Context: Unlike other areas of medicine, psychiatry is almost entirely dependent on patient repor... more Context: Unlike other areas of medicine, psychiatry is almost entirely dependent on patient report to assess the presence and severity of disease; therefore, it is particularly crucial that we find both more accurate and efficient means of obtaining that report. Objective: To develop a computerized adaptive test (CAT) for depression, called the Computerized Adaptive Test-Depression Inventory (CAT-DI), that decreases patient and clinician burden and increases measurement precision. Design: Case-control study. Setting: A psychiatric clinic and community mental health center. Participants: A total of 1614 individuals with and without minor and major depression were recruited for study. Main Outcome Measures: The focus of this study was the development of the CAT-DI. The 24-item Hamilton Rating Scale for Depression, Patient Health Questionnaire 9, and the Center for Epidemiologic Studies Depression Scale were used to study the convergent validity of the new measure, and the Structured Clinical Interview for DSM-IV was used to obtain diagnostic classifications of minor and major depressive disorder. Results: A mean of 12 items per study participant was required to achieve a 0.3 SE in the depression severity estimate and maintain a correlation of r =0.95 with the total 389-item test score. Using empirically derived thresholds based on a mixture of normal distributions, we found a sensitivity of 0.92 and a specificity of 0.88 for the classification of major depressive disorder in a sample consisting of depressed patients and healthy controls. Correlations on the order of r=0.8 were found with the other clinician and self-rating scale scores. The CAT-DI provided excellent discrimination throughout the entire depressive severity continuum (minor and major depression), whereas the traditional scales did so primarily at the extremes (eg, major depression). Conclusions: Traditional measurement fixes the number of items administered and allows measurement uncertainty to vary. In contrast, a CAT fixes measurement uncertainty and allows the number of items to vary. The result is a significant reduction in the number of items needed to measure depression and increased precision of measurement.
Objective: To examine long-term outcome of late-life anxiety disorders and utilization of mental ... more Objective: To examine long-term outcome of late-life anxiety disorders and utilization of mental health care services. Method: A cohort of subjects (aged ‡55 years) with an anxiety disorder (n ¼ 112) was identified in the Longitudinal Aging Study Amsterdam (n ¼ 3107). At 6 year follow-up, the rate of persistence and prognostic factors for persistence of anxiety were established. Results: Six years after baseline 23% of our sample met the criteria for an anxiety disorder. Another 47% suffered from subclinical anxiety symptoms. Persistence of anxiety was associated with a high score on neuroticism at baseline. Use of benzodiazepines was high (43%), while use of mental health care facilities (14%) and anti-depressants (7%) remained low in those with persistent anxiety. Conclusion: Results indicate that those high in neuroticism are at greater risk for persistence of anxiety. Efforts to enhance appropriate referral of anxious older adults do not seem to have had the desired effect.
Oratie uitgesproken door Prof.dr. E. de Beurs bij de aanvaarding van het ambt van hoogleraar op h... more Oratie uitgesproken door Prof.dr. E. de Beurs bij de aanvaarding van het ambt van hoogleraar op het gebied van Routine Outcome Monitoring en Benchmarken in de Geestelijke Gezondheidszorg aan de Universiteit Leiden op vrijdag 27 november 2015Psycholog
BACKGROUND In Dutch mental health care there is an ongoing debate about the benefits of rom and u... more BACKGROUND In Dutch mental health care there is an ongoing debate about the benefits of rom and utility of benchmarking. Opinions vary regarding the reliability and validity of performance indicators. AIM: Investigation of the reliability of the main indicator of Foundation Benchmark Mental Health Care (sbg), Delta-T, the indicator of treatment outcome. METHOD: The reliability was established with two indices: the intraclass correlation coefficient (icc) for the agreement between repeated assessments of average treatment outcome and the consistency in rank order of mental health care providers over time. RESULTS: The reliability of Delta-T proved to be excellent. CONCLUSION: Reliability is a basic requirement, but only the first step in establishing the utility of Delta-T. Further investigation of its validity is ongoing, especially on how robust treatment outcome is for bias due to instrumentation, selection, and confounding by casemix composition. Ultimately, the usefulness of tre...
