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Depression: HELP
Articles by Huibert Burger
Based on 31 articles published since 2008
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Between 2008 and 2019, Huibert Burger wrote the following 31 articles about Depression.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Pharmacological treatment for psychotic depression. 2015

Wijkstra, Jaap / Lijmer, Jeroen / Burger, Huibert / Cipriani, Andrea / Geddes, John / Nolen, Willem A. ·Department of Psychiatry, UMCU, B.01.206, Postbox 85500, 3508 GA, Utrecht, Netherlands. ·Cochrane Database Syst Rev · Pubmed #26225902.

ABSTRACT: BACKGROUND: Evidence is limited regarding the most effective pharmacological treatment for psychotic depression: combination of an antidepressant plus an antipsychotic, monotherapy with an antidepressant or monotherapy with an antipsychotic. This is an update of a review first published in 2005 and last updated in 2009. OBJECTIVES: 1. To compare the clinical efficacy of pharmacological treatments for patients with an acute psychotic depression: antidepressant monotherapy, antipsychotic monotherapy and the combination of an antidepressant plus an antipsychotic, compared with each other and/or with placebo.2. To assess whether differences in response to treatment in the current episode are related to non-response to prior treatment. SEARCH METHODS: A search of the Cochrane Central Register of Controlled Trials and the Cochrane Depression, Anxiety and Neurosis Group Register (CCDANCTR) was carried out (to 12 April 2013). These registers include reports of randomised controlled trials from the following bibliographic databases: EMBASE (1970-), MEDLINE (1950-) and PsycINFO (1960-). Reference lists of all studies and related reviews were screened and key authors contacted. SELECTION CRITERIA: All randomised controlled trials (RCTs) that included participants with acute major depression with psychotic features, as well as RCTs consisting of participants with acute major depression with or without psychotic features, that reported separately on the subgroup of participants with psychotic features. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias in the included studies, according to the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. Data were entered into RevMan 5.1. We used intention-to-treat data. For dichotomous efficacy outcomes, the risk ratio (RR) with 95% confidence intervals (CIs) was calculated. For continuously distributed outcomes, it was not possible to extract data from the RCTs. Regarding the primary outcome of harm, only overall dropout rates were available for all studies. MAIN RESULTS: The search identified 3659 abstracts, but only 12 RCTs with a total of 929 participants could be included in the review. Because of clinical heterogeneity, few meta-analyses were possible. The main outcome was reduction of severity (response) of depression, not of psychosis.We found no evidence for the efficacy of monotherapy with an antidepressant or an antipsychotic.However, evidence suggests that the combination of an antidepressant plus an antipsychotic is more effective than antidepressant monotherapy (three RCTs; RR 1.49, 95% CI 1.12 to 1.98, P = 0.006), more effective than antipsychotic monotherapy (four RCTs; RR 1.83, 95% CI 1.40 to 2.38, P = 0.00001) and more effective than placebo (two identical RCTs; RR 1.86, 95% CI 1.23 to 2.82, P = 0.003).Risk of bias is considerable: there were differences between studies with regard to diagnosis, uncertainties around randomisation and allocation concealment, differences in treatment interventions (pharmacological differences between the various antidepressants and antipsychotics) and different outcome criteria. AUTHORS' CONCLUSIONS: Psychotic depression is heavily understudied, limiting confidence in the conclusions drawn. Some evidence indicates that combination therapy with an antidepressant plus an antipsychotic is more effective than either treatment alone or placebo. Evidence is limited for treatment with an antidepressant alone or with an antipsychotic alone.

2 Review Pharmacological treatment for psychotic depression. 2013

Wijkstra, Jaap / Lijmer, Jeroen / Burger, Huibert / Geddes, John / Nolen, Willem A. ·Department of Psychiatry, UMCU, B.01.206, Postbox 85500, 3508 GA, Utrecht, Netherlands. ·Cochrane Database Syst Rev · Pubmed #24282034.

