Search

Objectives Research suggests that military personnel frequently delay disclosing mental health issues and illness (MHI), including substance use disorder, to supervisors. This delay causes missed opportunities for support and workplace accommodations which may help to avoid adverse occupational outcomes. The current study aims to examine disclosure-related beliefs, attitudes and needs, to create a better understanding of personnel’s disclosure decision making. Design A cross-sectional questionnaire study among military personnel with and without MHI. Beliefs, attitudes and needs regarding the (non-)disclosure decision to a supervisor were examined, including factors associated with (non-)disclosure intentions and decisions. Descriptive and regression (logistic and ordinal) analyses were performed. Setting The study took place within the Dutch military. Participants Military personnel with MHI (n=324) and without MHI (n=554) were participated in this study. Outcome measure (Non-)disclosure intentions and decisions. Results Common beliefs and attitudes pro non-disclosure were the preference to solve one’s own problems (68.3%), the preference for privacy (58.9%) and a variety of stigma-related concerns. Common beliefs and attitudes pro disclosure were that personnel wanted to be their true authentic selves (93.3%) and the desire to act responsibly towards work colleagues (84.5%). The most reported need for future disclosure (96.8%) was having a supervisor who shows an understanding for MHI. The following factors were associated both with non-disclosure intentions and decisions: higher preference for privacy (OR (95% CI))=(1.99 (1.50 to 2.65)intention, 2.05 (1.12 to 3.76)decision) and self-management (OR (95% CI))=(1.64 (1.20 to 2.23)intention, 1.79 (1.00 to 3.20)decision), higher stigma-related concerns (OR (95% CI))=(1.76 (1.12 to 2.77)intention, 2.21 (1.02 to 4.79)decision) and lower quality o

Since the Dutch tolerance policy, allowing the purchase of cannabis in ‘coffeeshops’, is associated with problems of public order and safety as well as health risks, there has been a long debate about legalisation of cannabis production and supply. It was therefore decided to conduct an experiment with a controlled legal (‘closed’) cannabis supply chain for recreational use. This is of international relevance in view of the current illegal cannabis exports from the Netherlands, the importance of sharing knowledge about the effectiveness of cannabis policies, and the accumulation of evidence needed to evaluate and update international treaties. Here we describe and discuss the background, general approach and design of the experiment. An independent expert committee elaborated how the closed chain will operate and be evaluated, based on the experience with the medicinal cannabis chain, and round table discussions with stakeholders (mayors, coffeeshop owners, cannabis consumers, growers, regulators, scientists, and addiction experts). Ten trusted cannabis growers are contracted to produce and supply cannabis to the coffeeshops in intervention municipalities, with product quality control, law enforcement against criminal interference, and preventive efforts to reduce health risks being implemented. No changes will be made in the cannabis supply to the coffeeshops in participating control municipalities. A process evaluation will assess whether the chain from production to sale in the intervention municipalities was really closed. In a quasi-experimental study comparing intervention and control municipalities, the chain's effects on public health, cannabis-related crime, safety and public nuisance will be estimated. The fieldwork period is expected to start early 2024 and will take four years, including reporting to the government and parliament. These will then decide whether and what further steps towards legalisation of the production and supply of cannabis will b

Previous studies have found evidence for a relationship between debt and crime, and for problems in childhood, education, work, and mental and physical health as underlying risk factors. However, insight into the interplay between these possible risk factors is limited. Therefore, a mixed methods approach was applied by both creating a quantitative Gaussian Graphical Model (GGM) and conducting qualitative analyses on 250 client files including risk assessment data from the Dutch probation service, to gain more specific insight into the interaction between potential risk factors. The results show that debt is strongly related to criminal behavior and problems in many life domains for most probation clients. Debt seems to be a direct risk factor for crime, but debt and crime also appear to be highly interrelated as part of a complex interplay of risk factors. The most frequently rated factors – limited or incomplete education, no job and related lack of income, and mental and physical health problems – are highly interwoven and increase the risk of both debt and crime. The findings stress the importance of paying attention to and using interventions focusing on strongly related crime risk factors, including debt, and their complex interplay, to supervise probation clients effectively.

