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Objective: The aim of the study was to investigate patterns of comorbidity among the anxiety disorders in a community‐based older population, and the relationship of these disorders with major depression, use of alcohol and benzodiazepines, cognitive impairment and chronic somatic illnesses. Method: The data were derived from the Longitudinal Aging Study Amsterdam (LASA) study. A two‐stage screening design was adopted to identify respondents with anxiety disorders. Results: In total, 10% of the elderly with an anxiety diagnosis suffered from two or more anxiety disorders. Major depression (13% vs. 3%), benzodiazepine use (24% vs. 11%) and chronic somatic diseases (12% vs. 7%) were significantly more prevalent in respondents with an anxiety disorder than in respondents without anxiety disorders. Heavy or excessive alcohol intake (5% vs. 4%) and cognitive impairment (11% vs. 13%) were not significantly associated with any anxiety disorder. Conclusion: When anxiety disorders are diagnosed, in older people there is a relatively high probability of comorbid conditions being present. [ABSTRACT FROM AUTHOR]

Abstract: The effect of social roles (partner, parent, worker) on mental health may depend on the total number or the quality of the individual occupied social roles. With longitudinal data from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), the effect of the number and quality of occupied social roles on mental health over three years was examined among 2471 men and women aged 25–55 years without mental disorders at baseline. Mental health was assessed using 3-year change in the SF-36 mental health scale as well as using the 3-year incidence of anxiety and depressive disorders defined by DSM-III criteria. The quality of social roles was assessed by the GQSB (Groningen Questionnaire Social Behavior). The number of social roles had no significant effect on the risk of developing depressive and anxiety disorders, but particularly the partner-role had a significant positive effect on mental health (β of mental health=1.19, p =0.01; HR of incident disorders=0.75, 95% CI:0.51–1.00, p =0.05). A good quality of each of the three social roles was associated with higher levels of mental health and lower risks of incident disorders over 3 years. More than the number of social roles, knowledge about social role quality might provide opportunities for prevention of depressive and anxiety disorders. [Copyright &y& Elsevier]

Background: A validated screening instrument for PTSD in community dwelling older people is lacking. This study evaluates a newly developed measure, the self-rating inventory for posttraumatic stress disorder (SRIP) on its usefulness in survey research. The predictive value of the SRIP in a community setting is investigated. Methods: In a two-phase epidemiologic design the criterion validity of the SRIP was tested against diagnosis made with the comprehensive international diagnostic interview (CIDI) in 1721 older (55–90 years) inhabitants of the Netherlands. Optimal sensitivity and specificity was determined using a weighted receiver operator characteristic (ROC)-curve. Results: Optimal sensitivity (74.2%) and specificity (81.4%) was reached with a cut-off of 39 points. Limitations: According to a strictly applied CIDI algorithm the number of ‘true’ cases was limited. Conclusion: Overall findings indicate that posttraumatic stress disorder can be identified adequately in a community-based population of older adults using the SRIP. Use of the SRIP may improve recognition and diagnosis of posttraumatic stress disorder in the community. [Copyright &y& Elsevier]

