hoe gek is nederland? how nuts are the dutch?...suicidal ideation . core: at least 1 . total: at...

Hoe gek is Nederland? How Nuts are the Dutch?

Understanding Depression as a Continuum and a Process:

Peter de Jonge, prof Psychiatric Epidemiology [email protected]

Vici grant “Deconstructing Depression” (NWO/ZonMW) Unstrestricted grant “Leefplezier bij ouderen” (Espria)

Interests

All disorders Lifetime: 41.2% Past year: 23.3% Mood disorders Lifetime: 19.0% Past year: 7.6%

Nemesis

Bijl et al. Soc Psych Psych Epi 1998

Mood All

Colombia 6.8% 17.8%

Mexico 4.8% 12.2%

USA 9.6% 26.4%

Belgie 6.2% 12.0%

Frankrijk 8.5% 18.4%

Duitsland 3.6% 9.1%

Italie 3.8% 8.2%

Nederland 6.9% 14.9%

Spanje 4.9% 9.2%

Oekraine 9.1% 20.5%

Libanon 6.6% 16.9%

Nigeria 0.8% 4.7%

Japan 3.1% 8.8%

China 2.5% 9.1%

Sjanghai 1.7% 4.3%

Demyttenaere et al. JAMA2004

All disorders: 23.3% 18.0% Mood disorders: 7.6% 6.1%

Nemesis and Nemesis II

De Graaf et al. Soc Psych Psych Epi 2012

1996 2008

Predicted global burden of disease (Lancet, 1998)

disease DALYs %

1 ischaemic heart disease 82.3 5.9

2 depression 78.7 5.7

3 traffic 71.2 5.1

4 cerebrovascular 61.4 4.4

5 COPD 57.6 4.2

6 Airway infections 42.7 3.1

7 tuberculosis 42.5 3.0

8 war 41.3 3.0

9 diarrhea 37.1 2.7

10 HIV 36.3 2.6

Operationalisation of depression according to DSM-IV and V

DSM-IV / ICD-10 Depressed mood Diminished interest Weight loss or weight gain Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss or energy Worthlessness or guilt Concentration problems Suicidal ideation

Core: at least 1

Total: at least 5

227 profiles fulfilling DSM criteria Why distinguish between core

and other? Is a sumscore useful? Why cut-off at 5, and not 4 or 6? Should we want to use a cut-off

at all? Why not rumination? How can 1 single disease produce

such contradicting symptoms?

APA, 1980.

GROMGAV methode

Groep Respectabele Oudere Mannen Gezeten Aan Vergadertafel

BOGSAT. Kendler 2012.

For science:

SSRIs/SNRIs

Turner EH et al. N Engl J Med 2008.

Small and overestimated…

Real effect MDD 0.32 (0.27-0.35)

Apparent effect MDD 0.41 (0.36-0.45)

% explained variance Effect size (d) % explained var % overlap

0.2 1% 92%

0.3 2% 88%

0.4 4% 84%

0.5 6% 80%

1.0 20% 62%

2.0 50% 32%

3.0 68% 13%

From study to guideline/ approval • Richtlijn: depressie => ssri FDA: at least 2 positive trials Positive trial: significant better than placebo (depends on N and effectsize) Example: dubbelblind trial (N=91; 44 placebo, 47 antidepressant After 8 weeks: difference in HAM-D: 2,6 (s.d =7) cohen’s D 0.37

Visual, aggregated

V

Visual, disaggregated

SSRIs/SNRIs

Roest AM, Jonge P, Williams CD, de Vries YA, Schoevers RA, Turner EH. JAMA Psychiatry. In Press.

GAD 0.34 (0.28-0.43) PD 0.35 (0.25-0.45) SAD 0.42 (0.35-0.49) PTSD 0.32 (0.14-0.50) OCD 0.45 (0.30-0.51)


Small, over-rated and

Real efficacy MDD 0.32 (0.27-0.35) (turner et al 2008)

Apparent efficacy MDD 0.41 (0.36-0.45)

Interchangeable accross disorders

Rethink mental health

• Not GROMGAV • Not only based on complaints but also on

strengths • Personalised and transdiagnostic

Structure internalising symptoms – LifeLines (N=75.000)

Wanders RBK et al. In Prep.

57.0% 14.8% 11.6%

8.4% 4.9% 3.2%

SSRIs/SNRIs

Roest AM, Jonge P, Williams CD, de Vries YA, Schoevers RA, Turner EH. JAMA Psych, in press.



Klein, overschat en

Werkelijk effect MDD 0.32 (0.27-0.35) (turner et al 2008)

Schijnbaar effect MDD 0.41 (0.36-0.45)

uitwisselbaar over stoornissen

HoeGekIsNL / HowNutsAreTheDutch

– 12.781 participants (62.307 questionnaires)

– 302 at least 60 assessments (>22.000 questionnaires)

– 17 approved proposals

24-2-2015 24

Negative affect

Posi

tive

affe

ct

Mental problems are gradual and multidimensional

Activity

Dep

ress

ion

Interindividual ≠ Intraindividual

Personal etiological models

Thank you for your attention

hoe gek is nederland? how nuts are the dutch?...suicidal ideation . core: at least 1 . total: at...

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