J. Spijker

Prevalence and predictors of recurrence of major depressive disorder in the adult population.

Hardeveld F, Spijker J, De Graaf R, Nolen WA, Beekman ATF. Prevalence and predictors of recurrence of major depressive disorder in the adult population.

Lifetime prevalence estimates of major depression: an indirect estimation method and a quantification of recall bias.

The measurement of lifetime prevalence of depression in cross-sectional surveys is biased by recall problems. We estimated it indirectly for two countries using modelling, and quantified the underestimation in the empirical estimate for one. A microsimulation model was used to generate population-based epidemiological measures of depression. We fitted the model to 1-and 12-month prevalence data from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) and the Australian Adult Mental Health and Wellbeing Survey. The lowest proportion of cases ever having an episode in their life is 30% of men and 40% of women, for both countries. This corresponds to a lifetime prevalence of 20 and 30%, respectively, in a cross-sectional setting (aged 15–65). The NEMESIS data were 38% lower than these estimates. We conclude that modelling enabled us to estimate lifetime prevalence of depression indirectly. This method is useful in the absence of direct measurement, but also showed that direct estimates are underestimated by recall bias and by the cross-sectional setting.

Temporal sequencing of lifetime mood disorders in relation to comorbid anxiety and substance use disorders - Findings from the Netherlands Mental Health Survey and Incidence Study

Abstract.Background: Little is known about the temporal sequencing of psychiatric disorders. The aim of this study was to obtain insight into patterns of co-occurrence of DSM-III-R mood disorders in relation to anxiety and substance use disorders, their temporal sequencing and the sociodemographic and long-term vulnerability predictors of this temporal sequencing. Methods: Data are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a psychiatric epidemiological study in a representative sample of 7,076 adults aged 18–64. Results: Of those who had ever experienced a mood disorder, 46 % of males and 57 % of females had a history of anxiety disorders, and 43 % and 15 % of substance use disorders. Mood disorders were associated with all anxiety and substance use disorders, except with alcohol abuse among males. In the majority of anxiety-comorbid cases, the mood disorder arose after the anxiety disorder; the pattern for substance use-comorbid disorders was more variable. Deviation from the usual sequence of major depression and anxiety disorders was more often seen among females, subjects with a higher educational level, subjects who experienced childhood parental divorce, and subjects who experienced childhood emotional neglect. Conclusions: When comorbid with anxiety disorders, mood disorders clearly tend to be secondary. Few of the studied demographic factors, familial vulnerability factors and childhood life events predict the sequencing of mood disorders in relation to other disorders.

Determinants of poor 1‐year outcome of DSM‐III‐R major depression in the general population: results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS)

Objective:  To investigate risk factors of poor 1‐year outcome of major depression in the general population and to compare the results with data from clinical populations.

Functional disability and depression in the general population. Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)

Objective:  Data on the temporal relationships between duration of depression and recovery and functional disability are sparse. These relationships were examined in subjects from the general population (n = 250) with newly originated episodes of DSM‐III‐R major depression.

Staging methods for treatment resistant depression. A systematic review

BACKGROUND Treatment resistant depressant (TRD) is classified in different staging models, but these are not used routinely. We aimed to identify staging models for TRD and compare them regarding predictive utility and reliability. METHODS Systematic review of Pubmed, Embase and PsycINFO (1985-January 2010) without language limits, plus articles identified from reference lists of previous reviews. We excluded articles focusing on TRD treatment. We qualitatively summarized characteristics of the identified staging models, describing strengths and limitations for each model. If available, we reported results of validation studies. RESULTS From 950 retrieved articles five staging models were found; the Antidepressant Treatment History Form, Thase and Rush Model, European Staging Model, Massachusetts General Hospital Staging model and the Maudsley Staging Model (MSM). Six studies investigated the predictive utility (of four models). We observed an evolution from single antidepressant adequacy ratings, towards a multidimensional and more continuous scored staging model which also introduced TRD characteristics (severity and duration). The operationalization criteria improved; the scoring of different treatment strategies (between/within class switching and augmentation/combination) changed according to the existing evidence. Over time, efforts to validate models improved. The predictive utility was assessed best for the MSM. LIMITATIONS Few staging models existed; their reliability was hardly assessed. CONCLUSIONS Despite validation of the MSM, further investigation of the reliability and predictive utility of TRD staging models and additional disease characteristics is required. Correct staging of TRD might improve generalizability of results from clinical studies and improve delivery of care to TRD patients. We propose methods to validate staging models in TRD.

