Papers by Aartjan Beekman
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Tijdschrift voor psychiatrie, 2018
BACKGROUND The prevention of mental disorders is feasible, but a broader implementation requires ... more BACKGROUND The prevention of mental disorders is feasible, but a broader implementation requires a more precise application of available interventions to target populations. AIM: A literature review of the different approaches where preventive measures are applied more precisely and personally. METHOD: A narrative review of existing literature. RESULTS: Several promising strategies to improve precision and personalisation of prevention are indeed available, but there is insufficient research to substantiate them. CONCLUSION: Prevention of mental health disorders is possible, and there are interventions proven to be effective. In order to have an actual impact at population level, we require a mix of universal, selective and indication-based preventive measures. The universal campaigns, aimed at the entire population, would hereby create conditions enabling the other strategies, aimed at risk groups, to succeed.
Dear Sir/Madam, Hereby, I resubmit our paper named 'Stepped care treatment for depression and anx... more Dear Sir/Madam, Hereby, I resubmit our paper named 'Stepped care treatment for depression and anxiety in primary care: A randomized controlled trial'. Our paper describes the effectiveness of a stepped care model for patients with mood and / or anxiety disorders in primary care. The manuscript is 18 pages long and 3 tables plus 2 figures are included. We would be grateful if you would consider our revised manuscript for publication in Trials. We inform you that this study is designed and carried out according to the APA ethical standards. This study received approval from an appropriate ethics committee. The trial is registered in the Current Controlled Trial's register (ISRCTN17831610). This manuscript is not under consideration nor published by another journal. All authors do not have any interests that might be interpreted as influencing the research. I added the letters to the reviewers and changed the format changes as suggested.
We are resubmitting our paper entitled "Measurement Invariance of the CES-D among the Chinese and... more We are resubmitting our paper entitled "Measurement Invariance of the CES-D among the Chinese and Dutch Elderly". It is a revision of manuscript (MS: 8128865234808560) as invited by you. According to your suggestions, all the changes we have made in the manuscript are highlighted by using the track changes mode. You can easily find all the changes in the revised version of the manuscript. We would like to thank you and the reviewers for the extremely helpful comments. We believe that this manuscript has been improved greatly based on the comments from you and reviewers. The following notes detail how this revision has dealt with all your comments. Each comment is presented, followed by the response given to it. RESPONSE TO EDITORIAL REQUESTS 1. Ethics-Experimental research that is reported in the manuscript must have been performed with the approval of an appropriate ethics committee. Research carried out on humans must be in compliance with the Helsinki Declaration (http://www.wma.net/en/30publications/10policies/b3/index.html), and any experimental research on animals must follow internationally recognized guidelines. A statement to this effect must appear in the Methods section of the manuscript, including the name of the body which gave approval, with a reference number where appropriate. (http://www.internationalscienceediting.com/) and English Manager Science Editing (http://www.sciencemanager.com/). BioMed Central has no first-hand experience of these companies and can take no responsibility for the quality of their service. RESPONSE: we have asked a native speaker to check the text, and we believe that the style of written English has been greatly improved. RESPONSE TO REVIEWER 1 1 Abstract results: better than what? most informative relative to what? RESPONSE: we have addressed the two issues in the abstract (see page 2). 2 Several instances of acronyms used without definition at first use (noted full name provided with subsequent use in at least some examples) RESPONSE: Full names have been noted in the manuscript for each acronym at its first use. 3 Numerous issues with wording that make interpretation difficult. RESPONSE: we have asked a native speaker to check the text, and we believe that the style of written English has been greatly improved. 4 Detail verification: the China sample included younger women than men (55 versus 60). I don't see this as a problem, it is just counterintuitive due to women's longer life expectancy (at least in US) RESPONSE: as our reviewer raised this age-related question, we double-checked the age ranges for this survey, and found out that actually for this survey both male and female participants were recruited from age of 55. 