy was not associated with higher delta scores for walking speed or handgrip strength. Furthermore, sex, age, and depression did not modify any association.Conclusion In a Dutch cohort of older people without dementia, apathy was associated with more decline in self-reported, but not in objective physical functioning. Sex, age, and depression did not modify these associations. In older people with apathy, subjective decline may precede decline in physical performance tests. Show less
Insufficient response to treatment is the main cause of prolonged suffering from major depressive disorder (MDD). Early identification of insufficient response could result in faster and more... Show moreInsufficient response to treatment is the main cause of prolonged suffering from major depressive disorder (MDD). Early identification of insufficient response could result in faster and more targeted treatment strategies to reduce suffering. We therefore explored whether baseline alterations within and between resting state functional connectivity networks could serve as markers of insufficient response to antidepressant treatment in two years of follow-up. We selected MDD patients (N = 17) from the NEtherlands Study of Depression and Anxiety (NESDA), who received >= two antidepressants, indicative for insufficient response, during the two year follow-up, a group of MDD patients who received only one antidepressant (N = 32) and a healthy control group (N = 19) matched on clinical characteristics and demographics. An independent component analysis (ICA) of baseline resting-state scans was conducted after which functional connectivity within the components was compared between groups. We observed lower connectivity of the right insula within the salience network in the group with >= two anti-depressants compared to the group with one antidepressant. No difference in connectivity was found between the patient groups and healthy control group. Given the suggested role of the right insula in switching between task-positive mode (activation during attention-demanding tasks) and task-negative mode (activation during the absence of any task), we explored whether right insula activation differed during switching between these two modes. We observed that in the 2 anti-depressant group, the right insula was less active compared to the group with one antidepressant, when switching from task-positive to task-negative mode than the other way around. These findings imply that lower right insula connectivity within the salience network may serve as an indicator for prospective insufficient response to antidepressants. This result, supplemented by the diminished insula activation when switching between task and rest related networks, could indicate an underlying mechanism that, if not sufficiently targeted by current antidepressants, could lead to insufficient response. When replicated, these findings may contribute to the identification of biomarkers for early detection of insufficient response. Show less
Loosman, W.L.; Haverkamp, G.L.G.; Beukel, T.O. van den; Hoekstra, T.; Dekker, F.W.; Shaw, P.K.C.; ... ; Honig, A. 2018
In een cross-sectioneel onderzoek is nagegaan hoe het op de lange duur met CVA patiënten gaat die in het Haaglanden Medisch Centrum te Den Haag opgenomen zijn geweest vanwege een beroerte. Er is... Show moreIn een cross-sectioneel onderzoek is nagegaan hoe het op de lange duur met CVA patiënten gaat die in het Haaglanden Medisch Centrum te Den Haag opgenomen zijn geweest vanwege een beroerte. Er is gekeken naar verschillende aspecten zoals handfunctie, werkhervatting, stemmingsproblemen en zorggebruik. Het blijkt dat, ondanks alle behandelingen die gegeven worden, een grote groep van deze mensen restbeperkingen ervaart. Hun partners voelen zich fors belast, vooral als er sprake is van stemmingsproblemen en als werkhervatting niet lukt. Ook jaren later geeft de meerderheid van CVA patiënten aan nog steeds zorgvragen te hebben die niet beantwoord zijn. Ze lijken beter hun weg te vinden in de eerstelijn voor hun fysieke problemen dan voor hun mentale problemen. Er is gekeken naar de mate waarin eerstelijns behandelaars zich hebben georganiseerd met betrekking tot chronische behandeling en begeleiding van CVA patiënten. Een goed georganiseerd netwerk, met een visie op kwaliteitsaspecten en scholing, is maar op enkele plaatsen in het land beschikbaar. Er zijn aanbevelingen geformuleerd om de ontwikkeling van eerstelijns netwerken voor CVA patiënten te stimuleren. Show less
It is not clear if treatments for depression targeting repetitive negative thinking (RNT: rumination, worry and content-independent perseverative thinking) have a specific effect on RNT resulting... Show moreIt is not clear if treatments for depression targeting repetitive negative thinking (RNT: rumination, worry and content-independent perseverative thinking) have a specific effect on RNT resulting in better outcomes than treatments that do not specifically target rumination. We conducted a systematic search of PsycINFO, PubMed, Embase and the Cochrane library for randomized trials in adolescents, adults and older adults comparing CBT treatments for (previous) depression with control groups or with other treatments and reporting outcomes on RNT. Inclusion criteria were met by 36 studies with a total of 3307 participants. At post-test we found a medium-sized effect of any treatment compared to control groups on RNT (g = 0.48; 95% CI: 0.37–0.59). Rumination-focused CBT: g = 0.76, <0.01; Cognitive Control Training: g = 0.62, p < .01; CBT: g = 0.57, p < .01; Concreteness training: g = 0.53, p < .05; and Mindfulness-based Cognitive Therapy: g = 0.42, p < .05 had medium sized and significantly larger effect sizes than other types of treatment (i.e., anti-depressant medication, light therapy, engagement counseling, life review, expressive writing, yoga) (g = 0.14) compared to control groups. Effects on RNT at post-test were strongly associated with the effects on depression severity and this association was only significant in RNT-focused CBT. Our results suggest that in particular RNT-focused CBT may have a more pronounced effect on RNT than other types of interventions. Further mediation and mechanistic studies to test the predictive value of reductions in RNT following RNT-focused CBT for subsequent depression outcomes are called for. Show less
Loosman, W.L.; Jong, R.W. de; Haverkamp, G.L.G.; Beukel, T.O. van den; Dekker, F.W.; Siegert, C.E.H.; Honig, A. 2018