Continuation and Maintenance Use of Antidepressants in Recurrent Depression

Background: Maintenance antidepressant (AD) medication is the most commonly used preventive strategy in a highly recurrent disease, i.e. depression. Little is known about the discontinuation of maintenance AD use and the association with recurrence in daily clinical practice. The purpose was to examine the discontinuation rate of maintenance AD in daily clinical practice in recurrently depressed patients and the associated risk of recurrence. Methods: Prospectively AD maintenance medication and recurrence were examined in 172 euthymic patients with recurrent depression. AD user profiles before recurrence (nonusers, intermittent users, continuous users) were examined and related to recurrence over a 2-year follow-up period. Results: Less than half of the patients (42%) used AD continuously. Taking into account the minimal required adequate used dosage (≧20 mg fluoxetine equivalent), only 26% of the patients used AD as recommended by international guidelines. Despite continuous use of AD, 60.4% relapsed in 2 years. This relapse rate was comparable to the rate of the intermittent users (63.6%). In patients who stopped taking AD after remission and who received additional preventive CT, the recurrence rates were significantly lower than in non-AD-using patients treated with usual care (8 vs. 46%). Conclusions: The majority of recurrently depressed patients treated with AD discontinue maintenance AD therapy in daily primary and secondary clinical practice. AD seems to offer poor protection against relapse in this patient group. Patients who stopped using AD experienced less relapse, especially if they were treated with preventive CT. Alternative maintenance treatments (including preventive cognitive therapy after discontinuation of AD) should be studied in recurrently depressed patients with intermittent good remission, not only in secondary but also in primary care.

Care utilization and outcome of DSM-III-R major depression in the general population. Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)

Objective: To assess care utilization, individual characteristics and clinical and functional outcomes for various modalities of professional care in people with DSM‐III‐R major depression.

The 7-year course of depression and anxiety in the general population

Rhebergen D, Batelaan NM, de Graaf R, Nolen WA, Spijker J, Beekman ATF, Penninx BWJH. The 7‐year course of depression and anxiety in the general population.

Recurrence of major depressive disorder and its predictors in the general population: results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS).

BACKGROUND Knowledge of the risk of recurrence after recovery from major depressive disorder (MDD) in the general population is scarce. METHOD Data were derived from 687 subjects in the general population with a lifetime DSM-III-R diagnosis of MDD but without a current major depressive episode (MDE) or dysthymia. Participants had to be at least 6 months in remission, and were recruited from The Netherlands Mental Health Survey and Incidence Study (NEMESIS), using the composite international diagnostic interview (CIDI). Recency and severity of the last MDE were assessed retrospectively at baseline. Recurrence of MDD was measured prospectively during the 3-year follow-up. Kaplan-Meier survival curves were used to measure time to recurrence. Determinants of time to recurrence were analyzed using proportional hazard models. RESULTS The estimated cumulative recurrence of MDD was 13.2% at 5 years, 23.2% at 10 years and 42.0% at 20 years. In bivariate analysis, the following variables predicted a shorter time to recurrence: younger age, younger age of onset, higher number of previous episodes, a severe last depressive episode, negative youth experiences, ongoing difficulties before recurrence and high neuroticism. Multivariably, younger age, a higher number of previous episodes, a severe last depressive episode, negative youth experiences and ongoing difficulties remained significant. CONCLUSIONS In this community sample, the long-term risk of recurrence was high, but lower than that found in clinical samples. Subjects who had had an MDE had a long-term vulnerability for recurrence. Factors predicting recurrence included illness- and stress-related factors.