The societal toll and human misery associated with mental health disorders is well established. Nonetheless, only about one in five minors with mental health difficulties access adequate... Show moreThe societal toll and human misery associated with mental health disorders is well established. Nonetheless, only about one in five minors with mental health difficulties access adequate professional support. Care pathways and procedures have to facilitate timely recognition and adequate evaluation of patients’ needs to navigate those who can benefit towards ‘the right service in the right place, at the right time, and delivered by the right person’ - a meaningful Chinese proverb often used by authors from the field of healthcare. To reach this meaningful goal, professionals should be able to ‘look’ at a patient and ‘see’ patients’ needs. This by relying on their sufficient knowledge to recognize a probable mental health need, their skills and experience to enquire further, known methods to reliably assess strengths and weaknesses, and readily available resources to translate what they see into an adequate support or management plan. In this PhD thesis we present a series of studies aimed to fill gaps in empirical knowledge on this topic of recognition, assessment, and referral of youth with mental health problems at the interface of primary care and mental healthcare. The results of the studies could inform clinicians on the status quo considering recognition and referral of minors with mental health problems. Moreover, the findings could serve policy and curriculum makers, thereby improving effective practices in child and adolescent mental healthcare. Show less
Ottenheim, N.R.; Pan, K.Y.; Kok, A.A.L.; Jorg, F.; Eikelenboom, M.; Horsfall, M.; ... ; Giltay, E.J. 2022
Background Mental health was only modestly affected in adults during the early months of the COVID-19 pandemic on the group level, but interpersonal variation was large. Aims We aim to investigate... Show moreBackground Mental health was only modestly affected in adults during the early months of the COVID-19 pandemic on the group level, but interpersonal variation was large. Aims We aim to investigate potential predictors of the differences in changes in mental health. Method Data were aggregated from three Dutch ongoing prospective cohorts with similar methodology for data collection. We included participants with pre-pandemic data gathered during 2006-2016, and who completed online questionnaires at least once during lockdown in The Netherlands between 1 April and 15 May 2020. Sociodemographic, clinical (number of mental health disorders and personality factors) and COVID-19-related variables were analysed as predictors of relative changes in four mental health outcomes (depressive symptoms, anxiety and worry symptoms, and loneliness), using multivariate linear regression analyses. Results We included 1517 participants with (n = 1181) and without (n = 336) mental health disorders. Mean age was 56.1 years (s.d. 13.2), and 64.3% were women. Higher neuroticism predicted increases in all four mental health outcomes, especially for worry (beta = 0.172, P = 0.003). Living alone and female gender predicted increases in depressive symptoms and loneliness (beta = 0.05-0.08), whereas quarantine and strict adherence with COVID-19 restrictions predicted increases in anxiety and worry symptoms (beta = 0.07-0.11).Teleworking predicted a decrease in anxiety symptoms (beta = -0.07) and higher age predicted a decrease in anxiety (beta = -0.08) and worry symptoms (beta = -0.10). Conclusions Our study showed neuroticism as a robust predictor of adverse changes in mental health, and identified additional sociodemographic and COVID-19-related predictors that explain longitudinal variability in mental health during the COVID-19 pandemic. Show less
Meulen, M. van der; Amaya, J.M.; Dekkers, O.M.; Meijer, O.C. 2022
Objective: To test the hypothesis that systemic and inhaled glucocorticoid use is associated with changes in grey matter volume (GMV) and white matter microstructure. Design: Cross-sectional study.... Show moreObjective: To test the hypothesis that systemic and inhaled glucocorticoid use is associated with changes in grey matter volume (GMV) and white matter microstructure. Design: Cross-sectional study. Setting: UK Biobank, a prospective population-based cohort study of adults recruited in the UK between 2006 and 2010. Participants: After exclusion based on neurological, psychiatric or endocrinological history, and use of psychotropic medication, 222 systemic glucocorticoid users, 557 inhaled glucocorticoid users and 24 106 controls with available T1 and diffusion MRI data were included. Main outcome measures: Primary outcomes were differences in 22 volumetric and 14 diffusion imaging parameters between glucocorticoid users and controls, determined using linear regression analyses adjusted for potential confounders. Secondary outcomes included cognitive functioning (six tests) and emotional symptoms (four questions). Results: Both systemic and inhaled glucocorticoid use were associated with reduced white