This study examines the importance of job characteristics on absence and on-the-job performance in a large group of employees with diagnosed depressive and anxiety disorders. In a sample of 1522 employees (1129 persons with and 393 persons without psychopathology) participating in Netherlands Study of Depression and Anxiety (NESDA, n=2981) we examined associations between job characteristics and work functioning (absenteeism and work performance) in multinominal logistic regression models. Job characteristics were working hours, psychosocial working conditions and occupational status. As expected, depressed and anxious patients were at significantly elevated risk for absenteeism and poor work performance. In analyses adjusted for psychopathology, absenteeism and poor performance were significantly lower among persons reporting high job support, high job control, less working hours, self-employed and high skilled jobs. Associations were comparable between persons with and without psychopathology. High job support, high job control and reduced working hours were partially related to work functioning in both workers with- and without-psychopathology. Since depressed and anxious employees are at a substantially increased risk for absenteeism and poor work performance, strategies that improve job support and feelings of control at work may be especially helpful to prevent poor work functioning in this at-risk group of employees., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: Although attrition is inevitable in longitudinal epidemiological studies, psychiatric studies are thought to be especially sensitive to attrition. This study aimed to evaluate the sociodemographic and psychiatric determinants of attrition at 2-year follow-up in the Netherlands Study of Depression and Anxiety., Methods: Logistic regression was used to examine sociodemographic and psychiatric determinants of attrition and the influence of clinical psychiatric characteristics on attrition. In addition, differences in determinants between 3 types of attrition (refusal, noncontact, and not able to participate) were evaluated., Results: The attrition rate at the 2-year follow-up assessment was 12.9% (385/2981), representing 6 deceased persons, 250 refusers, 51 noncontacts, and 78 persons unable to participate because of health reasons. Determinants of attrition were younger age, less years of education, not being of North European descent, being recruited in Amsterdam, no previous participation in research, and having major depressive disorder. Only the effects of age, sampling site, and previous participation in research differed between types of attrition. Furthermore, comorbid depressive and anxiety disorders and higher symptom severity were associated with attrition., Conclusions: In contrast to the view that psychiatric epidemiological research is more prone to high attrition rates, this study revealed a relatively low attrition rate. Furthermore, both sociodemographic and psychiatric variables were independent determinants of attrition. Oversampling of subgroups that are at higher risk of dropout may be advisable for future psychiatric cohort studies., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Despite growing concerns of over-treatment, the under-diagnosis and undertreatment of major depressive disorders is still prevalent. Causal attributions are thought to be involved in help seeking behavior, time to diagnosis and the chance for successful referral. Yet, little is known about the extent to which these processes are influenced by causal attributions. 120 patients, involved in the nationwide second Dutch National Survey of General Practice (Schellevis, Westert, & Bakker, 2005), with a current DSM-IV diagnosis of depression, severe depression or with a depression lasting over six months, completed a causal attributions inventory. Demographic and clinical data from the survey, and causal attribution scores were used as independent variables in association with getting a diagnosis of depression from the general practitioner, or being in treatment by a mental health care provider for more than 3 sessions. Causal attributions related to intrapsychic fears were significantly associated with getting a diagnosis of depression and successful referral. Causal attributions related to childhood were also positively associated with successful referral. In association models derived from all the demographic and clinical data available in the survey, causal attributions substantially contributed to the explained variance, 55% and 39% respectively. The findings suggest causal attributions have a statistically significant impact on time to diagnosis and the chance of successful referral. Using the Causal Attribution Inventory with high-risk patients in primary care might enhance the chance of detection and successful referral of depressed patients. Schellevis, F. G., Westert, G. P., & De Bakker, D. H. (2005). The actual role of general practice in the dutch health-care system. Results of the second dutch national survey of general practice. Medizinische Klinik (Munich), 100(10), 656-661., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