ABSTRACT: BACKGROUND: Evidence is limited regarding the most effective pharmacological treatment for psychotic depression: combination of an antidepressant plus an antipsychotic, monotherapy with an antidepressant or monotherapy with an antipsychotic. This is an update of a review first published in 2005 and last updated in 2009. OBJECTIVES: 1. To compare the clinical efficacy of pharmacological treatments for patients with an acute psychotic depression: antidepressant monotherapy, antipsychotic monotherapy and the combination of an antidepressant plus an antipsychotic, compared with each other and/or with placebo.2. To assess whether differences in response to treatment in the current episode are related to non-response to prior treatment. SEARCH METHODS: A search of the Cochrane Central Register of Controlled Trials and the Cochrane Depression, Anxiety and Neurosis Group Register (CCDANCTR) was carried out (to 12 April 2013). These registers include reports of randomised controlled trials from the following bibliographic databases: EMBASE (1970-), MEDLINE (1950-) and PsycINFO (1960-). Reference lists of all studies and related reviews were screened and key authors contacted. SELECTION CRITERIA: All randomised controlled trials (RCTs) that included participants with acute major depression with psychotic features, as well as RCTs consisting of participants with acute major depression with or without psychotic features, that reported separately on the subgroup of participants with psychotic features. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias in the included studies, according to the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. Data were entered into RevMan 5.1. We used intention-to-treat data. For dichotomous efficacy outcomes, the risk ratio (RR) with 95% confidence intervals (CIs) was calculated. For continuously distributed outcomes, it was not possible to extract data from the RCTs. Regarding the primary outcome of harm, only overall dropout rates were available for all studies. MAIN RESULTS: The search identified 3659 abstracts, but only 12 RCTs with a total of 929 participants could be included in the review. Because of clinical heterogeneity, few meta-analyses were possible. The main outcome was reduction of severity (response) of depression, not of psychosis.We found no evidence for the efficacy of monotherapy with an antidepressant or an antipsychotic.However, evidence suggests that the combination of an antidepressant plus an antipsychotic is more effective than antidepressant monotherapy (three RCTs; RR 1.49, 95% CI 1.12 to 1.98, P = 0.006), more effective than antipsychotic monotherapy (four RCTs; RR 1.83, 95% CI 1.40 to 2.38, P = 0.00001) and more effective than placebo (two identical RCTs; RR 1.86, 95% CI 1.23 to 2.82, P = 0.003).Risk of bias is considerable: there were differences between studies with regard to diagnosis, uncertainties around randomisation and allocation concealment, differences in treatment interventions (pharmacological differences between the various antidepressants and antipsychotics) and different outcome criteria. AUTHORS' CONCLUSIONS: Psychotic depression is heavily understudied, limiting confidence in the conclusions drawn. Some evidence indicates that combination therapy with an antidepressant plus an antipsychotic is more effective than either treatment alone or placebo. Evidence is limited for treatment with an antidepressant alone or with an antipsychotic alone.

3 Review Double trouble: does co-morbid chronic somatic illness increase risk for recurrence in depression? A systematic review. 2013

Kok, Gemma D / Bockting, Claudi L H / Burger, Huibert / Hannig, Wiebke / Pijnenborg, Gerdina H M / Cuijpers, Pim / Hollon, Steven D. ·Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands. ·PLoS One · Pubmed #23472087.

ABSTRACT: OBJECTIVE: To perform a systematic review, and if possible a meta-analysis, to establish whether depressed patients with co-morbid chronic somatic illnesses are a high risk "double trouble" group for depressive recurrence. METHOD: The databases PubMed, EMbase and PsycINFO were systematically searched until the 4(th) of December 2012 by using MeSH and free text terms. Additionally, reference lists of retrieved publications and treatment guidelines were reviewed, and experts were consulted. Inclusion criteria were: depression had to be measured at least twice during the study with qualified instruments and the chronic somatic illness had to be assessed by self-report or by a medical professional. Information on depressive recurrence was extracted and additionally risk ratios of recurrence were calculated. RESULTS: The search generated four articles that fulfilled our inclusion criteria. These studies showed no differences in recurrence over one- two- three- and 6.5 years of follow-up for a total of 2010 depressed patients of which 694 patients with a co-morbid chronic somatic illness versus 1316 patients without (Study 1: RR = 0.49, 95% CI, 0.17-1.41 at one year follow-up and RR = 1.37, 95% CI, 0.78-2.41 at two year follow-up; Study 2: RR = 0.94, 95% CI, 0.65-1.36 at two year follow-up; Study 3: RR = 1.15, 95% CI, 0.40-3.27 at one year follow-up; RR = 1.07, 95% CI, 0.48-2.42 at two year follow-up and RR = 0.99, 95% CI,0.55-1.77 at 6.5 years follow-up; Study 4: RR = 1.16, 95% CI, 0.86-1.57 at three year follow-up). CONCLUSION: We found no association between a heightened risk for depressive recurrence and co-morbid chronic somatic illnesses. There is a need for more longitudinal studies to justify the current specific treatment advice such as long-term pharmacological maintenance treatment for this presumed "double trouble" group.

4 Article The effectiveness and cost-effectiveness of e-health interventions for depression and anxiety in primary care: A systematic review and meta-analysis. 2019

Massoudi, Btissame / Holvast, Floor / Bockting, Claudi L H / Burger, Huibert / Blanker, Marco H. ·University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands. Electronic address: b.massoudi@umcg.nl. · University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands. Electronic address: f.holvast@umcg.nl. · University of Utrecht, Department of Clinical Psychology, Utrecht, the Netherlands; University of Groningen, Department of Clinical Psychology, Groningen, the Netherlands. Electronic address: c.l.h.bockting@uu.nl. · University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands. Electronic address: h.burger@umcg.nl. · University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands. Electronic address: m.h.blanker@umcg.nl. ·J Affect Disord · Pubmed #30447572.

