H.W.J. van Marwijk

The Netherlands Study of Depression and Anxiety (NESDA): rationale, objectives and methods.

The Netherlands Study of Depression and Anxiety (NESDA) is a multi‐site naturalistic cohort study to: (1) describe the long‐term course and consequences of depressive and anxiety disorders, and (2) to integrate biological and psychosocial research paradigms within an epidemiological approach in order to examine (interaction between) predictors of the long‐term course and consequences.

Two-year course of depressive and anxiety disorders: Results from the Netherlands Study of Depression and Anxiety (NESDA).

BACKGROUND Whether course trajectories of depressive and anxiety disorders are different, remains an important question for clinical practice and informs future psychiatric nosology. This longitudinal study compares depressive and anxiety disorders in terms of diagnostic and symptom course trajectories, and examines clinical prognostic factors. METHODS Data are from 1209 depressive and/or anxiety patients residing in primary and specialized care settings, participating in the Netherlands Study of Depression and Anxiety. Diagnostic and Life Chart Interviews provided 2-year course information. RESULTS Course was more favorable for pure depression (n=267, median episode duration = 6 months, 24.5% chronic) than for pure anxiety (n=487, median duration = 16 months, 41.9% chronic). Worst course was observed in the comorbid depression-anxiety group (n=455, median duration > 24 months, 56.8% chronic). Independent predictors of poor diagnostic and symptom trajectory outcomes were severity and duration of index episode, comorbid depression-anxiety, earlier onset age and older age. With only these factors a reasonable discriminative ability (C-statistic 0.72-0.77) was reached in predicting 2-year prognosis. LIMITATION Depression and anxiety cases concern prevalent - not incident - cases. This, however, reflects the actual patient population in primary and specialized care settings. CONCLUSIONS Their differential course trajectory justifies separate consideration of pure depression, pure anxiety and comorbid anxiety-depression in clinical practice and psychiatric nosology.

Outcome of depression in later life in primary care: longitudinal cohort study with three years' follow-up

Objectives To study the duration of depression, recovery over time, and predictors of prognosis in an older cohort (≥55 years) in primary care. Design Longitudinal cohort study, with three years’ follow-up. Setting 32 general practices in West Friesland, the Netherlands. Participants 234 patients aged 55 years or more with a prevalent major depressive disorder. Main outcome measures Depression at baseline and every six months using structured diagnostic interviews (primary care evaluation of mental disorders according to diagnoses in Diagnostic and Statistical Manual of Mental Disorders, fourth edition) and a measure of severity of symptoms (Montgomery Åsberg depression rating scale). The main outcome measures were time to recovery and the likelihood of recovery at different time points. Multivariable analyses were used to identify variables predicting prognosis. Results The median duration of a major depressive episode was 18.0 months (95% confidence interval 12.8 to 23.1). 35% of depressed patients recovered within one year, 60% within two years, and 68% within three years. A poor outcome was associated with severity of depression at baseline, a family history of depression, and poorer physical functioning. During follow-up functional status remained limited in patients with chronic depression but not in those who had recovered. Conclusion Depression among patients aged 55 years or more in primary care has a poor prognosis. Using readily available prognostic factors (for example, severity of the index episode, a family history of depression, and functional decline) could help direct treatment to those at highest risk of a poor prognosis.

Big Five personality and depression diagnosis, severity and age of onset in older adults

BACKGROUND Personality may play an important role in late-life depression. The aim of this study is to examine the association between the Big Five personality domains and the diagnosis, severity and age of onset of late-life depression. METHODS The NEO-Five Factor Inventory (NEO-FFI) was cross-sectionally used in 352 depressed and 125 non-depressed older adults participating in the Netherlands Study of Depression in Older Persons (NESDO). Depression diagnosis was determined by the Composite International Diagnostic Interview (CIDI). Severity of depression was assessed by the Inventory of Depressive Symptomatology (IDS). Logistic and linear regression analyses were applied. Adjustments were made for sociodemographic, cognitive, health and psychosocial variables. RESULTS Both the presence of a depression diagnosis and severity of depression were significantly associated with higher Neuroticism (OR=1.35, 95% CI=1.28-1.43 and B=1.06, p<.001, respectively) and lower Extraversion (OR=.79, 95% CI=.75-.83; B=-.85, p<.001) and Conscientiousness (OR=.86, 95% CI=.81.-.90; B=-.86, p<.001). Earlier onset of depression was significantly associated with higher Openness (B=-.49, p=.026). LIMITATIONS Due to the cross-sectional design, no causal inferences can be drawn. Further, current depression may have influenced personality measures. CONCLUSIONS This study confirms an association between personality and late-life depression. Remarkable is the association found between high Openness and earlier age of depression onset.

Lithium augmentation in geriatric depression

In the geriatric department of a Dutch psychiatric hospital the charts of 51 patients treated with lithium in addition to cyclic antidepressants were reviewed. A response was seen in 33 patients (65%). For patients with recurrent depressive episodes, a statistical trend was found towards more responders with more complete responses, compared to patients with first depressive episodes. During lithium augmentation, 10 patients suffered from severe adverse effects 12 times. In spite of adverse effects, with expert monitoring lithium augmentation can, in our opinion, be of value in the treatment of older depressed patients.