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., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: It was previously shown that antidepressants are associated with diminished vagal control over the heart. Longitudinal studies are needed to test the causality of this association further., Methods: Longitudinal data were obtained in the Netherlands Study of Depression and Anxiety. At baseline and at 2-year follow-up, heart rate and cardiac vagal control as indexed by respiratory sinus arrhythmia were measured in 2114 subjects (mean age = 42.0 years; 66.2% female), who either used antidepressants at one or two time points (n = 603) or did not use antidepressants at any time point (n = 1511). Linear mixed-model analyses were conducted to compare changes in respiratory sinus arrhythmia and heart rate over time across antidepressant-naive subjects, subjects who started using an antidepressant during follow-up, subjects who stopped using an antidepressant, and persistent antidepressant users. Analyses were adjusted for demographics, health, and lifestyle factors., Results: Compared with continuous nonusers, subjects who started the use of a tricyclic antidepressant or a serotonergic and noradrenergic antidepressant showed a significantly greater increase in heart rate and a decrease of respiratory sinus arrhythmia at 2 years. Subjects who started the use of selective serotonin reuptake inhibitors also showed a decrease in respiratory sinus arrhythmia, but their heart rate did not increase. Discontinuing antidepressants systematically caused opposite effects; levels returned in the direction of those observed among nonusers., Conclusions: These 2-year longitudinal results indicate that all antidepressants cause a decrease in cardiac vagal control. After discontinuing antidepressants, autonomic function recovers, suggesting that the unfavorable effects are (partly) reversible., (Copyright © 2010 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Depressive and anxiety disorders affect work functioning and cause high labour costs., Aims: To examine and compare psychopathological characteristics of depressive and anxiety disorders in their effect on work functioning., Method: In 1876 working participants of the Netherlands Study of Depression and Anxiety (NESDA) associations of presence, severity, comorbidity, duration and type of DSM-IV anxiety and depressive disorders with both absenteeism (<2 weeks and >2 weeks) and work performance (reduced and impaired) were assessed., Results: People with current depressive disorders had 7.10 times greater odds for the risk of >2 weeks work-absence and 5.67 greater odds for the risk of impaired work performance, while persons with current anxiety disorders had 1.84 and 2.13 greater odds for the risk of >2 weeks absence and impaired work performance, respectively. Even when persons were recovered from depressive and anxiety disorders, they still had a higher risk of poor work functioning. Persons with comorbidity, chronic depressive disorder, a generalized anxiety disorder, and more severity of both anxiety and depressive disorder had higher odds for the risk of absenteeism and decreased work performance., Conclusion: Anxiety disorders have significant negative impact on work functioning, although smaller than the effect of depressive disorders. Comorbidity, severity, type and duration of the disorder, differentiate the risk of poor work functioning., (2010 Elsevier B.V. All rights reserved.)

Objective: Disturbed sleep has a high impact on daily functioning and has been correlated with psychopathology. We investigated the extent to which insomnia and sleep duration were associated with both current and remitted depressive and anxiety disorders in a large-scale epidemiologic study, taking sociodemographics, health factors, and medication use into account., Method: Data of 2,619 individuals from the Netherlands Study of Depression and Anxiety (NESDA) were analyzed. Psychopathology was classified as no, current, or remitted DSM-IV-based diagnosis of major depressive or anxiety disorder. Outcome measures were insomnia (Women's Health Initiative Insomnia Rating Scale score >or= 9) and sleep duration (or= 10 hours). Baseline measurement was conducted between September 2004 and February 2007., Results: Both current and remitted depressive disorder and current anxiety disorder were associated with insomnia and short sleep duration with odds ratios (ORs) for insomnia ranging from 1.42 to 3.23 and for short sleep duration ranging from 1.41 to 2.53. Associations were stronger for current than for remitted diagnoses and stronger for depressive than for anxiety disorders. Also long sleep duration was associated with current depressive disorder and anxiety disorders (OR range, 1.53-2.66). Sociodemographic factors, health indicators, and psychotropic medication use did contribute to sleep outcomes but could not explain much of the psychopathology and sleep associations., Conclusion: Depressive disorder-but also anxiety disorder-is strongly associated with sleep disturbances. Insomnia and short sleep duration persist after remittance of these disorders, suggesting that these are residual symptoms or possibly trait markers. Also, long sleep duration is associated with current depressive or anxiety disorders., ((c) 2010 Physicians Postgraduate Press, Inc.)

Objective: To determine whether patients with different types of anxiety disorder (panic disorder, social phobia, generalized anxiety disorder) have higher heart rate and lower heart rate variability compared with healthy controls in a sample that was sufficiently powered to examine the confounding effects of lifestyle and antidepressants., Methods: The standard deviation of the normal-to-normal intervals (SDNN), heart rate (HR), and respiratory sinus arrhythmia (RSA) were measured in 2059 subjects (mean age = 41.7 years, 66.8% female) participating in The Netherlands Study of Depression and Anxiety (NESDA). Based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) and Composite International Diagnostic Interview (CIDI), NESDA participants were classified as healthy controls (n = 616), subjects with an anxiety diagnosis earlier in life (n = 420), and subjects with current anxiety diagnosis (n = 1059)., Results: Current anxious subjects had a significantly lower SDNN and RSA compared with controls. RSA was also significantly lower in remitted anxious subjects compared with controls. These associations were similar across the three different types of anxiety disorders. Adjustment for lifestyle had little impact. However, additional adjustment for antidepressant use reduced all significant associations between anxiety and HRV to nonsignificant. Anxious subjects who used a tricyclic antidepressant, a selective serotonin reuptake inhibitor, or another antidepressant showed significantly lower mean SDNN and RSA compared with controls (effect sizes = 0.20-0.80 for SDNN and 0.42-0.79 for RSA). Nonmedicated anxious subjects did not differ from controls in mean SDNN and RSA., Conclusion: This study shows that anxiety disorders are associated with significantly lower HR variability, but the association seems to be driven by the effects of antidepressants.