Since the Dutch tolerance policy, allowing the purchase of cannabis in ‘coffeeshops’, is associated with problems of public order and safety as well as health risks, there has been a long debate about legalisation of cannabis production and supply. It was therefore decided to conduct an experiment with a controlled legal (‘closed’) cannabis supply chain for recreational use. This is of international relevance in view of the current illegal cannabis exports from the Netherlands, the importance of sharing knowledge about the effectiveness of cannabis policies, and the accumulation of evidence needed to evaluate and update international treaties. Here we describe and discuss the background, general approach and design of the experiment. An independent expert committee elaborated how the closed chain will operate and be evaluated, based on the experience with the medicinal cannabis chain, and round table discussions with stakeholders (mayors, coffeeshop owners, cannabis consumers, growers, regulators, scientists, and addiction experts). Ten trusted cannabis growers are contracted to produce and supply cannabis to the coffeeshops in intervention municipalities, with product quality control, law enforcement against criminal interference, and preventive efforts to reduce health risks being implemented. No changes will be made in the cannabis supply to the coffeeshops in participating control municipalities. A process evaluation will assess whether the chain from production to sale in the intervention municipalities was really closed. In a quasi-experimental study comparing intervention and control municipalities, the chain's effects on public health, cannabis-related crime, safety and public nuisance will be estimated. The fieldwork period is expected to start early 2024 and will take four years, including reporting to the government and parliament. These will then decide whether and what further steps towards legalisation of the production and s

For a long time already, attempts have been made to bridge the gap between research and practice. In this respect, society demands that universities should have a bigger social impact. University and society/societal organizations should work together (co-create) during the entire research process, from the articulation of the research question until the implementation of the results. There is controversy about the question whether it is possible for universities to work together with practice and at the same time to retain the academic quality standards. First, this article deals with the question what characteristics are important for universities in order to be able to work together with practice. In this respect, the Dutch scientist Steinbuch came up with a tantalizing idea arguing that universities may take a next step and develop into ‘fourth generation universities’. Second, it is described how a process of co-creation between university and the health promotion practice has been developed, bottom up, at Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, the Netherlands. The ideas developed by Steinbuch and the results of the bottom up processes in Tilburg are combined. Consequences of the Tilburg experiences for the characteristics of a fourth-generation university are discussed as well as consequences for the role of universities in society.

Purpose Little is known about effective supervision of offenders with debt. This multiple case study aims to gain insight into working elements in offender supervision on debt. This is important for probation officers to choose the most effective interventions in daily offender supervision. Design/methodology/approach This study included five best practice cases based on both interviews with involved professionals and clients and client file information. One case was described in detail to illustrate what probation officers and clients encounter when working on debt. All five cases were analyzed thematically using pattern matching techniques and crosscase syntheses on debt background, current supervision, barriers and working elements. Findings Organization processes and lack of aftercare hinder effective supervision. Close collaboration with other professionals (e.g. debt counselors) is important in supervising clients with debt. The client’s own behavior and motivation for supervision are crucial in the success of debt supervision and can be both hindering and effective. Working elements in supervision depend on personal characteristics of professionals involved and on the extent to which elements of a working alliance, particularly trust and bonding, are built. Practical implications Support and facilitation from probation organizations regarding primary conditions and collaboration, training professionals in methods of stimulating clients motivation and an effective working alliance are essential to supervise clients with debt adequately. Originality/value To the best of the authors’ knowledge, no other in-depth study has yet been conducted on working elements in supervision of probationers with debt.

Background A need-supportive group climate is a prerequisite for successful treatment in secure residential youth care. For girls, positive relationships with peers are an essential part of the group climate. Relational aggression threatens the residential group climate. Objectives This study explored whether a group counseling program can actively promote the quality of the interrelationships between girls in a residential group in the Netherlands; the aim is to elucidate how residential group climate affects treatment results. The girls in this single-gender residential group had been admitted because of (suspicions of) commercial sexual exploitation. Method The study combined participatory observations with a case-based time-series design. For 18 weeks, changes in the residential group climate and the interrelationships between the girls and achievement of treatment goals over time were measured. Results The residential group climate in this group was negative initially; much relational aggression between girls was found. Considering treatment, some girls were making significant progress, but others mainly deteriorated. Moderate improvement of residential group climate was visible after a group social worker was permanently present. Conclusions A group counseling program aimed at improving interrelationships cannot cure an overall negative residential group climate. This article offers implications for preventing and recognizing deterioration of residential group climate and improving girls' residential group climate.

