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Dimensions of religion contribute in different ways to the in general protective effect of religiosity and spirituality (R/S) against suicidality. Few studies have included a substantial number of dimensions, and even fewer a follow-up, to clarify the stability and contribution of R/S over the course of psychopathology. In this follow-up study among 155 religiously affiliated in- and outpatients with major depression, religious service attendance, frequency of prayer, type of God representation, moral objections to suicide, and social support were re-assessed in 59 subjects. Diverse statistical analyses show a partial change in R/S parameters. Supportive R/S is persistently associated with lower suicidality. R/S at T0 or change in R/S is not associated with additional changes in suicidality over time. The results suggest that the most important change in suicidality can be understood as an effect of a decline in depressive symptomatology, not of changes in R/S. Despite the limited follow-up and sample size, these results emphasize the importance of longitudinal and dynamic evaluation of especially affective and supportive aspects of R/S in suicidal persons.

Objective: The course over time of religious delusions (RDs) in late-life schizophrenia and psychotic depression may be relevant to know how long certain aspects of RDs may affect treatment. The present study examines (1) the 1-year follow-up of RDs and other prevalent delusions, (2) the association between RDs and the clinical course of psychotic depression and schizophrenia compared to those without RDs, and (3) associations of RDs and other prevalent delusions with “indicators of complexity” (e.g., suicidality, refusing medication). Design: Prospective study (half year and 1-year follow-up combined). Setting: Outpatients and inpatients in Geriatric Psychiatry Institution of Yulius, South-Holland, the Netherlands. Participants: One hundred and thirty seven older adult patients, mean age 76.3 (s.d. 8.1). Intervention: Natural follow-up study. Measurements: Diagnostic interview measures included Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.1), positive psychosis items of the Community Assessment of Psychic Experiences-42 (CAPE), and the 20-item measures from the Centre for Epidemiologic Studies Depression Scale (CES-D). Results: Although RDs in older adults decline in the clinical course of psychotic depression, the course is unfavorable compared to psychotic depression without RDs with regard to depressive symptom severity as measured by CES-D. No significant differences were noted in relation to clinical course of positive psychotic symptoms for both psychotic depression and schizophrenia. In schizophrenia, RDs persist more frequently compared to the most prevalent delusions. No significant difference was observed between patients with RDs compared to patients without RDs regarding indicators of clinical complexity. Conclusions: RDs predicting a less favorable course over time in psychotic depression. In schizophrenia, RDs appears to be relatively pervasive.

Purpose The aim of this study was to analyze the views of patients, police‐officers and emergency mental health workers on the use of the police cell as intervention in a mental health crisis. Design and Methods We analyzed interviews with individuals involved in police cell interventions, found first labels and categorized them in concordance with the four principles of biomedical ethics and compared them to relevant scientific literature. Findings and Practical Implications Professionals should know that emergency mental healthcare aimed at controlling the situation is not enough to provide good care. It probably generates better outcomes for patients in the short and long term when patient experiences are taken into consideration.

Background. Religious and spiritual (R/S) struggles may impact mental health treatment and recovery processes. The current study investigates how R/S struggles play a role in mental illness and what approaches are experienced as helpful. Methods. Thirty-five semi-structured interviews with clinical mental health patients in a Christian (N = 15) and a secular (N = 20) mental health clinic were narratively analyzed. Results. R/S struggles are common in people who suffer from mental illness and often coexist together with R/S support, mostly fluctuating over time. In summary, patients experience R/S struggles as negative feelings (e.g., loneliness, shame, mistrust) and the absence of positive feelings (e.g., hope and peace). These are influenced by someone’s R/S background and beliefs, as well as by the illness and other events. All participants appreciated a receptive approach (1) and many preferred an active approach (2) by mental health professionals. Some patients reported benefits from a directive approach (3). Conclusions. R/S struggles are tightly connected with other aspects that play a role in patients with mental illness. Mental health professionals are recommended to listen to patients’ narratives and carefully consider whether or not further interventions, in order to enhance R/S support and reduce R/S struggles, might be appropriate.