ABSTRACT: PURPOSE: Psychological interventions are labor-intensive and expensive, but e-health interventions may support them in primary care. In this study, we systematically reviewed the effectiveness and cost-effectiveness of e-health interventions for depressive and anxiety symptoms and disorders in primary care. METHODS: We searched MEDLINE, Cochrane library, Embase, and PsychINFO until January 2018, for randomized controlled trials of e-health interventions for depression or anxiety in primary care. Two reviewers independently screened the identified publications, extracted data, and assessed risk of bias using the Cochrane Collaboration's tool. RESULTS: Out of 3617 publications, we included 14 that compared 33 treatments in 4183 participants. Overall, the methodological quality was poor to fair. The pooled effect size of e-health interventions was small (standardized mean difference = -0.19, 95%CI -0.31 to -0.06) for depression compared to control groups in the short-term, but this was maintained in the long-term (standardized mean difference = -0.22, 95%CI -0.35 to -0.09). Further analysis showed that e-health for depression had a small effect compared to care as usual and a moderate effect compared to waiting lists. One trial on anxiety showed no significant results. Four trials reported on cost-effectiveness. LIMITATIONS: The trials studied different types of e-health interventions and had several risks of bias. Moreover, only one study was included for anxiety. CONCLUSIONS: E-health interventions for depression have a small effect in primary care, with a moderate effect compared to waiting lists. The approach also appeared to be cost-effective for depression. However, we found no evidence for its effectiveness for anxiety.

5 Article Non-adherence to antidepressants among older patients with depression: a longitudinal cohort study in primary care. 2019

Holvast, Floor / Oude Voshaar, Richard C / Wouters, Hans / Hek, Karin / Schellevis, Francois / Burger, Huibert / Verhaak, Peter F M. ·Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen. · University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen. · NIVEL, Netherlands Institute for Health Services Research, Utrecht. · Department of General Practice and Elderly Care Medicine/Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands. ·Fam Pract · Pubmed #30395196.

ABSTRACT: Background: Depression is common among older adults and is typically treated with antidepressants. Objective: To determine the non-adherence rates to antidepressants among older adults in primary care, based on non-initiation, suboptimal implementation or non-persistence. Methods: We selected all patients aged ≥60 years and diagnosed with depression in 2012, from the Netherlands Institute for Health Services Research (NIVEL) Primary Care Database. Non-initiation was defined as no dispensing within 14 days of the first prescription; suboptimal implementation, as fewer than 80% of the days covered by dispensed dosages; and non-persistence, as discontinuation within 294 days after first dispense. First, we determined the antidepressant non-initiation, suboptimal implementation and non-persistence rates. Second, we examined whether comorbidity and chronic drug use were associated with non-adherence by mixed-effects logistic regression (non-initiation or suboptimal implementation as dependent variables) and a clustered Cox regression (time to non-persistence). Results: Non-initiation, suboptimal implementation and non-persistence rates were 13.5%, 15.2% and 37.1%, respectively. As the number of chronically used drugs increased, the odds of suboptimal implementation (odds ratio, 0.89; 95% confidence interval, 0.83-0.95) and of non-persistence (hazard ratio, 0.87; 95% confidence interval, 0.82-0.92) reduced. Conclusions: Non-adherence to antidepressants is high among older patients with depression in primary care settings. Adherence is better when patients are accustomed to taking larger numbers of prescribed drugs, but this only provides partial explanation of the variance. GPs should be aware of the high rates of non-adherence. Emphasizing the importance of adhering to the optimal length of antidepressant therapy might be prudent first steps to improving adherence.

6 Article Low socioeconomic status increases effects of negative life events on antenatal anxiety and depression. 2019

Verbeek, Tjitte / Bockting, Claudi L H / Beijers, Chantal / Meijer, Judith L / van Pampus, Mariëlle G / Burger, Huibert. ·Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: t.verbeek@umcg.nl. · Department of Psychiatry, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands; Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands. · Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. · Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. · Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. · Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. ·Women Birth · Pubmed #29887508.

