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BackgroundKnowledge of the risk of recurrence after recovery from major depressive disorder (MDD) in the general population is scarce.MethodData were derived from 687 subjects in the general population with a lifetime DSM-III-R diagnosis of MDD but without a current major depressive episode (MDE) or dysthymia. Participants had to be at least 6 months in remission, and were recruited from The Netherlands Mental Health Survey and Incidence Study (NEMESIS), using the Composite International Diagnostic Interview (CIDI). Recency and severity of the last MDE were assessed retrospectively at baseline. Recurrence of MDD was measured prospectively during the 3-year follow-up. Kaplan–Meier survival curves were used to measure time to recurrence. Determinants of time to recurrence were analyzed using proportional hazard models.ResultsThe estimated cumulative recurrence of MDD was 13.2% at 5 years, 23.2% at 10 years and 42.0% at 20 years. In bivariate analysis, the following variables predicted a shorter time to recurrence: younger age, younger age of onset, higher number of previous episodes, a severe last depressive episode, negative youth experiences, ongoing difficulties before recurrence and high neuroticism. Multivariably, younger age, a higher number of previous episodes, a severe last depressive episode, negative youth experiences and ongoing difficulties remained significant.ConclusionsIn this community sample, the long-term risk of recurrence was high, but lower than that found in clinical samples. Subjects who had had an MDE had a long-term vulnerability for recurrence. Factors predicting recurrence included illness- and stress-related factors. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND: It has recently been proposed that major depression disorder (MDD) may, in a heterogeneous population-based cohort, be interpreted in terms of a random-mood model. Mood fluctuations are thought to result from stressors that occur randomly in time. We have investigated whether this concept also holds for more homogeneous groups, defined by known determinants for MDD, and whether the model's parameters, susceptibility (Z) and relaxation time (T), may be evaluated and used to differentiate between subcohorts.MethodFrom a large epidemiological survey, the Netherlands Mental Health Survey and Incidence Study (NEMESIS), data on the duration of MDD were obtained for subcohorts, based on gender, severity of depression, recurrence and co-morbidity with dysthymia, anxiety and somatic disorder, and were compared with random-mood simulation calculations. RESULTS: Susceptibility, Z, is empirically found to be proportional to incidence and may be identified with a risk ratio. A second scaling rule states the proportionality of mean duration with the product of Z and T. This Z-T classification proves to be more sensitive than conventional significance tests. Notably for men/women and for co-morbid anxiety, differences are seen that have previously gone unnoticed. CONCLUSIONS: Depression may be conceptualized as a disorder resulting from random-mood fluctuations, the response to which is influenced by a large variety of determinants or risk factors. The model's parameters can be evaluated and may be used in differentiating between risk factor-defined subgroups. [ABSTRACT FROM AUTHOR]

Background: The long-term course of anxiety, depression and the comorbid disorder is not well understood. Methods: Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective population based study and the Netherlands Study of Depression and Anxiety (NESDA), also a prospective study with patients form primary and specialist outpatient care. Results: The two year course of anxiety and depression in NESDA is best for depressive disorders, than for anxiety disorders and worse for the comorbid anxiety-depressive disorders with a median duration of depression 6 months, anxiety 16 months and comorbid depression-anxiety >24 months. Severity of the index episode, longer duration at baseline and early onset are predictors of a unfavourable course. Avoidance behaviour seems to predict a longer duration for the anxiety disorders. The course of major depressive disorder (MDD) in NEMESIS is better than for dysthymia and double depression. The cumulative incidence of recurrence of MDD after 20 years is 42% and recurrence is predicted by younger age of onset, previous episodes, severity of index episode, daily hassles and negative youth experiences. Conclusions: The long-term course anxiety and depression is unfavourable, especially for the comorbid condition Recurrence of MDD is high, even in the general population. Knowledge of the predictors of unfavourable course may help to distinguish the patients at risk. [ABSTRACT FROM AUTHOR]

