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Rates of self-reported psychotic experiences (SRPEs) in general population samples are high; however the reliability against interview-based assessments and the clinical significance of false-positive (FP) ratings remain unclear. Design: The second Netherlands Mental Health Survey and Incidence Study-2, a general population study.Methods:Trained lay interviewers administered a structured interview assessing psychopathology and psychosocial characteristics in 6646 participants. Participants with at least one SRPE (N = 1084) were reassessed by clinical telephone interview.Results:Thirty-six percent of participants with SRPEs were confirmed by clinical interview as true positive (TP). SPREs not confirmed by clinical interview (FP group) generated less help-seeking behavior and occurred less frequently compared with TP experiences (TP group). However, compared with controls without psychotic experiences, the FP group more often displayed mood disorder (relative risk [RR] 1.7, 1.4–2.2), substance use disorder (RR 2.0, 1.6–2.6), cannabis use (RR 1.5, 1.2–1.9), higher levels of neuroticism (RR 1.8, 1.5–2.2), affective dysregulation, and social dysfunction. The FP group also experienced more sexual (RR 2.0, 1.5–2.8) and psychological childhood trauma (RR 2.1, 1.7–2.6) as well as peer victimization (RR 1.5, 1.2–2.0) and recent life events (RR 2.0, 1.6–2.4) than controls without psychotic experiences. Differences between the FP group and the TP group across these domains were much smaller and less conclusive.Discussion:SRPEs not confirmed by clinical interview may epresent the softest expression of an extended psychosis phenotype that is phenotypically continuous with clinical psychosis but discontinuous in need for care.

Contains fulltext : 102705.pdf (Publisher’s version ) (Closed access) Subthreshold anxiety and subthreshold depressive symptoms often co-occur in the general population and in primary care. Based on their associated significant distress and impairment, a psychiatric classification seems justified. To enable classification, mixed anxiety depression (MAD) has been proposed as a new diagnostic category in DSM-5. In this report, we discuss arguments against the classification of MAD. More research is needed before reifying a new category we know so little about. Moreover, we argue that in patients with MAD symptoms and a history of an anxiety or depressive disorder, symptoms should be labeled as part of the course trajectories of these disorders, rather than calling it a different diagnostic entity. In patients with incident co-occurring subthreshold anxiety and subthreshold depression, subthreshold categories of both anxiety and depression could be classified to maintain a consistent classification system at both threshold and subthreshold levels. 5 p.

Background Much is unclear about the association between attention-deficit/hyperactivity disorder (ADHD) and alcohol use (disorder). Research on this subject is hindered by the role of conduct disorder (CD). We investigate whether (1) childhood ADHD is associated with higher prevalence and earlier onset of alcohol initiation, regular alcohol use and alcohol use disorder (AUD) (2) CD mediates or modifies this association. Methods Data were derived from the baseline assessment of the Netherlands Mental Health Survey and Incidence Study-2, a general population study. ADHD and CD were assessed among respondents aged 18–44 ( n = 3309). ADHD, CD, and alcohol use (disorder) were assessed using the Composite International Diagnostic Interview 3.0. Results Lifetime prevalence was 2.9% for ADHD, 5.6% for CD, 94.3% for alcohol initiation, 85.7% for regular alcohol use and 19.0% for AUD; mean ages of onset were 6.7, 11.5, 14.8, 16.7 and 19.2 years, respectively. After correction for gender and age, ADHD was associated with a higher prevalence of all three stages of alcohol use, but not with earlier onset of these stages. The association between ADHD and prevalence of AUD was fully explained by a mediating role of CD. CD did not modify the associations between ADHD and prevalence and onset of alcohol use (disorder). Conclusions The mediating role of CD in the association between ADHD and AUD suggests a developmental pathway from ADHD to CD and subsequent AUD. Early interventions in children with ADHD may prevent CD and subsequent onset of AUD.

Aim Very little is known about the relationship between obsessive–compulsive disorder (OCD) and substance use disorder (SUD). The aim of this study is to compare the co-occurrence of OCD with SUD to the co-occurrence of SUD with other psychiatric disorders in a representative community sample. Design In order to examine the association of SUD and OCD, logistic regression analyses were used generating odds ratios and 95% confidence intervals for life-time prevalence and 12-month prevalence. Setting and participants Cross-sectional data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a large representative sample of the Dutch population (n = 7076). Measurements The Composite International Diagnostic Interview (CIDI) 1.1 was used to assess Diagnostic and Statistical Manual of Mental Disorders Axis I criteria for psychiatric disorders. Findings The life-time and 12-month odds of being diagnosed with SUD in subjects with OCD are significantly higher than the odds of SUD for people without a psychiatric disorder. In men, the co-occurrence of substance dependence and OCD is significantly higher than the co-occurrence of substance dependence and other psychiatric disorders, whereas in women this co-occurrence does not differ significantly. Conclusions The co-occurrence of substance dependence in obsessive–compulsive disorder is higher than the co-occurrence of substance dependence in other non-obsessive–compulsive disorder DSM disorders, especially in men.

The use of services for mental problems is generally reported as being relatively low. However, the methods used for data collection in surveys may have influenced the quality of self-reported service use. This study compares the information on recourse to physicians for mental problems reported in different sections of a survey conducted in six European countries. Thus, 5545 respondents were asked questions on contacts with physicians at least twice: (1) after the symptoms checklist in any completed diagnostic section, and (2) in a section devoted to use of care for mental problems. Of these 39.3% reported contacts with physicians about mental problems in the diagnostic sections, whereas 29.5% did so in the use-of-care section. Inconsistencies concerned 20.1% of participants, among whom those reporting consultations in diagnostic sections without reporting them in the use-of-care section represented the majority (74.4%). Multiple logistic regression analysis revealed that age, marital status, educational level and country were associated with under-reporting in the use-of-care section, as well as having mood or sleep problems. In conclusion, services used for mental health reasons when measured through a question referring to use of care due to the presence of a mental problem may underestimate the care people received for their problems.

Epidemiological studies on mental health and mental comorbidity are usually based on prevalences and correlations between disorders, or some other form of bivariate clustering of disorders. In this paper, we propose a Factor Mixture Model (FMM) methodology based on conceptual models aiming to measure and summarize distinctive disorder information in the internalizing and externalizing dimensions. This methodology includes explicit modelling of subpopulations with and without 12 month disorders (“ill” and “healthy”) by means of latent classes, as well as assessment of model invariance and estimation of dimensional scores. We applied this methodology with an internalizing/externalizing two-factor model, to a representative sample gathered in the European Study of the Epidemiology of Mental Disorders (ESEMeD) study – which includes 8796 individuals from six countries, and used the CIDI 3.0 instrument for disorder assessment. Results revealed that southern European countries have significantly higher mental health levels concerning internalizing/externalizing disorders than central countries; males suffered more externalizing disorders than women did, and conversely, internalizing disorders were more frequent in women. Differences in mental-health level between socio-demographic groups were due to different proportions of healthy and ill individuals and, noticeably, to the ameliorating influence of marital status on severity. An advantage of latent model-based scores is that the inclusion of additional mental-health dimensional information – other than diagnostic data – allows for greater precision within a target range of scores. Copyright © 2011 John Wiley & Sons, Ltd.