Bij het opleggen van de (voorwaardelijke) PIJ-maatregel (Plaatsting in een Inrichting voor Jonger... more Bij het opleggen van de (voorwaardelijke) PIJ-maatregel (Plaatsting in een Inrichting voor Jongeren) door de rechter en de tenuitvoerlegging van de PIJ-maatregel in justitiele jeugdinstellingen, is in theorie een belangrijke rol weggelegd voor de pro Justitia rapportage. Dit onderzoek beoogt meer zicht te geven op de rol van de pro Justitia rapportage in de praktijk.
We investigated longitudinal measurement invariance in the Dutch–Flemish PROMIS adult v1.0 item b... more We investigated longitudinal measurement invariance in the Dutch–Flemish PROMIS adult v1.0 item banks for Depression and Anxiety using two clinical samples with mood and anxiety disorders ( n = 640 and n = 528, respectively). Factor analysis was used to evaluate whether the item banks were sufficiently unidimensional at two test-occasions and whether the measured constructs remained the same over time. The results indicated that the item banks were sufficiently unidimensional, but the thresholds and residual variances of the constructs changed over time. However, using tentative rules of thumb, these invariance violations did not substantially affect the endorsement of a specific response category of a specific item at a specific test-occasion. Furthermore, the impact on the mean latent change scores of the item banks remained below the proposed cutoff value for substantial bias. These findings suggest that the invariance violations lacked practical significance for test-users, mean...
Careless responding by mental health patients on self-report assessments is rarely investigated i... more Careless responding by mental health patients on self-report assessments is rarely investigated in routine care despite the potential for serious consequences such as faulty clinical decisions. We investigated validity indices most appropriate for detecting careless responding in routine outcome monitoring (ROM) in mental health-care. First, we reviewed indices proposed in previous research for their suitability in ROM. Next, we evaluated six selected indices using data of the Brief Symptom Inventory and the Mood and Anxiety Symptom Questionnaire from 3,483 outpatients. Simulations showed that for typical ROM scales the L max index, Mahalanobis distance, and inter-item standard deviation may be too strongly confounded with the latent trait value to compare careless responding across patients with different symptom severity. Application of two different classification methods to the validity indices did not converge in similar prevalence estimates of careless responding. Finally, results suggest that careless responding does not have a substantial biasing effect on scalescore statistics. We recommend the l p z person-fit index to screen for random careless responding in large ROM data sets. However, additional research should further investigate methods for detecting repetitive responding in typical ROM data and assess whether there are specific circumstances in which simpler validity statistics or direct screening methods perform similarly as the l p z index.
Approaches based on continuous indicators (the size of the pre-to-post-test change; effect size o... more Approaches based on continuous indicators (the size of the pre-to-post-test change; effect size or ΔT) and on categorical indicators (Percentage Improvement and the Jacobson-Truax approach to Clinical Significance) are evaluated to determine which has the best methodological and statistical characteristics, and optimal performance, in comparing outcomes of treatment providers. Performance is compared in two datasets from providers using the Brief Symptom Inventory or the Outcome Questionnaire. Concordance of methods and their suitability to rank providers is assessed. Outcome indicators tend to converge and lead to a similar ranking of institutes within each dataset. Statistically and conceptually, continuous outcome indicators are superior to categorical outcomes as change scores have more statistical power and allow for a ranking of providers at first glance. However, the Jacobson-Truax approach can complement the change score approach as it presents outcome information in a clini...