ABSTRACT: PROBLEM: Low socioeconomic status and prior negative life events are documented risk factors for antenatal anxiety and depression, preterm birth and birth weight. We aimed to asses whether the adverse effects of prior negative life events increase with lower socioeconomic status and which aspects of socioeconomic status are most relevant. METHODS: We performed a population-based cohort study in the Netherlands including 5398 women in their first trimester of pregnancy. We assessed the number of negative life events prior to pregnancy, aspects of paternal and maternal socio-economic position and symptoms of anxiety and depression. Associations of the number of prior negative life events with anxiety, depression, low birth weight and gestational age were quantified. FINDINGS: The number of prior negative life events, particularly when they had occurred in the two years before pregnancy and maternal aspects of low socioeconomic status (educational level, unemployment and income) were associated with antenatal anxiety and depression. Furthermore, low socioeconomic status increased the adverse effects of prior negative life events. Obstetric outcomes showed similar trends, although mostly not statistically significant. DISCUSSION: Low socioeconomic status and prior negative life events both have an adverse effect on antenatal anxiety and depression. Furthermore, low socioeconomic status increases the adverse impact of prior negative life events on anxiety and depressive symptoms in pregnancy. CONCLUSION: Interventions for anxiety and depression during pregnancy should be targeted particularly to unemployed, less-educated or low-income women who recently experienced negative life events.

7 Article Effectiveness of cognitive-behavioral therapy on quality of life, anxiety, and depressive symptoms among patients with inflammatory bowel disease: A multicenter randomized controlled trial. 2017

Bennebroek Evertsz', Floor / Sprangers, Mirjam A G / Sitnikova, Kate / Stokkers, Pieter C F / Ponsioen, Cyriel Y / Bartelsman, Joep F W M / van Bodegraven, Ad A / Fischer, Steven / Depla, Annekatrien C T M / Mallant, Rosalie C / Sanderman, Robbert / Burger, Huibert / Bockting, Claudi L H. ·Department of Medical Psychology. · Department of General Practice & Elderly Care Medicine, VU University Medical Center Amsterdam. · Department of Gastroenterology, Sint Lucas Andreas Hospital. · Department of Gastroenterology, Academic Medical Center, University of Amsterdam. · Department of Gastroenterology and Hepatology, VU University Medical Center Amsterdam. · Department of Medical Psychology, Slotervaart Hospital. · Department of Gastroenterology and Hepatology, Slotervaart Hospital. · Department of Gastroenterology and Hepatology, Flevo Hospital. · Department of Health Psychology, University Medical Center Groningen, University of Groningen. · Department of General Practice, University Medical Center Groningen, University of Groningen. · Department of Clinical and Health Psychology, University of Utrecht. ·J Consult Clin Psychol · Pubmed #28857595.

ABSTRACT: OBJECTIVE: Inflammatory bowel disease (IBD) is characterized by a low level of quality of life (QoL) and a high prevalence of anxiety and depression, especially in patients with poor QoL. We examined the effect of IBD-specific cognitive-behavioral therapy (CBT) on QoL, anxiety, and depression in IBD patients with poor mental QoL. METHOD: This study is a parallel-group multicenter randomized controlled trial. One hundred eighteen IBD patients with a low level of QoL (score ≤23 on the mental health subscale of the Medical Outcomes Study Short Form 36 Health Survey [SF-36]) were included from 2 academic medical centers (Academic Medical Center Amsterdam, VU University Medical Centre Amsterdam) and 2 peripheral medical centers (Flevo Hospital, Slotervaart Hospital) in the Netherlands. Patients were randomized to an experimental group receiving CBT (n = 59) versus a wait-list control group (n = 59) receiving standard medical care for 3.5 months, followed by CBT. Both groups completed baseline and 3.5 months follow-up assessments. The primary outcome was a self-report questionnaire and disease-specific QoL (Inflammatory Bowel Disease Questionnaire [IBDQ]). Secondary outcomes were depression (Hospital Anxiety and Depression Scale-Depression Subscale [HADS-D], Center for Epidemiologic Studies Depression Scale [CES-D]), anxiety (HADS-Anxiety Subscale [HADS-A]) and generic QoL (SF-36). RESULTS: Data were analyzed both on intention to treat as well as on per protocol analysis (completed ≥5 sessions). CBT had a positive effect on disease-specific-QoL (Cohen's d = .64 for IBDQ total score), depression (Cohen's d = .48 for HADS-D and .78 for CES-D), anxiety (Cohen's d = .58 for HADS-A), and generic QoL (Cohen's d = 1.08 for Mental Component Summary of the SF-36; all ps < .01). CONCLUSIONS: IBD-specific CBT is effective in improving QoL and in decreasing anxiety and depression in IBD patients with poor QoL. Clinicians should incorporate screening on poor mental QoL and consider offering CBT. (PsycINFO Database Record

8 Article Blended care vs. usual care in the treatment of depressive symptoms and disorders in general practice [BLENDING]: study protocol of a non-inferiority randomized trial. 2017

Massoudi, Btissame / Blanker, Marco H / van Valen, Evelien / Wouters, Hans / Bockting, Claudi L H / Burger, Huibert. ·Department of General Practice, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD, Groningen, the Netherlands. b.massoudi@umcg.nl. · Department of General Practice, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD, Groningen, the Netherlands. · Department of Clinical Psychology, University of Utrecht, Utrecht, The Netherlands. · Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands. ·BMC Psychiatry · Pubmed #28610561.