Sex differences in opportunities to use alcohol or drugs, and transition to use, were investigated in 15 surveys, in 2001-2004 (Europe 6; Americas 3; Africa 2, Asia 3; Oceania 1). The paper focuses on 18-29 year olds (N = 9,873). The World Mental Health Survey Initiative oversaw the surveys; each country obtained its own funding. A complex picture emerged with different results for alcohol and for drugs and for opportunity to use and the transition to use. Sex differences in opportunity to use alcohol were small except in Lebanon and Nigeria, whereas for drugs, the largest differences were in Mexico and Colombia.

In a Dutch longitudinal study on the dynamics of cannabis dependence, at baseline 600 frequent cannabis users (? 3 days cannabis use per week in past 12 months) aged 18–30 years were interviewed. Nearly half of all participants (42%) met DSM-IV criteria for cannabis dependence in the 12 months prior to the interview. Participants were recruited by respondent-driven sampling; referrals were understood as proxy for social networks to explore peer associations and social exclusion. Analyses revealed that networks of frequent cannabis users were mostly heterogeneous. Cannabis dependence did not emerge as a main selector. However, within segments of networks some clustering of cannabis dependence (indicating differential inclusion), sex and ethnicity was found. Methodological questions are discussed regarding the applicability of respondent-driven sampling in noninjecting, nonmarginalized drug users. The study's limitations are noted.

This study analyzed use of services from psychiatrists and other mental health professionals (psychologists, psychotherapists, counselors, and social workers) in six European countries.Data were from respondents (N=8,796) to the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional survey (2001-2003) of a representative sample of noninstitutionalized adults in Belgium, France, Germany, Italy, the Netherlands, and Spain that was conducted via computer-assisted interviews with the Composite International Diagnostic Interview, version 3.0.Twenty-three percent of respondents reported lifetime use of any professional for mental health problems, and 60% consulted a mental health provider. Among these, 56% used a psychiatrist and 68% used a nonpsychiatrist provider. Factors associated with use of psychiatrists only were being retired or unemployed, having 12 or fewer years of education, living in France or Spain, having a severe disorder, and using psychotropic medication. Factors associated with use of nonpsychiatrist providers only were living in the Netherlands or Germany, never being married, and having an anxiety disorder.The findings suggest that there is no simple model of associations between mental health care system and patterns of service use. System characteristics, such as practitioner-population ratios, levels of practitioner availability, and gatekeeping and reimbursement policies, affect patterns of use of mental health providers. Recent British and Australian plans could be used as models for better allocation of services in some ESEMeD countries.

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.

This paper presents an overview of the prospective cohort design of the Dutch Cannabis Dependence (CanDep) study, which investigates (i) the three-year natural course of frequent cannabis use (≥ three days per week in the past 12 months) and cannabis dependence; and (ii) the factors involved in the transition from frequent non-dependent cannabis use to cannabis dependence, and remission from dependence. Besides its scientific relevance, this knowledge may contribute to improve selective and indicated prevention, early detection, treatment and cannabis policies. The secondary objectives are the identification of factors related to treatment seeking and the validation of self report measures of cannabis use. Between September 2008 and April 2009, baseline data were collected from 600 frequent cannabis users with an average age of 22.1 years, predominantly male (79.3%) and an average cannabis use history of 7.1 years; 42.0% fulfilled a (12-month DSM-IV) diagnosis of cannabis dependence. The response rate was 83.7% after the first follow up at 18 months. The second and last follow-up is planned at 36 months. Computer assisted personal interviews (CAPI) were conducted which covered: cannabis use (including detailed assessments of exposure, motives for use and potency preference); use of other substances; DSM-IV internalizing and externalizing mental disorders; treatment seeking; personality; life events; social support and social functioning. Copyright © 2011 John Wiley & Sons, Ltd.

This study examines the association of work and health-related characteristics with the intention to continue working after the age of 65 years. Data were from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a nationally representative population survey, including 1854 employees aged 45-64 years; 29.0% reported the intention to continue working after 65 years. Lower education, more adverse psychosocial working conditions and any physical disorder were negatively associated with this intention. Mental disorders were not associated. These findings highlight the importance of favourable working conditions and good physical health in relation to employees' intention to continue working after 65 years.

BackgroundSuicide is a leading cause of death worldwide, but the precise effect of childhood adversities as risk factors for the onset and persistence of suicidal behaviour (suicide ideation, plans and attempts) are not well understood.AimsTo examine the associations between childhood adversities as risk factors for the onset and persistence of suicidal behaviour across 21 countries worldwide.MethodRespondents from nationally representative samples (η = 55 299) were interviewed regarding childhood adversities that occurred before the age of 18 years and lifetime suicidal behaviour.ResultsChildhood adversities were associated with an increased risk of suicide attempt and ideation in both bivariate and multivariate models (odds ratio range 1.2–5.7). The risk increased with the number of adversities experienced, but at a decreasing rate. Sexual and physical abuse were consistently the strongest risk factors for both the onset and persistence of suicidal behaviour, especially during adolescence. Associations remained similar after additional adjustment for respondents' lifetime mental disorder status.ConclusionsChildhood adversities (especially intrusive or aggressive adversities) are powerful predictors of the onset and persistence of suicidal behaviours.

BACKGROUND: The link between physical conditions and mental health is poorly understood. Functional disability could explain the association of physical conditions with major depressive episode (MDE) as an intermediary factor. METHODS: Data was analyzed from a subsample (N=8796) of the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional general population survey. MDE during the last 12 months was assessed using a revision of the Composite International Diagnostic Interview (CIDI 3.0). Lifetime chronic physical conditions were assessed by self-report. Functional disability was measured using a version of the World Health Organization Disability Assessment Schedule (WHODAS). The associations of physical conditions with MDE and explanation by functional disability were quantified using logistic regression. RESULTS: All physical conditions were significantly associated with MDE. The increases in risk of MDE ranged from 30% for allergy to amply 100% for arthritis and heart disease. When adjusted for physical comorbidity, associations decreased and were no longer statistically significant for allergy and diabetes. Functional disability explained between 17 and 64% of these associations, most substantially for stomach or duodenum ulcer, arthritis and heart disease. LIMITATIONS: Due to the cross-sectional nature of the study the temporal relationship of the variables could not be assessed and the amount of explanation cannot simply be interpreted as the amount of mediation. CONCLUSIONS: Our findings suggest that the association of chronic physical conditions with MDE is partly explained by functional disability. Such explanation is more pronounced for pain causing conditions and heart disease. Health professionals should be particularly aware of the increased risk of depressive disorder when patients experience disability from these conditions. ispartof: Journal of Affective Disorders vol:124 issue:1 pages:38-44 ispartof: location:Netherlands status: published

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.