Aims: Risk factors for the onset of bipolar disorder and factors influencing recognition were examined in a general population sample. Method: In the Netherlands Mental Health Survey and Incidence Study (NEMESIS) symptoms of depression, mania, psychosis and substance use were assessed among 7076 respondents with the Composite International Diagnostic Interview at baseline, after one and after three years. In a reappraisal study among 40 respondents with bipolar disorder confirmed by the Structured Clinical Interview for DSM-IV (SCID) data on illness and treatment history were collected. Results: Predictive values of subclinical depression and (hypo)mania for bipolar disorder ranged from 14.3% to 50%. Cannabis use at baseline increased the risk for manic symptoms during follow-up (OR 2.70, 95%CI:1.54-4.75) (Henquet et al., 2006). Comorbid subclinical psychosis in respondents with subclinical mania had predictive value for future diagnosis of bipolar disorder (positive predictive value of 3% versus 10% respectively) (Kaymaz et al., 2007). The majority of the respondents with a SCID diagnosis bipolar disorder consulted a health professional, only 12.5% received a diagnosis of bipolar disorder and agreed with the diagnosis. Only these respondents used a moodstabilizer and had contact with a psychiatrist. Type of bipolar disorder, number of mood episodes and age of onset did not influence recognition. Conclusion: Subclinical depression and (hypo)mania, and comorbity of subclinical psychosis and mania are predictive for future diagnosis of bipolar disorder. Cannabis use affects the expression of manic symptoms. Self-recognition of bipolar disorder is an important factor in treatment seeking and receiving adequate treatment. [Copyright &y& Elsevier]

In the Netherlands, the Depression Initiative has been launched in 2006 as a nationwide attempt to implement the Multidisciplinary Guideline for Depression and to evaluate its cost effectiveness. An evaluation of the selected strategy to implement the guidelines, a Breakthrough Collaborative, was conducted as a quasi experimental trial. The intervention group consisted of around 530 patients coming from 10 multidisciplinary teams in primary care. The intervention teams received a set of implementation strategies, as part of the Breakthrough Method, developed by the Institute for Healthcare Improvement (www.ihi.org). The aim of the participants in this implementation project was to implement guideline recommendations directed at a reduction of unnecessary antidepressant treatment for patients with mild depression, better use of effective, but minimally invasive treatment options and improved antidepressant and psychotherapeutic treatment for patients with severe symptoms. Monitoring depression severeness was also one of the goals. This guideline derived, stepped care approach was compared to Care As Usual in the primary care setting, as provided in a different study group (NESDA). Outcomes were measured in terms of quality of care provided by the general practitioner (antidepressant prescription rates) and clinical outcomes (BDI, IDS-SR, WHODAS). A process evaluation and simple economic evaluation was part of the study design. In the presentation, preliminary results will be presented. [Copyright &y& Elsevier]

Background: Twice weekly sessions of cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for major depressive disorder (MDD) lead to less drop-out and quicker and better response compared to once weekly sessions at posttreatment, but it is unclear whether these effects hold over the long run., Aims: Compare the effects of twice weekly v. weekly sessions of CBT and IPT for depression up to 24 months since the start of treatment., Methods: Using a 2 × 2 factorial design, this multicentre study randomized 200 adults with MDD to once or twice weekly sessions of CBT or IPT over 16-24 weeks, up to a maximum of 20 sessions. Main outcome measures were depression severity, measured with the Beck Depression Inventory-II and the Longitudinal Interval Follow-up Evaluation. Intention-to-treat analyses were conducted., Results: Compared with patients who received once weekly sessions, patients who received twice weekly sessions showed a significant decrease in depressive symptoms up through month 9, but this effect was no longer apparent at month 24. Patients who received CBT showed a significantly larger decrease in depressive symptoms up to month 24 compared to patients who received IPT, but the between-group effect size at month 24 was small. No differential effects between session frequencies or treatment modalities were found in response or relapse rates., Conclusions: Although a higher session frequency leads to better outcomes in the acute phase of treatment, the difference in depression severity dissipated over time and there was no significant difference in relapse.