ABSTRACT: BACKGROUND: The majority of patients with depressive disorders are treated by general practitioners (GPs) and are prescribed antidepressant medication. Patients prefer psychological treatments but they are under-used, mainly due to time constraints and limited accessibility. A promising approach to deliver psychological treatment is blended care, i.e. guided online treatment. However, the cost-effectiveness of blended care formatted as an online psychological treatment supported by the patients' own GP or general practice mental health worker (MHW) in routine primary care is unknown. We aim to demonstrate non-inferiority of blended care compared with usual care in patients with depressive symptoms or a depressive disorder in general practice. Additionally, we will explore the real-time course over the day of emotions and affect, and events within individuals during treatment. METHODS: This is a pragmatic non-inferiority trial including 300 patients with depressive symptoms, recruited by collaborating GPs and MHWs. After inclusion, participants are randomized to either blended care or usual care in routine general practice. Blended care consists of the 'Act and Feel' treatment: an eight-week web-based program based on behavioral activation with integrated monitoring of depressive symptomatology and automatized feedback. GPs or their MHWs coach the participants through regular face-to-face or telephonic consultations with at least three sessions. Depressive symptomatology, health status, functional impairment, treatment satisfaction, daily activities and resource use are assessed during a follow-up period of 12 months. During treatment, real-time fluctuations in emotions and affect, and daily events will be rated using ecological momentary assessment. The primary outcome is the reduction of depressive symptoms from baseline to three months follow-up. We will conduct intention-to-treat analyses and supplementary per-protocol analyses. DISCUSSION: This trial will show whether blended care might be an appropriate treatment strategy for patients with depressive symptoms and depressive disorder in general practice. TRIAL REGISTRATION: Netherlands Trial Register: NTR4757; 25 August 2014. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4757 . (Archived by WebCite® at http://www.webcitation.org/6mnXNMGef ).

9 Article Late-life depression and the association with multimorbidity and polypharmacy: a cross-sectional study. 2017

Holvast, Floor / van Hattem, Bernard A / Sinnige, Judith / Schellevis, François / Taxis, Katja / Burger, Huibert / Verhaak, Peter F M. ·Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. · Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands. · NIVEL, Netherlands Institute of Health Services Research, Utrecht, The Netherlands. · Department of General Practice and Elderly care medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. · Department of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands. ·Fam Pract · Pubmed #28369380.

ABSTRACT: Background: Late-life depression often coincides with chronic somatic diseases and, consequently, with polypharmacy, which may complicate medical treatment. Objective: To determine the associations between patients diagnosed with late-life depression in primary care and multimorbidity and polypharmacy. Methods: This cross-sectional observational study was performed using 2012 primary care data. Depressed patients aged ≥60 years were compared to age and gender matched patients diagnosed with other psychological diagnoses and mentally healthy controls. Morbidity and prescription data were combined, and regression analyses were performed for the associations between depression and chronic disease and chronic drug use. Results: We included 4477 patients; 1512 had a record of depression, 1457 of other mental health or psychological diagnoses and 1508 were controls. Depressed patients had a 16% [Prevalence Ratio (PR) 1.16; 95% confidence interval (95% CI) 10%-24%] higher rate of chronic somatic disease and higher odds for multimorbidity (OR 1.55; 95% CI 1.33-1.81) compared with controls. No differences existed between depressed patients and patients with other psychological diagnoses. Compared with controls, depressed patients had a 46% (95% CI 39-53%) higher rate of chronic drug use and higher odds for polypharmacy (OR 2.89; 95% CI 2.41-3.47). Depressed patients also had higher rates of chronic drug use and higher odds for polypharmacy compared with patients with other psychological diagnoses (PR 1.26; OR 1.75; both P < 0.001). Conclusions: Late-life depression in primary care patients is associated with more chronic drug use, even beyond the increased rates of comorbid somatic diseases. General practitioners should consider medication reviews to prevent unnecessary drug-related problems in these patients.

10 Article Beliefs about the causes of depression and recovery and their impact on adherence, dosage, and successful tapering of antidepressants. 2017

Klein, Nicola S / van Rijsbergen, Gerard D / Ten Doesschate, Mascha C / Hollon, Steven D / Burger, Huibert / Bockting, Claudi L H. ·Department of Clinical Psychology, University of Groningen, Groningen, the Netherlands. · Department of early detection and intervention in psychosis, GGZ Drenthe, the Netherlands. · Department de Swaai, GGZ Friesland, the Netherlands. · Department of Psychology, Vanderbilt University, Nashville, TN, USA. · Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands. · Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands. ·Depress Anxiety · Pubmed #28102582.