Background To disentangle cross-sectionally and longitudinally the relationship between arthritis and psychiatric disorders, and to examine the relationship between age and incidence of (1) any psychiatric disorder among respondents with and without arthritis and (2) arthritis among respondents with and without any psychiatric disorder. Methods Data are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a nationally representative household survey with repeated measurements in 1996, 1997 and 1999. Self-report was used to ascertain arthritis. Psychiatric and substance use disorders were diagnosed with the WHO Composite International Diagnostic Interview. Results Regarding the cross-sectional results, it was found that the strength of the association of arthritis with mood and anxiety disorders was similar [odds ratio (OR)=1.48, 95% confidence interval (CI)=1.09–1.99 and OR=1.42, 95% CI=1.11–1.81, respectively]. The longitudinal results showed that preexisting arthritis elevated the risk of developing any mood disorder (OR=1.94, 95% CI=1.23–3.07), whereas having any mood or any anxiety disorder did not predict new-onset arthritis. The incidence of any psychiatric disorder was significantly higher among younger persons ( Conclusions Arthritis is associated with psychiatric disorders. The temporal relationship points to one direction: arthritis predicts new onset of psychiatric disorder (mood disorder) instead of the reverse. Especially younger people (

Background: Depressive disorders have a large impact on psychosocial functioning. Since lower functioning predicts recurrence of a depressive episode, insight into the post-morbid course of psychosocial functioning of persons with different depressive disorders may facilitate recurrence prevention.Methods: Data were derived from NEMESIS, an epidemiologic survey in the adult population in the Netherlands. Respondents, who met the CIDI criteria of major depression (MDD; n = 102), dysthymic disorder (Dysth; n = 66) or double depression (DD; n = 73) at baseline, and recovered during three year follow-up, were included; as was a control group without any diagnosis (NoDiag, n = 4140). Functioning was assessed using the Groningen Social Disability Schedule (GSDS) and the SF-36 physical health summary-scale. Linear Mixed Models were conducted to compare 3-year trajectories of functioning across depressive groups and with NoDiag group.Results: Compared to NoDiag, all depressed groups were significantly impaired on social and physical functioning. Dysth and DD had a lower level of post-morbid physical functioning compared to MDD (after 1 and 3 years respectively: Dysth: B = -13.8, p=.002 and B=- 8.11, p=.09; DD: B = -8.9, p =.03 and B = -9.1, p =.05). Determinants for impaired social functioning (neuroticism) and for impaired physical functioning (age, comorbid somatic disorders and neuroticism) were identified.Limitations: Attrition was higher among persons with a depression. Inclusion of the drop-outs would most likely have resulted in stronger associations, since we expect lower functioning among the drop-outs.Conclusion: This study indicates the long-term debilitating effects of psychopathology, even after recovery of depressive disorders. Duration of the index symptoms appears to be associated with impaired functioning, since especially those with Dysthymia (either with or without a MDD) showed slower and less recovery of functioning. (C) 2009 Elsevier B.V. All rights reserved.

BackgroundDiagnostic criteria for (subthreshold) mixed anxiety depression (MADD) were proposed in DSM-IV. Yet the usefulness of this classification is questioned. We therefore assessed the prevalence of MADD, and investigated whether MADD adds to separate classifications of pure subthreshold depression and anxiety.MethodData of the Netherlands Mental Health and Incidence Study were used.ResultsThe 12-month prevalence of MADD was 0.6%. Between the three subthreshold categories few differences were found with regard to socio-demographic variables, care utilisation and functioning. Course in MADD seems more favourable and MADD is not a stable diagnosis over time.LimitationsThe MADD criteria used in the present study differed slightly from the proposed criteria in DSM-IV and sample sizes were small.ConclusionsGiven these results, MADD is not a relevant diagnosis in terms of prevalence and consequences when classified according to the currently proposed criteria.

Background: Although panic disorder is generally considered to be a chronic condition, little is known about the natural history of panic attacks and the factors predicting the prognosis of panic. It is expected that data derived from the community show more variation in the prognosis of panic and that subjects with less severe, 'subthreshold panic disorder' have a better prognosis. Methods: Using a large, representative population-based study, the 2-year course of panic attacks and its predictors were investigated among 155 subjects with panic disorder and subthreshold panic disorder. Presence and frequency of attacks were studied using structured interviews. Putative risk-indicators of chronicity included socio-demographics, psychobiological, environmental, psychiatric and panic-related factors. Results: Thirty-nine percent of those with panic disorder and 17% of those with subthreshold panic disorder reported panic episodes during more than 75% of the observed time periods in the Life Chart Interview. Forty-three percent of those with panic disorder and 14% of those with subthreshold panic disorder reported over 24 attacks per 3-month period. Male gender, severity of panic and agoraphobia predicted a high proportion of time spent in panic episodes. Low self-esteem, limited positive life events and severity of panic predicted highly frequent attacks. Limitations: The sample size was small, thereby limiting statistical power. The reported outcome may have overestimated chronicity. Conclusions: As was expected, the 2-year prognosis of panic was more varied than is often found in clinical studies. Although subthreshold panic disorder had a more favourable prognosis than full-blown panic disorder, a sizeable proportion of those with subthreshold panic disorder had an unfavourable prognosis. © 2009 Elsevier B.V. All rights reserved.

Background Severe mental disorders are associated with social distance from the general population, but there is lack of data on the stigma reported by individuals with common mental disorders. Aims To identify the correlates and the impact of stigma among individuals with common mental disorders. Methods Cross-sectional, household interview survey of 8796 representing the non-institutionalized adults of Belgium, France, Germany, Italy, the Netherlands and Spain. Two perceived stigma questions (embarrassment and discrimination) were asked to respondents with significant disability. Health-related quality of life measured by the SF-12, work and activity limitation and social limitation were also assessed. Results Among the 815 participants with a 12-month mental disorder and significant disability, 14.8% had perceived stigma. Stigma was significantly associated with low education, being married/living with someone and being unemployed. Perceived stigma was associated with decreased quality of life (SF-12 PCS score − 4.65; p Conclusion Individuals with mental disorders are more likely to report stigma if they have lower education, are married, or are unemployed. Perceived stigma is associated with considerably decrease in quality of life and role functioning. Health professionals and society at large must be aware of these findings, which suggest that fighting stigma should be a public health priority.

The Mental Health Inventory (MHI)-5 is an attractive, brief screening questionnaire for depression and anxiety disorders. It has been suggested that the three questions on depression (MHI-d) may be as good as the full MHI-5 in assessing depressive disorders. We examined the validity of the MHI-d and the MHI-a (the remaining two items on anxiety) in a large population-based sample of 7076 adults in the Netherlands. We also examined the validity of the MHI in assessing specific anxiety disorders. The presence of depressive and anxiety disorders in the past month was assessed with the Composite International Diagnostic Interview (CIDI), computerized version 1.1. ROC analyses indicated no significant difference between the MHI-5 (area under the curve of 0.93) and the MHI-d (area under the curve of 0.91) in detecting major depression and dysthymia. There was no difference either between the MHI-5 (area under the curve of 0.73) and the MHI-a (area under the curve 0.73) in detecting anxiety disorders. Both the MHI-5 and the MHI-a also seem to be adequate as a screener for some anxiety disorders (generalized anxiety disorder; panic disorder; obsessive-compulsive disorder), but not others, especially phobias (agoraphobia; social phobia; simple phobia). © 2008 Elsevier B.V. All rights reserved.

