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Purpose The health correlates of polygenic risk (PRS-SCZ) and exposome (ES-SCZ) scores for schizophrenia may vary depending on age and sex. We aimed to examine age- and sex-specific associations of PRS-SCZ and ES-SCZ with self-reported health in the general population. Methods Participants were from the population-based Netherlands Mental Health Survey and Incidence Study–2 (NEMESIS-2). Mental and physical health were measured with the 36-item Short Form Survey 4 times between 2007 and 2018. The PRS-SCZ and ES-SCZ were respectively calculated from common genetic variants and exposures (cannabis use, winter birth, hearing impairment, and five childhood adversity categories). Moderation by age and sex was examined in linear mixed models. Results For PRS-SCZ and ES-SCZ analyses, we included 3099 and 6264 participants, respectively (age range 18–65 years; 55.7–56.1% female). Age and sex did not interact with PRS-SCZ. Age moderated the association between ES-SCZ and mental (interaction: p = 0.02) and physical health (p = 0.0007): at age 18, + 1.00 of ES-SCZ was associated with − 0.10 of mental health and − 0.08 of physical health, whereas at age 65, it was associated with − 0.21 and − 0.23, respectively (all units in standard deviations). Sex moderated the association between ES-SCZ and physical health (p Conclusion There were larger associations between higher ES-SCZ and poorer health among female and older individuals. Accounting for these interactions may increase ES-SCZ precision and help uncover populational determinants of environmental influences on health.

Purpose Psychosis has been associated with adult victimisation. However, it remains unclear whether psychosis predicts incident adult victimisation, or whether adult victimisation predicts incident psychosis. Furthermore, a moderating effect of childhood victimisation on the association between psychosis and adult victimisation has not been investigated. Methods The longitudinal association between baseline psychotic experiences and six-year incidence of adult victimisation was assessed in a prospective general population cohort of 6646 adults using logistic regression analysis. The association between baseline adult victimisation and six-year incidence of psychotic experiences was examined as well. Furthermore, the moderating effect of childhood victimisation on these bidirectional associations was analysed. Results Psychotic experiences and childhood victimisation were both associated with an increased risk of incident adult victimisation. However, this was through competing pathways, as suggested by a negative interaction between psychotic experiences and childhood victimisation. Baseline adult victimisation and childhood victimisation both independently increased the risk of incident psychotic experiences, but there was no interaction between adult victimisation and childhood victimisation. Conclusions Psychosis and victimisation are interconnected throughout the life course. Childhood victimisation is connected to psychosis through two pathways: one direct and one indirect through adult victimisation. In individuals without childhood victimisation, psychosis and adult victimisation bidirectionally impact on each other.

Purpose: To estimate the disease burden due to 15 mental disorders at both individual and population level. Methods: Using a population-based survey (Nemesis, N = 7,056) the number of years lived with disability per one million population were assessed. This was done with and without adjustment for comorbidity. Results: At individual level, major depression, dysthymia, bipolar disorder, panic disorder, social phobia, eating disorder and schizophrenia are the disorders most markedly associated with health-related quality of life decrement. However, at population level, the number of affected people and the amount of time spent in an adverse health state become strong drivers of population ill-health. Simple phobia, social phobia, depression, dysthymia and alcohol dependence emerged as public health priorities. Conclusions: From a clinical perspective, we tend to give priority to the disorders that exact a heavy toll on individuals. This puts the spotlight on disorders such as bipolar disorder and schizophrenia. However, from a public health perspective, disorders such as simple phobia, social phobia and dysthymia - which are highly prevalent and tend to run a chronic course - are identified as leading causes of population ill-health, and thus, emerge as public health priorities. © 2013 Springer-Verlag Berlin Heidelberg.

To estimate work loss days due to absenteeism and presenteeism associated with commonly occurring mental and physical disorders.In a nationally representative face-to-face survey (Netherlands Mental Health Survey and Incidence Study-2) including 4,715 workers, the presence of 13 mental and 10 chronic physical disorders was assessed using the Composite International Diagnostic Interview 3.0 and a physical disorder checklist. Questions about absent days due to illness and days of reduced quantitative and qualitative functioning while at work were based on the WHO Disability Assessment Schedule. Total work loss days were defined as the sum of the days of these three types of loss, where days of reduced functioning were counted as half. Both individual and population-level effects of disorders on work loss were studied, taking comorbidity into account.Any mental disorder was associated with 10.5 additional absent days, 8.0 days of reduced-qualitative functioning and 12.0 total work loss days. For any physical disorder, the number of days was 10.7, 3.5 and 11.3, respectively. Adjusted for comorbidity, drug abuse, bipolar disorder, major depression, digestive disorders and panic disorder were associated with the highest number of additional total work loss days. At population-level, major depression, chronic back pain, respiratory disorders, drug abuse and digestive disorders contributed the most. Annual total work loss costs per million workers were estimated ateuro360 million for any mental disorder; andeuro706 million for any physical disorder.Policies designed to lessen the impact of commonly occurring disorders on workers will contribute to a reduction in absenteeism and presenteeism. As the indirect costs of (mental) disorders are much higher than their medical costs, prevention and treatment of these conditions may be cost-effective.