Background: Schema-focused therapy (SFT) and transference-focused psychotherapy (TFP) for borderline personality disorder were recently compared in a randomised multicentre trial., Aims: To assess the societal cost-effectiveness of SFT v. TFP in treating borderline personality disorder., Method: Costs were assessed by interview. Health-related quality of life was measured using EQ-5D. Outcomes were costs per recovered patient (recovery assessed with the Borderline Personality Disorder Severity Index) and costs per quality-adjusted life-year (QALY)., Results: Mean 4-year bootstrapped costs were euro37 826 for SFT and euro46 795 for TFP (95% uncertainty interval for difference -21 775 to 3546); QALYs were 2.15 for SFT and 2.27 for TFP (95% UI -0.51 to 0.28). The percentages of patients who recovered were 52% and 29% respectively. The SFT intervention was less costly and more effective than TFP (dominant), for recovery; it saved euro90 457 for one QALY loss., Conclusions: Despite the initial slight disadvantage in QALYs, there is a high probability that compared with TFP, SFT is a cost-effective treatment for borderline personality disorder.

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. Its design is an eight-year longitudinal cohort study among 2981 participants aged 18 through 65 years. The sample consists of 1701 persons with a current (six-month recency) diagnosis of depression and/or anxiety disorder, 907 persons with life-time diagnoses or at risk because of a family history or subthreshold depressive or anxiety symptoms, and 373 healthy controls. Recruitment took place in the general population, in general practices (through a three-stage screening procedure), and in mental health organizations in order to recruit persons reflecting various settings and developmental stages of psychopathology. During a four-hour baseline assessment including written questionnaires, interviews, a medical examination, a cognitive computer task and collection of blood and saliva samples, extensive information was gathered about key (mental) health outcomes and demographic, psychosocial, clinical, biological and genetic determinants. Detailed assessments will be repeated after one, two, four and eight years of follow-up. The findings of NESDA are expected to provide more detailed insight into (predictors of) the long-term course of depressive and anxiety disorders in adults. Besides its scientific relevance, this may contribute to more effective prevention and treatment of depressive and anxiety disorders.

Background: Minor and mild-major depression are highly prevalent in primary care. There is insufficient evidence for the effectiveness of antidepressants in the treatment of minor and mild-major depression. We compared the effectiveness of usual primary care treatment, with or without antidepressants, in minor and mild-major depression., Methods: A pragmatic patient-randomized equivalence trial with 52 weeks follow-up was conducted in The Netherlands. In total, 59 primary care physicians (PCPs) recruited and treated 181 adult patients with minor or mild-major depression. Patients were randomized to four consultations within 3 months of usual care plus antidepressants (UCandAD) or usual care alone (UCnoAD). The Montgomery Asberg Depression Rating Scale (MADRS) was used to assess changes in severity of depressive symptoms. The predefined equivalence margin was set at five points. Multilevel analysis was used to analyze the data. Secondary outcome measures were the Short-Form 36 (SF-36), and the Client Satisfaction Questionnaire (CSQ-8)., Results: Patients received on average 3.0 (SD 1.4) 15-min consultations within 3 months with (n = 85) or without paroxetine (n = 96). Equivalence of UCandAD and UCnoAD was demonstrated in the intention-to-treat analyses as well as the per-protocol analysis after 6 weeks, but not at 13, 26 and 52 weeks follow-up. No statistical differences in effectiveness between treatment groups were found in the intention-to-treat analysis. No differences in the physical and mental functioning (SF-36) were found between the treatment groups. Patients allocated to UCandAD were slightly more satisfied with their treatment at 13 weeks follow-up (but not at 52 weeks follow-up) than patients allocated to UCnoAD. Preliminary analyses suggested that subgroups such as patients with mild-major (instead of a minor) depression might benefit from antidepressant treatment. Patients who were assigned to their preferred treatment (in particular to UCnoAD) were more often compliant and had better clinical outcomes., Conclusion: UCandAD was as effective as UCnoAD over the first 6 weeks, but not at 13, 26, and 52 weeks. However, superiority of either treatment could not be demonstrated either. The question whether antidepressants add any clinical effect to usual care remains unresolved. We recommend future studies to look for subgroups of patients who may benefit from antidepressants., Trial Registration: Dutch Trial Registry ISRCN03007807.