Background: Recent studies support a distinction between acute and chronic forms of depression, which contrasts the single-disease hypothesis for depressive disorders. Insight into the (determinants of) the 3-year naturalistic course of major depressive disorder (MDD), dysthymic disorder (Dysth) and double depression (DD) may contribute to this debate.Methods: Data were derived from NEMESIS, an epidemiologic survey in the adult population of the Netherlands. 400 Respondents who met the Composite International Diagnostic Interview (CIDI) criteria of MDD and/or Dysth were selected. Cox proportional hazards analyses and Linear Mixed Models were conducted to examine 3-year course trajectories of MDD, Dysth and DD and determinants for course.Results: Adjusted analyses showed similar course trajectories for Dysth and DD, which were significantly worse than the course for MDD. Determinants of unfavorable course were neuroticism and poor functioning.Limitations: Attrition was higher among persons with Dysth. However, since attrition is generally associated with poorer outcome, this would indicate that differences in course may even have been larger in reality.Conclusions: Dysth and DD involve a similar course which is worse than the course of MDD only. These results do not support a distinction between Dysth and DD. Duration of symptoms and level of functioning may serve as two clinically relevant classifying dimensions within the broad category of depressive disorders. (C) 2008 Published by Elsevier B.V.

The EQ-5D questionnaire is an instrument for describing and valuing health states.To compare general population health status measured by the EQ-5D in 6 European countries.In the European Study of the Epidemiology of Mental Disorders representative population samples in Belgium (n = 2411), France (n = 2892), Germany (n = 3552), Italy (n = 4709), the Netherlands (n = 2367), and Spain (n = 5473) completed the EQ-5D as part of personal computer-based home interviews in 2001 to 2003.Of all respondents, 35.1% reported problems in one or more EQ-5D dimensions, most frequently pain/discomfort (28.5%), followed by mobility (13.6%), usual activities (10.5%), anxiety/depression (8.0%), and self-care (3.6%). Proportions of respondents reporting any problems differed significantly between countries, ranging from 26.6% in Spain to 44.5% in France. Mean EQ VAS score was 77.1, ranging from 75.0 in Spain to 82.0 in the Netherlands. After adjusting for sociodemographic variables, the proportion of respondents reporting problems in any of the EQ-5D dimensions was significantly higher in France and lower in Spain and Italy than the grand mean. Even after controlling for reported EQ-5D health states, mean EQ VAS scores were significantly higher in the Netherlands and lower in Spain than the grand mean. Age, female gender, low educational level, lack of paid employment, and low income were associated with more problems in most of the EQ-5D dimensions and lower EQ VAS scores.Self-reported EQ-5D health status differed considerably between countries, calling for caution when making international comparisons of disease burden and health care effectiveness.

Background: Although it is known that childhood attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood, childhood predictors of this persistence have not been widely studied.Methods: Childhood history of ADHD and adult ADHD were assessed in 10 countries in the World Health Organization World Mental Health Surveys. Logistic regression analysis was used to study associations of retrospectively reported childhood risk factors with adult persistence among the 629 adult respondents with childhood ADHD. Risk factors included age; sex; childhood ADHD symptom profiles, severity, and treatment; comorbid child/adolescent DSM-IV disorders; childhood family adversities; and child/adolescent exposure to traumatic events.Results: An average of 50% of children with ADHD (range: 32.8%-84.1% across countries) continued to meet DSM-IV criteria for ADHD as adults. Persistence was strongly related to childhood ADHD symptom profile (highest persistence associated with the attentional plus impulsive-hyperactive type, odds ratio [OR] = 12.4, compared with the lowest associated with the impulsive-hyperactive type), symptom severity (OR = 2.0), comorbid major depressive disorder (MDD; OR = 2.2), high comorbidity (>= 3 child/adolescent disorders in addition to ADHD; OR = 1.7), paternal (but not maternal) anxiety mood disorder (OR = 2.4), and parental antisocial personality disorder (OR = 2.2). A multivariate risk profile of these variables significantly predicts persistence of ADHD into adulthood (area under the receiving operator characteristic curve = .76).Conclusions: A substantial proportion of children with ADHD continue to meet full criteria for ADHD as adults. A multivariate risk index comprising variables that can be assessed in adolescence predicts persistence with good accuracy.

OBJECTIVE: The WHODAS-II was substantially modified for use in the World Mental Health Surveys. This article considers psychometric properties and implications of filter items used to reduce respondent burden of the modified WHODAS-II. STUDY DESIGN AND SETTING: Seventeen surveys in 16 countries administered a modified WHODAS-II to population samples (N=38,934 adults). Modifications included introducing filter questions for four subscales and substituting questions on the number of days activity was limited for the Life Activities domain. We evaluated distributional properties, reliability, and validity of the modified WHODAS-II. RESULTS: Most respondents (77%-99%) had zero scores on filtered subscales. Lower bound estimates of internal consistency (alpha) for the filtered subscales were typically in the 0.70s, but were higher for the Global scale. Loadings of subscale scores on a Global Disability factor were moderate to high. Correlations with the Sheehan Disability Scale were modest but consistently positive, while correlations with SF-12 Physical Component Summary were considerably higher. Cross-national variability in disability scores was observed, but was not readily explainable. CONCLUSIONS: Internal consistency and validity of the modified WHODAS-II was generally supported, but use of filter questions impaired measurement properties. Group differences in modified WHODAS-II disability scores may be compared within, but not necessarily across, countries. These activities were supported by the United States National Institute of Mental Health (R01MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R01-TW006481). The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544-H). The ESEMeD project was funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain. The World Mental Health Japan (WMHJ) Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013) from the Japan Ministry of Health, Labour and Welfare. The South Africa Stress and Health Study (SASH) is supported by the US National Institute of Mental Health (R01-MH059575). The Ukraine Comorbid Mental Disorders during Periods of Social Disruption (CMDPSD) study is funded by the US National Institute of Mental Health (RO1-MH61905). The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the Robert Wood Johnson Foundation (RWJF; Grant 044708)

Objective: To examine the association between body mass, mental disorders, and functional disability in the general population of 6 European countries. Method: Data ( n = 21 425) were derived from the European Study on the Epidemiology of Mental Disorders (ESEMeD). The third version of the Composite International Diagnostic Interview was administered to assess mental disorders (mood, anxiety, and alcohol disorders) according to the Diagnostic Statistical Manual of Mental Disorders-fourth edition, body mass index (BMI) (kg/m2, based on self-reported height and weight), and functional disability in the previous 30 days, assessed with the World Health Organization Disablement Assessment Scale—second version. Results: About 3% of the respondents were underweight (BMI < 18.5 kg/m2), 53% had normal weight (BMI 18.5 to 24.9 kg/m2), 33% were overweight (BMI 25 to 29.9 kg/m2), and the remaining 12% met criteria for obesity (BMI > 30.0 kg/m2). Compared with individuals of normal weight, obese individuals were more likely to have mood (OR 1.3; 95%CI, 1.0 to 1.8) or more than one mental disorder (OR 1.4; 95%CI, 1.0 to 2.2). BMI had no impact on work loss days, whereas mental disorders had a considerable effect on work loss days. Conclusions: This is the first cross-national study investigating the role between BMI, mental disorders, and functional disability in the general population. Being overweight or obese is a common condition in the 6 ESEMeD countries. Although there is a moderate association between obesity and mental disorders, BMI did not independently influence functional disability.