ABSTRACT: BACKGROUND: Continuation of antidepressant medication (ADM) after remission is widely used to prevent depressive relapse/recurrence. Little is known about predictors of ADM use in terms of adherence, dosage, and successful tapering. The current study aimed to explore beliefs about the causes of depression and recovery (i.e., causal beliefs) and to examine whether they predict ADM use. METHODS: The data were drawn from a controlled trial and an extension of this trial with additional experience sampling. In total, 289 remitted patients with recurrent depression (ADM ≥ 6 months) were randomly assigned to Preventive Cognitive Therapy (PCT) with ADM tapering, PCT with maintenance ADM, or maintenance ADM alone. Adherence, ADM dosage, and causal beliefs regarding the first and last depressive episodes were explored via questionnaires. RESULTS: Most patients mentioned stressful life events as cause of depression, although more patients tended to endorse external causes for the first episode and internal causes for the last episode. ADM was most often mentioned as helpful during recovery from both episodes. Over half of all patients were adherent and under half of the patients in the tapering condition were able to complete the taper. Causal beliefs did not predict ADM use. CONCLUSIONS: The results suggest that causal beliefs play little role in the use of maintenance ADM. More information is needed on factors contributing to successful tapering. The results must be interpreted with caution as this is not a naturalistic study and the results might be biased toward a more favorable view regarding ADM.

11 Article Diffusion tensor imaging in euthymic bipolar disorder - A tract-based spatial statistics study. 2016

Haarman, Bartholomeus C M 'Benno' / Riemersma-Van der Lek, Rixt F / Burger, Huibert / de Groot, Jan Cees / Drexhage, Hemmo A / Nolen, Willem A / Cerliani, Leonardo. ·University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands; Radiology Morphological Solutions, Berkel en Rodenrijs, The Netherlands. Electronic address: b.c.m.haarman@rug.nl. · University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands. · University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands. · University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands. · Erasmus MC, Department of Immunology, Rotterdam, The Netherlands. · University of Groningen, Neuroimaging Center, Groningen, The Netherlands; Institute du Cerveau et de la Moelle épinière, Paris, France. ·J Affect Disord · Pubmed #27317921.

ABSTRACT: BACKGROUND: In the current DTI study we compared euthymic bipolar I disorder (BD-I) patients and healthy controls (HC). We subsequently divided the total patient group into lithium-users and non-lithium-users and estimated differences across the three groups. METHODS: Twenty-one euthymic BD-I patients and twenty-two HC participants were included in psychiatric interviews and MRI image acquisition (diffusion-weighted (DW) and T1-weighted scans). Fractional anisotropy (FA), radial, mean and axial diffusivity (RD, MD, AD) were estimated from the DW data, using DTI. These measures were then compared between groups using FSL Tract Based Spatial Statistics (TBSS). Correlations with age at onset, number of episodes and depression score were analyzed. RESULTS: A difference in FA, MD, RD and AD between the whole sample of euthymic BD-I patients and healthy controls could not be detected. Amongst others, lithium-using patients demonstrated a higher FA and lower RD when compared to non-lithium-using BD-I patients in the corpus callosum and left anterior corona radiata. Widespread clusters demonstrated negative FA associations and positive RD and MD associations with minor depressive symptoms. LIMITATIONS: Patients were naturalistically treated. Although the sample size is comparable to several other DTI studies, a larger sample size would have been benificial. TBSS and DTI have their own limitations. CONCLUSION: Our findings support the theory that previously described DTI-based microstructural differences between HC and BD patients could be less pronounced in euthymic BD patients. Differences in FA between patients using and not using lithium suggest a counteracting effect of lithium on white matter microstructural disturbances.

12 Article Stop or go? Preventive cognitive therapy with guided tapering of antidepressants during pregnancy: study protocol of a pragmatic multicentre non-inferiority randomized controlled trial. 2016

Molenaar, Nina M / Brouwer, Marlies E / Bockting, Claudi L H / Bonsel, Gouke J / van der Veere, Christine N / Torij, Hanneke W / Hoogendijk, Witte J G / Duvekot, Johannes J / Burger, Huibert / Lambregtse-van den Berg, Mijke P. ·Department of Psychiatry, Erasmus Medical Centre, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. · Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands. · Department of Obstetrics and Gynaecology, Erasmus Medical Centre, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. · Department of Pediatrics, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. · Department of obstetrics and birth care, Hogeschool Rotterdam, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands. · Department of General Practice, University Medical Centre Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands. · Department of Psychiatry, Erasmus Medical Centre, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. mijke.vandenberg@erasmusmc.nl. · Department of Obstetrics and Gynaecology, Erasmus Medical Centre, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. mijke.vandenberg@erasmusmc.nl. · Department of Child and Adolescent Psychiatry, Erasmus Medical Centre - Sophia Childrens Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands. mijke.vandenberg@erasmusmc.nl. ·BMC Psychiatry · Pubmed #26993629.