The current study focuses on care for West African Victims of human trafficking (VHTs) in The Netherlands and addresses the question of how (1) social and legal professionals and (2) religious leaders of African-led migrant (Pentecostal) churches perceive their relationship with these VHTs. Thematic analyses of qualitative interviews (N = 21) revealed that both groups share the perception that VHTs are vulnerable, especially in view of so-called voodoo spells. Social and legal professionals noticed that West African VHTs prototypically appear as ‘demanding’ in a rather pro-active manner. Religious leaders on the other hand indicated that the VHTs feel at ease in the church in a more adaptive sense and may find ways of changing their lives after experiencing the Pentecostal “deliverance” ritual. Keywords: Human trafficking, Pentecostalism, West-African, migrant churches, cultural and intercultural identity, religious coping

One point that emerges from qualitative research on religion and bipolar disorder (BD) is the problem patients with BD experience in distinguishing between genuine religious experiences and hyper-religiosity. However, clinical practice does not obviously address communication about differences in explanatory models for illness experiences. The aim of the current study is first to estimate the frequencies of different types of explanations (medical versus religious) for experiences perceived as religious and related to BD, second to explore how these types relate to diagnosis and religiousness, and third to explore the frequency of expectation of treatment for religiosity. In total, 196 adult patients at a specialist outpatient center for BD in the Netherlands completed a questionnaire consisting of seven types of explanations for religious experiences and several items on religiousness. Of the participants who had had religious experiences (66%), 46% viewed the experiences as ‘part of spiritual development’ and 42% as ‘both spiritual and pathological,’ 31% reported ‘keeping distance from such experiences,’ and 15% viewed them as ‘only pathological.’ Measures of religiousness were positively associated with ‘part of spiritual development’ and negatively associated with ‘keeping distance from the experiences’ and ‘only pathological.’ Half of the sample viewed religiosity as an important topic in treatment. It can be hypothesized that strength of religiousness may help people to integrate destabilizing experiences related to BD into their spiritual development. However, the ambiguity of strong religious involvement in BD necessitates careful exploration of the subject in clinical practice.

Background Many empirical studies have shown inverse associations between measures of religiousness and spirituality (R/S) and depression. Although the majority of these studies is cross-sectional, a considerable number of prospective studies have also appeared. Methods The current systematic review offers an overview of the major pattern of associations between the measures of R/S and depression / depressive symptoms in 152 prospective studies (until 2017). Results With on average two R/S measures per study (excluding measures of religious struggle, treated separately), 49% reported at least one significant association between R/S and better course of depression, 41% showed a non-significant association, and 10% indicated an association with more depression or mixed results. The estimated strength of these associations was modest (d = -0.18). Of the studies that included religious struggle, 59% reported a significant association with more depression (d = +0.30). Especially among persons identified with psychiatric symptoms, R/S was significantly more often protective (d = -0.37). In younger samples and in samples of patients with medical illness, R/S was less often protective. Studies with more extensive adjustment for confounding variables showed significantly more often associations with less depression. Geographical differences in the findings were not present. Limitations Given the huge heterogeneity of studies (samples size, duration of follow-up), the current synthesis of evidence is only exploratory. Conclusion In about half of studies, R/S predicted a significant but modest decrease in depression over time. Further inquiry into bi-directional associations between religious struggle and (clinical) depression over time seems warranted.

This descriptive record-based study included 75 patients who had engaged in domestic property damaging (DPD) and needed assessment by an urban emergency psychiatric service team in The Netherlands. The DPD patients were compared to 1145 other patients referred because of aggression, suicidality or other reasons. DPD patients were more often diagnosed with a psychotic disorder or a manic episode, had more often a migration background, were less often diagnosed with depression, and had lower GAF scores. There were no differences with respect to personality disorders or substance use. DPD patients were two to six times more likely to be (mostly involuntarily) admitted to a psychiatric department (64%), than the other patient groups (aggression 45%, suicidality 21%, other referral reasons 37%). The findings indicate that DPD patients represent an exclusive group who possibly have more intercultural and communication disadvantages due to less cultural acceptance or lack of knowledge about mental healthcare in the Netherlands.

Meaning in life is a motivational force and an existential theme for many people. The concept of meaning comprises purpose, comprehension and mattering. According to the Section III model of personality disorder (DSM-5), lack of meaning, purpose and direction in life is part of personality dysfunction. The present study aimed to determine the association between personality disorder (PD), personality dysfunction and 'lack of meaning, purpose and direction' as a distinct facet of personality dysfunction, using Livesley's self-report questionnaire-the General Assessment of Personality Disorder. This comparative quantitative study showed significant differences in lack of meaning, purpose and direction between a group of patients with PD (n = 126, PD with depression n = 51 and PD without depression n = 75), a group of non-PD patients (n = 76, with depression n = 27 and without depression n = 49) and a control group (n = 444). The PD groups had similar scores as the non-PD patients with depression. Lack of meaning was significantly associated with 'difficulty setting and attaining goals' in all groups, with 'lack of affiliative relationships' in the PD groups and 'sense of inner emptiness' in the PD group without depression and in controls. © 2019 John Wiley & Sons, Ltd.

