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Background Previous research suggests that family caregivers contemplate suicide at a higher rate than the general population. Much of this research has been disease specific and in relatively small samples. This study aimed to compare suicidal thoughts between non-caregivers and informal caregivers of people with a variety of conditions, in a large representative sample, and to identify significant risk factors. Methods The general population study NEMESIS-2 (N at baseline = 6646) included 1582 adult caregivers at the second wave (2010–2012) who also participated at the third wave (2013–2015). Suicidal thoughts were assessed over 4 years, with the Suicidality Module of the Composite International Diagnostic Interview 3.0. The presence of suicidal thoughts was estimated and risk factors for suicidal thoughts were assessed with logistic regression analyses adjusted for age and gender. Results Thirty-six informal caregivers (2.9%) reported suicidal thoughts during the 4 year study period. The difference between caregivers and non-caregivers (3.0%) was not significant. Among caregivers, significant risk factors for suicidal thoughts included being unemployed, living without a partner, having lower levels of social support, having a chronic physical disorder, a mood disorder or an anxiety disorder, and having impaired social, physical and emotional functioning. These risk factors were also found in non-caregivers. No caregiving-related characteristics were associated with suicidal thoughts. Conclusion There was no elevated rate of suicidal thoughts in caregivers and risk factors for suicidal thoughts in caregivers were consistent with risk factors in non-caregivers. No association between caregiving characteristics and suicidal thoughts was found. Caregivers with limited resources and in poorer health might still benefit from prevention and intervention efforts.

The study aimed to determine whether some depressive, anxiety, and substance-use (DAS) disorders are mild, transient cases that remit without treatment. The first two waves of the first Netherlands Mental Health Survey and Incidence Study were used (age 18–64 years at baseline; wave two N = 5618). Mental disorders were assessed using CIDI 1.1. Past-year and past-month measures of DAS disorders, health service use, and quality of life were assessed at both waves. Individuals with a past-year DAS disorder who received no prior lifetime treatment were significantly more likely than those who received treatment to: (1) remit from their index disorder(s) without subsequent treatment, (2) be free of comorbid disorders, and (3) not have attempted suicide during follow-up (remission rates: 68.5 versus 32.0 %, respectively, p

Nederland telt ongeveer 3,5 miljoen mantelzorgers. Gezien de voortschrijdende vergrijzing en extramuralisering van de zorg, zal dit aantal in de toekomst waarschijnlijk toenemen. Kennis over de relatie tussen het geven van mantelzorg en psychische stoornissen bij de mantelzorger is beperkt. Met gegevens van de tweede meting van de ’Netherlands Mental Health Survey and Incidence Study-2’ (NEMESIS-2), een landelijke cohort studie naar psychische aandoeningen onder volwassen Nederlanders (n=5303; 21-68 jaar) onderzochten wij met een gestructureerd diagnostisch interview de prevalentie van stemmings- en angststoornissen (twee veelvoorkomende psychische stoornissen, hierna aangeduid met emotionele stoornissen). Daarnaast zijn risico-indicatoren voor deze stoornissen bepaald bij mantelzorgers. Mantelzorg werd breed gedefinieerd als het verlenen van enigerlei zorg aan een hulpbehoevende uit het sociale netwerk. Een derde van de respondenten verleende mantelzorg (31,1%), deze zorg varieerde in tijd (≥8 uur/week: 32,1%) en duur (≥1 jaar: 48,7%). Mantelzorgers hadden niet vaker een emotionele stoornis dan andere, vergelijkbare, Nederlanders. Geen betaald werk hebben, zonder partner wonen, beperkte sociale steun ervaren, zorg verlenen aan een eerstegraads familielid, partner of vriend, en mantelzorg bieden in de vorm van emotionele steun verhoogden het risico op een emotionele stoornis onder mantelzorgers. Deze risico-indicatoren kunnen gebruikt worden om preventieprogramma’s af te stemmen op kwetsbare mantelzorgers.

To examine the association between baseline functional status and any emotional disorder at follow-up, after controlling for potential confounders. The effect modification of previous mental disorders and physical conditions was assessed. Data are from the Netherlands Mental Health Survey and Incidence Study-2, a representative population-based, 3-year longitudinal study completed in 2012. Individuals at risk of a new or a recurrent emotional disorder were selected at baseline (n = 4,574). The appearance of any emotional disorder between waves, assessed with the Composite International Diagnostic Interview 3.0, was the outcome. Functional status at baseline was assessed with the physical (PCS) and mental component summary (MCS) of the Short Form-36 Health Survey version 1 and with the number of disability days collected with the World Health Organization Disability Assessment Scale II. Multivariable logistic regression models adjusted by socio-demographic and lifestyle factors were fitted. Interaction terms between previous mental disorders or physical conditions with the predictors were tested. At baseline, 12.1 % had low PCS score, 5.9 % had low MCS score and 30.3 % reported any disability days. The incidence of emotional disorders in 3 years was 9.1 % [95 % confidence interval (95 % CI) 8.1–10.3]. Having low PCS or low MCS at baseline [PCS adjusted OR (aOR) 1.51, p value = 0.02; MCS aOR 1.90, p = 0.002] or reporting more than 15 disability days (aOR 1.63, p = 0.035) was significantly associated with 3-year incidence of emotional disorders. Having a previous mental disorder modified the relationship between MCS and incidence. Among those with a low MCS score, a previous mental disorder considerably increased the risk of incident emotional disorders (aOR 2.72, p =

