Marijke Schotanus-Dijkstra

What Do the Bereaved by Suicide Communicate in Online Support Groups? A Content Analysis.

BACKGROUND Every year, more than six million people lose a loved one through suicide. These bereaved by suicide are at relatively high risk for mental illnesses including suicide. The social stigma attached to suicide often makes it difficult to talk about grief. Participating in online forums may be beneficial for the bereaved by suicide, but it is unknown what they communicate in these forums. AIMS What do the bereaved by suicide communicate in online forums? We examined which self-help mechanisms, grief reactions, and experiences with health-care services they shared online. METHOD We conducted a content analysis of 1,250 messages from 165 members of two Dutch language forums for the bereaved by suicide. RESULTS We found that sharing personal experiences featured most prominently in the messages, often with emotional expressions of grief. Other frequently used self-help mechanisms were expressions of support or empathy, providing advice, and universality (recognition), while experiences with health-care services featured only occasionally. Compared with previous studies about online forums for somatic illnesses, the bereaved by suicide communicated more personal experiences and engaged much less in chitchat. CONCLUSION Online forums appear to have relevant additional value as a platform for talking about grief and finding support.

An early intervention to promote well-being and flourishing and reduce anxiety and depression: A randomized controlled trial

Background There is growing evidence that fostering mental well-being and flourishing might effectively prevent mental disorders. In this study, we examined whether a 9-week comprehensive positive self-help intervention with email support (TL-E) was effective in enhancing well-being and flourishing and decreasing anxiety and depressive symptoms in a non-clinical sample. Methods A total of 275 participants with low or moderate well-being (mean age = 48 years, 86% female) were randomly assigned to a TL-E (n = 137) or wait-list control group (WL; n = 138). Participants completed online self-reporting questionnaires at baseline and at 3, 6 and 12 months. Results Repeated measure analyses revealed significant more improvement on mental well-being (F = 42.00, p ≤ 0.001, d = 0.66, 95% CI = 0.42–0.90), anxiety (F = 21.65, p ≤ 0.001, d = 0.63, 95% CI = 0.39–0.87) and depression (F = 13.62, p ≤ 0.001, d = 0.43, 95% CI = 0.19–0.67) in the TL-E group versus the WL group. The proportion of flourishing in the TL-E group increased from 7 to 30% after 3 months (NNT = 5.46) and to 34% after 6 months (NNT = 5.25). All within group effects were maintained up to 12 months. We found no meaningful dose-response relationship for adherence, nor a clear moderator pattern. Limitations It is unknown whether results were influenced by the email support that accompanied the self-help intervention since TL-E was only compared to a wait-list condition. The generalizability of the findings is limited by the self-selected sample of mainly higher-educated women. Conclusion A guided positive self-help intervention might be considered as a new mental health promotion strategy because it has the potential to improve well-being up to the status of flourishing mental health, and to decrease anxiety and depressive symptomatology.

The longitudinal relationship between flourishing mental health and incident mood, anxiety and substance use disorders

Background High levels of mental well-being might protect against the onset of mental disorders but longitudinal evidence is scarce. This study examines whether flourishing mental health predicts first-incidence and recurrent mental disorders 3 years later. Data were used from 4482 representative adults participating in the second (2010-12) and third wave (2013-15) of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). Mental well-being was assessed with the Mental Health Continuum-Short Form (MHC-SF) at the second wave. The classification criteria of this instrument were used to classify participants as having flourishing mental health: high levels of both hedonic well-being (life-satisfaction, happiness) and eudaimonic well-being (social contribution, purpose in life, personal growth). DSM-IV mood, anxiety and substance use disorders were measured with the Composite International Diagnostic Interview (CIDI) 3.0 at all waves. Odds ratios of (first and recurrent) incident disorders were estimated, using logistic regression analyses adjusting for potential confounders. Flourishing reduced the risk of incident mood disorders by 28% and of anxiety disorders by 53%, but did not significantly predicted substance use disorders. A similar pattern of associations was found for either high hedonic or high eudaimonic well-being. Significant results were found for substance use disorders when life-events and social support were removed as covariates. This study underscores the rationale of promoting mental well-being as a public mental health strategy to prevent mental illness. In wealthy European nations it seems fruitful to measure and pursuit a flourishing life rather than merely high levels of hedonic well-being.

