Research Interests: Endocrinology, Neuropsychopharmacology, Medicine, Anxiety, Cortisol, and 15 moreHumans, Internal Medicine, Female, Male, HPA axis, Depressive Disorder, Middle Aged, Major Depression, Adult, Biological markers, ANXIETY, Oral Contraceptive, hydrocortisone, Medical and Health Sciences, and Arginine Vasopressin
Purpose Treatment outcome for common psychiatric disorders, such as mood and anxiety disorders, is usually assessed by self-report measures regarding psychopathology [e.g., via Brief Symptom Inventory (BSI)]. However, health-related... more
Purpose Treatment outcome for common psychiatric disorders, such as mood and anxiety disorders, is usually assessed by self-report measures regarding psychopathology [e.g., via Brief Symptom Inventory (BSI)]. However, health-related quality of life [as measured by the 36-item Short-Form Health Survey (SF-36)] may be a useful supplementary outcome domain for routine outcome monitoring (ROM). To date, the assessment of both outcomes has become fairly commonplace with severe mental illness, but this is not yet the case for common psychiatric disorders. The present study examined among outpatients with common psychiatric disorders whether aggregate assessments of change across treatment regarding psychopathology and health-related quality of life yield similar results and effect sizes. Methods We compared treatment outcome on the BSI and the SF-36 in a sample of 13,423 outpatients. The concordance of both instruments was assessed at various time points during treatment. Results Scores o...
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Major depressive disorder (MDD) is often handled as an episodic and isolated disorder, resulting in an optimistic view about its prognosis. Herein, we test the idea that the prognosis of MDD changes if we vary the perspective in terms of... more
Major depressive disorder (MDD) is often handled as an episodic and isolated disorder, resulting in an optimistic view about its prognosis. Herein, we test the idea that the prognosis of MDD changes if we vary the perspective in terms of (1) a longer time frame and (2) a broader diagnostic conceptualisation including dysthymia, (hypo)mania and anxiety disorders as relevant outcomes. Patients with current MDD at baseline (n = 903) and available 2-, 4-, and/or 6-year follow-up assessments were selected from the Netherlands Study of Depression and Anxiety, a psychiatric cohort study. Combining psychiatric DSM-IV-based diagnoses and life-chart data, patient course trajectories were classified as (1) recovered (no diagnoses at 2-year follow-up or thereafter), (2) recurrent without chronic episodes, (3) recurrent with chronic episodes or (4) consistently chronic since baseline. A chronic episode was defined as having a current diagnosis at the follow-up assessment and consistent symptoms ...
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Huntington disease (HD) is a severe neuropsychiatric disorder caused by a cytosine-adenine-guanine (CAG) repeat expansion in the HTT gene. Although HD is frequently complicated by depression, it is still unknown to what extent common HTT... more
Huntington disease (HD) is a severe neuropsychiatric disorder caused by a cytosine-adenine-guanine (CAG) repeat expansion in the HTT gene. Although HD is frequently complicated by depression, it is still unknown to what extent common HTT CAG repeat size variations in the normal range could affect depression risk in the general population. Using binary logistic regression, we assessed the association between HTT CAG repeat size and depression risk in two well-characterized Dutch cohorts─the Netherlands Study of Depression and Anxiety and the Netherlands Study of Depression in Older Persons─including 2165 depressed and 1058 non-depressed persons. In both cohorts, separately as well as combined, there was a significant non-linear association between the risk of lifetime depression and HTT CAG repeat size in which both relatively short and relatively large alleles were associated with an increased risk of depression (β = -0.292 and β = 0.006 for the linear and the quadratic term, respec...
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Major depressive disorder (MDD) is a notably complex illness with a lifetime prevalence of 14%.1 It is often chronic or recurrent and is thus accompanied by considerable morbidity, excess mortality, substantial costs, and heightened risk... more
Major depressive disorder (MDD) is a notably complex illness with a lifetime prevalence of 14%.1 It is often chronic or recurrent and is thus accompanied by considerable morbidity, excess mortality, substantial costs, and heightened risk of suicide.2-7 MDD is a major cause of disability worldwide.8 We conducted a genome-wide association (GWA) meta-analysis in 130,664 MDD cases and 330,470 controls, and identified 44 independent loci that met criteria for statistical significance. We present extensive analyses of these results which provide new insights into the nature of MDD. The genetic findings were associated with clinical features of MDD, and implicated prefrontal and anterior cingulate cortex in the pathophysiology of MDD (regions exhibiting anatomical differences between MDD cases and controls). Genes that are targets of antidepressant medications were strongly enriched for MDD association signals (P=8.5×10−10), suggesting the relevance of these findings for improved pharmacot...