5 Page 8: is it appropriate to say Chinese and Netherlands VERSION of the CES-D? This could suggest an adaption of the scale, whereas in context it seems it is a translation of the scale. RESPONSE: As the CES-D scale was adapted in both China and the Netherlands before being used in the surveys, including reliability and validity examination, and minor adjustments were made to fit the habits of languages in the two countries, it is appropriate to say Chinese and Dutch version of the CES-D. 6 From which model are the factor loadings and intercepts reported in Table 3? Loadings but not factors are presented. RESPONSE: the factor loadings and intercepts are from the four-factor model suggested by Radloff (1977). On page 12 of the manuscript, we have clarified the issue of the baseline model for testing measurement invariance across the Chinese and Dutch sample in the subsequent analyses. We agree with your comments and factors have been added in table 3 (see page 32, table 3). 7 Page 16: factor loadings for blues, depressed and sadness (not failure) are larger in the Dutch sample RESPONSE: many thanks for pointing out the error. We have corrected it in the revised version of our manuscript (see page 18). RESPONSE TO REVIEWER 3 Review of "Measurement invariance of the CES-D among the Chinese and Dutch elderly" 1. The question by the authors is well-defined. The authors compared the factor structure of the CES-D in an elderly Chinese and an elderly Dutch sample. The authors found that the four-factor model fit the data best in both samples and that the factor structure was invariant across the samples. The results for invariance in the metric and scalar relations were less strong, although there was evidence of partial invariance in these areas. 2. The methods are appropriate and adequately described. 3. The data appear to be sound. a. I did wonder, however, why gender was not included in any of the initial analyses, given that the authors point out significant gender differences on the CES-D in elderly samples? RESPONSE: The main purpose of the present study is to examine the effects of culture on the factor structures of CES-D. There could be gender differences in CES-D within each sample, but this was beyond our research interest. Furthermore, as both males and females are immersed in the same cultural environment, it seems reasonable to believe that the country's culture would affect its population universally, irrespective of gender, in other words, there would be no interaction between culture and gender.
BMC Psychiatry, 2017
Background: Despite the availability of evidence based treatments, many people with major depress... more Background: Despite the availability of evidence based treatments, many people with major depression receive no or delayed professional treatment, which may put them at risk for adverse outcomes. The aim of this study was to examine which demographic and need factors distinguish early, delayed and no treatment use. Methods: Data were obtained from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). People with a diagnosis of major depression in the past 12 months were included (N = 434). Mental health care use was assessed during this same period and at follow up (three years later). Multinomial regression analysis was used to distinguish early, delayed and no mental health care users with respect to demographic and need factors. Results: The majority of participants accessed treatment early (62%). Early treatment users were characterized by more severe and persistent symptoms and were more likely not to have a partner compared to no treatment users. The majority of those without treatment reached remission in three years (85%). Delayed treatment users were, compared to early users, characterized by relatively mild symptoms and a persistent or new major depressive disorder at follow up. Conclusions: Early access to treatment and the finding that need factors determine mental health care use among people with depression show that the filters along the pathway to treatment are not influenced by unfavorable determinants like education or age.
Multiple sclerosis (Houndmills, Basingstoke, England), 2016
Depression in multiple sclerosis (MS) patients is common but may stay untreated. Physical limitat... more Depression in multiple sclerosis (MS) patients is common but may stay untreated. Physical limitations impede face-to-face treatment. Internet-based treatment is therefore a promising tool for treating depression in MS. To investigate effectiveness of a guided Internet-based problem-solving treatment (IPST) for depressed MS patients. MS patients with moderate or severe depressive symptoms were randomly assigned to IPST or a wait list control. Primary outcome was the change in depressive symptoms defined by a change in sum score on the Beck Depression Inventory Second Edition (BDI-II). Assessments took place at baseline (T0), within a week after the intervention (T1), and at 4 months follow-up (T2). Analyses were based on the intention-to-treat principle. A total of 171 patients were randomized to IPST ( n = 85) or a wait list control ( n = 86). T1 was completed by 152 (89%) and T2 by 131 patients (77%). The IPST group and wait list control showed large significant improvements in dep...