Around 2009, ‘recovery’ was introduced in the Netherlands as a new approach to drug addiction and addiction services. Recovery is now featured in practice-level policy but is absent in governmental drug policy. To investigate whether the Dutch recovery vision is coherent with governmental drug policy, we apply Bacchi’s What’s the problem represented to be? approach to analyse problematizations of ‘drug addiction’. We analysed two influential practice-level policy documents and one governmental drug policy document. We found that governmental policy addresses the harms and public nuisance of drug addiction, whilst practice-level policy addresses the wellbeing of persons with addiction. Despite these different starting points, the Dutch recovery vision seems coherent with both problematizations. Its adoption in the Netherlands was less subject to political debate compared to other countries. This may be a result of recovery being driven by bottom-up efforts without government intervention, leading to constructive ambiguity between government- and practice-level policies.

Although studies point to a relationship between debt and crime, there is a limited understanding of their reciprocal relationship and possible mediating risk factors. Moreover, knowledge about the prevalence and scope of debt among offenders is lacking. Therefore, the present study analyzed 250 client files including risk assessment data from the Dutch probation service on the prevalence of debt and possibly related risk factors. The results show that debt is highly prevalent and complex, which underlines the importance of acquiring more knowledge about debt as a potential risk factor for relapse during supervision. It was found that problems with regard to childhood and living situation, education and work/daytime activities, and mental and physical health may be possible underlying risk factors in the relationship between debt and crime. These insights can help professionals adequately support clients with regard to debt in order to prevent recidivism.

Problematic alcohol use has been increasing in older adults (55+) in recent decades. Many of the effective interventions that are available to prevent or reduce the negative effects of alcohol consumption are aimed at adults in general. It is unclear whether these interventions also work for older adults. The objective of this review was to understand how (i.e., which elements), in which context, and why (which mechanisms) interventions are successful in preventing or reducing (problematic) alcohol consumption among older adults. A systematic review of articles published between 2000 and 2022 was performed using PubMed, PsycINFO, Web of Science and CHINAHL. Realist evaluation was used to analyze the data. We found 61 studies on interventions aimed at preventing or reducing problematic alcohol use. Most of the interventions were not specifically designed for older adults but also included older adults. The findings of the current study highlight three major effective elements of interventions: (1) providing information on the consequences of alcohol consumption; (2) being in contact with others and communicating with them about (alcohol) problems; and (3) personalized feedback about drinking behavior. Two of these elements were also used in the interventions especially designed for older adults. Being in contact with others and communicating with them about (alcohol) problems is an important element to pay attention to for developers of alcohol interventions for older adults because loneliness is a problem for this age group and there is a relationship between the use of alcohol and loneliness.

Doel Veel werknemers in hoogrisicoberoepen, zoals militairen, worden op het werk blootgesteld aan stressoren. Dit verhoogt het risico op het ontwikkelen van psychische klachten (inclusief verslaving). Het kunnen bespreken van psychische klachten met de leidinggevende of collega’s kan positieve gevolgen hebben voor het werk, zoals sociale steun en werkaanpassingen, maar het kan ook leiden tot negatieve gevolgen zoals stigma en discriminatie. Dit maakt de keuze om wel of niet open te zijn over psychische klachten en verslaving een complex dilemma met gevolgen voor gezondheid, welzijn en duurzame inzetbaarheid. Het doel van de huidige studie was de belemmerende en bevorderende factoren voor het bespreken van psychische klachten in de werkomgeving bij militairen in kaart te brengen, vanuit meerdere perspectieven. Methode Een kwalitatieve focusgroepstudie binnen de Nederlandse krijgsmacht vanuit verschillende perspectieven is uitgevoerd. De focusgroepgesprekken zijn opgenomen en getranscribeerd. Inhoudsanalyse met inductieve benadering werd uitgevoerd in het softwareprogramma Atlas.ti. Deelnemers In totaal hebben 46 mensen deelgenomen, verdeeld over 8 homogene focusgroepen, die drie perspectieven vertegenwoordigden: militairen met psychische klachten (N=20), militairen zonder psychische klachten (N=10) en militaire zorgprofessionals (N=16). Resultaten Er werden vijf belemmerende factoren gevonden voor het bespreken van psychische klachten in de werkomgeving: (1) angst voor negatieve carrière consequenties, (2) angst voor sociale afwijzing, (3) gebrek aan steun vanuit de leidinggevende, (4) het moeilijk vinden te praten over psychische klachten en (5) de werkcultuur waarin mensen geacht worden sterk te zijn. Er zijn ook drie bevorderende factoren gevonden: (1) verwachte positieve gevolgen van openheid (dat je beter kan worden en dat je openheid anderen kan helpen), (2) steun vanuit de leidinggevende en (3) psychische kla