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Stress responses are controlled by the hypothalamus pituitary adrenal (HPA)-axis and maladaptive stress responses are associated with the onset and maintenance of stress-related disorders such as major depressive disorder (MDD). Genes... more
Stress responses are controlled by the hypothalamus pituitary adrenal (HPA)-axis and maladaptive stress responses are associated with the onset and maintenance of stress-related disorders such as major depressive disorder (MDD). Genes that play a role in the HPA-axis regulation may likely contribute to the relation between relevant neurobiological substrates and stress-related disorders. Therefore, we performed gene-wide analyses for 30 a priori literature-based genes involved in HPA-axis regulation in 2014 subjects (34% male; mean age: 42.5) to study the relations with lifetime MDD diagnosis, cortisol awakening response, and dexamethasone suppression test (DST) levels (subsample N=1472) and hippocampal and amygdala volume (3T MR images; subsample N=225). Additionally, gene by childhood maltreatment (CM) interactions were investigated. Gene-wide significant results were found for dexamethasone suppression (CYP11A1, CYP17A1, POU1F1, AKR1D1), hippocampal volume (CYP17A1, CYP11A1, HSD3...
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Research Interests: Psychology, Clinical Psychology, Anxiety Disorders, Personality, Fear, and 15 moreMedicine, Humans, Child, Affective Disorders, Child Abuse, Female, Male, Depressive Disorder, Middle Aged, Longitudinal Studies, Adult, Retrospective Studies, Case Control Studies, Psychology and Cognitive Sciences, and Medical and Health Sciences
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In a post hoc simulation study (N = 3,597 psychiatric outpatients), we investigated whether the efficiency of the 90-item Mood and Anxiety Symptom Questionnaire (MASQ) could be improved for assessing clinical subjects with computerized... more
In a post hoc simulation study (N = 3,597 psychiatric outpatients), we investigated whether the efficiency of the 90-item Mood and Anxiety Symptom Questionnaire (MASQ) could be improved for assessing clinical subjects with computerized adaptive testing (CAT). A CAT simulation was performed on each of the 3 MASQ subscales (Positive Affect, Negative Affect, and Somatic Anxiety). With the CAT simulation's stopping rule set at a high level of measurement precision, the results showed that patients' test administration can be shortened substantially; the mean decrease in items used for the subscales ranged from 56% up to 74%. Furthermore, the predictive utility of the CAT simulations was sufficient for all MASQ scales. The findings reveal that developing a MASQ CAT for clinical subjects is useful as it leads to more efficient measurement without compromising the reliability of the test outcomes. (PsycINFO Database Record
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To investigate the effect of childhood life events and childhood trauma on the onset and recurrence of depressive and/or anxiety disorders over a 2-year period in participants without current psychopathology at baseline. Longitudinal data... more
To investigate the effect of childhood life events and childhood trauma on the onset and recurrence of depressive and/or anxiety disorders over a 2-year period in participants without current psychopathology at baseline. Longitudinal data in a large sample of participants without baseline DSM-IV depressive or anxiety disorders (n = 1,167, aged 18 to 65 years; assessed between 2004-2007) were collected in the Netherlands Study of Depression and Anxiety (NESDA). Childhood life events and childhood trauma were assessed at baseline with a semistructured interview. The Composite International Diagnostic Interview, based on DSM-IV criteria, was used to diagnose first onset or recurrent depressive and/or anxiety disorders over a 2-year period. At baseline, 172 participants (14.7%) reported at least 1 childhood life event, and 412 (35.3%) reported any childhood trauma. During 2 years of follow-up, 226 participants (19.4%) developed a new (n = 58) or recurrent (n = 168) episode of a depressi...