To present prevalences of lifetime and 12-month DSM-IV mood, anxiety, substance use and impulse-control disorders from the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2), and to compare the 12-month prevalence of mood, anxiety and substance use disorders with estimates from the first study (NEMESIS-1). Between November 2007 and July 2009, a nationally representative face-to-face survey was conducted using the Composite International Diagnostic Interview 3.0 among 6,646 subjects aged 18–64. Trends in 12-month prevalence of mental disorders were examined with these data and NEMESIS-1 data from 1996 (n = 7,076). Lifetime prevalence estimates in NEMESIS-2 were 20.2% for mood, 19.6% for anxiety, 19.1% for substance use disorder and 9.2% for impulse-control disorder. For 12-month disorders, these figures were 6.1, 10.1, 5.6 and 2.1%, respectively. Between 1996 and 2007–2009, the 12-month prevalence of anxiety and substance use disorder did not change. The prevalence of mood disorder decreased slightly but lost significance after controlling for differences in sociodemographic variables between the two studies. This study shows that in the Netherlands mental disorders are prevalent. In about a decade, no clear change in mental health status was found.

Dropping out from mental health treatment is a major problem because mental health treatments delivered for inadequate durations are ineffective. The aim of this study was to compare treatment dropout rates by type of provider, dropout risk by number of visit, and to ascertain factors associated with treatment dropout. A cross-sectional household survey of a representative sample of 626 out of 21,425 non-institutionalized adults from the general population of six European countries was carried out. Dropout was defined as terminating treatment before recommendation. Dropout from all treating providers during a 12-month period was 14%. Among psychiatrists, psychologists, and general practitioners figures were: 19.6, 20.3, and 20.3%, respectively. While the hazard risk for dropping out was higher during the first three visits to GPs and psychologists, it was stable for psychiatrists. Older age, female gender, and living in large or midsize urban areas were associated with a decreased risk of dropping out. Efforts for increasing patients’ proportion completing adequate courses of care for mental disorders in Europe should focus on the first visits, especially those made to the general medical care.

To examine the prevalence rate, impairment, comorbidity, course of illness and determinants of eight specific phobia variants: animals (animal subtype); heights, water, storms (natural environment subtype); flying, enclosed spaces, being alone (situational subtype); and blood/injury (blood/injury subtype).Data were obtained from the Netherlands Mental Health Survey and Incidence Study, a prospective study in the Dutch general population aged 18-65 (N = 7,076).The most prevalent condition was specific phobia with a fear of heights (4.9%). On all parameters except duration, specific phobia with a fear of being alone emerged as the most severe condition. Phobias with fear of enclosed spaces and phobias with fear of blood showed a slightly greater likelihood of impairment, comorbidity and personality problems than phobias with fear of animals, heights, water or storms.The situational and blood/injury phobia subtypes appear to be a more significant index for impairments and for comorbid psychiatric disorders than the animal and natural environment phobia subtypes.

Little is known about late-onset psychosis (onset after the age 45 years) and how it relates to early-onset psychosis (before age 45 years). The aims of this study were to calculate the incidence of non-affective, non-organic psychotic symptoms across the life span and to explore the contribution of different sets of risk factors in relation to age at onset. Data were obtained from the three measurements of the Netherlands Mental Health Survey and Incidence Study. Symptoms of psychosis were assessed in individuals aged 18–64 years using the Composite International Diagnostic Interview. All individuals reporting first-onset of psychotic symptoms within a three-year interval were included. The degree to which sets of risk factors affected the psychosis outcome similarly across age groups was assessed. The number of subjects displaying incident psychotic symptoms was similar across age groups. Cumulative incidence rates ranged from 0.3% to 0.4%. Age differences were found for life-time depressive symptoms (risk difference = 5%, 95% CI = 1%, 9%) and baseline neuroticism (risk difference = 3%, 95% CI = 0%, 6%), indicating that late-onset psychosis was less often preceded by these. In contrast, no effect modification by age was observed for female sex, hearing impairment, being single, or life-time cannabis use. Onset of psychotic symptoms in late life is no rare event. Compared to early onset psychosis, the late-onset counterpart less often arises in a context of emotional dysfunction and negative affectivity, suggesting qualitative differences in aetiology and more effective premorbid coping styles.