Validation of the Flourishing Scale in a sample of people with suboptimal levels of mental well-being

BackgroundThere is growing interest in measuring the eudaimonic perspective of mental well-being (social and psychological well-being) alongside existing measures of the hedonic perspective of mental well-being (subjective well-being). The Flourishing Scale (FS) assesses core aspects of social-psychological functioning and is now widely used in research in practice. However, the reliability and validity of eudaimonic measures such as the FS has not yet been tested in people with low or moderate levels of well-being. This group is at risk for developing mental disorders and, therefore, an important target group for public mental health.MethodsWe extensively evaluated the psychometric properties of the 8-item FS in a sample of adults with low or moderate levels of well-being in The Netherlands (N = 275) using confirmatory factor analysis (CFA), item response theory analysis and a multitrait matrix.ResultsThe unidimensional structure of the scale was confirmed with CFA and an adequate fit to the Rasch model. However, our sample showed positive skewness of the scale, but lacked measurement precision at the higher end of the social-psychological continuum. In general, the multitrait matrix demonstrated the convergent validity of the scale, with strong to weak correlations between the FS and (1) overall well-being, (2) social and psychological well-being (3) positive eudaimonic states, (4) hedonic states, (5) psychopathology and (6) personality traits. Nevertheless, relatively low correlations were found, specifically in comparison with the Mental Health Continuum-Short Form (MHC-SF).ConclusionsThe FS seems a reliable and valid instrument for measuring social-psychological functioning in adults with suboptimal well-being, but its use in intervention studies and clinical practice might be debatable. Therefore, the FS seems most suitable to include in epidemiological studies alongside existing hedonic measures to more fully capture mental well-being. Future research should examine the temporal stability of the FS and the consequences of the positive skewness and limited external validity of the scale found in the current study.

Possible mechanisms in a multicomponent email guided positive psychology intervention to improve mental well-being, anxiety and depression: A multiple mediation model

Abstract The efficacy of several multicomponent positive psychology interventions (PPIs) have been demonstrated, but little is known about its possible mechanisms of change. We examined (1) the efficacy of an email guided self-help PPI on six core well-being processes (positive emotion, use of strengths, optimism, self-compassion, resilience and positive relations) and (2) the mediating role of these processes on mental well-being, anxiety and depressive symptoms. Adults ≥ 18 years were recruited in the general population and randomized into the intervention (n = 137) or wait-list control group (n = 138). Repeated measures analyses showed that the intervention group improved significantly more than the control group on all six processes. Improvement (t0–t1) on each process statistically mediated improvement (t0–t2) on mental well-being, anxiety and depressive symptoms. Simple-mediation analyses revealed small to moderate effect sizes. Multiple-mediation analyses revealed most pronounced results for positive relations and self-compassion, suggesting that these processes might be key mechanisms in promoting well-being.

How WEIRD are positive psychology interventions? A bibliometric analysis of randomized controlled trials on the science of well-being

ABSTRACT The past two decades have witnessed a rapid rise in well-being research, and a profusion of empirical studies on positive psychology interventions (PPIs). This bibliometric analysis quantifies the extent to which rigorous research on PPIs that employ randomized controlled trials (RCTs) reaches beyond Western Educated Industrialized Rich Democratic (WEIRD) populations. A search was conducted through databases including PubMed, PsycINFO, and Scopus for studies from 1998 to 2017. In total, we found 187 full-text articles that included 188 RCTs from 24 countries. We found that RCTs on the efficacy of PPIs are still predominately conducted in western countries, which accounted for 78.2% of the studies. All these countries are highly industrialized and democratic, and study populations are often highly educated and have a high income. However, there has been a strong and steady increase in publications from non-Western countries since 2012, indicating a trend towards globalization of positive psychology research.