Background: Interpersonal Psychotherapy (IPT) is recommended in most depression treatment guidelines and proved to be a suitable treatment for elderly depressed patients. Despite the favorable results of IPT in research populations, the dissemination to general practice is surprisingly limited. Little is known about uptake and satisfaction when this therapy is introduced into real-life general practice., Methods: Motivation and evaluation of patients, GPs and therapists were recorded and organizational barriers described alongside a randomized controlled trial. IPT, given by mental health workers, was compared with usual general practitioner (GP) care. Included were patients (> or =55 years) who met the DSM-IV criteria for major depressive disorder., Results: Patients were motivated for the psychotherapy intervention: of the 205 eligible patients, 143 (70%) entered the study, and of the 69 patients who were offered IPT, 77% complied with the treatment. IPT proved to be an attractive therapy for patients as well as for therapists from mental health organizations. General practitioners evaluated the intervention positively afterwards, mainly because of the time-limited and structured approach. Organizational barriers: no IPT therapists were available; an IPT trainer and supervisor had to be trained and training materials had to be developed and translated. Additionally, there was a lack of office space in some general practices; for therapists from private practices it was not feasible to participate because of financial reasons. IPT was superior to usual care in patients with moderate to severe depression., Conclusion: As we succeeded in delivering IPT in primary care practice, and as IPT was superior to usual care, there are grounds to support the implementation of IPT for depressed elderly patients within general practice, as long as the practices have room for the therapists and financial barriers can be overcome. Consolidation may be achieved by making this intervention available through practice nurses or community psychiatric nurses who deliver IPT as part of a more comprehensive depression management program.

Objective: To measure the impact of PTSD and subthreshold PTSD on daily life functioning, well-being and health care use in a community based-sample of the elderly population in the Netherlands., Methods: Consequences of PTSD were investigated in an elderly community-based population (LASA study) by comparing three groups: subjects with PTSD, with subthreshold PTSD, and a reference group. Indicators of well-being (loneliness, self-perceived health and satisfaction with life), disability (days spent in bed and disability days) and use of health care (general practitioners, medical specialists, psychiatrists, mental health care, social workers and professional home care) were investigated., Results: In comparison to the reference group, subjects with PTSD or subthreshold PTSD spent more days in bed due to illness and had more disability days, even when corrected for concurring other diseases or functional limitations. They were less satisfied with life in general, used health care for predominantly somatic care and evaluated the care they received to be inadequate. Psychotropic drugs, if prescribed, were predominantly benzodiazepines and seldom antidepressants., Conclusions: The findings strongly suggest that elderly with either PTSD or subthreshold PTSD suffer grave impairments in daily life, are less satisfied with life and do not receive optimum treatment. Especially elderly with PTSD frequently visit medical specialists but are rarely treated by psychiatrists or other mental health professionals, nor do they receive antidepressant treatment from their GP. Lack of adequate treatment may be the cause of dissatisfaction with the care they receive., (Copyright (c) 2006 John Wiley & Sons, Ltd.)