Research Interests: Psychology, Anxiety Disorders, Adolescent, Medicine, Comorbidity, and 15 moreAnxiety, Humans, Child Abuse, Female, Male, Netherlands, Depressive Disorder, Middle Aged, Longitudinal Studies, Adult, Clinical Psychiatry, ANXIETY, Life Change Events, Psychology and Cognitive Sciences, and Medical and Health Sciences
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To examine the contribution of a mental and physical symptom count to the detection of single or comorbid anxiety, depressive and somatoform disorders. In primary care 1,046 consulting patients completed the Hospital Anxiety and... more
To examine the contribution of a mental and physical symptom count to the detection of single or comorbid anxiety, depressive and somatoform disorders. In primary care 1,046 consulting patients completed the Hospital Anxiety and Depression Scale (HADS) and the Physical Symptom Checklist (PSC-51). In a stratified sample of 473 patients DSM-IV psychiatric disorders were assessed using the WHO-SCAN interview. The diagnostic value of the HADS total score and the PSC-51 symptom count was examined with ROC-analyses. The discriminative power of PSC-51 and HADS was highest for patients with both a somatoform disorder and an anxiety or depressive disorder, with an AUC of 0.86 (95% CI: 0.81-0.91) and 0.91 (95% CI: 0.87-0.94) respectively. Using both symptom counts together did not increase the diagnostic value for the detection of the psychiatric disorders. Both symptom counts preferentially detected patients with comorbid disorders. When interpreting diagnostic values of screening questionnaires one should keep in mind that the validity of these values can be dependent of the presence of comorbid disorders.
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Research Interests: Psychology, Primary Care, Mental Health, Primary Health Care, Cognition, and 15 morePublic Health, Medicine, Humans, Female, Psychosomatics, Cognitive Therapy, Male, Netherlands, Cognitive Behavioral Treatment Method, Clinical Sciences, Middle Aged, Adult, Family Physician, Logistic Models, and Psychiatric Status Rating Scales
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BACKGROUND Cigarette smoking has been recognized as an important risk factor for cardiovascular disease in men and women. Whether the increased risk results from an atherogenic effect of smoking is still debated. We examined the relation... more
BACKGROUND Cigarette smoking has been recognized as an important risk factor for cardiovascular disease in men and women. Whether the increased risk results from an atherogenic effect of smoking is still debated. We examined the relation between cigarette smoking and atherosclerotic changes in the abdominal aorta. METHODS AND RESULTS The association between cigarette smoking and atherosclerotic changes in the abdominal aorta was examined in a population-based cohort of 758 women, initially aged 45 to 64 years. All women were examined radiographically for calcified deposits in the abdominal aorta, which have been shown to represent intimal atherosclerosis. After 9 years of follow-up, atherosclerotic changes, indicating development or progression of plaques, could be demonstrated in 37% of women. A direct association was found between atherosclerotic change and number of cigarettes smoked per day. Compared with women who had never smoked, the relative risks of those who smoked 1 to 9,...
Research Interests: Medicine, Population, Humans, Internal Medicine, Female, and 15 moreRisk factors, Clinical Sciences, Middle Aged, Risk Factor, Cigarette Smoking, Public health systems and services research, Circulation, Risk Factors, Aorta, Confidence Interval, Cohort Studies, Relative Risk, Abdominal Aorta, Aorta Abdominal, and Cardiovascular medicine and haematology
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The aim of the study was to develop a cognitive behavioural treatment model for medically unexplained physical symptoms and assess its feasibility and effect in a small sample of patients. This study was the first step in the realization... more
The aim of the study was to develop a cognitive behavioural treatment model for medically unexplained physical symptoms and assess its feasibility and effect in a small sample of patients. This study was the first step in the realization of a randomized controlled trial. The study population consisted of consecutive patients presenting at a general medical outpatient clinic, whose symptoms could not be explained by objective abnormal findings. The treatment was based on a general model of the disorder, consisting of the physical symptoms, the…
Research Interests: Psychology, Cognitive Behavioral Therapy, Cognitive Science, Treatment Outcome, Adolescent, and 13 moreHumans, Models, Chronic Disease, Cognitive Behaviour Therapy, Cognitive Therapy, Follow-up studies, Behavioural, Middle Aged, Pilot study, Adult, Somatoform disorders, Cognitive Behavioural Psychotherapy, and Psychological Stress
Research Interests: Menopause, Medicine, Humans, Diabetes mellitus, Blood Pressure, and 15 moreFemale, Bone Density, Body Mass Index, Clinical Sciences, Middle Aged, Longitudinal Studies, Calcinosis, Cross Section, Longitudinal Study, Bone Loss, Calcification, Hormone Replacement Therapy, Bone mass, Abdominal Aorta, and Cardiovascular medicine and haematology
For classification problems in psychology (e.g., clinical diagnosis), batteries of tests are often administered. However, not every test or item may be necessary for accurate classification. In the current article, a combination of... more
For classification problems in psychology (e.g., clinical diagnosis), batteries of tests are often administered. However, not every test or item may be necessary for accurate classification. In the current article, a combination of classification and regression trees (CART) and stochastic curtailment (SC) is introduced to reduce assessment length of questionnaire batteries. First, the CART algorithm provides relevant subscales and cutoffs needed for accurate classification, in the form of a decision tree. Second, for every subscale and cutoff appearing in the decision tree, SC reduces the number of items needed for accurate classification. This procedure is illustrated by post hoc simulation on a data set of 3,579 patients, to whom the Mood and Anxiety Symptoms Questionnaire (MASQ) was administered. Subscales of the MASQ are used for predicting diagnoses of depression. Results show that CART-SC provided an assessment length reduction of 56%, without loss of accuracy, compared with t...