Research on the association between paranoia and self-esteem has yielded inconsistent findings. Some studies have indicated an association between paranoia and low self-esteem, while other studies have shown an association with high self-esteem. A plausible explanation for these inconsistencies is that self-esteem is unstable in paranoid individuals.The association between instability in self-esteem and paranoia was assessed in a general population risk set of 4636 individuals using logistic regression analysis.Self-esteem instability was significantly associated with the presence of paranoid symptoms (OR 1.27 95% CI 1.12-1.45) and not with other positive psychotic symptoms (OR 1.09 95% CI 0.96-1.23), adjusted for a range of a priori selected confounders.The finding of a specific association between unstable self-esteem and paranoia is in line with a recent psychological model suggesting that paranoid beliefs arise partly as a consequence of dysfunctional efforts to regulate self-esteem.

Recollections of cold and overprotective behaviors from parents have been hypothesized to lead to the presence of mental disorders in young adulthood through their detrimental effects on individuals' satisfaction in later partner relationships. Previous studies have not explicitly tested, however, whether partner relationship satisfaction mediates the longitudinal relationship from parental bonds to DSM-III-R disorders in young adults.We examined: (1) whether recollections of parental bonds in the first 16 years of life were related to the prevalence of DSM-III-R mental disorders in young adulthood, and (2) whether young adults' satisfaction with current partner relationships mediated these links. Data were used from 1,581 Dutch young adults aged 18-34 years, who were interviewed in three waves (1996, 1997, and 1999) of a nationwide epidemiological study.Structural Equation Models demonstrated that recollections of caring, non-intrusive parenting behaviors were significantly, negatively associated with the prevalence of mood and anxiety disorders (but not substance disorders) in young adulthood. The satisfaction with current partner relationships did not mediate these negative associations.Results replicate and extend earlier findings from the National Comorbidity Survey (Enns et al. 2002), demonstrating that mental disorders are directly related to people's recollections of parental care and overprotection. Low-quality parental bonds were only related to internalizing types of psychopathology, however, and were of a modest strength. Results may indicate that there is relatively little cross-relationship continuity in the experience of intimacy between relationships with parents and with partners.

Item does not contain fulltext Little is known about the emotional responses of participants in community surveys to standardised psychiatric interviews like the Composite International Diagnostic Interview (CIDI). This study investigates the proportion of subjects responding negatively or positively to the CIDI, and identifies their sociodemographic, psychopathological, personality and social characteristics. At the end of the three-wave Netherlands Mental Health Survey and Incidence Study, 4796 participants aged 18–64 at baseline were questioned about how the interviews had affected them. In all, 2.7% found the interviews quite distressing and 9.5% somewhat distressing. Compared to those without distress, they were more likely to be female, not living with a partner, not in paid employment, and to have a somatic disorder. A total of 5.7% of subjects reported that participation had helped them cope better with problems, and 3.4% reported they could now seek help more easily. These were more likely to be older, less educated, not in paid employment (except those seeking help more easily) and to have a somatic disorder. Both negative and positive responses were associated with mood, anxiety and substance use disorders and comorbidity, as well as with neuroticism, external mastery, low self-esteem and low social support. Only a small minority of participants reported distress from the interviews. This is an important finding for ethics committees charged with approving general population surveys that use the CIDI. It can also be valuable for planning such studies, enabling researchers to inform participants more fully about the effects of the interview before asking them for informed consent.

Many studies have been published on the association between adverse psychosocial working conditions and mental health, but only a few related types of adverse job conditions and a count of these adversities to workers’ mental health, using standardized diagnostic interviews. This study addresses this issue. Data were used from the second wave of the Netherlands Mental Health Survey and Incidence Study-2, a nationally representative face-to-face survey of the general population, including 3,672 workers, 166 unemployed and 239 disabled persons. Among workers, psychosocial working conditions (decision latitude, psychological job demands, job security and co-worker support) were assessed with the Job Content Questionnaire. Mental health symptoms were assessed with the Mental Health Inventory (MHI)-5 and DSM-IV diagnoses/syndromes with the Composite International Diagnostic Interview 3.0. Adverse psychosocial job conditions were related to workers’ mental health. The strongest association was found for low job security which increased the chance of mental health symptoms and mental disorders by twofold. Workers in the poorest quality jobs, i.e. experiencing at least three adverse working conditions, had a 3 to almost 5 times higher chance of mental disorders than those in the most optimal jobs. Having a poor quality job was not associated with better mental health compared to being unemployed or disabled. In general, similar relations were found for mood, anxiety and substance use disorders. In planning future strategies to prevent mental disorders at the workplace, the focus should be on workers who experience job insecurity and on those who report several adversities.