Background Often, military personnel do not seek treatment for mental illness or wait until they reach a crisis point. Effective, selective, and indicated prevention is best achieved by seeking treatment early. Aims We aimed to examine military personnel's attitudes, beliefs, and needs around seeking treatment for mental illness. We compared those who sought treatment to those who did not and those with and without the intention to seek treatment. Finally, we examined factors associated with intentions of not seeking treatment. Method We conducted a cross-sectional questionnaire study of military personnel with (N = 324) and without (N = 554) mental illness. Descriptive and regression analyses (logistic and ordinal) were performed. Results The majority of the personnel believed treatment was effective (91.6%); however, most preferred to solve their own problems (66.0%). For personnel with mental illness, compared to those who sought treatment, those who did not had a higher preference for self-management and found advice from others less important. For those without mental illness, those with no intention to seek treatment indicated a higher preference for self-management, stigma-related concerns, denial of symptoms, lower belief in treatment effectiveness and found it less important to be an example, compared to those with treatment-seeking intentions. A clear indication of where to seek help was the most reported need (95.7%). Regression analyses indicated that not seeking treatment was most strongly related to preference for self-management (OR(95%CI) = 4.36(2.02–9.39); no intention to seek treatment was most strongly related to a lower belief that treatment is effective (OR(95%CI) = .41(0.28–0.59) and with not having had positive earlier experiences with treatment seeking (OR(95%CI) = .34(0.22–0.52). Conclusions To facilitate (early) treatment seeking, interventions should align with a high preference for s

We aimed to obtain reliable reference charts for sleep duration, estimate the prevalence of sleep complaints across the lifespan and identify risk indicators of poor sleep. Studies were identified through systematic literature search in Embase, Medline and Web of Science (9 August 2019) and through personal contacts. Eligible studies had to be published between 2000 and 2017 with data on sleep assessed with questionnaires including ≥100 participants from the general population. We assembled individual participant data from 200,358 people (aged 1–100 years, 55% female) from 36 studies from the Netherlands, 471,759 people (40–69 years, 55.5% female) from the United Kingdom and 409,617 people (≥18 years, 55.8% female) from the United States. One in four people slept less than age-specific recommendations, but only 5.8% slept outside of the ‘acceptable’ sleep duration. Among teenagers, 51.5% reported total sleep times (TST) of less than the recommended 8–10 h and 18% report daytime sleepiness. In adults (≥18 years), poor sleep quality (13.3%) and insomnia symptoms (9.6–19.4%) were more prevalent than short sleep duration (6.5% with TST < 6 h). Insomnia symptoms were most frequent in people spending ≥9 h in bed, whereas poor sleep quality was more frequent in those spending <6 h in bed. TST was similar across countries, but insomnia symptoms were 1.5–2.9 times higher in the United States. Women (≥41 years) reported sleeping shorter times or slightly less efficiently than men, whereas with actigraphy they were estimated to sleep longer and more efficiently than man. This study provides age- and sex-specific population reference charts for sleep duration and efficiency which can help guide personalized advice on sleep length and preventive practices.