Ger van der Werf Keywords alcoholisme Á angststoornis Á angststoornis Á gedragstherapie Á proefsc... more Ger van der Werf Keywords alcoholisme Á angststoornis Á angststoornis Á gedragstherapie Á proefschrift
Achtergrond Aansluitend op de toenemende belangstelling voor gedeelde besluitvorming (shared deci... more Achtergrond Aansluitend op de toenemende belangstelling voor gedeelde besluitvorming (shared decision making; sdm) in de geestelijke gezondheidszorg (ggz), ontstaat behoefte om de toepassing ervan te evalueren. Het begrip ‘beslissingsambivalentie’ (decisional conflict), dat vanuit patientperspectief de tevredenheid over het besluitvormingsproces en de genomen besluiten in kaart brengt, kan hierbij helpen. Doel Inzicht geven in decisional conflict en reflectie op de bruikbaarheid bij de evaluatie van sdm in de ggz. Methode Een literatuurstudie naar het begrip ‘decisional conflict’ gevolgd door een vertaalslag naar een visueel model. Resultaten Decisional conflict is een veelomvattend begrip dat zowel in gaat op de beinvloedende factoren (informatie, steun, helderheid over persoonlijke waarden) van het besluitvormingsproces, de mate van onzekerheid over keuzes als wel de kwaliteit van de besluitvorming. Decisional conflict is gevisualiseerd in een model en kan via de Decisional Confli...
... Page 13. Alfred Lnnge and Edwin de Beurs 57 ... Her father had died when she was six years ol... more ... Page 13. Alfred Lnnge and Edwin de Beurs 57 ... Her father had died when she was six years old. She had suffered from panic attacks with agoraphobia since she was 19 years old. At that time there were problems at work and her partner had just terminated their relationship. ...
The aim of the study was to investigate patterns of comorbidity among the anxiety disorders in a ... more The aim of the study was to investigate patterns of comorbidity among the anxiety disorders in a community-based older population, and the relationship of these disorders with major depression, use of alcohol and benzodiazepines, cognitive impairment and chronic somatic illnesses. The data were derived from the Longitudinal Aging Study Amsterdam (LASA) study. A two-stage screening design was adopted to identify respondents with anxiety disorders. In total, 10% of the elderly with an anxiety diagnosis suffered from two or more anxiety disorders. Major depression (13% vs. 3%), benzodiazepine use (24% vs. 11%) and chronic somatic diseases (12% vs. 7%) were significantly more prevalent in respondents with an anxiety disorder than in respondents without anxiety disorders. Heavy or excessive alcohol intake (5% vs. 4%) and cognitive impairment (11% vs. 13%) were not significantly associated with any anxiety disorder. When anxiety disorders are diagnosed, in older people there is a relatively high probability of comorbid conditions being present.
Background: Clark and Watson developed the tripartite model in which a symptom dimension of 'nega... more Background: Clark and Watson developed the tripartite model in which a symptom dimension of 'negative affect' covers common psychological distress that is typically seen in anxious and depressed patients. The 'positive affect' and 'somatic arousal' dimensions cover more specific symptoms. Although the model has met much support, it does not cover all relevant anxiety symptoms and its negative affect dimension is rather unspecific. Therefore, we aimed to extend the tripartite model in order to describe more specific symptom patterns with unidimensional measurement scales. Method: 1333 outpatients provided self report data. To develop an extended factor model, exploratory factor analysis (EFA) was conducted in one part of the data (n = 578). Confirmatory factor analysis (CFA) was conducted in the second part (n = 755), to assess model-fit and comparison with other models. Rasch analyses were done to investigate the unidimensionality of the factors. Results: EFA resulted in a 6-factor model: feelings of worthlessness, fatigue, somatic arousal, anxious apprehension, phobic fear and tension. CFA in the second sample showed that a 6factor model with a hierarchical common severity factor fits the data better than alternative 1-and 3-factor models. Rasch analyses showed that each of the factors and the total of factors can be regarded as unidimensional measurement scales. Limitations: The model is based on a restricted symptom-pool: more dimensions are likely to exist. Conclusion: The extended tripartite model describes the clinical state of patients more specifically. This is relevant for both clinical practice and research.