matter integrity (lower fractional anisotropy (FA) and higher mean diffusivity (MD)) compared with controls, with larger effect sizes in systemic users (FA: adjusted mean difference (AMD)=-3.7e-3, 95% CI=-6.4e-3 to 1.0e-3; MD: AMD=7.2e-6, 95% CI=3.2e-6 to 1.1e-5) than inhaled users (FA: AMD=-2.3e-3, 95% CI=-4.0e-3 to -5.7e-4; MD: AMD=2.7e-6, 95% CI=1.7e-7 to 5.2e-6). Systemic use was also associated with larger caudate GMV (AMD=178.7 mm(3), 95% CI=82.2 to 275.0), while inhaled users had smaller amygdala GMV (AMD=-23.9 mm(3), 95% CI=-41.5 to -6.2) than controls. As for secondary outcomes, systemic users performed worse on the symbol digit substitution task (AMD=-0.17 SD, 95% CI=-0.34 to -0.01), and reported more depressive symptoms (OR=1.76, 95% CI=1.25 to 2.43), disinterest (OR=1.84, 95% CI=1.29 to 2.56), tenseness/restlessness (OR=1.78, 95% CI=1.29 to 2.41), and tiredness/lethargy (OR=1.90, 95% CI=1.45 to 2.50) compared with controls. Inhaled users only reported more tiredness/lethargy (OR=1.35, 95% CI=1.14 to 1.60). Conclusions: Both systemic and inhaled glucocorticoid use are associated with decreased white matter integrity and limited changes in GMV. This association may contribute to the neuropsychiatric side effects of glucocorticoid medication, especially with chronic use. Show less
Background: Ambulatory assessments offer opportunities to evaluate daily dynamics of sleep and momentary affect using mobile technologies. This study examines day-to-day bidirectional associations... Show moreBackground: Ambulatory assessments offer opportunities to evaluate daily dynamics of sleep and momentary affect using mobile technologies. This study examines day-to-day bidirectional associations between sleep and affect using mobile monitoring, and evaluates whether these associations differ between people without and with current or remitted depression/anxiety.Methods: Two-week ecological momentary assessment (EMA) and actigraphy data of 359 participants with current (n = 93), remitted (n = 176) or no (n = 90) CIDI depression/anxiety diagnoses were obtained from the Netherlands Study of Depression and Anxiety. Objective sleep duration (SD) and efficiency were obtained from actigraphy data. Self-reported SD, sleep quality (SQ), positive affect (PA) and negative affect (NA) were assessed by electronic diaries through EMA.Results: A bidirectional longitudinal association was found between self-reported SQ and affect, while no asso-ciation was found for self-reported SD and objective SD and efficiency. Better SQ predicted affect the same day (higher PA: b = 0.035, p < 0.001; lower NA: b =-0.022, p < 0.001), while lower NA on the preceding day predicted better SQ (b =-0.102, p = 0.001). The presence of current depression/anxiety disorders moderated the association between better SQ and subsequent lower NA; it was stronger for patients compared to controls (p = 0.003).Limitations: Observational study design can only point to areas of interest for interventions.Conclusions: This 2-week ambulatory monitoring study shows that, especially among depression/anxiety patients, better self-reported SQ predicts higher PA and lower NA the same day, while lower NA predicts better self-reported SQ. The value of mobile technologies to monitor and potentially intervene in patients to improve their affect should be explored. Show less
The fact that most healthcare resources are spend on a small subgroup of patients with an unfavourable prognosis has long been recognized. Therefore change is needed in terms of an improved... Show moreThe fact that most healthcare resources are spend on a small subgroup of patients with an unfavourable prognosis has long been recognized. Therefore change is needed in terms of an improved identification of patients with an unfavourable prognosis, early in their treatment course, which may facilitate proactive approaches to improve outcomes. We discussed two conceptually distinct constructs of predictors of prognosis in order to improve the identification of patients with an unfavourable prognosis. First, the level of control of the chronic condition as a predictor could reflect to some extent the presence of a multitude of other risk factors. Second, information on early treatment response had better predictive ability for long-term outcomes and so acts as a proxy for treatment effectiveness. Treatment effectiveness depends on different aspects e.g. adequateness of initial treatment and/or drugs, the mutual trust between clinician and patient and behavioral aspects such as treatment adherence. Treatment response adds an insight that can be acted upon; guiding personalized decisions in the treatment plan. In conclusion, this thesis leads to improvement of personalized medicine and thereby could increase the efficient use of healthcare resources, with the early identification of patients at risk of an unfavourable prognosis. Show less
Abbing, A.C.; De Sonneville, L.; Baars, E.; Bourne, D.; Swaab, H. 2019