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.

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.

This paper shows how decision theory can be used to determine optimal cut‐off scores on mental health screeners. The procedure uses (a) the costs and benefits of correct and erroneous decisions, and (b) the rates of correct and erroneous decisions as a function of the cut‐off score. Using this information, for each cut‐off point expected costs are calculated. The cut‐off point with the lowest expected costs is the optimal cut‐off score. An illustration is given in which the General Health Questionnaire is employed as a major depression screener. Optimal cut‐off points are determined for four different contexts: patients, health service providers, society, and mental health researchers. As in these four situations different costs are encountered, different optimal cut‐off points were found. Copyright © 2008 John Wiley & Sons, Ltd.

Aims To investigate whether cannabis use predicted the first incidence of mood and anxiety disorders in adults during a 3-year follow-up period. Design and participants Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective study in the adult population of 18–64 years. The analysis was carried out on 3881 people who had no life-time mood disorders and on 3854 people who had no life-time anxiety disorders at baseline. Measurements Life-time cannabis use and DSM-III-R mood and anxiety disorders, assessed with the Composite International Diagnostic Interview (CIDI). Findings After adjustment for strong confounders, any use of cannabis at baseline predicted a modest increase in the risk of a first major depression (odds ratio 1.62; 95% confidence interval 1.06–2.48) and a stronger increase in the risk of a first bipolar disorder (odds ratio 4.98; 95% confidence interval 1.80–13.81). The risk of ‘any mood disorder’ was elevated for weekly and almost daily users but not for less frequent use patterns. However, dose–response relationships were less clear for major depression and bipolar disorder separately. None of the associations between cannabis use and anxiety disorders remained significant after adjustment for confounders. Conclusions The associations between cannabis use and the first incidence of depression and bipolar disorder, which remained significant after adjustment for strong confounders, warrant research into the underlying mechanisms.

Aims: It is well established that tobacco use is associated with mental disorders. However, the association between tobacco use and mental disorders has not yet been examined sufficiently in prospective, population-based studies. The current study is aimed at examining whether smoking is associated with first-ever incidence of mental disorders. Design, setting and participants: We conducted a prospective, population-based epidemiological study (the Netherlands Mental Health Survey and Incidence Study: NEMESIS) in which a representative sample of adults aged 18-64 years (n = 7076) were interviewed to establish the presence of a broad range of mental disorders. We re-interviewed them at 1 year (n = 5618; response 79.4%) and 3 years (n = 4796; 67.8%) after baseline. Measurements: The presence of mental disorders was assessed according to DSM-III-R criteria with the Composite International Diagnostic Interview (CIDI), which was administered by trained lay interviewers. Tobacco use was assessed by asking respondents whether they had smoked in the past year, and how many cigarettes they smoked. Findings: Subjects who smoked but never had a mental disorder in their life, had an increased risk of developing a mental disorder (P < 0.01), and this remained significant after correcting for major risk indicators of mental disorders. Conclusions: Smoking is associated not only with the prevalence, but also with first-ever incidence of mental disorders. More research is needed to study the causal pathways. © 2007 The Authors.

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.

AIMS: To investigate if school-related contextual factors (school alcohol policy and school ethnic composition) explain episodic heavy drinking by individual students, while taking individual-level variables into account. DESIGN AND PARTICIPANTS: Data were derived from the 2003 Dutch National School Survey on Substance Use, a nationally representative cross-sectional study with a total of 7324 respondents aged 12-16 years. METHODS: Student-level data were collected by written questionnaire administered in classroom settings, assessing alcohol and drug use as well as socio-demographic and behavioural variables. School-level data were gathered by written questionnaire completed by the school principal, assessing school policy on substance use and school compositional factors. The data were analysed using a multi-level logistic regression model. FINDINGS: The study revealed an association between ethnic composition of the school and episodic heavy drinking: a relatively high percentage of ethnic minorities (10-30%) at the school was associated with a lower probability of episodic heavy drinking, but only in interaction with individual-level ethnicity. Thus, ethnic-minority students attending schools of high minority density had less risk of episodic heavy drinking (OR = 0.69, 95% CI: 0.47-1.00). None of the school policy factors was associated with episodic heavy drinking. CONCLUSIONS: Within a school context, peer modelling and reinforcement mechanisms can affect individual students' alcohol use, but a certain level of identification with the group and the resulting social control may be necessary. School policy seems to have no impact on students' alcohol use, possibly because students are faced with these only during special events, including school parties and excursions. Language: en

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.

Objective: Although rates of mental health service utilization differ dramatically across countries, little information is available about differences in self-reported barriers to mental health service utilization. Perceived barriers were examined in three locations with differing health care systems. Methods: Data came from three methodologically similar population-based surveys of adults conducted in the 1990s in Ontario, Canada (N=6,261), the United States (N=5,384), and the Netherlands (N=6,031) that assessed DSM-III-R nonpsychotic mental disorders with the Composite International Diagnostic Interview. Respondents who reported a need for professional help were asked to indicate reasons for not seeking care. Multiple logistic regression analyses were used to determine the sociodemographic, mental disorder, and location-specific correlates of each perceived barrier. Results: The pattern of reported barriers to mental health service utilization was similar across locations: attitudinal barriers (thoughts that the problem would get better on its own) were more prevalent than structural barriers (inability to get an appointment). Fear of stigmatization was not commonly endorsed. With adjustment for sociodemographic factors and type of mental disorder, low-income respondents were significantly more likely to report a financial barrier in the United States than in either Ontario or the Netherlands. Conclusions: Across locations, attitudinal barriers were more likely to be endorsed than structural barriers to service utilization. The most striking reported cross-national difference was structural, with many more U.S. respondents (especially those with low incomes) reporting financial barriers than respondents in either Ontario or the Netherlands. (Psychiatric Services 58:357–364, 2007)

Poor working conditions may be an important source of stress and may therefore contribute to the development of depressive and anxiety disorders. Social support may act as a buffer and protect against the development of depression or anxiety in the face of poor working conditions. With longitudinal data from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), the effect of working conditions and social support on the incidence of depressive and anxiety disorders was examined among 2646 working men and women, aged 18 through 65 years. Three dimensions of self reported working conditions were assessed: psychological demands, decision latitude and job security. Social support was assessed through validated scales for daily emotional support. About 10.5% of working women and 4.6% among working men developed an incident depressive and/or anxiety disorder over 2 years. Psychological demands predicted the incidence of depressive and anxiety disorders in both men and women (RR per score increase=2.29, 95% CI: 1.44-3.63), whereas decision latitude and job security did not. Social support protected against the incidence of depressive and anxiety disorders. This effect was stronger for men compared to women. Social support did not buffer the unfavorable mental effect of working conditions. Women were more likely to report low levels of decision latitude, whereas men reported higher psychological demands. Working conditions did not explain sex differences in the incidence of depressive and anxiety disorders.