Background Substance use disorders (SUDs) are prevalent in the general population, tend to follow a chronic course, are associated with many individual and social problems, and often have their onset in adolescence. However, the knowledge base from prospective population surveys and treatment-outcome studies on the course of SUD in adolescents is limited at best. The present study aims to fill this gap and focuses on a subgroup that is particularly at risk for chronicity: adolescents in addiction treatment. We will investigate the rate of persistent SUD and its predictors longitudinally from adolescence to young adulthood among youth with DSM-5 SUD from the start of their addiction treatment to 2 and 4 years following treatment-entry. In addition to SUD, we will investigate the course of comorbid mental disorders, social functioning, and quality of life and their association with SUD over time. Methods/design In a naturalistic, multi-center prospective cohort design, we will include youths (n = 420), who consecutively enter addiction treatment at ten participating organizations in the Netherlands. Inclusion is prestratified by treatment organization, to ensure a nationally representative sample. Eligible youths are 16 to 22 years old and seek help for a primary DSM-5 cannabis, alcohol, cocaine or amphetamine use disorder. Assessments focus on lifetime and current substance use and SUD, non-SUD mental disorders, family history, life events, social functioning, treatment history, quality of life, chronic stress indicators (hair cortisol) and neuropsychological tests (computerized executive function tasks) and are conducted at baseline, end of treatment, and 2 and 4 years post-baseline. Baseline data and treatment data (type, intensity, duration) will be used to predict outcome – persistence of or desistance from SUD. Discussion There are remarkably few prospective studies worldwide that investigated the course of SUD in adolescents in add

Objectives: Many workers in high-risk occupations, such as soldiers, are exposed to stressors at work, increasing their risk of developing mental health conditions and substance abuse (MHC/SA). Disclosure can lead to both positive (eg, support) and negative (eg, discrimination) work outcomes, and therefore, both disclosure and non-disclosure can affect health, well-being and sustainable employment, making it a complex dilemma. The objective is to study barriers to and facilitators for disclosure in the military from multiple perspectives. Design: Qualitative focus groups with soldiers with and without MHC/SA and military mental health professionals. Sessions were audiotaped and transcribed verbatim. Content analysis was done using a general inductive approach. Setting: The study took place within the Dutch military. Participants: In total, 46 people participated in 8 homogeneous focus groups, including 3 perspectives: soldiers with MHC/SA (N=20), soldiers without MHC/SA (N=10) and military mental health professionals (N=16). Results: Five barriers for disclosure were identified (fear of career consequences, fear of social rejection, lack of leadership support, lack of skills to talk about MHC/SA, masculine workplace culture) and three facilitators (anticipated positive consequences of disclosure, leadership support, work-related MHC/SA). Views of the stakeholder groups were highly congruent. Conclusions: Almost all barriers (and facilitators) were related to fear for stigma and discrimination. This was acknowledged by all three perspectives, suggesting that stigma and discrimination are considerable barriers to sustainable employment and well-being. Supervisor knowledge, attitudes and behaviour were critical for disclosure, and supervisors thus have a key role in improving health, well-being and sustainable employment for soldiers with MHC/SA. Furthermore, adjustments could be made by the military

An increasing body of evidence shows that informal mutual aid groups benefit those in addiction recovery. However, attention for mutual aid groups in practice and policy varies internationally and is only recently emerging in continental Europe. Existing evidence is mostly limited to studies of Alcoholics Anonymous groups in the United States. The aim of this cross-sectional study is to examine the relationship between membership of a variety of mutual aid groups and recovery capital, participation in social networks, and commitment to sobriety for individuals in drug addiction recovery (N = 367), living in the UK, the Netherlands, and Belgium. A convenience sample of participants completed an extensive assessment about their recovery experiences. Sixty-nine percent of participants reported lifetime (ever) membership of different mutual aid groups. Analyses reveal that membership of mutual aid groups is strongly associated with more participation and (self-reported) changes in social networks, greater levels of recovery capital, and a stronger commitment to sobriety. The findings suggest that participation in mutual aid groups may support addiction recovery through multiple mechanisms of change in favor of recovery. These findings highlight how mutual aid support may complement formal addiction treatment.

There is a well-established relationship between isolation and both morbidity and mortality in the context of addiction recovery, yet the protective effects of intimate and familial relationships have not been adequately assessed. The current paper uses the European Life In Recovery database to assess the association between relationship status and living with dependent children on recovery capital of people in recovery from drug addiction, operationalised by the Strengths And Barriers Recovery Scale (SABRS). The study participants were drawn from the REC-PATH study and supplemented by a second sample recruited by the Recovered Users Network (RUN) across various European countries, resulting in a combined sample of 1,313 individuals completing the survey, primarily online. The results show that, in recovery, those who are married or co-habiting reported significantly greater recovery strengths and fewer barriers to recovery, and reported greater gains in recovery capital across their recovery journeys. Similar associations are found for participants who have dependent children living with them. There is also some indication that this association is stronger for female than for male participants. Finally, having more people that one can rely on and a greater proportion of people in recovery in the social network are both linked to greater recovery capital and greater self-reported growth in recovery capital. We conclude that this study provides further evidence in favour of a “social cure” in recovery, in which close familial ties are associated with stronger recovery resources.