ObjectivesTo explore possible working mechanisms of anxiety reduction in women with anxiety disorders, treated with art therapy (AT).MethodsA RCT comparing AT versus waiting list (WL) condition on... Show moreObjectivesTo explore possible working mechanisms of anxiety reduction in women with anxiety disorders, treated with art therapy (AT).MethodsA RCT comparing AT versus waiting list (WL) condition on aspects of self-regulation. Stress regulation (heart rate and heart rate variability) and executive functioning (daily behavioural and cognitive performance aspects of executive functioning (EF)) were evaluated in a pre-post design. Participants were women, aged 18–65 years with moderate to severe anxiety symptoms.ResultsEffectiveness of AT compared to WL was demonstrated in a higher resting HRV post treatment, improvements in aspects of self-reported daily EF (emotion control, working memory, plan/organize and task monitor), but not in cognitive performance of EF, stress responsiveness and down regulation of stress. The decrease in anxiety level was associated with improvements in self-reported daily EF.ConclusionsAT improves resting HRV and aspects of EF, the latter was associated with art therapy-related anxiety reduction Show less
The main aim of my Ph.D. thesis is to further explore the value of using early developing zebrafish larvae (up to 5 dpf) as a model to study anxiety-like behaviour and their pharmacological... Show moreThe main aim of my Ph.D. thesis is to further explore the value of using early developing zebrafish larvae (up to 5 dpf) as a model to study anxiety-like behaviour and their pharmacological modulation with drugs. Several behavioural parameters of larval zebrafish were used to evaluate anxiety-like behaviours, which are locomotion, startle response, and thigmotaxis. In addition to this, behavioural assays are also used to screen synthetic anxiolytics commonly used in the treatment of anxiety disorders. Finally, the toxic effects of the synthetic and herbal-based anxiolytics were also assessed on the developing zebrafish larvae. Show less
Bas-Hoogendam, J.M.; Steenbergen, H. van; Wee, N.J.A. van der; Westenberg, P.M. 2018
Anxiety disorders as a group are the most prevalent psychiatric disorders. Although they have been studied extensively, previous research has focussed primarily on members of the general... Show moreAnxiety disorders as a group are the most prevalent psychiatric disorders. Although they have been studied extensively, previous research has focussed primarily on members of the general population, or on participants in clinical trials. As both groups may differ substantially from patients who are seen in clinical practice, it is unclear to what extent previous findings can be generalised to a clinical setting. In order to gain insight in the clinical epidemiology of anxiety, it is necessary to study outpatients. This thesis describes several studies in which naturalistic data, collected through Routine Outcome Monitoring, were used. Chapter two describes the age of onset of panic disorder, agoraphobia, social phobia and generalised anxiety disorder. Chapter three explores age related differences. In chapter four predictors of treatment response are identified and the fifth chapter describes patient characteristics that are associated with the course of suicidal ideation in anxiety and depression. In chapter seven a self-report measure of anxiety severity is compared with an observer rated measure and patient characteristics associated with discrepancies between both measures are identified. In the final chapter findings are discussed and recommendations for future research are made. Show less
Muntingh, A.D.T.; Feltz-Cornelis, C.M. van der; Marwijk, H.W.J. van; Spinhoven, P.; Balkom, A.J.L.M. van 2016
The aim of this thesis was to investigate the effect of childhood trauma and childhood life-events on the development and course of depressive and anxiety disorders, and to identify risk factors... Show moreThe aim of this thesis was to investigate the effect of childhood trauma and childhood life-events on the development and course of depressive and anxiety disorders, and to identify risk factors contributing to these associations. In brief, our findings indicate that childhood trauma is an important risk factor for the development of depressive and/or anxiety disorders, especially depressive and comorbid disorders, and predicts a more chronic course of illness. Emotional neglect, as core component of childhood trauma, is of particular relevance and has a predominant and strong negative impact on onset and course of depressive and anxiety disorders. Our mediation analyses demonstrate the lifelong scarring through which childhood trauma may affect cognitive style, personality traits and ultimately psychopathology in adulthood. The findings of this thesis are keys to increased awareness of the negative impact of childhood trauma on psychosocial functioning, personality profile, and psychopathology. Based on our findings, recommendations for Chapter 7 Summary 136 clinical practice and future research have been formulated. Show less
Leeuw, G. van der; Gerrits, M.J.; Terluin, B.; Numans, M.E.; Feltz-Cornelis, C.M. van der; Horst, H.E. van der; ... ; Marwijk, H.W.J. van 2015