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BackgroundGeneral practitioners play a pivotal part in the recognition and treatment of psychiatric disorders. Identifying somatoform disorders is important for the choice of treatment.AimsTo quantify the prevalence of, and functional... more
BackgroundGeneral practitioners play a pivotal part in the recognition and treatment of psychiatric disorders. Identifying somatoform disorders is important for the choice of treatment.AimsTo quantify the prevalence of, and functional impairment associated with, somatoform disorders, and their comorbidity with anxiety/depressive disorders.MethodTwo-stage prevalence study: a set of questionnaires was completed by 1046 consecutive patients of general practitioners (aged 25–80 years), followed by a standardised diagnostic interview (SCAN 2.1).ResultsThe prevalence of somatoform disorders was 16.1% (95% CI 12.8-19.4). When disorders with only mild impairment were included, the prevalence increased to 21.9%. Comorbidity of somatoform disorders and anxiety/depressive disorders was 3.3 times more likely than expected by chance. In patients with comorbid disorders, physical symptoms, depressive symptoms and functional limitations were additive.ConclusionsOur findings underline the importanc...
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Research Interests: Anxiety Disorders, Psychometrics, Developing Countries, Kuwait, Cross-Cultural Comparison, and 11 moreHumans, Female, Male, Depressive Disorder, Middle Aged, Adult, Reproducibility of Results, Ambulatory Care, Psychiatric Status Rating Scales, Psychology and Cognitive Sciences, and Medical and Health Sciences
Cigarette smoking has been recognized as an important risk factor for cardiovascular disease in men and women. Whether the increased risk results from an atherogenic effect of smoking is still debated. We examined the relation between... more
Cigarette smoking has been recognized as an important risk factor for cardiovascular disease in men and women. Whether the increased risk results from an atherogenic effect of smoking is still debated. We examined the relation between cigarette smoking and atherosclerotic changes in the abdominal aorta. The association between cigarette smoking and atherosclerotic changes in the abdominal aorta was examined in a population-based cohort of 758 women, initially aged 45 to 64 years. All women were examined radiographically for calcified deposits in the abdominal aorta, which have been shown to represent intimal atherosclerosis. After 9 years of follow-up, atherosclerotic changes, indicating development or progression of plaques, could be demonstrated in 37% of women. A direct association was found between atherosclerotic change and number of cigarettes smoked per day. Compared with women who had never smoked, the relative risks of those who smoked 1 to 9, 10 to 19, and 20 or more cigarettes per day were 1.4 (95% confidence interval, 1.0 to 2.0), 2.0 (1.6 to 2.5), and 2.3 (1.8 to 3.0), respectively, after adjustment for age and other cardiovascular risk factors. Associations of atherosclerotic change with inhaling habit and duration of smoking were borderline significant after number of cigarettes smoked per day was taken into account. Among former smokers, the risk decreased with increasing duration of stopping but a significant excess risk was still observed after 5 to 10 years since quitting (relative risk, 1.6; 95% confidence interval, 1.1 to 2.2). These follow-up data support the evidence for an effect of cigarette smoking on atherosclerosis. The findings suggest that the rate of atherosclerotic change may be reduced by cessation of smoking, but a residual effect appears to be present for at least 10 years.