Dissociative style may correspond to an enhanced ability to avoid conscious recollection of traum... more Dissociative style may correspond to an enhanced ability to avoid conscious recollection of traumatic experiences, which may, however, remain dormant in nonconscious memory. This hypothesis was tested in two “directed-forgetting” experiments with affectively neutral words (experiment 1) and sex and threat words (experiment 2) employing students high and low in dissociative style, and dissociative patients. Conscious and nonconscious memory were
Context: Unlike other areas of medicine, psychiatry is almost entirely dependent on patient repor... more Context: Unlike other areas of medicine, psychiatry is almost entirely dependent on patient report to assess the presence and severity of disease; therefore, it is particularly crucial that we find both more accurate and efficient means of obtaining that report. Objective: To develop a computerized adaptive test (CAT) for depression, called the Computerized Adaptive Test-Depression Inventory (CAT-DI), that decreases patient and clinician burden and increases measurement precision. Design: Case-control study. Setting: A psychiatric clinic and community mental health center. Participants: A total of 1614 individuals with and without minor and major depression were recruited for study. Main Outcome Measures: The focus of this study was the development of the CAT-DI. The 24-item Hamilton Rating Scale for Depression, Patient Health Questionnaire 9, and the Center for Epidemiologic Studies Depression Scale were used to study the convergent validity of the new measure, and the Structured Clinical Interview for DSM-IV was used to obtain diagnostic classifications of minor and major depressive disorder. Results: A mean of 12 items per study participant was required to achieve a 0.3 SE in the depression severity estimate and maintain a correlation of r =0.95 with the total 389-item test score. Using empirically derived thresholds based on a mixture of normal distributions, we found a sensitivity of 0.92 and a specificity of 0.88 for the classification of major depressive disorder in a sample consisting of depressed patients and healthy controls. Correlations on the order of r=0.8 were found with the other clinician and self-rating scale scores. The CAT-DI provided excellent discrimination throughout the entire depressive severity continuum (minor and major depression), whereas the traditional scales did so primarily at the extremes (eg, major depression). Conclusions: Traditional measurement fixes the number of items administered and allows measurement uncertainty to vary. In contrast, a CAT fixes measurement uncertainty and allows the number of items to vary. The result is a significant reduction in the number of items needed to measure depression and increased precision of measurement.
Objective: To examine long-term outcome of late-life anxiety disorders and utilization of mental ... more Objective: To examine long-term outcome of late-life anxiety disorders and utilization of mental health care services. Method: A cohort of subjects (aged ‡55 years) with an anxiety disorder (n ¼ 112) was identified in the Longitudinal Aging Study Amsterdam (n ¼ 3107). At 6 year follow-up, the rate of persistence and prognostic factors for persistence of anxiety were established. Results: Six years after baseline 23% of our sample met the criteria for an anxiety disorder. Another 47% suffered from subclinical anxiety symptoms. Persistence of anxiety was associated with a high score on neuroticism at baseline. Use of benzodiazepines was high (43%), while use of mental health care facilities (14%) and anti-depressants (7%) remained low in those with persistent anxiety. Conclusion: Results indicate that those high in neuroticism are at greater risk for persistence of anxiety. Efforts to enhance appropriate referral of anxious older adults do not seem to have had the desired effect.
Oratie uitgesproken door Prof.dr. E. de Beurs bij de aanvaarding van het ambt van hoogleraar op h... more Oratie uitgesproken door Prof.dr. E. de Beurs bij de aanvaarding van het ambt van hoogleraar op het gebied van Routine Outcome Monitoring en Benchmarken in de Geestelijke Gezondheidszorg aan de Universiteit Leiden op vrijdag 27 november 2015Psycholog
BACKGROUND In Dutch mental health care there is an ongoing debate about the benefits of rom and u... more BACKGROUND In Dutch mental health care there is an ongoing debate about the benefits of rom and utility of benchmarking. Opinions vary regarding the reliability and validity of performance indicators. AIM: Investigation of the reliability of the main indicator of Foundation Benchmark Mental Health Care (sbg), Delta-T, the indicator of treatment outcome. METHOD: The reliability was established with two indices: the intraclass correlation coefficient (icc) for the agreement between repeated assessments of average treatment outcome and the consistency in rank order of mental health care providers over time. RESULTS: The reliability of Delta-T proved to be excellent. CONCLUSION: Reliability is a basic requirement, but only the first step in establishing the utility of Delta-T. Further investigation of its validity is ongoing, especially on how robust treatment outcome is for bias due to instrumentation, selection, and confounding by casemix composition. Ultimately, the usefulness of tre...