INTRODUCTION: In the last decades, the attention for religion/spirituality (R/S) in mental health care (MHC) has considerably increased. However, patients' preferences concerning R/S in treatment have not often been investigated. The aim of this study was to find out how patients in clinical multidisciplinary MHC want R/S to be addressed in their care.METHODS:Thirty-five semi-structured interviews were carried out between September 2015 and July 2016 among patients in a secular and a Christian MHC in the Netherlands. Qualitative inductive content analysis was performed, using Atlas Ti.RESULTS:Patients appreciated (1) individual R/S conversations between patients and care team members (mainly nurses), (2) a familiar R/S environment, (3) a special R/S program and (4) contact with their R/S network. Patients varied in their presentation of R/S care needs from (a) explicit, mostly in the Christian MHC, to (b) implicit, predominantly in the secular MHC, or showed (c) hidden R/S care needs. A non-acute stage of the illness and R/S affinity of the mental health professionals, were classified as possible conditions for addressing R/S. DISCUSSION AND IMPLICATIONS FOR PRACTICE: Nurses are recommended to be aware of the diversity of patients' R/S care needs. Actively addressing R/S may help in recognizing implicit or even hidden R/S care needs. Further considerations on whether and how to respond to patients' R/S care needs would be justified.

Limited research has been conducted on the religious experiences of people with bipolar disorder (BD). Qualitative research indicates that the disentanglement of pathology and genuine religiosity is an important issue for persons with BD and that some patients experience discrepancy between the explanatory models of mental health care professionals and religious leaders. The current study explores the ways patients with BD interpret religious experiences they have had during illness episodes, how this interpretation changes over an individual's lifetime, and the expectations of treatment that persons with BD have regarding these religious experiences. Semi-structured interviews with 34 stable BD patients were conducted by a hospital chaplain and a psychiatrist trainee. The method of analysis was interpretative phenomenological analysis. For many participants, a religious quest originated after a religious experience during mania, and then a variety of medical and religious sources supported the interpretation process. Most participants endorsed mixed medical and religious explanations for their experiences and tried to distinguish between spiritual and pathological features. The interpretation process changed over time, influenced by religious affiliation and views, mood swings and the course of BD, and communication with others about the experiences. Discourse about the experiences was often problematic within treatment; a majority expressed the need for recognition of the spiritual value of the experiences, together with a critical sounding board for reflecting on their meaning and the influence of BD. More attention could be paid to the subject in treatment, and the expertise of hospital chaplains could contribute to this.

Background: Patient satisfaction with religious/spiritual (R/S) care during mental health treatment has been associated with a better treatment alliance. Aims: To investigate the longitudinal relations between (un)met R/S care needs and treatment alliance/compliance over a 6-month period. Method: 201 patients in a Christian (CC) and a secular mental health clinic completed a questionnaire (T0) containing an R/S care needs questionnaire, the Working Alliance Inventory (WAI) and the Service Engagement Scale (SES). After 6 months 136 of them took part in a follow-up (T1). Associations were analysed using hybrid linear mixed models and structural equation modelling. Results: R/S care needs decreased over time, but a similar percentage remained unanswered (e.g. 67% of the needs on R/S conversations in a secular setting). Over a 6-month period, met R/S care needs were associated with a higher WAI score (β = .25; p Conclusions: Satisfaction with R/S care among mental health patients is related to a better treatment alliance. When unmet R/S care needs persist, they precede a decrease in treatment compliance. Mental health professionals are recommended to assess the presence of R/S care needs and consider possibilities of R/S care especially in the first weeks of treatment.

Background. Although religious delusions (RDs) are common in geriatric psychiatry, we know little about their frequency and content. Our study examines the prevalence and content of religious hallucinations (RHs) and RDs and how they relate to the diagnosis and the patients&rsquo, denominational background and other aspects of religiousness. Methods. Semi-structured diagnostic interviews were conducted with inpatients and outpatients (N = 155, mean age 76.5) at a geriatric psychiatry department in the Netherlands. We used the Schedules for Clinical Assessment in Neuropsychiatry 2.1. Results. The prevalences of RHs and RDs were 19% and 32%, respectively. RHs were mostly auditory. There was no statistically significant difference between the prevalence of RHs in schizophrenia (17.5%) and in psychotic depression (9.4%). Compared to non-affiliated patients and mainline Protestants, RDs were significantly more prevalent in raised and current strict Protestants, especially in those with psychotic depression. RHs were more prevalent in Evangelical (e.g., Pentecostal) and strict Protestant patients. The presence of RDs was associated with several measures of religiousness (e.g., dogmatism, religious coping). Conclusions. Religion is likely to act as a symptom-formation factor for psychotic symptoms in strict Protestant older adults. More detailed research might lead to a fuller understanding of how strict religious beliefs may affect the content of psychotic symptoms and unintentionally add a component of existential suffering. It is important for mental health professionals, especially the predominantly secular professionals in the Netherlands, to recognize and address religious themes.