ABSTRACT: BACKGROUND: Approximately 6.2 % of women in the USA and 3.7 % of women in the UK, use Selective Serotonin Reuptake Inhibitors (SSRIs) during their pregnancies because of depression and/or anxiety. In the Netherlands, this prevalence is around 2 %. Nonetheless, SSRI use during pregnancy is still controversial. On the one hand SSRIs may be toxic to the intrauterine developing child, while on the other hand relapse or recurrence of depression during pregnancy poses risks for both mother and child. Among patients and professionals there is an urgent need for evidence from randomized studies to make rational decisions regarding continuation or tapering of SSRIs during pregnancy. At present, no such studies exist. METHODS/DESIGN: 'Stop or Go' is a pragmatic multicentre randomized non-inferiority trial among 200 pregnant women with a gestational age of less than 16 weeks who use SSRIs without clinically relevant depressive symptoms. Women allocated to the intervention group will receive preventive cognitive therapy with gradual, guided discontinuation of SSRIs under medical management (STOP). Women in the control group will continue the use of SSRIs (GO). Primary outcome will be the (cumulative) incidence of relapse or recurrence of maternal depressive disorder (as assessed by the Structured Clinical Interview for DSM disorders) during pregnancy and up to three months postpartum. Secondary outcomes will be child outcome (neonatal outcomes and psychomotor and behavioural outcomes up to 24 months postpartum), and health-care costs. Total study duration for participants will be therefore be 30 months. We specified a non-inferiority margin of 15 % difference in relapse risk. DISCUSSION: This study is the first to investigate the effect of guided tapering of SSRIs with preventive cognitive therapy from early pregnancy onwards as compared to continuation of SSRIs during pregnancy. We will study the effects on both mother and child with a pragmatic approach. Additionally, the study examines cost effectiveness. If non-inferiority of preventive cognitive therapy with guided tapering of SSRIs compared to intended continuation of SSRIs is demonstrated for the primary outcome, this may be the preferential strategy during pregnancy. TRIAL REGISTRATION: Netherlands Trial Register (NTR): NTR4694 ; registration date: 16-jul-2014.

13 Article The association between cardiac rehabilitation and mortality risk for myocardial infarction patients with and without depressive symptoms. 2015

Meurs, Maaike / Burger, Huibert / van Riezen, Jerry / Slaets, Joris P / Rosmalen, Judith G M / van Melle, Joost P / Roest, Annelieke M / de Jonge, Peter. ·University of Groningen/University Medical Center Groningen, Department of Psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands. Electronic address: m.meurs@umcg.nl. · University of Groningen/University Medical Center Groningen, Department of Psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands; University of Groningen/University Medical Center Groningen - Department of General Practice, The Netherlands. · University of Groningen/University Medical Center Groningen, Department of Psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands. · University of Groningen/University Medical Center Groningen - Department of Internal Medicine, The Netherlands. · University of Groningen/University Medical Center Groningen, Department of Psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands; University of Groningen/University Medical Center Groningen - Department of Internal Medicine, The Netherlands. · University of Groningen/University Medical Center Groningen - Department of Cardiology, Thoraxcenter, The Netherlands. ·J Affect Disord · Pubmed #26384014.

ABSTRACT: BACKGROUND: Post-myocardial infarction (MI) depression is associated with reduced adherence to cardiac rehabilitation (CR) and increased mortality risk. The present study investigated whether all-cause mortality reduction associated with CR is different for MI-patients with and without depressive symptoms. METHODS: Data of 2198 post-MI patients from the Depression after Myocardial Infarction (DepreMI) study and Myocardial Infarction and Depression Intervention Trial (MIND-IT) was used. Depression was assessed at hospitalization, defined as a score≥10 on the Beck Depression Inventory (BDI). Participation in CR was assessed with a self-report questionnaire, 12 months post-MI. Cox regression was used to estimate hazard ratios (HR) for all-cause mortality, up till 10 years post-MI. Missing data was imputed, using multiple imputation. RESULTS: 878 (52%) Patients attended CR, 517 (26%) patients had a BDI score ≥10, and 379 (18%) patients died during the follow-up period. Overall, CR was not associated with a lower mortality risk (HR: 0.83; 0.54-1.30; p=0.41), adjusted for age, sex, left ventricle ejection fraction, previous MI, and past or current heart failure. However, there was a significant interaction between depression and CR on mortality (HR: 0.49; 0.27-0.90; p=0.02). CR was significantly associated with reduced mortality in depressed patients (HR: 0.48; 0.28-0.84; p=0.01), but not in non-depressed patients (HR: 1.09; 0.63-1.89; p=0.74). LIMITATIONS: Patients were not randomized to CR. We had no information about the specific reasons of clinicians to offer CR and about the patients' motives to participate. CONCLUSIONS: CR was associated with reduced mortality risk only for MI-patients with depression. Clinicians should therefore particularly encourage MI-patients with depression to participate in CR.