Background Despite increasing knowledge of the prevalence of borderline personality disorder (BPD) in the general population, and rising awareness of mental disorders both as a categorical and a dimensional construct, research is still lacking on the prevalence of the number of BPD symptoms and their associated consequences, such as comorbidity, disability, and the use of mental health services) in the general population. Methods Data were obtained from the second wave of the Netherlands Mental Health Survey and Incidence Study-2 (N = 5303), a nationally representative face-to-face survey of the general population. BPD symptoms were measured by means of questions from the International Personality Disorder Examination. Comorbidity of common mental disorders was assessed with the Composite International Diagnostic Interview version 3.0. Results Of the total population studied, 69.9 % reported no BPD symptoms, while 25.2 % had 1–2 symptoms, 3.8 % had 3–4 symptoms, and 1.1 % had ≥ 5 BPD symptoms. The number of BPD symptoms reported was found to be positively associated with not living with a partner, having no paid job, and/or having a comorbid mood, anxiety or substance use disorder. Even after adjustment for sociodemographic characteristics and comorbidity, the number of BPD symptoms turned out to be uniquely associated with disability. It also showed a positive relationship with using services for dealing with mental health problems, although this relationship was strongly affected by the presence of comorbid disorders. Conclusions Because even a relatively low number of BPD symptoms appears to be associated with psychiatric comorbidity and functional disability, not only full-blown BPD but also subthreshold levels of BPD symptoms need to be identified in clinical practice and research.

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.

Major depressive disorder (MDD) aggregates in families and is associated with high rates of lifetime axis-I comorbidity. This study examined whether familiality of MDD is associated with the presence of specific comorbid disorders, which might be an important factor to be taken into account in MDD treatment and research into MDD etiology. A population sample was divided into subjects with familial (f-MDD; n = 432) and nonfamilial MDD (nf-MDD; n = 454). Since, more comorbidity was expected in clinical cases, a clinical sample with f-MDD (n = 120) was also studied. Subjects were assessed with the Composite International Diagnostic Interview and family history methods. Binary logistic regression analyses were carried out to examine the influence of familiality of MDD on comorbidity. Analyses were adjusted for potential confounders, including MDD characteristics such as severity and age of onset. Dysthymia, anxiety disorders, and alcohol use disorders were significantly more prevalent in subjects with f-MDD than in subjects with nf-MDD. Clinical f-MDD was associated with more anxiety disorders and fewer alcohol use disorders than population f-MDD. After adjustment for MDD characteristics including age at onset, severity, and disease course, comorbid disorders remained more prevalent in f-MDD than in nf-MDD. The instruments used in the population and the clinical samples were not identical, however, they were comparable to a substantial degree. F-MDD, especially in clinical cases, appears to increase the risk of development of comorbid disorders, regardless of MDD characteristics. The link between familiality and comorbidity is important because it will aid a better understanding of the MDD phenotype, and it contributes to planning of effective treatment and to molecular genetic studies.

De afgelopen jaren bestaat er een toenemende belangstelling voor de relatie tussen cannabisgebruik en psychische stoornissen. De aandacht richt zich daarbij vooral op psychosen. Maar hoe zit het met de samenhang tussen cannabisgebruik en psychische stoornissen die veel vaker voorkomen in de bevolking, zoals angst-, stemmings-, en alcoholstoornissen? Dit artikel beschrijft de resultaten van een analyse van gegevens over cannabisgebruik, afkomstig uit een groot bevolkingsonderzoek naar psychische problematiek bij volwassen Nederlanders. De uitkomsten laten zien dat cannabisgebruik vaak samengaat met een stemmings-, angst-, of alcoholstoornis. De sterkste verbanden worden gevonden voor cannabisafhankelijkheid.

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.

Professional HIV risk taking (nonconsistent condom use with clients) of female prostitutes in The Netherlands is addressed within the context of (early) experiences with abuse, well-being, coping behavior, job satisfaction, and financial need. Data were gathered from 127 female prostitutes on condom use, financial need, and professional attitude, and on experiences with violence and abuse, physical complaints, psychosocial problems, and coping responses. Violent traumatic experiences were found to relate to more severe complaints and problems, and a higher frequency of emotion-focused coping strategies. A risk-taking protection style (as opposed to consistent condom use and selective risk taking) appeared to be associated with more severe experiences with violence, both in childhood and in adult life, with more frequent dissociation as a coping behavior, and with more psychosomatic complaints. Of all the relationships found, more severe experiences with violence on the job were most strongly related to a higher professional HIV risk.