Background: Patients with persistent medically unexplained symptoms often exhibit general dysfunction and psychiatric comorbidity and frequently resist psychiatric referral. The aim of this study was to evaluate the efficacy of a collaborative care model including training for general practitioners (GPs) and a psychiatric consultation model for patients with persistent medically unexplained symptoms in general practice., Method: Randomised controlled trial. Cluster randomisation at GP practices and multilevel analysis were performed. A total of 81 patients from 36 general practices completed the study. A collaborative care model of training and psychiatric consultation in general practice in the presence of the GP was compared with training plus care as usual by the GP. Outcome assessment on the patients' well-being, functioning and utilisation of health care services was performed 6 weeks and 6 months later., Results: All the patients had somatoform disorders (Whitely Index 7.46), and 86% had comorbid psychiatric disorders. In the intervention group, the severity of the main medically unexplained symptoms decreased by 58%. The patients' social functioning improved. The utilization of health care was lower than in the care as usual group., Conclusions: A collaborative care model combining training with psychiatric consultation in the general practice setting is an effective intervention in the treatment of persistent medically unexplained symptoms. Anxiety and depressive disorders are highly comorbid in this group. The findings warrant a larger study.

The aim of this study was to investigate familial influences and their dependence on sex for panic disorder and/or agoraphobia, social phobia, generalized anxiety disorder and major depression. Data from Australian (N = 2287) and Dutch (N = 1185) twins and siblings who were selected for a linkage study and participated in clinical interviews to obtain lifetime Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) diagnoses were used. In a liability model, tetrachoric correlations were estimated in sibling pairs and sex differences between sibling correlations were tested. For each diagnosis, the sibling correlations could be constrained to be equal across the Australian and Dutch samples. With the exception of panic disorder and/or agoraphobia, all sibling correlations were the same for brother, sister and opposite-sex sibling pairs and were around .20. For panic disorder and/or agoraphobia, the correlation was .23 in brother and sister pairs, but absent in opposite-sex sibling pairs. From these results it can be concluded that upper heritability estimates, based on twice the correlations in the sibling pairs, vary between 36% (major depression) and 50% (social phobia). Furthermore, different genetic risk factors appear to contribute to the vulnerability for panic disorder and/or agoraphobia in men and women. No other sex differences were found.

Objective: To examine long-term outcome of late-life anxiety disorders and utilization of mental health care services., Method: A cohort of subjects (aged > or = 55 years) with an anxiety disorder (n = 112) was identified in the Longitudinal Aging Study Amsterdam (n = 3107). At 6 year follow-up, the rate of persistence and prognostic factors for persistence of anxiety were established., Results: Six years after baseline 23% of our sample met the criteria for an anxiety disorder. Another 47% suffered from subclinical anxiety symptoms. Persistence of anxiety was associated with a high score on neuroticism at baseline. Use of benzodiazepines was high (43%), while use of mental health care facilities (14%) and anti-depressants (7%) remained low in those with persistent anxiety., Conclusion: Results indicate that those high in neuroticism are at greater risk for persistence of anxiety. Efforts to enhance appropriate referral of anxious older adults do not seem to have had the desired effect.

Purpose: The psychometric properties of the Dutch version of the Washington Psychosocial Seizure Inventory (WPSI) were investigated., Methods: The dimensional structure, reliability, and validity of the WPSI scales were assessed in 218 patients with epilepsy. The association with relevant patient and epilepsy characteristics also was studied., Results: An exploratory seven-factor principal components analysis was compared with a confirmatory factor analysis, and a loss of 3.36% of total variance was found. To increase the homogeneity of the scales, 30 items with low factor loadings or highest factor loading on the wrong clinical scale were excluded. This resulted in a higher amount of explained variance and improvement of the factor loadings of the remaining items. The reliability and validity of the WPSI scales was satisfactory to good. No clinically relevant associations were found between the WPSI scales and patient and epilepsy characteristics., Conclusions: The factor structure, reliability, and validity of the Dutch translation of the WPSI are good and comparable to the original English version of Dodrill. The results demonstrate that shortening the WPSI makes the inventory more reliable and the clinical scales less dependent on each other., (Copyright 2004 International League Against Epilepsy)