Bij het opleggen van de (voorwaardelijke) PIJ-maatregel (Plaatsting in een Inrichting voor Jonger... more Bij het opleggen van de (voorwaardelijke) PIJ-maatregel (Plaatsting in een Inrichting voor Jongeren) door de rechter en de tenuitvoerlegging van de PIJ-maatregel in justitiele jeugdinstellingen, is in theorie een belangrijke rol weggelegd voor de pro Justitia rapportage. Dit onderzoek beoogt meer zicht te geven op de rol van de pro Justitia rapportage in de praktijk.
We investigated longitudinal measurement invariance in the Dutch–Flemish PROMIS adult v1.0 item b... more We investigated longitudinal measurement invariance in the Dutch–Flemish PROMIS adult v1.0 item banks for Depression and Anxiety using two clinical samples with mood and anxiety disorders ( n = 640 and n = 528, respectively). Factor analysis was used to evaluate whether the item banks were sufficiently unidimensional at two test-occasions and whether the measured constructs remained the same over time. The results indicated that the item banks were sufficiently unidimensional, but the thresholds and residual variances of the constructs changed over time. However, using tentative rules of thumb, these invariance violations did not substantially affect the endorsement of a specific response category of a specific item at a specific test-occasion. Furthermore, the impact on the mean latent change scores of the item banks remained below the proposed cutoff value for substantial bias. These findings suggest that the invariance violations lacked practical significance for test-users, mean...
Careless responding by mental health patients on self-report assessments is rarely investigated i... more Careless responding by mental health patients on self-report assessments is rarely investigated in routine care despite the potential for serious consequences such as faulty clinical decisions. We investigated validity indices most appropriate for detecting careless responding in routine outcome monitoring (ROM) in mental health-care. First, we reviewed indices proposed in previous research for their suitability in ROM. Next, we evaluated six selected indices using data of the Brief Symptom Inventory and the Mood and Anxiety Symptom Questionnaire from 3,483 outpatients. Simulations showed that for typical ROM scales the L max index, Mahalanobis distance, and inter-item standard deviation may be too strongly confounded with the latent trait value to compare careless responding across patients with different symptom severity. Application of two different classification methods to the validity indices did not converge in similar prevalence estimates of careless responding. Finally, results suggest that careless responding does not have a substantial biasing effect on scalescore statistics. We recommend the l p z person-fit index to screen for random careless responding in large ROM data sets. However, additional research should further investigate methods for detecting repetitive responding in typical ROM data and assess whether there are specific circumstances in which simpler validity statistics or direct screening methods perform similarly as the l p z index.
Approaches based on continuous indicators (the size of the pre-to-post-test change; effect size o... more Approaches based on continuous indicators (the size of the pre-to-post-test change; effect size or ΔT) and on categorical indicators (Percentage Improvement and the Jacobson-Truax approach to Clinical Significance) are evaluated to determine which has the best methodological and statistical characteristics, and optimal performance, in comparing outcomes of treatment providers. Performance is compared in two datasets from providers using the Brief Symptom Inventory or the Outcome Questionnaire. Concordance of methods and their suitability to rank providers is assessed. Outcome indicators tend to converge and lead to a similar ranking of institutes within each dataset. Statistically and conceptually, continuous outcome indicators are superior to categorical outcomes as change scores have more statistical power and allow for a ranking of providers at first glance. However, the Jacobson-Truax approach can complement the change score approach as it presents outcome information in a clini...