PURPOSE: The objective of the present study was to provide updated data from nine European countries about the impact of social inequalities in the prevalence of common mental disorders. METHODS: Cross-sectional household survey of a representative sample of the adult general population of Belgium, Bulgaria, Germany, Italy, The Netherlands, Northern Ireland, Portugal, Romania and Spain. In total, 34,395 individuals were included. Social inequalities in 12-month mood, anxiety and alcohol-related disorders were evaluated. RESULTS: In Europe, income seems not to be related to the prevalence of mental disorders. Unemployment and disablement are associated with mental disorders. Lower educational level augments the risk for mood disorders. Living in small (rural) areas decreases the risk for mood disorders and living in urban settings increases it. Northern Ireland, Portugal and Belgium are the countries with the highest risks for mental disorders. CONCLUSIONS: Despite some contradictions with previous literature, in Europe there are social inequalities in the prevalence of mental disorders. However, income showed not to be associated with inequalities in mental health. Being younger, unemployed or disabled, with no education or incomplete primary studies, living in urban settings, and in Northern Ireland, Portugal or Belgium were associated to an augmented prevalence of mental disorders. Policy makers could focus on mental health promotion and mental disorders prevention programmes for risk groups such as unemployed/disabled individuals. Support to vulnerable groups (unemployed or those with less education) and mental health literacy can improve European citizens' mental health.

This study served to replicate and extend the findings from the National Comorbidity Survey [Enns MW, Cox BJ, Clara I (2002) Psychol Med 32:997-1008], in examining associations between recalled parental bonding and the prevalence and incidence of mental disorders in adulthood.Data were used from 4,796 adults aged 18-64, who had participated in three waves (i.e., 1996, 1997, and 1999) of a large-scale Dutch epidemiological study.Parental lack of care and overprotection were significantly associated with both prevalence and incidence of DSM-III-R disorders. However, the impact of parental bonding was modest, explaining only 1-5% of the variance in the occurrence and onset of psychopathology. Chi-square tests demonstrated there were no differences between the impact of paternal and maternal rearing behaviors on mental disorders, or between lack of care and overprotection in the prediction of mental disorders.Overall, individuals' recollections of parental lack of care and overprotection appear to be non-specifically, modestly related to the prevalence and incidence of DSM-III-R disorders in adults from the general population. Future research may examine indirect or mediated links between parental bonding and (clinical diagnoses of) mental health problems.

Objectives: High rates of psychotic disorders and psychotic symptoms have been found in urban environments but reports for bipolar affective illness have been inconsistent, possibly due to failure to stratify for comorbid psychotic symptoms. It was hypothesised, therefore, that any effect of urbanicity on the bipolar phenotype would be moderated by comorbid psychotic symptoms. Methods: In a random, representative population cohort of 7049 adults with no history of non-affective psychotic disorder, the cumulative incidence of bipolar and psychotic symptoms and syndromes, assessed with the CIDI, was examined over five levels of population density of place of residence. Similarly, the degree of comorbidity between broadly and narrowly defined bipolar phenotypes on the one hand, and the dichotomous presence of broadly (17.2%) and narrowly defined (3.8%) psychotic symptoms on the other, was examined as a function of population density of place of residence. Results: The rate of bipolar disorder, however defined, was progressively higher in more urbanised areas. However, in models of bipolar phenotypes, a strong interaction between comorbid psychosis and level of urbanicity was apparent, indicating that the greater the degree of psychotic comorbidity, the greater the effect size of the urban environmental factor. For bipolar disorder without psychosis, no effect of urbanicity was apparent. Conclusions: The results suggest differential environmental causal effects on affective and cognitive dimensions of bipolar psychopathology that are nevertheless strongly comorbid within the same categorically defined disorder, possibly due to the effect of shared genetic risk factors.

Background Low self-esteem and high neuroticism are common features in psychosis, but in the absence of longitudinal studies it is unclear whether they represent consequences of the illness or risk factors acting before illness onset. Methods A population sample of 3,929 individuals with no lifetime evidence of psychosis were interviewed with the Composite International Diagnostic Interview and were administered the Groningen Neuroticism Scale and the Rosenberg Self-Esteem Scale at baseline and 1 and 3 years later. At year 3, individuals with CIDI evidence of psychotic symptoms were interviewed by clinicians to identify incident psychotic or psychosis-like symptoms. Results Baseline neuroticism and self-esteem predicted first-ever onset of psychotic symptoms at year 3 (neuroticism, OR 1.16, 95 % CI 1.09, 1.23; self-esteem, OR 1.09, 95 % CI 1.01, 1.18). When adjusted for each other and for level of anxiety and depression, neuroticism was the strongest independent predictor for onset of psychotic symptoms (OR 1.16, 95 % CI 1.07, 1.26). Conclusions Neuroticism increases the risk for development of psychotic symptoms. Mechanisms of risk may involve certain cognitive styles associated with neuroticism, such as beliefs about the uncontrollability of certain events and experiences. The association between low self-esteem and psychosis may involve the area of overlap between self-esteem and neuroticism.