Journal of the neurological sciences, Jan 15, 2017
Prevalence rates of depression and anxiety in patients with Multiple Sclerosis (MS) vary widely a... more Prevalence rates of depression and anxiety in patients with Multiple Sclerosis (MS) vary widely across studies. Aim of this systematic review and meta-analysis was to a) estimate the prevalence of depression and anxiety in MS, and specifically b) explore sources of heterogeneity (assessment method, prevalence period, study quality, recruitment resource, region) by extensive analyses. A computerized search in PubMed, EMBASE, and PsycINFO for studies on depression and anxiety in MS was performed up to December 2014. Fifty-eight articles with a total sample size of 87,756 MS patients were selected. Pooled mean prevalence was 30.5% (95% CI=26.3%-35.1%) for depression, and 22.1% (95% CI=15.2%-31.0%) for anxiety. Prevalence of clinically significant depressive or anxiety symptoms was higher (35% and 34%) compared with disorders (21%; p=0.001 and 10%; p<0.001). Prevalence of a depressive disorder was relatively lower in studies from Europe. Anxiety disorder was more prevalent in communi...
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 20, 2017
Purpose A stepped care (SC) program in which an effective yet least resource-intensive treatment ... more Purpose A stepped care (SC) program in which an effective yet least resource-intensive treatment is delivered to patients first and followed, when necessary, by more resource-intensive treatments was found to be effective in improving distress levels of patients with head and neck cancer or lung cancer. Information on the value of this program for its cost is now called for. Therefore, this study aimed to assess the cost-utility of the SC program compared with care-as-usual (CAU) in patients with head and neck cancer or lung cancer who have psychological distress. Patients and Methods In total, 156 patients were randomly assigned to SC or CAU. Intervention costs, direct medical costs, direct nonmedical costs, productivity losses, and health-related quality-of-life data during the intervention or control period and 12 months of follow-up were calculated by using Trimbos and Institute of Medical Technology Assessment Cost Questionnaire for Psychiatry, Productivity and Disease Question...
Journal of affective disorders, 2016
Previous studies have demonstrated the effectiveness of Internet-based interventions for depressi... more Previous studies have demonstrated the effectiveness of Internet-based interventions for depression in comparison with usual care. However, evidence on the cost-effectiveness of these interventions when delivered in outpatient clinics is lacking. The aim of this study was to estimate the cost-effectiveness of an Internet-based problem-solving guided self-help intervention in comparison with enhanced usual care for outpatients on a waiting list for face-to-face treatment for major depression. After the waiting list period, participants from both groups received the same treatment at outpatient clinics. An economic evaluation was performed alongside a randomized controlled trial with 12 months follow-up. Outcomes were improvement in depressive symptom severity (measured by CES-D), response to treatment and Quality-Adjusted Life-Years (QALYs). Statistical uncertainty around cost differences and incremental cost-effectiveness ratios were estimated using bootstrapping. Mean societal cost...
Disorders of the brain exhibit considerable epidemiological comorbidity and frequently share symp... more Disorders of the brain exhibit considerable epidemiological comorbidity and frequently share symptoms, provoking debate about the extent of their etiologic overlap. We quantified the genetic sharing of 25 brain disorders based on summary statistics from genome-wide association studies of 215,683 patients and 657,164 controls, and their relationship to 17 phenotypes from 1,191,588 individuals. Psychiatric disorders show substantial sharing of common variant risk, while neurological disorders appear more distinct from one another. We observe limited evidence of sharing between neurological and psychiatric disorders, but do identify robust sharing between disorders and several cognitive measures, as well as disorders and personality types. We also performed extensive simulations to explore how power, diagnostic misclassification and phenotypic heterogeneity affect genetic correlations. These results highlight the importance of common genetic variation as a source of risk for brain diso...