Depression, disability and somatic diseases among elderly

OBJECTIVE Depression among older adults is associated with both disability and somatic disease. We aimed to further understand this complicated relationship and to study the possible modifying effect of increasing age. DESIGN Cross sectional survey. SETTING Outpatient and inpatient clinics of regional facilities for mental health care and primary care. PARTICIPANTS Elderly people, 60 years and older, 378 persons meeting DSM-IV criteria for a depressive disorder and 132 non-depressed comparisons. MEASUREMENTS Depression diagnoses were assessed with the CIDI version 2.1. Disability was assessed with the WHO Disability Assessment Schedule (WHODAS). Social-demographic information and somatic diseases were assessed by self-report measurements. RESULTS Disability, in general and on all its subscales, was strongly related to depression. Presence of somatic disease did not contribute independently to variance in depression. The relationship was stronger for people of 60-69 years old than for those older than 70 years. Important aspects of disability that contributed to depression were disability in participation, self-care and social activities. LIMITATIONS Results are based on cross sectional data. No inferences about causal relationships can be drawn. CONCLUSION Disability, especially disability regarding participation, self-care, or social activities is strongly related to late-life depression. Somatic diseases in itself are less of a risk for depression, except that somatic diseases are related to disability.

Does patient feedback improve the consultation skills of general practice trainees? A controlled trial

Medical Education 2010: 44 : 156–164

Adverse effects of multiple physical symptoms on the course of depressive and anxiety symptoms in primary care

389 Harald Baumeister Engelbergerstrasse 41 DE–79085 Freiburg (Germany) Tel. +49 761 203 3044, Fax +49 761 203 3040 E-Mail baumeister @ psychologie.uni-freiburg.de 3 Parker G: Beyond major depression. Psychol Med 2005; 35: 467–474. 4 Parker G, Roy K, Mitchell P, Wilhelm K, Malhi G, Hadzi-Pavlovic D: Atypical depression: a reappraisal. Am J Psychiatry 2002; 159: 1470– 1479. 5 Leventhal AM, Rehm LP: The empirical status of melancholia: implications for psychology. Clin Psychol Rev 2005; 25: 25–44. 6 Thase ME: Atypical depression: useful concept, but it’s time to revise the DSM-IV criteria. Neuropsychopharmacology 2009; 34: 2633–2641. 7 Lurie SJ, Gawinski B, Pierce D, Rousseau SJ: Seasonal affective disorder. Am Fam Physician 2006; 74: 1521–1524. 8 Baumeister H, Kufner K: It is time to adjust the adjustment disorder category. Curr Opin Psychiatry 2009; 22: 409–412. 9 Sneed JR, Roose SP, Sackeim HA: Vascular depression: a distinct diagnostic subtype? Biol Psychiatry 2006; 60: 1295–1298.

Psychological treatment of anxiety in primary care: a meta-analysis

BACKGROUND Guidelines and mental healthcare models suggest the use of psychological treatment for anxiety disorders in primary care but systematic estimates of the effect sizes in primary care settings are lacking. The aim of this study was to examine the effectiveness of psychological therapies in primary care for anxiety disorders. METHOD The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Medline, PsycINFO and Pubmed databases were searched in July 2010. Manuscripts describing psychological treatment for anxiety disorders/increased level of anxiety symptoms in primary care were included if the research design was a randomized controlled trial (RCT) and if the psychological treatment was compared with a control group. RESULTS In total, 1343 abstracts were identified. Of these, 12 manuscripts described an RCT comparing psychological treatment for anxiety with a control group in primary care. The pooled standardized effect size (12 comparisons) for reduced symptoms of anxiety at post-intervention was d = 0.57 [95% confidence interval (CI) 0.29-0.84, p = 0.00, the number needed to treat (NNT) = 3.18]. Heterogeneity was significant among the studies (I 2 = 58.55, Q = 26.54, p < 0.01). The quality of studies was not optimal and missing aspects are summarized. CONCLUSIONS We found a moderate effect size for the psychological treatment of anxiety disorders in primary care. Several aspects of the treatment are related to effect size. More studies are needed to evaluate the long-term effects given the chronicity and recurrent nature of anxiety.

Test-characteristics of the GDS-15 in screening for major depression in elderly patients in general practice

Abstract The aim of this study was to assess whether a cut-off of five on the 15-item version of the Geriatric Depression Scale (GDS)that was determined beforehand yielded the best sensitivity and specificity for the diagnosis of major depression in the elderly in primary care. A sample of 330 patients was drawn from a group of elderly patients (⩽ 55 years) that participated in a clinical trial, the West-Friesland Study (WFS). The mood-module of the PRIMary care Evaluation of Mental Disorder (PRIME-MD)served as the external criterion for major depression. The results showed that using a ROC-curve the best cut-off score of the GDS-15was five. This cut-off score gave a sensitivity of 0.79 and a specificity of 0.67 and a negative predictive value of 0.94. It is concluded that the validation in retrospect of the a priori chosen cut-off score of five in a sample of the study population supports our a priori choice.