What is known on the subject?: The relationship between patient and professional is one of the cornerstones of successful treatment in mental health care. For part of the mental health patients, a similar outlook on life with their caregiver(s) is important. Attention to religion/spirituality (R/S) in mental health care is likely to influence the relationship between a patient and mental health professional, for patients preferring so. What the paper adds to existing knowledge?: Patients, who appreciate and experience personalized attention to R/S in conversations with practitioners and nurses, are likely to receive the highest therapeutic benefit from their relationship with their mental health professionals Patients who welcome personalized attention to R/S in conversations but find themselves unsupported in this regard experience significantly lower levels of treatment alliance than do those whose needs are met or those who do not express such needs For religious and nonreligious patients attaching importance to a similar outlook on life with practitioner or nurse, this experience was also related to a better relationship, compared with patients preferring so but experiencing a different outlook on life. What are the implications for practice?: Personalized attention to R/S in conversations is recommended, both for practitioners and nurses. In case of a different outlook on life between a patient and mental health professional, addressing R/S with an open and respectful attitude may prevent negative effects on a patient’s treatment experience. Abstract: Introduction Attention to religion and spirituality (R/S) in mental health care has increased and may benefit treatment alliance. Aim To describe the association of (un)met R/S care needs with treatment alliance and compliance among mental health patients. Methods Patients in a Christian and a secular mental health clinic (n = 201) filled in a questionnaire. Scales of met and unmet R/S care needs (range 0‒14) were regressed on the Working Alliance Inventory (WAI), Service Engagement Scale and Medication Adherence Report Scale. Ancova analyses were performed for the fourteen R/S care needs separately. Results In the Christian clinic, met R/S care needs were associated with a higher WAI score (p =.001) and unmet R/S care needs, with a lower WAI score (p =.000). For the Secular clinic, the same trends were observed, but insignificant. Items with the strongest associations were conversations about religious distress with a nurse (p =.000) and a similar outlook on life with practitioner (p =.001) or nurse (p =.005). (Un)met R/S care needs were not associated with treatment compliance. Discussion and implications for practice We recommend personalized attention to R/S in conversations. A (perceived) similar outlook on life with mental health professionals may be beneficial for religious and nonreligious patients.

This study examines religious/spiritual (R/S) care needs and their possible determinants among mental health patients in the Netherlands. Patients in a Christian (CC, n = 100) and a secular (SC, n = 101) mental health clinic completed a questionnaire. Analysis revealed three factors on the R/S care needs measure: (1) "R/S conversations,"(2) "R/S program and recovery,"and (3) "R/S similar outlook on life."The presence of R/S care needs was predicted by the following: site (CC versus SC), R/S involvement, and religious strain. Most commonly, unmet R/S care needs were explanation about R/S and illness by the practitioner, prayer with a nurse, conversations about religious distress with a nurse, conversation when R/S conflicts with treatment, help in finding a congregation, and contact between chaplain and practitioner. "R/S similar outlook on life"was equally important to patients with and without R/S involvement. Patients appreciate a match in worldview with health professionals, either religious or secular.

This review explores the literature to test the hypothesis that 'moral objections to suicide (MOS), especially the conviction of going to hell after committing suicide, exert a restraining effect on suicide and suicidality.' Medline and PsycInfo were searched using all relevant search terms; all relevant articles were selected, rated and reviewed. Fifteen cross-sectional studies were available on this topic, and raise sufficient evidence to confirm a restraining effect of MOS, and sparse data on fear of hell. MOS seem to counteract especially the development of suicidal intent and attempts, and possibly the lethality of suicidal attempts. A differential pattern of influence of MOS on the suicidal continuum is suggested.

A multidisciplinary guideline on religion, spirituality (R/S), and psychiatry aims to address: (1) organising R/S consultation in mental health care, (2) categorising research findings, and (3) pro...

