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Mental disorders are of concern because of their high prevalence rate, the burden of the disease and the attendant high social expenditure. Hospitalisation has been the standard care modality for people with mental disorders who experience an acute psychiatric crisis, a situation in which the severity of someone’s current clinical problems, social problems, and associated risk factors necessitates acute admission to a psychiatric ward. Nevertheless, there is an extensive history of attempting to avoid hospitalising patients when treating an acute psychiatric crisis. Intensive Home Treatment (IHT) is one of the more recent care modalities that focuses on stabilising acute psychiatric crises in order to either prevent hospitalisation or facilitate early discharge from hospital. In order to widely implement IHT as an alternative to acute hospital care, high-quality evidence from randomised controlled trials (RCTs) was needed to evaluate both its therapeutic effectiveness and cost-effectiveness. Therefore, it is important to assess both the effects and costs of IHT in comparison to care as usual (CAU), and evaluate the added value of IHT for both patients and mental healthcare. Patients experiencing an acute psychiatric crisis severe enough to be considered for hospital admission by a psychiatrist, were pre-randomised to the treatment group IHT or CAU. Between November 2016 and November 2018, patients were recruited from either the psychiatric emergency service or inpatient wards in Amsterdam. In total, 246 patients participated in the RCT, which resulted in the several studies that are presented in this thesis.

Additional file 4: Table S3. Association between self-efficacy, clinical recovery and quality of life during 26 weeks. Included data according per-protocol analyses. Recovery defined as a symptomatic outcome was measured using the Brief Psychiatric Rating Scale (BPRS). The 5-dimensional EuroQol instrument (EQ-5D-5L) was used to assess quality of life.

Additional file 1: Figure S1. The intensive home treatment randomised controlled study, selection flowchart.

Additional file 2: Table S1. Sensitivity analysis of intensive home treatment on self-efficacy. Outcome of self-efficacy dimensions during 26 weeks using linear mixed modelling analyses.

Additional file 3: Table S2. Psychiatric disorders and the development of self-efficacy across three time points. Psychiatric disorders include depressive, bipolar, personality and schizophrenia spectrum and other psychotic disorders. The baseline, 6 and 26 weeks follow-up measurements were used in the analyses.

Beeldzorg is zorg verlenen op afstand, via een beeldscherm. Deze technologie wordt in Nederland nog maar mondjesmaat toegepast. Een belangrijke oorzaak daarvan is weerstand onder professionals. Het lectoraat Vraaggestuurde Zorg heeft onderzocht waar deze weerstand vandaag komt en hoe die overwonnen kan worden. Weerstand tegen beeldzorg komt vooral voort uit onbekendheid met de gebruiksvoorwaarden en het nut voor de cliënt. Daar kunnen thuiszorg- en onderwijsinstellingen iets aan doen.

Objective. To test the hypotheses that dysregulation of the autonomic nervous system (ANS) is associated with the presence of chronic widespread pain (CWP), and that dysregulation of the ANS is associated with higher pain intensity in CWP. Methods. Cross-sectional data were obtained from 1,574 subjects (healthy controls as well as persons with depressive and anxiety disorders) participating in The Netherlands Study of Depression and Anxiety. The Chronic Pain Grade was used to assess pain intensity and pain-related disability. Heart rate (HR), SD of the normal-to-normal interval (SDNN), the preejection period (PEP), and respiratory sinus arrhythmia (RSA) were used to assess the ANS. Logistic regression analyses and linear regression analyses were conducted with adjustment for potential confounders. Results. No differences in HR, PEP, SDNN, or RSA values were found between CWP subjects and controls after adjustment for confounders. However, lower SDNN and lower RSA were associated with higher pain intensity in subjects with CWP. Conclusion. Lower parasympathetic activity, as assessed with SDNN and RSA, is associated with higher pain intensity in subjects with CWP. This large and well-controlled study does not provide evidence for an association between dysregulation of the ANS and the presence of CWP.