In health care research, the patient-doctor relationship as perceived by the patient is considered important. Our aim was to develop and validate a questionnaire that assesses the Patient-Doctor Relationship, the Patient-Doctor Relationship Questionnaire (PDRQ-9). The PDRQ-9 was developed out of the Helping Alliance Questionnaire of Luborsky, a scale that measures the therapeutic alliance in psychotherapy. Its psychometric qualities and validity in general practice were assessed, with the collaboration of 110 general practice patients and 55 patients in an Epilepsy Clinic. Principal components analysis demonstrates a two-factorial structure, one related to the doctor, and one related to the medical symptoms of the patient. Both show high reliability but as the second factor explains only 9% of the variance, it is eliminated from the questionnaire. The PDRQ-9 provides researchers a brief measure of the therapeutic aspects of the patient-doctor relationship in the primary care setting. It is a valuable tool for scientific and practical purposes involving the monitoring of the patient-doctor relationship.

Background: Posttraumatic stress disorder (PTSD) has scarcely been researched in the elderly. There is no population-based information on prevalence and risk factors in older persons. Patients with PTSD are often not recognized or incorrectly diagnosed. As the disorder has great implications for the quality of life, a correct diagnosis and treatment are crucial. Increased knowledge on vulnerability factors for PTSD can facilitate diagnostic procedures and health management in the elderly., Methods: PTSD cases were found following a two-phase sampling procedure: a random selection of 1,721 subjects were screened and in 422 subjects a psychiatric diagnostic interview was administered. Prevalence of PTSD and subthreshold PTSD were calculated. Vulnerability factors regarding demographics, physical health, personality, social factors, recent distress and adverse events in early childhood were assessed., Results: 6-month prevalence of PTSD and of subthreshold PTSD was 0.9 and 13.1%, respectively. The strongest vulnerability factors for both PTSD and subthreshold PTSD were neuroticism and adverse events in early childhood., Conclusions: This is the first population-based study on PTSD in older persons. With a 6-month prevalence of almost 1% the disease is not rare. Comparisons with younger populations suggest some accumulation of cases among older people reflecting the chronic risk factors, which are found in this study: neuroticism and adverse events in early childhood., (Copyright 2003 S. Karger AG, Basel)

In 1986, the traditional psychiatric hospital where 70% of Amsterdam's intramural treatment took place, was closed down. The progress of two groups of long-stay patients was followed by longitudinal cohort research for five years after their transferral to new small-scale facilities in Amsterdam. The ADL-functioning of the most severely handicapped clients improved and their psychiatric symptoms decreased, while no improvement was seen in the functioning of the more independent and less handicapped clients. Now, thirteen years after closure of the old hospital, the use of the psychiatric facilities by these clients is being evaluated. This evaluation makes clear that the improvement of the severely disabled patients depends on the intensity of care given. Apparently, the improvement in the new facilities is no guarantee for a further development into a less care-intensive environment. The less handicapped and more independent clients, however, could more easily be transferred to less care-intensive facilities.

Objective: The purpose of this study was to examine the comorbidity of and communality of risk factors associated with major depressive disorder and anxiety disorders in later life., Method: A random age- and sex-stratified community-based sample (N=3,056) of the elderly (age 55-85 years) in the Netherlands was studied. A two-stage screening design was used, with the Center for Epidemiologic Studies Depression Scale as a screening instrument and the National Institute of Mental Health Diagnostic Interview Schedule as a criterion instrument. Risk factors were measured with well-validated instruments and represented a broad range of vulnerability and stress-related factors associated with anxiety and depression. Multivariate analyses examined risk factors associated with pure major depressive disorder, pure anxiety disorders, and comorbid conditions., Results: Comorbidity was highly prevalent: 47.5% of those with major depressive disorder also met criteria for anxiety disorders, whereas 26.1% of those with anxiety disorders also met criteria for major depressive disorder. While the only variables associated with pure major depressive disorder were younger age and external locus of control, risk factors representing a wide range of both vulnerability and stress were associated with pure anxiety disorders. External locus of control was the only common factor. The group with anxiety disorders plus major depressive disorder had a distinct risk factor profile and may represent those with a more severe disorder., Conclusions: Although high levels of comorbidity between major depressive disorder and anxiety disorders were found, comparing risk factors associated with pure major depressive disorder and pure anxiety disorders revealed more differences than similarities. Anxiety disorders in later life merit separate study.