The aim of the current cross-sectional study was to estimate the prevalence of religious and spiritual (R/S) experiences and their perceived lasting influence in outpatients with bipolar disorder (BD; n = 196). A questionnaire with a range of R/S was constructed, building on the results of an earlier qualitative study. Experiences of horizontal transcendence (not necessarily referring to the divine) such as the experience of "intense happiness, love, peace, beauty, freedom" (77%) or "meaningful synchronicity" (66%) were the most prevalent. The experience of "divine presence" (vertical transcendence, referring to the divine) had a prevalence of 44%. Perceived lasting influence of the experiences was 20% to 67% of the total frequency, depending on the type. Most positive R/S experiences were significantly more related to BD I and mania, and on average, persons with BD I had more R/S experiences (mean = 4.5, SD = 2.6) than those with BD II (mean = 2.8, SD = 2.4, p = 0.000). Patient-reported R/S experiences in BD can have both R/S and pathological features.

For immigrant chronic dialysis patients, religious behavior and religious coping may have a different impact on depressive symptoms compared to native patients. This study aims to describe both cross-sectional and longitudinal associations between religious behavior and coping with symptoms of depression for 281 native and 277 immigrant dialysis patients in the Netherlands. A higher prevalence of depressive symptoms was found in immigrant compared to native patients (49% vs. 36%). No significant cross-sectional or longitudinal associations were found in both groups between religious behavior and positive religious coping with depressive symptoms. Strong significant cross-sectional associations were found between negative religious coping items and depressive symptoms in both groups, while no longitudinal associations were found. So, similar impact of religiousness on the presence of depressive symptoms was found for both native and immigrant dialysis patients. Therefore, these results do not explain the higher prevalence of depressive symptoms found in immigrant chronic dialysis patients compared to native patients.

© 2016 Taylor & Francis. ABSTRACT: The Dutch Questionnaire of God Representations (QGR) was investigated by means of item response theory (IRT) modeling in a clinical (n = 329) and a nonclinical sample (n = 792). Through a graded response model and IRT-based differential functioning techniques, detailed item-level analyses and information about measurement invariance between the clinical and nonclinical sample were obtained. On the basis of the results of the IRT analyses, a shortened version of the QGR (S-QGR) was constructed, consisting of 22 items, which functions in the same way in both the clinical and the nonclinical sample. Results indicated that the QGR consists of strong and reliable scales which are able to differentiate among persons. Psychometric characteristics of the S-QGR were adequate. ispartof: International Journal for the Psychology of Religion vol:26 issue:2 pages:152-166 status: published

In Western countries, professionals in mental health care (“professionals”) tend to be less religious than “consumers”. This qualitative study explores the meaning of this “religiosity gap” for professionals and consumers in mental health care. Both a regular, secular and a Christian clinic in the Netherlands participated in this study. Content analysis was applied to 35 consumer interviews and 18 interviews with professionals. Consumers reported negative experiences (e.g., perceived disrespect and a lack of confidence) and/or negative expectations (e.g., misunderstanding and misinterpretation) related to a religiosity gap. They also mentioned advantages of a “religiosity match”, like safety and confidence and appreciated professionals’ religious/spiritual self-disclosure. Professionals in secular care setting tended to avoid religion and spirituality. In both clinics, they tended to neutralise religious/spiritual differences and be reticent in self-disclosure. Professionals are recommended to recognise the relevance of a religiosity gap and to consider different strategies in approaching religion/spirituality.

The authenticity of religious and spiritual experiences during mania is an important subject for bipolar patients. The exploration of such experience in bipolar disorder is the central point of this qualitative study. A psychiatrist and a hospital chaplain conducted 35 semi-structured interviews with recovered participants, recruited from mental health care institutions in the Netherlands, the patients' association and via the internet, about their religious and spiritual experiences during illness episodes and in stable times. A variety in types (such as divine presence, unity, mission, meaningful synchronicity) during mania was reported, which were on a sliding scale with experiences/views in stable times in more than half of the interviews. During depression, absence of religious or spiritual experience was predominant. The reported experiences were viewed by most participants as both authentically religious or spiritual but also related to the disorder, requiring therefore language that transcended medical terminology. Also indicated is the relevance of the results for fundamental discussions about the nature or religious experience.