Raising a minimum legal drinking age (MLDA) has generated interest and debate in research and politics, but opposition persists. Up to now, the presentation of impacts focussed on effectiveness (i.e., intended impact); to our knowledge, no literature syntheses focussed on both intended and unintended impacts. A systematic scoping review was conducted in which a search strategy was developed iteratively and literature was obtained from experts in alcohol research and scientific and grey databases. Ninety-one studies were extracted and analysed using formative thematic content analysis. Intended impacts were reported in 119 units of information from the studies (68% positive), forming four paths: implementation, primary and (two) on secondary societal harm and violence. Unintended developments were reported in 43 units of information (30% positive), forming five themes. Only eight studies reported on implementation. Furthermore, a division between primary and secondary paths and the use of a bridging variable (drinking patterns in analyses or methodology) was discovered. These results provide an insight into how well legislation works and can be used to discover or implement new means of curbing underage drinking and alcohol-related violence and harm. They also offer valuable starting points for future research and underline the importance of considering unintended developments.

The aim of the present study was to examine differences in perceived living group climate between boys and girls in a sample of 344 youth (68.6% male, M age = 16, SD = 1.58) receiving residential youth care in the Netherlands. Participants filled out self-report measures on living group climate. Results of multilevel regression models indicated that girls in non-correctional facilities experienced living group climate most positively, and girls in correctional facilities experienced living group climate most negatively compared to girls and boys in non-correctional facilities. We conclude that residential treatment settings should adapt gender-responsive approaches to address specific needs of girls, specifically in secure residential care. Future studies should focus on specific needs of girls to advance knowledge on how they can benefit optimally from their stay in residential care to facilitate gender-specific programming in residential youth care.

Achtergrond Wereldwijd worden miljoenen mensen op het werk blootgesteld aan stressvolle factoren die de kans op het ontwikkelen van psychische klachten en/of verslaving (PK/V) verhogen (bijvoorbeeld militairen, politie, artsen). Maar het zijn ook juist deze beroepen waar men geacht wordt sterk en gezond te zijn. Hierdoor is het soms moeilijker om hulp te zoeken voor PK/V. Zo laat Engels onderzoek zien dat 60% van de militairen met PK/V hier geen professionele hulp voor zoekt. Eerder onderzoek naar hulp zoeken voor PK/V richtte zich met name op het perspectief van militairen met PK/V, waarbij andere belangrijke perspectieven niet meegenomen werden. Daarnaast is dit probleem niet eerder onderzocht binnen de Nederlandse krijgsmacht. Doel Het doel van de huidige studie was de belemmerende en bevorderende factoren voor het zoeken van hulp voor PK/V in kaart te brengen binnen de Nederlandse krijgsmacht vanuit verschillende perspectieven. Methode In totaal hebben 46 mensen deelgenomen aan de studie verdeeld over acht focusgroepen, met drie verschillende perspectieven: vier groepen militairen met PK/V (totaal 20 deelnemers), twee groepen militairen zonder PK/V (totaal 10 deelnemers) en twee groepen zorgprofessionals (totaal 16 deelnemers). De focusgroepen zijn opgenomen en letterlijk uitgeschreven. Vervolgens is met behulp van kwalitatieve data-analysesoftware contentanalyse uitgevoerd vanuit een inductieve benadering. Resultaten Er zijn vijf belemmerende factoren voor het zoeken van hulp gevonden: (1) angst voor negatieve carrièregevolgen, (2) angst voor sociale afwijzing, (3) zorgen rond de vertrouwelijkheid, (4) de militaire werkcultuur en (5) praktische barrières. Ook zijn drie bevorderende factoren gevonden: (1) sociale steun, (2) toegankelijkheid zorgverlening en kennis over waar hulp te verkrijgen en (3) militaire zorgverlening. Ondanks dat het onderzoek zich expliciet richtte op verschillende perspectieven kwamen de vis