Objective: The aim of the study was to investigate patterns of comorbidity among the anxiety disorders in a community-based older population, and the relationship of these disorders with major depression, use of alcohol and benzodiazepines, cognitive impairment and chronic somatic illnesses., Method: The data were derived from the Longitudinal Aging Study Amsterdam (LASA) study. A two-stage screening design was adopted to identify respondents with anxiety disorders., Results: In total, 10% of the elderly with an anxiety diagnosis suffered from two or more anxiety disorders. Major depression (13% vs. 3%), benzodiazepine use (24% vs. 11%) and chronic somatic diseases (12% vs. 7%) were significantly more prevalent in respondents with an anxiety disorder than in respondents without anxiety disorders. Heavy or excessive alcohol intake (5% vs. 4%) and cognitive impairment (11% vs. 13%) were not significantly associated with any anxiety disorder., Conclusion: When anxiety disorders are diagnosed, in older people there is a relatively high probability of comorbid conditions being present.

Objective: To study the prevalence and risk factors of anxiety disorders in the older (55-85) population of The Netherlands., Method: The Longitudinal Aging Study Amsterdam (LASA) is based on a random sample of 3107 older adults, stratified for age and sex, which was drawn from the community registries of 11 municipalities in three regions in The Netherlands. Anxiety disorders were diagnosed using the Diagnostic Interview Schedule in a two-stage screening design. The risk factors under study comprise vulnerability, stress and network-related variables. Both bivariate and multivariate statistical methods were used to evaluate the risk factors., Results: The overall prevalence of anxiety disorders was estimated at 10.2%. Generalized anxiety disorder was the most common disorder (7.3%), followed by phobic disorders (3.1%). Both panic disorder (1.0%) and obsessive compulsive disorder (0.6%) were rare. These figures are roughly similar to previous findings. Ageing itself did not have any impact on the prevalence in both bivariate and multivariate analyses. The impact of other factors did not change much with age. Vulnerability factors (female sex, lower levels of education, having suffered extreme experiences during World War II and external locus of control) appeared to dominate, while stresses commonly experienced by older people (recent losses in the family and chronic physical illness) also played a part. Of the network-related variables, only a smaller size of the network was associated with anxiety disorders., Conclusions: Anxiety disorders are common in later life. The risk factors support using a vulnerability-stress model to conceptualize anxiety disorders. Although the prevalence of risk factors changes dramatically with age, their impact is not age-dependent. The risk factors indicate which groups of older people are at a high risk for anxiety disorders and in whom active screening and treatment may be warranted.

This study describes the extent of verbal and/or physical aggression as reported by caregivers and correlates of each type of aggression against the demented care recipient. The extent of verbal aggression alone was 30.2% and of physical aggression, 10.7%. Verbal and physical aggression were associated with sharing the same household with the care recipient, caring for a male and caring for an elderly person more severely impaired in cognitive functioning and more dependent in Instrumental Activities of Daily Living. Verbal aggression was also associated with proving more care, and physical aggression with caring for a spouse and more psychological complaints of the caregiver. Accordingly, physical aggression does not seem to be a mere extension of verbal aggression, and different intervention strategies may be required for verbally and physically aggressive caregivers.

Objective: The purpose of the study was to assess the feasibility of a psychiatric consultation intervention for somatizing patients in the family practice setting in terms of 1) patient compliance, 2) patient satisfaction, and 3) compliance and satisfaction of general practitioners (GPs)., Method: In a period of nine months, forty-six patients were selected for psychiatric consultation in six solo family practices in a semi-urban area in the Netherlands. The consultation included an interview with the consulting psychiatrist, the patient, and the GP. A written summary of the consultation was provided to the GP and the patient. A booster session with a GP and psychiatrist was included to evaluate and reinforce the recommendations., Results: The majority of the selected patients agreed to participate after informed consent. An intervention was implemented containing interpersonal techniques, reattribution, clarification, and structuring. GP compliance with recommendations was 100 percent, patient compliance 75 percent., Conclusion: A standardized psychiatric consultation for somatizing patients in a family practice setting can be implemented. Several levels of implementation can be distinguished.