Recent studies suggested a favorable association between the ethnic density of the neighborhood and the risk of psychotic disorders among ethnic minorities. In this study, it was investigated whether this so-called 'ethnic density hypothesis' is also relevant to suicide risk, which is not sensitive to bias associated with ethnic differences in access to health care and reflects a broad range of mental health problems.Suicides in the four big cities in the Netherlands during 2000-2011 were ascertained using the cause of death register of Statistics Netherlands and analyzed in a multilevel Poisson model in relation to individual- and neighborhood-level characteristics.With increasing non-Western minority density, the adjusted rate ratio (RR) of suicide in non-Western immigrants compared to native Dutch persons decreased from 0.69 to 0.39 (P0.001). This was explained by higher suicide rates among Dutch persons (RR = 1.28, P = 0.048) and lower rates among non-Western persons (RR = 0.72, P = 0.004) in neighborhoods with high (55.9 %) compared to neighborhoods with low non-Western minority density (36.5 %). Similar results were found for Turkish, Moroccan, Surinamese/Antillean and other non-Western subgroups separately. Compared to personally matched controls, non-Western cases (i.e., those who committed suicide) more often moved house to own-group high-dense areas and less often to own-group low-dense areas in the 5 years prior to suicide.Our findings support the beneficial influence of the presence of the own ethnic group in the neighborhood on suicide risk among non-Western minorities. As moving to minority more dense areas prior to suicide was observed, this influence of ethnic density as measured on population level may have been underestimated.

Gerotranscendence defines a shift in meta-perspective from earlier materialistic and pragmatic concerns, toward more cosmic and transcendent ones in later life. Population-based studies that have empirically examined this concept using Tornstam's gerotranscendence scale, highlight cosmic transcendence as a core component, which includes a sense of belongingness with past and future generations. Such generative concerns may increase expectations regarding the quality of the bond with one's children in later life. This study examined whether the association between emotional support exchanged with children and feelings of loneliness later in life varied by the degree of cosmic transcendence of the older parent. Data from 1,845 older parents participating in a population-based study living in The Netherlands were analyzed from the 1995/1996 cycle of the Longitudinal Aging Study Amsterdam. Interviews included self-report measures of cosmic transcendence, loneliness, emotional support exchanged with children, health indicators, and marital status. Results indicated that a negative association between loneliness and level of emotional support exchanged with children was more pronounced among older parents with higher cosmic transcendence scores, in particular among the married. It is argued that cosmic transcendence reflects a sense of generativity and an increased emotional dependency on children in later life. Under favorable social conditions (supportive relationships with children and being married) cosmic transcendent views had a positive impact on social well-being in later life. When children no longer met emotional needs of older parents, cosmic transcendence increased feelings of loneliness. © Springer-Verlag 2006.

Background In the epidemiology of late life depression, few insights are available on the co-occurrence of subthreshold depression and comorbid symptoms of anxiety. The current study aims to describe prevalence patterns of comorbid anxiety symptoms across different levels of depression in old age, and to describe the burden of depressive symptoms and functional disability across patterns of comorbidity. Methods Respondents were older adults in the community, age 65–104 (N=14,200), from seven European countries, with in total nine study centres, collaborating in the EURODEP concerted action. Depression and anxiety were assessed using the Geriatric Mental State examination (GMS-AGECAT package), providing subthreshold level and case-level diagnoses. Presence of anxiety symptoms was defined as at least three distinct symptoms of anxiety. Number of depressive symptoms was assessed with the EURO-D scale. Results The prevalence of anxiety symptoms amounts to 32% for respondents without depression, 67% for those with subthreshold depression, and 87% for those with case-level depression. The number of depressive symptoms is similar for those with subthreshold-level depression with comorbid anxiety, compared to case-level depression without symptoms of anxiety. In turn, at case level, comorbid symptoms of anxiety are associated with higher levels of depressive symptoms and more functional disability. Limitations GMS-AGECAT is insufficiently equipped with diagnostic procedures to identify specific types of anxiety disorders. Conclusions Anxiety symptoms in late life depression are highly prevalent, and are likely to contribute to the burden of symptoms of the depression, even at subthreshold level.

Objectives: Gerotranscendence has been defined as a developmental shift in meta-perspective from a materialistic and pragmatic view to a more cosmic and transcendent view. Although gerotranscendence has been argued to increase with age and life experiences, the results have been mixed and based on cross-sectional studies. We use a longitudinal setting to investigate the role of negative life events, age, and gender on change in one dimension of gerotranscendence, cosmic transcendence. Method: 1569 individuals (ages 58-89) answered a questionnaire on cosmic transcendence in two cycles of the Longitudinal Aging Study Amsterdam in 1995-1996 (time 1) and 1998-1999 (time 2). Controlling for education, marital status, religious affiliation, chronic diseases, functional limitations, depressive symptoms, and social support, change models based on structural equation modeling were fitted to the data to test whether negative life events, age, and gender were associated with change in cosmic transcendence. Results: A higher number of negative life events, especially negative life events other than deaths of others, were associated with increased cosmic transcendence, whereas experiencing no negative life events was associated with decreased cosmic transcendence. The level of cosmic dimension was higher at older than younger ages. Cosmic transcendence decreased over time among the older participants and women, whereas it increased among the younger participants and men. Conclusion: Experiencing negative life events has the potential to promote the development of cosmic transcendence, even when controlling for age and gender. In the absence of negative life events, however, cosmic transcendence was observed to decline with aging. © 2013 Taylor & Francis.