International audience; Introduction: When evaluating gender differences in mental disorders and suicidality, specifically between European countries, studies are sparse and frequently hindered by methodological issues, such as the limited items evaluated and inconsistent sampling designs.Methods: In ten European countries participating in the World Mental Health Survey Initiative, lifetime internalizing and externalizing disorders and suicidality were assessed among 37,289 respondents. Disorders were classified using DMS-IV criteria. Odds ratios (OR) for gender differences were calculated using logistic regression, while trends across age-groups were tested via gender × age interaction.Results: Within countries, prevalence of any lifetime internalizing disorder ranged from 10.8% to 44.5% among women and 5.9% to 26.5% among men, with women having consistently higher odds than men (OR range: 1.52-2.73). Prevalence of any lifetime externalizing disorders ranged from 0.2% to 6.6% among women and 2.2% to 22.4% among men, with women having consistently lower odds than men (OR range: 0.05-0.35). Any lifetime suicide attempt was found in 0.8-5.4% of women and 0.3-2.4% of men, showing inconsistent relative gender-differences across countries (OR range: 0.77-4.72). Significant effects in gender OR across age-groups were not observed for any internalizing disorder or suicide attempt, yet were present for any externalizing disorder in France (p = 0.01), the Netherlands (p = 0.05), and Spain (p = 0.02).Limitations: Mental disorders were assessed with the CIDI 3.0 and not psychiatric evaluations. Suicidality does not fully represent more important clinical events, such as suicide mortality.Conclusions: Consistent across European countries, internalizing disorders are more common among women and externalizing disorders among men, whereas gender differences in suicidality varied.

BackgroundPrevious research suggests that many people receiving mental health treatment do not meet criteria for a mental disorder but are rather ‘the worried well’.AimsTo examine the association of past-year mental health treatment with DSM-IV disorders.MethodThe World Health Organization's World Mental Health (WMH) Surveys interviewed community samples of adults in 23 countries (n = 62 305) about DSM-IV disorders and treatment in the past 12 months for problems with emotions, alcohol or drugs.ResultsRoughly half (52%) of people who received treatment met criteria for a past-year DSM-IV disorder, an additional 18% for a lifetime disorder and an additional 13% for other indicators of need (multiple subthreshold disorders, recent stressors or suicidal behaviours). Dose–response associations were found between number of indicators of need and treatment.ConclusionsThe vast majority of treatment in the WMH countries goes to patients with mental disorders or other problems expected to benefit from treatment.

Item does not contain fulltext Background: This longitudinal study aims to compare long-term work disability and absenteeism between anxiety and depressive disorders focusing on the effects of different course trajectories (remission, recurrence and chronic course) and specific symptom dimensions (anxiety arousal, avoidance behaviour and depressive mood). Methods: We included healthy controls, subjects with a history of - and current anxiety and/or depressive disorders with a paid job (n=1632). The Composite International Diagnostic Interview was used to diagnose anxiety and depressive disorders and to assess course trajectories at baseline, over 2 and 4 years. The World Health Organization Disability Assessment Schedule II and the Health and Labour Questionnaire Short Form were used to measure work disability and absenteeism. Symptom dimensions were measured using the Beck Anxiety Inventory, the Fear Questionnaire and the Inventory for Depressive Symptomatology. Results: A history of - and current anxiety and/or depressive disorders were associated with increasing work disability and absenteeism over 4 years, compared to healthy controls. Long-term work disability and absenteeism were most prominent in comorbid anxiety-depressive disorder, followed by depressive disorders, and lowest in anxiety disorders. A chronic course, anxiety arousal and depressive mood were strong predictors for long-term work disability while baseline psychiatric status, a chronic course and depressive mood were strong predictors for long-term work absenteeism. Limitations: Results cannot be generalized to other anxiety disorders, such as obsessive compulsive disorder, posttraumatic stress disorder and specific phobias. Self-reported measures of work disability and absenteeism were used. Conclusions: Our results demonstrate that depressive syndromes and symptoms have more impact on future work disability and absenteeism than anxiety, implying that prevention of depression is of major importance.

The Marijuana Motives Measure (MMM) has so far been examined mainly in student populations, often with relatively limited involvement in cannabis use. This study evaluated the factor structure of the MMM in a demographically mixed sample of 600 young adult (18–30 years) frequent (≥ 3 days per week) cannabis users in the Netherlands. Analysis confirmed a five-factor solution, denoting coping, enhancement, social, conformity and expansion motives. Additionally, the original MMM was extended with two items (boredom and habit), which formed a distinct, internally consistent sixth factor labelled routine motives. In a multivariable logistic regression analysis, coping and routine motives showed significant associations with 12-month DSM-IV cannabis dependence. The results suggest general reliability and validity of the MMM in a heterogeneous population of experienced cannabis users.