The American Journal of Geriatric Psychiatry, 2011
Objective: Depressive and anxiety disorders in later life have a high incidence and are associate... more Objective: Depressive and anxiety disorders in later life have a high incidence and are associated with reduced quality of life. Elsewhere, we demonstrated that a steppedcare prevention approach was successful in halving the incidence of these disorders over a period of 12 months. As a decreasing effect over time is to be expected, our aim was to investigate the longer-term effects. Design: Randomized controlled trial. Setting: Thirty-three primary care practices in the Netherlands. Participants: One hundred seventy consenting individuals, age 75 years and older, presenting with subthreshold depression or anxiety, not meeting the diagnostic criteria. Intervention: Participants were randomized to a preventive intervention or usual care. In the first 12 months, the preventive intervention entailed watchful waiting, minimally supported CBT-based self-help intervention, problem-solving treatment, and referral to a primary care physician for medication, if required. In the last 12 months, 95% of the participants ceased to receive such support. Measurements: Mini International Neuropsychiatric Interview. Results: The cumulative incidence rate of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, major depression or anxiety disorder over a period of 24 months was halved by the intervention, from 33 of 84 (39.3%) in the usual care group to 17 of 86 (19.8%) in the intervention group (odds ratio = 0.38; 95% confidence interval = 0.19-0.76), which was significant (z = 2.75; p = 0.006). The corresponding number needed to treat was 5 (95% confidence interval = 3-16). Conclusions: A stepped-care approach to the prevention of depression and anxiety in late life was not only successful in halving the incidence of depressive and anxiety disorders after 1 year, but these favorable effects were also sustained over 24 months.
The journal of mental health policy and economics, 2006
Mental disorders are highly prevalent and are associated with substantial disease burden, but the... more Mental disorders are highly prevalent and are associated with substantial disease burden, but their economic costs have been relatively less well researched. Moreover, few cost-of-illness studies used population-based psychiatric surveys for estimating direct medical, direct non-medical and indirect costs, and were able to do so for several well diagnosed mental disorders. To calculate the cost of nine common mental disorders. The costs were calculated at individual level (per capita costs), and at population level per one million population for both prevalence (current cases) and incidence (new cases). Data were derived from the Netherlands Mental Health Survey and Incidence Study (Nemesis), a population-based psychiatric cohort study among 5,504 adults in the age bracket of 18-65 years. DSM-III-R disorders were assessed with help of the Composite International Diagnostic Interview (CIDI). The costs of health service uptake, patients' out-of-pocket costs, and production losses ...
Abou-Saleh/Principles and Practice of Geriatric Psychiatry, 2010
Journal of affective disorders, 2015
Subclinical depression is common. Although interventions have proven to be effective, participati... more Subclinical depression is common. Although interventions have proven to be effective, participation rates are low. This study first aimed to get more insight in help-seeking and reasons for (not) seeking care. The second aim was to identify characteristics that distinguish people who receive help, those with an unmet need, or no perceived need for care. Respondents with a subclinical depression (n=162) were recruited from the general population. They were eligible for participation if they were aged 18 years or older, scored 20 or higher on the K10 screening instrument for depression, and did not meet the criteria for major depression. Of all participants, 27% received help, 33% had an unmet need, and 40% had no perceived need for care. Participants with no perceived need reported not to experience symptoms, were able to solve problems on their own, and could mobilize their own support. They were characterized by lower scores on neuroticism and an older age than those who received c...
Huisarts en Wetenschap, 2009
Social Psychiatry and Psychiatric Epidemiology, 2013
To estimate the disease burden due to 15 mental disorders at both individual and population level... more To estimate the disease burden due to 15 mental disorders at both individual and population level. Using a population-based survey (NEMESIS, N = 7,056) the number of years lived with disability per one million population were assessed. This was done with and without adjustment for comorbidity. At individual level, major depression, dysthymia, bipolar disorder, panic disorder, social phobia, eating disorder and schizophrenia are the disorders most markedly associated with health-related quality of life decrement. However, at population level, the number of affected people and the amount of time spent in an adverse health state become strong drivers of population ill-health. Simple phobia, social phobia, depression, dysthymia and alcohol dependence emerged as public health priorities. From a clinical perspective, we tend to give priority to the disorders that exact a heavy toll on individuals. This puts the spotlight on disorders such as bipolar disorder and schizophrenia. However, from a public health perspective, disorders such as simple phobia, social phobia and dysthymia--which are highly prevalent and tend to run a chronic course--are identified as leading causes of population ill-health, and thus, emerge as public health priorities.