Objectives Growing evidence shows several possible relations between religiousness and late-life depression. Emotional aspects of religiousness such as facets of the perceived relationship with God can be crucial in this connection. The aim of the current study was to examine the association between the course of late-life depression and feelings about God and religious coping. Design Longitudinal survey study; naturalistic; 12-year follow-up. Setting Longitudinal Aging Study Amsterdam; population-based, in three regions in The Netherlands. Participants A subsample of 343 respondents (mean age: 77.2 years), including all respondents with high levels of depressive symptoms at any measurement cycle between 1992 and 2003 (assessed by using the Center for Epidemiologic Studies Depression Scale and the Diagnostic Interview Schedule) and a random sample of nondepressed respondents who completed a postal questionnaire in 2005. Measurements Scales on God Image and Religious Coping. Twelve-year depression course trajectories serve as predicting variables and are specified according to recency and seriousness. Results Persistent and emergent depression are significantly associated with fear of God, feeling wronged by God, and negative religious coping. In terms of negative religious coping, significant associations were observed after adjustment for concurrent depression with a history of repeated minor depression and previous major depression. Conclusions Late-life depression seems to maintain a pervasive relationship over time with affective aspects of religiousness. Religious feelings may parallel the symptoms of anhedonia or a dysphoric mood and could represent the experience of an existential void.

Background: Studies on trends in the self-rated health (SRH) of older people have shown conflicting results, which might partly be explained by changing associations between SRH and indicators of other health dimensions over time. Therefore, this study investigates 17-year time trends in older adults' poor SRH, in the context of trends in chronic diseases and disability, between 1992 and 2009. Methods: Data originate from six measurement waves of the Longitudinal Aging Study Amsterdam (N = 4009, ages 60-85 years). SRH was assessed with the question 'How is your health in general?' The presence of lung disease, cardiac disease, peripheral arterial disease, diabetes mellitus, stroke, arthritis and cancer was assessed by self-report. Two severity levels of disability were assessed with six questions on physical functioning. Generalized Estimating Equations (GEE) analysis was applied to assess statistical significance in each time trend. Results: There was a stable trend in the prevalence of poor SRH and severe disability, while the mean number of chronic diseases (1.3-1.8) and the prevalence of mild disability (20.5-32.1%) increased between 1992 and 2009. The association between poor SRH and chronic diseases became weaker, whereas the association between poor SRH and severe disability became stronger over time. Most unfavourable trends were observed in the older old and the lower educated. Conclusion: Our results suggest that the seeming stability of poor SRH hides underlying increases in chronic diseases and disability: over time, people may attach importance to different aspects of health when rating their overall health. © 2012 The Author. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Aim Studies have shown better predictive value of self-rated health (SRH) for mortality when prospective change in SRH is considered. However, retrospective change is more feasible and might have better sensitivity to objective health changes. This study compares the predictive value for mortality of retrospectively measured change in SRH (based on a “then-test”) with current SRH and prospectively measured change in SRH. Methods Data from two waves of the Longitudinal Aging Study Amsterdam (2001–2003 and 2005–2006 [T0], n = 1894) were used. Retrospective change was defined as the difference between SRH at T0 (“current SRH”) and SRH measured with a then-test at T0, asking for a renewed judgement of one's health at the previous wave. Prospective change was defined as change in SRH between the two waves. We applied Cox proportional hazards analysis to predict 5-year mortality. Results Having poorer current SRH significantly predicted mortality (HR poor vs very good SRH = 4.42). Declined SRH was associated with higher mortality risk, but only when measured prospectively (one point decline vs no change HR = 1.33; two points decline HR = 1.95). After adjusting for current SRH, neither change measure predicted mortality. Results were similar in subgroups that did and did not experience incident diseases or limitations between the two waves. Conclusions Neither retrospective, nor prospective changes in SRH improved the prediction of mortality in older adults over current SRH. These results imply that using a standard single indicator for self-rated health in research or clinical practice might suffice to identify those with a high risk of future negative health outcomes. Geriatr Gerontol Int 2013; 13: 678–686.