How to flourish in everyday life? Enhancing flourishing mental health in the general population as a new strategy for the prevention of anxiety and depressive disorders

In psychology research and clinical practice the focus has long been predominantly on how to repair subclinical complaints and mental disorders. Since the introduction of positive psychology in 2000, many researchers and psychologists today not only help people to repair the negative and focus on their weaknesses but also help people to build their full potential and focus on their strengths and the positive things in life. Flourishing mental health is a state wherein people use their full potential in connection with others and society. In this PhD thesis, Marijke Schotanus-Dijkstra examined the prevalence, characteristics and importance of flourishing mental health using longitudinal data. She also evaluated the efficacy and cost-effectiveness of a multicomponent well-being intervention called “This is your life”. The aim of this intervention is to increase mental well-being and flourishing mental health and, thereby, to prevent anxiety and depressive disorders in people with suboptimal levels of mental well-being.

Tien jaar monitor GGZ-preventie: inzichten en vraagstukken. Ontwikkelingen in organisatie, capaciteit, financiering en bereik

De Monitor Aard en Omvang GGZ-preventie geeft inzicht in de organisatie, capaciteit en financiering van preventieafdelingen in de tweedelijns GGZ, de door hen uitgevoerde preventieve interventies en het bereik daarvan. Dit artikel schetst de ontwikkelingen die in de afgelopen tien jaar hebben plaatsgevonden in de GGZ-preventie. De resultaten interpreteren we vervolgens aan de hand van literatuur en reflectieve interviews met twee ervaren preventiefunctionarissen in de GGZ. De drie voornaamste ontwikkelingen in de GGZ-preventie waren de komst van omvangrijke GGZ-instellingen na fusies en het verdwijnen van RIAGG’s, de verschuiving van AWBZ financiering naar financiering van zorgverzekeraars en gemeenten, en een toename in het interventieaanbod en het bereik. Het bereik van preventieve interventies is sterk toegenomen van 13.008 deelnemers in 2006 naar 26.968 deelnemers in 2010 (dit is exclusief de deelnemers aan E-health interventies). Binnen de thema’s depressie, angst, mantelzorg en KOPP/KVO is de meeste vooruitgang geboekt. Op dit moment staat preventie onder druk. Er vindt een verschuiving plaats van tweedelijnszorg (gespecialiseerde GGZ) naar de eerstelijnszorg (basis GGZ). Kansen liggen er op het gebied van zelfmanagement en veerkracht, E-health, en positionering in de eerstelijn. Een opvolger van de monitor is gewenst die tevens de kosteneffectiviteit van de GGZ-preventie kan aantonen.AbstractTen years of monitoring mental health prevention: insights and issues The organizational characteristics and capacity of preventive mental health care, the financing structure for prevention activities as well as the participation rates, have been investigated by the Dutch ’Monitor Aard en Omvang GGZpreventie’. This article outlines developments between 2000 and 2010 in preventive mental health care. The results of ten years of monitoring were verified in interviews with two professionals. The three main developments were the rise of extensive mental health institutes after mergers, the transference of ’AWBZ’ to financing by health insurance companies and local authorities, and an increase in interventions and participation rates. The participation rates of preventive interventions increased from 13.008 participants in 2006 to 26.968 participants in 2010 (participants of online interventions not included). Most progress was made for the themes depression, anxiety, volunteer aid and ’Children of parents with psychiatric disorders’. Nevertheless, prevention is under pressure at the moment. Interventions that used to be carried out by specialist mental health institutes are now expected to be conducted in primary health care. A strong position in the latter, as well as self management and resilience, and E-health are opportunities for the future. A follow-up of the monitor is needed with attention for (cost) effectiveness of mental health prevention.