The majority of cannabis dependent people do not seek professional treatment. Whether this indicates a ‘treatment gap’ depends on clinical characteristics of dependence in absence of treatment. In addition, motives for (not) seeking treatment are largely unknown. The current study compares 70 cannabis dependent patients with 241 non-treatment seeking cannabis dependent community subjects. Treatment facilitators were assessed in the 70 patients and barriers in 160 of the 241 dependent non-treatment seekers, who precluded to seek treatment. Compared to non-treatment seekers, patients reported more symptoms of dependence, more cannabis use, more mental health problems and more functional impairments due to physical and/or psychological problems. Patients also more often perceived lack of social support, while they received more support from family or friends, who also more often pressured to seek treatment. Patients reported mental health problems and functional impairment as facilitators to seek treatment. Cannabis dependent ‘precluders’ reported desire for self-reliance, preference for informal help from family or friends, and absent treatment need as their main reasons not to seek treatment. Non-treatment seekers showed better clinical characteristics compared with patients, and often deemed treatment unnecessary, suggestive of a limited ‘treatment gap’. While indeed treatment may often be unnecessary when it is not sought, some may still benefit from low threshold interventions, which should consider the desire for self-reliance and the preference for informal help, and would allow referral of severe cases to more intensive interventions. ___De meeste mensen met cannabisafhankelijkheid zoeken geen hulp. Een ‘behandelkloof’ ontstaat als niet-hulpzoekers niet spontaan herstellen en ernstige klinische kenmerken hebben. Het is onbekend in hoeverre hier sprake van is. Ook is er nauwelijks iets bekend over de redenen om al dan niet hulp te zoeken. In dit onderzoek werden 70 cannabisafhankelijke patiënten in de verslavingszorg vergeleken met 241 cannabisafhankelijke gebruikers uit de algemene bevolking die geen hulp hadden gezocht. Redenen om al dan niet hulp te zoeken werden vastgesteld bij alle 70 patiënten en bij 160 van de 241 cannabisafhankelijke gebruikers die zeiden in geval van cannabisproblemen geen hulp te zullen zoeken. Vergeleken met niet-hulpzoekers rapporteerden patiënten meer afhankelijkheidscriteria, meer cannabisgebruik, meer psychische problemen en meer beperkingen in het functioneren als gevolg van lichamelijke en/of psychische problemen. Patiënten ervoeren vaker dan niet-hulpzoekers een tekort aan sociale steun, ondanks dat zij vaker steun van vrienden of familie kregen, die ook vaker aandrongen om hulp te zoeken. Geestelijke gezondheidsproblemen en hinder in het functioneren waren de meestgenoemde redenen om hulp te zoeken. De belangrijkste motieven om geen hulp te zoeken waren: zelf willen stoppen, liever stoppen met hulp van familie of vrienden en behandeling voor cannabisproblematiek niet nodig vinden. Al met al lijkt de ‘behandelkloof’ mee te vallen, want vergeleken met patiënten in de verslavingszorg hebben niet-hulpzoekers met cannabisafhankelijkheid minder ernstige klinische kenmerken en vinden ze hulp vaak onnodig. Behandeling lijkt vaak onnodig voor niet-hulpzoekers, hoewel sommigen baat zouden kunnen hebben bij laagdrempelige interventies die rekening houden met de behoefte zelf te stoppen en met ondersteuning door familie of vrienden. Dergelijke interventies zouden daarnaast doorverwijzing van degenen met ernstige problemen kunnen faciliteren.

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.

Background Cannabis use is common in patients with bipolar disorder, however little is known about cannabis as a risk factor for mania. In order to investigate the association between exposure to cannabis and subsequent development of manic symptoms whilst controlling for psychotic symptoms, a longitudinal population-based study was carried out. Methods 4815 individuals aged 18 to 64 years were interviewed using the Composite International Diagnostic Interview at baseline, 1 year follow up and 3 year follow up, including assessment of substance use, manic symptoms and psychotic symptoms. Results Use of cannabis at baseline increased the risk for manic symptoms during follow-up (adjusted OR 2.70, 95% CI: 1.54, 4.75), adjusted for age, sex, educational level, ethnicity, single marital status, neuroticism, use of other drugs, use of alcohol, depressive symptoms and manic symptoms at baseline. The association between cannabis use and mania was independent of the prevalence and the incidence of psychotic symptoms. There was no evidence for reverse causality, as manic symptoms at baseline did not predict the onset of cannabis use during follow-up (OR = 0.35, 95% CI: 0.03, 3.49). Limitations As 3 years is a relative short period of follow-up, long-term effects of cannabis use on mania outcomes could not be detected. Conclusion The results suggest that cannabis use may affect population expression of manic symptoms (and subsequent risk to develop bipolar disorder [Regeer, E.J., Krabbendam, L., R, DE Graaf, Ten Have, M., Nolen, W.A., Van Os, J., 2006. A prospective study of the transition rates of subthreshold (hypo)mania and depression in the general population. Psychol Med, 1-9.]). These findings may not be due to the emergence of psychotic symptoms or the effects of self-medication.

AIMS: To determine the course of alcohol use disorders (AUD) in a prospective general population study using three different classification systems: Diagnostic and Statistical Manual version IV (DSM-IV), International Classification of Diseases version 10 (ICD-10) and the craving withdrawal model (CWM). The latter is an alternative classification, which requires craving and withdrawal for alcohol dependence and raises the alcohol abuse threshold to two criteria. DESIGN, SETTING AND PARTICIPANTS: Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a large (n=7,076) representative general population study with a baseline and 1- and 3-year follow-up assessments. MEASUREMENTS: Diagnostic status according to DSM-IV, ICD-10 and CWM at baseline and at follow-up was established using a structured interview (Composite International Diagnostic Interview: CIDI). FINDINGS: DSM-IV abuse, ICD-10 harmful use and CWM abuse all showed a favourable course with remission rates of 81, 89 and 71%, respectively, at 1-year follow-up and 85, 92 and 79% at 3-year follow-up. Dependence according to DSM-IV, ICD-10 and CWM had a somewhat less favourable course, with remission rates (no dependence) of 67, 67 and 57% at 1-year follow-up and 74, 69 and 73% at 3-year follow-up, respectively. Subjects who were remitted at 1-year follow-up showed relapse-rates of 0-14% for dependence and 4-12% for abuse at 3-year follow-up. Although CWM diagnoses tended towards greater diagnostic stability than DSM-IV and ICD-10, most differences were not significant. CONCLUSION: The conviction that addiction is a chronic relapsing disease may apply to treatment-seeking alcoholics, but our data show a far more favourable course of alcohol use disorders in the general population

Background: Mental disorders are highly prevalent and are associated with substantial disease burden, but their economic costs have been relatively less well researched. Moreover, few cost-of-illness studies used population-based psychiatric surveys for estimating direct medical, direct non-medical and indirect costs, and were able to do so for several well diagnosed mental disorders. Aims: To calculate the cost of nine common mental disorders. The costs were calculated at individual level (per capita costs), and at population level per one million population for both prevalence (current cases) and incidence (new cases). Method: Data were derived from the Netherlands Mental Health Survey and Incidence Study (Nemesis), a population-based psychiatric cohort study among 5,504 adults in the age bracket of 18-65 years. DSM-III-R disorders were assessed with help of the Composite International Diagnostic Interview (CIDI). The costs of health service uptake, patients' out-of-pocket costs, and production losses were calculated for the reference year 2003. Robust regression methods, with 1,000 bootstrap replications, were used to estimate the excess costs of the distinct mental disorders and their 95% confidence intervals, while adjusting for physical illnesses and concurrent mental disorders in the regression equation. Results: The annual per capita excess costs of the mood disorders (€ 5,009) were higher than those of the anxiety disorders (€ 3,587) and alcohol-related disorders (€ 1,431). Being more prevalent, the excess costs of anxiety disorders are higher than those of mood disorders at population level. The annual influx of new cases (incidence) accounts for 39.2% of the costs at population level. It appeared that in the general population, in the productive age of 18-65 years, the bulk of the costs (85%) were related to production losses. Discussion: The study has some strengths and limitations. The data were derived from a large and representative population-based sample. Disorders were assessed with a reliable instrument. The costs were comprehensive in that they included direct medical, direct non-medical and indirect costs. The costs attributable to mental disorders were obtained with robust regression models while adjusting for the presence of somatic illnesses. For several reasons the costs figures must be seen as conservative lower bounds of the true costs. (i) People who were hospitalised were likely to be underrepresented in the sample, and it is well known that hospitalisation is one of the major cost drivers. (ii) Resource use was based on self-report, and this is likely to have resulted in underreporting. (iii) Work loss days were included in the analysis, but work cutback data were unavailable, while it is known that the costs due to work cutback can be substantial. Implications: (i) The costs of mental disorders are comparable to those of physical illnesses. This throws some light on the allocation of budgets for research and development in mental versus physical illnesses. (ii) At population level, a substantial part of the costs are caused by new cases, and this is a strong argument for strengthening the role of preventive psychiatry in public health with the aim to reduce incidence and avoid the future costs. (iii) In particular, reducing the incidence of major depression, panic disorder, agoraphobia and dysthymia should be considered as public health priorities, because these disorders are associated with substantial disability, and have, in addition, important economic ramifications. (iv) The bulk of the costs are due to production losses; this makes employers pertinent stakeholders in mental health promotion, and thoughts should be given to the question how to involve them more actively in health promotion. (v) It is well to emphasise that adoption of the above mentioned policies will require that first more prevention trials and cost-effectiveness studies are conducted in the selected disorders. Copyright © 2006 ICMPE.

