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Background While frank discussion of suicidal thoughts in patients with depression is important for the prevention of suicide, suicide exploration of General Practitioners (GPs) is suboptimal. This study aimed to assess whether an intervention that prompts pop-up screens nudges GPs to more frequently explore suicidal thoughts over the course of two years. Methods From January 2017 to December 2018, the intervention was incorporated in the information system of the Dutch general practice sentinel network. New registration of an episode of depression triggered a pop-up screen referring to a questionnaire about GPs’ behaviour with regard to exploring suicidal thoughts. In two years, 625 questionnaires were completed by GPs and analysed using multilevel logistic regression analyses. Results Compared to the first year, GPs were 50% more likely to explore suicidal thoughts among patients in the second year (OR 1.48; 95%CI 1.01–2.16). When adjusting for patients’ gender and age we found that the effect of the pop-up screens disappeared (OR 1.33; 95% CI 0.90–1.97). Suicide exploration occurred less frequently in women than in men (OR 0.64; 95% CI 0.43–0.98) and in older compared to younger patients (OR 0.97; 95% CI 0.96–0.98 per year older). In addition, 26% of variation in suicide exploration was because of differences in general practice. There was no evidence that general practices developed differently over time. Conclusions Although low cost and easy to administer, the pop-up system was not effective in nudging GPs to explore suicidality more frequently. We encourage studies to test whether implementing these nudges as part of a multifaceted approach will lead to a stronger effect. Moreover, we recommend researchers to include more variables, such as work experience or previous mental health training, to better understand the effects of the intervention on GPs’ behaviour.

© 2022 The AuthorsObjective: Previous studies suggest that prevention of cardiovascular disease (CVD) is more difficult in depressed persons. Although the prevalence and incidence of CVD decreased over the past decades, it is uncertain whether this is also true for depressed persons. This study examined whether changes in the prevalence and incidence of CVD differ between depressed and non-depressed older persons. Methods: Longitudinal data from three community-based representative birth cohorts aged 55–65 years of the Longitudinal Aging Study Amsterdam were used; N = 1070 born in 1926–1937, N = 995 born in 1938–1947, N = 1019 born in 1948–1957. The outcome included fatal and non-fatal CVD. Depression was defined as ≥16 points on the Center for Epidemiological Studies Depression Scale or a general practitioner's diagnosis of depression. Data were analysed with for age and sex adjusted logistic regression and cox regression models. Results: Comparing cohort 2 and 3 with cohort 1 in the complete sample, the prevalence of CVD decreased by 2% (OR = 0.98, 95%CI = 0.76–1.26) and 32% (OR = 0.68, 95%CI = 0.52–0.89), respectively, and the three-year incidence of CVD decreased by 6% (OR = 0.94, 95%CI = 0.63–1.41) and 26% (OR = 0.74, 95%CI = 0.48–1.15), respectively. The 13-year incidence of CVD decreased by 19% (HR = 0.81, 95%CI = 0.67–0.99) in cohort 2 compared to cohort 1. These decreases did not differ statistically significantly between depressed and non-depressed respondents (p-values of interaction terms: 0.35–0.98). Conclusion: Substantial decreases in the prevalence and incidence of CVD were observed in depressed and non-depressed older persons. Although this is encouraging, cardiovascular risk remained higher in depressed persons over time, warranting tailored prevention programs for depressed older persons.

Additional file 1. Employment outcomes of IPS participants and associations of employment with group without ongoing IPS trajectories (n = 1148).

Additional file 3. Employment outcomes of IPS participants and associations of employment with group and double IPS trajectories (n = 1433).

Additional file 4. Employment outcomes of IPS participants and associations of employment with primary or secondary PD diagnosis group (n = 335).

BACKGROUND: The Dutch health care system is a hybrid mix of public and market oriented elements. The market orientation harbours strong financial incentives for health insurance companies to select for the most healthy, least costly insurees. This is countered by an elaborate financial compensation for high risk, more costly health care users. Dysfunctioning of the compensatory financial mechanisms would render the mental health sector uninsurable. AIM: To test the risk-compensatory mechanisms for mental health care in the Netherlands and to discuss consequences of malfunctioning. METHOD: We used governmental data to study: the distribution of mental health costs, the total mental health expenditures that are redirected to compensate insurance companies, and the accuracy of this compensation. The consequences of putative inaccuracies are discussed. RESULTS: 0.8% of the insured (all Dutch citizens are insured) are responsible for 66% of the mental health care costs. To compensate insurance companies for unequal distribution of costs, 3.9 billion euros were redirected. This compensation is based on inaccurate predictions of future health care costs of individual patients. The consequence is that insurance companies run a loss on every patient that uses mental health care. This loss is directly proportional to the amount of care used and therefore highest in patients with severe mental illness. CONCLUSION: Due to inaccurate redirection of mental health-care costs, a strong financial incentive is in place to avoid investing in mental health care. Under prevailing regulations, mental health is de facto uninsurable in the Netherlands. This affects especially patients with the most severe and complex mental illness.

Additional file 2. Employment outcomes of IPS participants and associations of employment with group, without participants of which the last registered diagnosis was not PD (n = 1312).

Additional file 5. Personality disorder clusters within personality disorders group (n = 335).