In Colombia, the prevalence of obesity has been increasing in recent years due to changes in dietary and nutritional patterns. While previous studies have focussed on describing obesity and its associated factors, they have mainly used a cross-sectional methodology. Accordingly, this study aims to conduct a descriptive quasi-cohort analysis to capture age-specific cohort trends in body mass index (BMI) according to sex and ethnicity (indigenous, Afro-Colombian, and the remaining population). The study utilised data from the National Survey of the Nutritional Situation in Colombia (ENSIN) conducted in 2005, 2010, and 2015 that included 214,136 individuals aged 20-64 years after screening. Data on ethnicity were only available from the 2010 and 2015 surveys. Overall, the prevalence of obesity increased by 6.1 percentage points (from 15.2% to 21.3%) between 2005 and 2015 (men from 10.4% to 15.7%; women from 18.2% to 25.7%). Among Afro-Colombians, obesity rose 6.6 percentage points (from 19.4% to 26.0%), again more so in women than in men (2015: 35.2% versus 17.8%). Among indigenous people, the proportion increased by 5.3 percentage points (from 13.5% to 18.8%), with women reporting highest rates (2015: 23.7% against 12.6% in men). Age- and cohort-specific results also indicate that recent adult cohorts are experiencing sharp increases in BMI, for example, while 25-29-year-old males born in 1975-1979 had a BMI of 24.2 kg/m 2 , among 40-44-year-olds of the same cohort, this equalled 26.8 kg/m 2 . In the case of women, these age differences in BMI among the same cohort are even greater (24.4 and 28.0 kg/m 2 ). In summary, the results of this study indicate that Colombia is still in the early stages of the obesity transition, urging the need to monitor obesity trends in Colombia from both an age and cohort perspective. To achieve this, longitudinal surveys or repeated cross-sectional surveys like the ENSIN could be utilised.

Background: Cost-effective treatments are needed to reduce the burden of depression. One way to improve the cost-effectiveness of psychotherapy might be to increase session frequency, but keep the total number of sessions constant., Aim: To evaluate the cost-effectiveness of twice-weekly compared with once-weekly psychotherapy sessions after 12 months, from a societal perspective., Method: An economic evaluation was conducted alongside a randomised controlled trial comparing twice-weekly versus once-weekly sessions of psychotherapy (cognitive-behavioural therapy or interpersonal psychotherapy) for depression. Missing data were handled by multiple imputation. Statistical uncertainty was estimated with bootstrapping and presented with cost-effectiveness acceptability curves., Results: Differences between the two groups in depressive symptoms, physical and social functioning, and quality-adjusted life-years (QALY) at 12-month follow-up were small and not statistically significant. Total societal costs in the twice-weekly session group were higher, albeit not statistically significantly so, than in the once-weekly session group (mean difference €2065, 95% CI -686 to 5146). The probability that twice-weekly sessions are cost-effective compared with once-weekly sessions was 0.40 at a ceiling ratio of €1000 per point improvement in Beck Depression Inventory-II score, 0.32 at a ceiling ratio of €50 000 per QALY gained, 0.23 at a ceiling ratio of €1000 per point improvement in physical functioning score and 0.62 at a ceiling ratio of €1000 per point improvement in social functioning score., Conclusions: Based on the current results, twice-weekly sessions of psychotherapy for depression are not cost-effective over the long term compared with once-weekly sessions.

Background: The benefits of peer support interventions (PSIs) for individuals with mental illness are not well known. The aim of this systematic review and meta-analysis was to assess the effectiveness of PSIs for individuals with mental illness for clinical, personal, and functional recovery outcomes., Methods: Searches were conducted in PubMed, Embase, and PsycINFO (December 18, 2020). Included were randomized controlled trials (RCTs) comparing peer-delivered PSIs to control conditions. The quality of records was assessed using the Cochrane Collaboration Risk of Bias tool. Data were pooled for each outcome, using random-effects models., Results: After screening 3455 records, 30 RCTs were included in the systematic review and 28 were meta-analyzed (4152 individuals). Compared to control conditions, peer support was associated with small but significant post-test effect sizes for clinical recovery , g = 0.19, 95% CI (0.11-0.27), I 2 = 10%, 95% CI (0-44), and personal recovery, g = 0.15, 95% CI (0.04-0.27), I 2 = 43%, 95% CI (1-67), but not for functional recovery , g = 0.08, 95% CI (-0.02 to 0.18), I 2 = 36%, 95% CI (0-61). Our findings should be considered with caution due to the modest quality of the included studies., Conclusions: PSIs may be effective for the clinical and personal recovery of mental illness. Effects are modest, though consistent, suggesting potential efficacy for PSI across a wide range of mental disorders and intervention types.