Ger van der Werf Keywords alcoholisme Á angststoornis Á angststoornis Á gedragstherapie Á proefsc... more Ger van der Werf Keywords alcoholisme Á angststoornis Á angststoornis Á gedragstherapie Á proefschrift
Achtergrond Aansluitend op de toenemende belangstelling voor gedeelde besluitvorming (shared deci... more Achtergrond Aansluitend op de toenemende belangstelling voor gedeelde besluitvorming (shared decision making; sdm) in de geestelijke gezondheidszorg (ggz), ontstaat behoefte om de toepassing ervan te evalueren. Het begrip ‘beslissingsambivalentie’ (decisional conflict), dat vanuit patientperspectief de tevredenheid over het besluitvormingsproces en de genomen besluiten in kaart brengt, kan hierbij helpen. Doel Inzicht geven in decisional conflict en reflectie op de bruikbaarheid bij de evaluatie van sdm in de ggz. Methode Een literatuurstudie naar het begrip ‘decisional conflict’ gevolgd door een vertaalslag naar een visueel model. Resultaten Decisional conflict is een veelomvattend begrip dat zowel in gaat op de beinvloedende factoren (informatie, steun, helderheid over persoonlijke waarden) van het besluitvormingsproces, de mate van onzekerheid over keuzes als wel de kwaliteit van de besluitvorming. Decisional conflict is gevisualiseerd in een model en kan via de Decisional Confli...
... Page 13. Alfred Lnnge and Edwin de Beurs 57 ... Her father had died when she was six years ol... more ... Page 13. Alfred Lnnge and Edwin de Beurs 57 ... Her father had died when she was six years old. She had suffered from panic attacks with agoraphobia since she was 19 years old. At that time there were problems at work and her partner had just terminated their relationship. ...
The aim of the study was to investigate patterns of comorbidity among the anxiety disorders in a ... more The aim of the study was to investigate patterns of comorbidity among the anxiety disorders in a community-based older population, and the relationship of these disorders with major depression, use of alcohol and benzodiazepines, cognitive impairment and chronic somatic illnesses. The data were derived from the Longitudinal Aging Study Amsterdam (LASA) study. A two-stage screening design was adopted to identify respondents with anxiety disorders. In total, 10% of the elderly with an anxiety diagnosis suffered from two or more anxiety disorders. Major depression (13% vs. 3%), benzodiazepine use (24% vs. 11%) and chronic somatic diseases (12% vs. 7%) were significantly more prevalent in respondents with an anxiety disorder than in respondents without anxiety disorders. Heavy or excessive alcohol intake (5% vs. 4%) and cognitive impairment (11% vs. 13%) were not significantly associated with any anxiety disorder. When anxiety disorders are diagnosed, in older people there is a relatively high probability of comorbid conditions being present.
Background: Clark and Watson developed the tripartite model in which a symptom dimension of 'nega... more Background: Clark and Watson developed the tripartite model in which a symptom dimension of 'negative affect' covers common psychological distress that is typically seen in anxious and depressed patients. The 'positive affect' and 'somatic arousal' dimensions cover more specific symptoms. Although the model has met much support, it does not cover all relevant anxiety symptoms and its negative affect dimension is rather unspecific. Therefore, we aimed to extend the tripartite model in order to describe more specific symptom patterns with unidimensional measurement scales. Method: 1333 outpatients provided self report data. To develop an extended factor model, exploratory factor analysis (EFA) was conducted in one part of the data (n = 578). Confirmatory factor analysis (CFA) was conducted in the second part (n = 755), to assess model-fit and comparison with other models. Rasch analyses were done to investigate the unidimensionality of the factors. Results: EFA resulted in a 6-factor model: feelings of worthlessness, fatigue, somatic arousal, anxious apprehension, phobic fear and tension. CFA in the second sample showed that a 6factor model with a hierarchical common severity factor fits the data better than alternative 1-and 3-factor models. Rasch analyses showed that each of the factors and the total of factors can be regarded as unidimensional measurement scales. Limitations: The model is based on a restricted symptom-pool: more dimensions are likely to exist. Conclusion: The extended tripartite model describes the clinical state of patients more specifically. This is relevant for both clinical practice and research.
Dissociative style may correspond to an enhanced ability to avoid conscious recollection of traum... more Dissociative style may correspond to an enhanced ability to avoid conscious recollection of traumatic experiences, which may, however, remain dormant in nonconscious memory. This hypothesis was tested in two “directed-forgetting” experiments with affectively neutral words (experiment 1) and sex and threat words (experiment 2) employing students high and low in dissociative style, and dissociative patients. Conscious and nonconscious memory were
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