Seasonal variations in the prevalence of mental disorders in general population surveys have rarely been noted. Using a representative sample of the Dutch population, the authors studied the seasonality of 1-month mental disorders and gender-by-season and age-by-season interactions. Data were obtained from the Netherlands Mental Health Survey and Incidence Study, a psychiatric epidemiologic study in which 7,076 adults aged 18-64 years were interviewed (1996) using the Composite International Diagnostic Interview. Seasonal statistical differences were not found for the category "any diagnosis", although prevalence was higher in winter (18.1%) and lower in summer (16.0%). Seasonal variations were also not found for the main categories "mood disorders", "anxiety disorders", "substance-use disorders", "eating disorders", and "schizophrenia". Some differences were found for individual disorders, mostly anxiety. Panic disorder was more frequently reported in winter than in summer, generalized anxiety disorder more frequently in winter than in other seasons, and obsessive-compulsive disorder more frequently in autumn than in summer. Only a few gender and age differences in seasonal variation were found. The authors conclude that there are only limited seasonal variations in mental disorders in general population studies, at least in countries with a mild maritime climate. For reliable estimation of the prevalence of some disorders, these findings have implications for the design of large-scale population studies.

Aims: To investigate whether DSM-IV abuse and dependence criteria and the ICD-10 criterion for craving differentially predict a chronic course of alcohol use disorders (AUD) in the general population. Methods: Data were derived from the Netherlands Mental Health Survey and Incidence Study, a large representative sample of the general Dutch population with a baseline and a 1- and 3-year follow-up assessment. In the present study, a cohort of subjects with a DSM-IV AUD diagnosis at baseline was followed (n � 382). Diagnostic criteria of AUD according to DSM-IV and ICD-10 were assessed using the Composite International Diagnostic Interview (CIDI). Results: In our cohort of subjects with an AUD diagnosis at baseline, the presence of all dependence criteria, except tolerance, significantly increased the risk for dependence at 1 and 3 years follow-up. Abuse criteria displayed much lower and often non-significant risks for dependence at follow-up, with the exception of the criterion 'legal problems'. The ICD-10 criterion 'craving' had the highest relative risk (RR) of all criteria for dependence at 1 year (RR � 12.4, 95% CI � 5.5-27.8) and 3 years follow-up (RR � 12.9, 95% CI � 4.4-37.7). Conclusion: With the exception of tolerance, all DSM-IV dependence criteria are useful in predicting the course of AUD in the general population.

Aims To investigate the hypothesis that changes in cannabis prevalence among Dutch secondary school students (aged 12-17 years) were paralleled by shifts in the age of Krst cannahis use. Design and participants Data were derived from five waves (1988. 1992. 1996.1999 and 2003) of the Dutch National School Survey on Substance Use. a nationally representative cross-sectional study, with a total of i2 777 respondents. Measurements Written questionnaires on cannabis. tobacco, alcohol, other drug use and soclo-dcmographic and behavioural variables were administered in classroom settings. Findings Survival analysis showed a strong increase in cumulative incidences hy age of lirsl cannabis use Troin 1988 to 1992, a further increase in 1996 and stabilization in 1999. continuing into 2003. From 1992 to 1996. age of onset shifted towards younger ages. Onset peaked at age 15 in 1992 and age 14 in 1996, The proportion of life-time cannabis users starting at age 1 3 or younger increased from 26% in 1992 to 41% in 1996. The overall trend was similar for boys and girls. Conclusions The study largely confirmed the expectation that the increase in cannabis use from 1988 to 1996 was paralleled by a decrease in the age of first cannabis use. From 1996 to 2003 age of first cannabis use and prevalence stabilized, possibly occasioned by a change in cannabis policy in the mid-1990s. KEYWORDS Age of onset, cannabis use. secondary school students. trends.

Aims: To compare the discriminant validity of the DSM-IV and the ICD-10 classification of alcohol use disorders (AUD) with an alternative classification, the craving withdrawal model (CWM). CWM requires craving and withdrawal for the diagnosis of alcohol dependence and raises the alcohol abuse threshold to two DSM-IV AUD criteria. Methods: Data were derived from The Netherlands Mental Health Survey and Incidence Study, a large representative sample of the general Dutch population. In the present study, only non-abstinent subjects were included (n = 6041). Three diagnostic systems (DSM-IV, ICD-10, and CWM) were compared using the following discriminant variables: alcohol intake, psychiatric comorbidity, functional status, familial alcohol problems, and treatment sought. Results: The year prevalence of CWM alcohol dependence was lower than the prevalence of ICD-10 and DSM-IV dependence (0.3% vs 1.4% and 1.4%). The year prevalence of abuse was similar for CWM and DSM-IV (4.7 and 4.9%), but lower for ICD-10 harmful use (1.7%). DSM-IV resulted in a poor distinction between normality and abuse and ICD-10 resulted in a poor distinction between harmful use and dependence. In contrast, the CWM distinctions between normality and abuse, and between abuse, and dependence were significant for most of the discriminant variables. Conclusion: This study indicates that CWM improves the discriminant validity of AUD diagnoses. The predictive validity of the CWM for alcohol and other substance use disorders remain to be studied.

Introduction: The pathway from subclinical psychotic experiences to need for care may depend on type of psychotic experience, level of associated distress, and previous experience of psychosis. Method: In a general population sample with no previous Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, psychotic disorder (n = 4722), 83 subjects displayed at least one psychotic experience. Within the group of 83, subjects with (n = 24) and without need for care (n = 59) were compared. Presence of psychotic experiences at younger ages had been assessed at earlier interviews. Results: Of 7 different psychotic experiences, only hearing voices, nonverbal hallucinations, and passivity phenomena were significantly associated with need for care. These associations were largely explained by the distress associated with the psychotic experience, but whether individuals had had psychotic experiences at earlier ages did not matter. Conclusions: Different psychotic experiences differ in the associated level of need for care and the mediating role of distress. Longer prior exposure to psychosis may not influence the pathway from subclinical to clinical.