Background: It is unclear what session frequency is most effective in cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT) for depression., Aims: Compare the effects of once weekly and twice weekly sessions of CBT and IPT for depression., Method: We conducted a multicentre randomised trial from November 2014 through December 2017. We recruited 200 adults with depression across nine specialised mental health centres in the Netherlands. This study used a 2 × 2 factorial design, randomising patients to once or twice weekly sessions of CBT or IPT over 16-24 weeks, up to a maximum of 20 sessions. Main outcome measures were depression severity, measured with the Beck Depression Inventory-II at baseline, before session 1, and 2 weeks, 1, 2, 3, 4, 5 and 6 months after start of the intervention. Intention-to-treat analyses were conducted., Results: Compared with patients who received weekly sessions, patients who received twice weekly sessions showed a statistically significant decrease in depressive symptoms (estimated mean difference between weekly and twice weekly sessions at month 6: 3.85 points, difference in effect size d = 0.55), lower attrition rates (n = 16 compared with n = 32) and an increased rate of response (hazard ratio 1.48, 95% CI 1.00-2.18)., Conclusions: In clinical practice settings, delivery of twice weekly sessions of CBT and IPT for depression is a way to improve depression treatment outcomes.

Background: Mindfulness-based cognitive therapy (MBCT) and maintenance antidepressant medication (mADM) both reduce the risk of relapse in recurrent depression, but their combination has not been studied., Aims: To investigate whether MBCT with discontinuation of mADM is non-inferior to MBCT+mADM., Method: A multicentre randomised controlled non-inferiority trial (ClinicalTrials.gov:NCT00928980). Adults with recurrent depression in remission, using mADM for 6 months or longer (n= 249), were randomly allocated to either discontinue (n= 128) or continue (n= 121) mADM after MBCT. The primary outcome was depressive relapse/recurrence within 15 months. A confidence interval approach with a margin of 25% was used to test non-inferiority. Key secondary outcomes were time to relapse/recurrence and depression severity., Results: The difference in relapse/recurrence rates exceeded the non-inferiority margin and time to relapse/recurrence was significantly shorter after discontinuation of mADM. There were only minor differences in depression severity., Conclusions: Our findings suggest an increased risk of relapse/recurrence in patients withdrawing from mADM after MBCT., (© The Royal College of Psychiatrists 2016.)

Background: Current classification of unipolar depression reflects the idea that prognosis is essential. However, do DSM categories of major depressive disorder (MDD), dysthymic disorder (Dysth) and double depression (DD=MDD+Dysth) indeed adequately represent clinically relevant course trajectories of unipolar depression? Our aim was to test DSM categories (MDD, Dysth and DD) in comparison with empirically derived prognostic categories, using a prospectively followed cohort of depressed patients., Method: A large sample (n=804) of out-patients with unipolar depression were derived from a prospective cohort study, the Netherlands Study of Depression and Anxiety (NESDA). Using latent class growth analysis (LCGA), empirically derived 2-year course trajectories were constructed. These were compared with DSM diagnoses and a wider set of putative predictors for class membership., Results: Five course trajectories were identified, ranging from mild severity and rapid remission to high severity and chronic course trajectory. Contrary to expectations, more than 50% of Dysth and DD were allocated to classes with favorable course trajectories, suggesting that current DSM categories do not adequately represent course trajectories. The class with the most favorable course trajectory differed on several characteristics from other classes (younger age, more females, less childhood adversity, less somatic illnesses, lower neuroticism, higher extraversion). Older age, earlier age of onset and lower extraversion predicted poorest course trajectory., Conclusions: MDD, Dysth and DD did not adequately match empirically derived course trajectories for unipolar depression. For the future classification of unipolar depression, it may be wise to retain the larger, heterogeneous category of unipolar depression, adopting cross-cutting dimensions of severity and duration to further characterize patients.

Background: Data on the duration of major depressive episodes (MDE) in the general population are sparse., Aims: To assess the duration of MDE and its clinical and socio-demographic determinants in a study group drawn from the general population with newly originated episodes of major depression., Method: The Netherlands Mental Health Survey and Incidence Study is a prospective epidemiological survey in the adult population (n=7076), using the Composite International Diagnostic Interview. Duration of MDE over 2 years was assessed with a Life Chart Interview., Results: The median duration of MDE was 3.0 months; 50% of participants recovered within 3 months, 63% within 6 months, 76% within 12 months and nearly 20% had not recovered at 24 months. Determinants of persistence were severity of depression and comorbid dysthymia. A recurrent episode predicted shorter duration., Conclusions: Although half of those affected with MDE recovered rapidly, the risk of chronicity (duration 24 months or more) was considerable. This underlines the necessity of diagnosing and treating those at risk.