Objectives Gerotranscendence is defined as a transition from a materialistic and rationalistic perspective to a more cosmic and transcendent view of life accompanying the aging process. Would gerotranscendence levels still increase in later life? The current prospective study investigates 10-year trajectories of cosmic transcendence (a core dimension of gerotranscendence). Methods Four interview cycles of the Longitudinal Aging Study Amsterdam with 3-year intervals from 1995 to 2006 provide data on cosmic transcendence, demographics (ages 57–85), religiousness, health, sense of mastery, and humor coping. Data are available for 2,257 respondents and 1,533 respondents in multivariate models. Results Latent Class Growth Analysis shows three course trajectories of cosmic transcendence: stable high, intermediate with a decrease, and stable low. Higher levels are predicted by age, importance of prayer, Roman Catholic affiliation, a low sense of mastery, higher cognitive ability, and humor coping. Similar results were obtained for the respondents who died during the study ( N = 378). Discussion Although levels of cosmic transcendence do not show much change during 10 years of follow-up, the oldest respondents nonetheless attain the highest cosmic transcendence levels. An inclination toward relativism and contemplation may facilitate cosmic transcendence. However, lower cognitive ability probably impairs the development toward cosmic transcendence.

Objective:Itis not clear whether the prevalence of psychosis increases withage. We studied the age-specific prevalence of psychotic symptoms in older people in Western Europe. Methods:Older people without dementia (age 65–104years, N=8762) from the western part of Europe in the EURODEP concerted action took part in psychiatric examinations. Results: In total, 2.4% of the men and 2.9% of the women had psychotic symptoms. Using a multilevel logistic regression model that included gender and age as a continuous variable, we found that a 5-year increase in age increased the prevalence of psychotic symptoms (odds ratio 1.2 95% confidence interval 1.06–1.3, p=0.001). A second multilevel regression model showed that wishing to be dead, depressed mood, functionaldisability, not being married and cognitive impairment measured with Mini mental state examination were all associated with psychotic symptoms whereas gender was not. Conclusion: The prevalence of psychotic symptoms in non-demented older people increases with age, and these symptoms are associated with other psychopathology, social isolation and problems with daily living. Copyright # 2012 John Wiley & Sons, Ltd.

A young woman hospitalized herself for a picture resembling Stockholm syndrome (becoming a willing captive in a cult, sympathetic to the leader). After a short period of time, it became clear that she had used a false identity and had invented the story, leading to diagnoses of both Munchausen syndrome and dissociative identity disorder. Despite a long period of treatment, she eventually suicided. The authors examine the coexistence of these two unusual disorders and their possible shared etiologies in this complex case. (Journal of Psychiatric Practice 2012;18:296-303) Copyright © 2012 Lippincott Williams & Wilkins Inc.

Clergy members (CMs) frequently offer support and counselling for people withmental health problems. The current study aims to obtain insight into the abilityamong CMs to recognise psychopathology and need for psychiatric treatment. Arandom sample of CMs (N ¼ 143) and a control sample of mental healthprofessionals (MHPs, N ¼ 73), were compared as to their evaluations of fourvignettes. CMs considered the psychiatric states to be related to religious orspiritual problems to a similar degree as they did for the non-psychiatric states.Sensitivity of CMs with regard to the need of psychiatric care for the psychiatricstates was modest (66%) and differed significantly from MHPs (96%). Specificityof the CMs was 89%, which was significantly lower than the MHPs (97%). TheCMs did recognise psychopathology with religious content but clearly to a lowerextent than MHPs. Requests by CMs for education about recognising psychopathology may be considered as justified.

Objective: Evidence shows that self-rated health (SRH) remains remarkably stable during aging. Individuals may change their conceptualization of health or revise their standard of good health when facing health decline. Although this "response shift" phenomenon is potentially beneficial to the individual, it also challenges comparison of SRH assessments over time. The present study investigates this response shift. Study Design and Setting: Data come from two waves (T1 and T2) of the Longitudinal Aging Study Amsterdam (N: 1,274; age: 55-89 years; mean follow-up: 3.6 years). Linear regression models were used for predicting SRH at T1 and T2. To capture changes in individual health standards, we administered a then-test at T2, asking respondents to retrospectively rate their health at T1 again. Results: No support was found for a changed conceptualization of SRH after health decline: predictive models for SRH at T1 and T2 were not significantly different. In the subgroup that reported identical SRH at T1 and T2, participants who experienced incident diseases were three times more likely to retrospectively overrate health at T1 with the then-test, suggesting that they had a lowered health standard. Conclusion: Older people's concept of health remains stable when they encounter significant health problems, but they potentially lower their standard of good health over time. © 2012 Elsevier Inc. All rights reserved.