Psychotherapy and Psychosomatics, 2011
Psychologie en Gezondheid, 2010
Psychiatric Services, 2010
There are widespread concerns about disparities in mental health treatment for ethnic minority gr... more There are widespread concerns about disparities in mental health treatment for ethnic minority groups. However, previous research in this area has been limited mainly to the United States and Great Britain, raising doubts about the external validity with respect to other European countries. This study addressed ethnic differences in characteristics of outpatient treatment for depression in the Netherlands. Methods: Longitudinal data (2001-2005) were extracted from a nationwide psychiatric case register. The sample consisted of 17,270 episodes of outpatient depression care. Information was available about timeliness of the initial treatment contact, treatment intensity, dropout, and early reregistration for mental health care. Data were analyzed with linear, logistic, and Cox regression analyses. Results: When analyses were controlled for illness and demographic characteristics, timeliness and treatment intensity were somewhat less favorable for Moroccan, Turkish, and other non-Western clients compared with ethnic Dutch. No significant differences were found between minority and ethnic Dutch groups in dropout and early reregistration. Some treatment characteristics were in fact more favorable for Surinamese and Antillean clients compared with ethnic Dutch. Conclusions: The data provided insufficient support for the idea that treatment characteristics are generally less favorable for clients from ethnic minority groups. This finding may be related to the promotion of culturally sensitive approaches to care in mainstream mental health services but may also indicate that the role of traditional barriers, like stigma and taboo, is smaller than is usually suggested. However, the influence of language proficiency, which is notably better among Surinamese and Dutch Antillean compared with Turkish and Moroccan clients, should not be disregarded. (Psychiatric Services 61:690-697, 2010)
Journal of the Neurological Sciences, 2012
Background: Depressive symptoms are highly prevalent among patients with multiple sclerosis (MS).... more Background: Depressive symptoms are highly prevalent among patients with multiple sclerosis (MS). Webbased problem solving therapy (PST) is easily accessible and showed to be effective in depressed patients. Objectives: The aims of this pilot study were to examine feasibility and outcome (reduction of depressive symptoms) of an applied web-based PST intervention in MS patients. Methods: Forty-four MS patients with mild to severe depressive symptoms followed a web-based PST intervention. Feasibility was measured by compliance rate and satisfaction scales. The Beck Depression Inventory (BDI-II) was used to measure depressive symptoms before and after the intervention. Results: The compliance rate was 52%, and 85% of the patients rated the quality of the intervention as good or excellent. After the intervention, depressive symptoms had significantly decreased (BDI-II change: mean= −3.9, p =0.01, d = 0.51 in intention-to-treat analysis; BDI-II change: mean= −9.0, p b 0.001, d =1.50 in completers analysis). Conclusions: This study suggests that applied web-based PST is feasible and reduces depressive symptoms in MS patients. Especially MS patients who experience disease-related or other barriers to participate in face-to-face counselling could benefit. However, ways to increase compliance should be considered. A randomized controlled trial is recommended to more extensively investigate effectiveness of this intervention in treating depressive symptoms in MS patients.
Journal of Affective Disorders, 2004
Background: Given the existing economic constraints, prevention of depression has to be carefully... more Background: Given the existing economic constraints, prevention of depression has to be carefully targeted, and applied where it is likely to yield the highest possible health benefits at the lowest possible cost. Aim: To identify those risk factors of depression that have the greatest use potential from the perspective of prevention. Method: Data were derived from a population-based prospective cohort of 4664 adults who had never experienced a depression. Their health status was reexamined after 1 year. Incidence rate ratios (IRR), population attributable risks (PAR) and numbers needed to be treated (NNT) were calculated to create a hierarchy of risk factors. Results: Selecting high-risk groups with migraine, abdominal and respiratory complaints and markers of vulnerability or childhood trauma appears to be an indicated strategy. Conclusions: This study illustrates how epidemiology can contribute towards setting a Research and Development agenda for primary prevention of depression.
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Papers by Aartjan Beekman