Background: Mismatch between need and mental healthcare (MHC) use (under-and overuse) has mainly been studied with cross-sectional designs, not accurately capturing patterns of persistence or... Show moreBackground: Mismatch between need and mental healthcare (MHC) use (under-and overuse) has mainly been studied with cross-sectional designs, not accurately capturing patterns of persistence or change in clinical burden and MHC-use among persons with depressive and/or anxiety disorders. Aims: Determining and describing [mis]match of longitudinal trajectories of clinical burden and MHC-use. Methods: Six-year longitudinal burden and MHC-use data came from the Netherlands Study of Depression and Anxiety (n=2981). The sample was split into four subgroups: I) no clinical burden but constant MHC use, II) constant clinical burden but no MHC-use, III) changing clinical burden and MHC-use, and IV) healthy non-users. Within subgroups I)-III), specific clinical burden and MHC trajectories were identified (growth mixture modeling). The resulting classes' associations with predisposing, enabling, and need factors were investigated (regression analysis). Results: Subgroups I-III revealed different trajectories. I) increasing MHC without burden (4.1%). II) slightly increasing (1.9%), strongly increasing (2.4%), and decreasing (9.5%) burden without MHC. III) increasing (41.4%) or decreasing (19.4%) burden and concurrently increasing MHC use (first underuse, then matched care), thus revealing delayed MHC-use. Only having suicidal ideation (p<.001, Cohen's d=.6-1.5) was a significant determinant of being in latter classes compared to underusers (strongly increasing burden without MHC-use). Limitations: More explanatory factors are needed to explain [mis]match. Conclusion: Mismatch occurred as constant underuse or as delayed MHC-use in a high-income country (Netherlands). Additionally, no meaningful class revealed constantly matched care on average. Presence of suicidal ideation could influence the probability of symptomatic individuals receiving matched MHC or not. Show less
The dissertation studies harmful tax competition in the East African Community (EAC). With a focus on Rwanda, it mainly refers to the EU and OECD standards. The objective of the study was to... Show moreThe dissertation studies harmful tax competition in the East African Community (EAC). With a focus on Rwanda, it mainly refers to the EU and OECD standards. The objective of the study was to investigate Rwanda’s tax competition practices, in order to determine whether Rwanda is within the parameters of internationally accepted practices. The main orientation was not to draw a new distinction between acceptable versus unacceptable tax practices. Rather, it was to apply the criteria already developed and accepted at the international level to the particular case of Rwanda. The main materials used are: the EAC Treaty, the draft EAC Code of Conduct against harmful tax competition, the 1997 EU Code of Conduct on business taxation, the 1998 OECD Report on harmful tax competition, the COCG assessment reports, the OECD Progress reports, the Rwandan income tax law of 2018 and the investment law of 2021. This dissertation shows the possibility of applying EU and OECD standards by non- OECD and EU countries, particularly developing countries, to create tax systems that are free of harmful tax competition. However, it also shows that OECD and EU standards are not sufficient to eradicate all harmful tax practices, both in developed and developing countries. Show less