14 Article Loneliness is associated with poor prognosis in late-life depression: Longitudinal analysis of the Netherlands study of depression in older persons. 2015

Holvast, Floor / Burger, Huibert / de Waal, Margot M W / van Marwijk, Harm W J / Comijs, Hannie C / Verhaak, Peter F M. ·University of Groningen, University Medical Center Groningen, Department of General Practice, PO Box 196, 9700 AD Groningen, The Netherlands. Electronic address: f.holvast@umcg.nl. · University of Groningen, University Medical Center Groningen, Department of General Practice, PO Box 196, 9700 AD Groningen, The Netherlands. · Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. · Clinical Chair in Primary Care Research, Centre for Primary Care, University of Manchester, United Kingdom. · Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. · University of Groningen, University Medical Center Groningen, Department of General Practice, PO Box 196, 9700 AD Groningen, The Netherlands; NIVEL, Netherlands Institute of Health Services Research, The Netherlands. ·J Affect Disord · Pubmed #26142687.

ABSTRACT: BACKGROUND: Although depression and loneliness are common among older adults, the role of loneliness on the prognosis of late-life depression has not yet been determined. Therefore, we examined the association between loneliness and the course of depression. METHODS: We conducted a 2-year follow-up study of a cohort from the Netherlands Study of Depression in Older Persons (NESDO). This included Dutch adults aged 60-90 years with a diagnosis of major depression, dysthymia, or minor depression according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. We performed regression analyses to determine associations between loneliness at baseline and both severity and remission of depression at follow-up. We controlled for potential confounders and performed multiple imputations to account for missing data. RESULTS: Of the 285 respondents, 48% were still depressed after 2 years. Loneliness was independently associated with more severe depressive symptoms at follow-up (beta 0.61; 95% CI 0.12-1.11). Very severe loneliness was negatively associated with remission after 2 years compared with no loneliness (OR 0.25; 95% CI 0.08-0.80). LIMITATIONS: Despite using multiple imputation, the large proportion of missing values probably reduces the study's precision. Generalizability to the general population may be limited by the overrepresentation of ambulatory patients with possibly more persistent forms of depression. CONCLUSION: In this cohort, the prognosis of late-life depression was adversely affected by loneliness. Health care providers should seek to evaluate the degree of loneliness to obtain a more reliable assessment of the prognosis of late-life depression.

15 Article Cognitive reactivity, self-depressed associations, and the recurrence of depression. 2015

Elgersma, Hermien J / de Jong, Peter J / van Rijsbergen, Gerard D / Kok, Gemma D / Burger, Huibert / van der Does, Willem / Penninx, Brenda W J H / Bockting, Claudi L H. ·Department of Clinical Psychology, University of Groningen, The Netherlands. Electronic address: h.j.elgersma@rug.nl. · Department of Clinical Psychology, University of Groningen, The Netherlands. · Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands. · Institute of Psychology, Leiden University, Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands. · Department of Psychiatry/EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. · Department of Clinical Psychology, University of Groningen, The Netherlands; Utrecht University, Department of Clinical and Health Psychology, Utrecht, The Netherlands. ·J Affect Disord · Pubmed #26047308.

ABSTRACT: BACKGROUND: Mixed evidence exists regarding the role of cognitive reactivity (CR; cognitive responsivity to a negative mood) as a risk factor for recurrences of depression. One explanation for the mixed evidence may lie in the number of previous depressive episodes. Heightened CR may be especially relevant as a risk factor for the development of multiple depressive episodes and less so for a single depressive episode. In addition, it is theoretically plausible but not yet tested that the relationship between CR and number of episodes is moderated by the strength of automatic depression-related self-associations. AIM: To investigate (i) the strength of CR in remitted depressed individuals with a history of a single vs. multiple episodes, and (ii) the potentially moderating role of automatic negative self-associations in the relationship between the number of episodes and CR. METHOD: Cross-sectional analysis of data obtained in a cohort study (Study 1) and during baseline assessments in two clinical trials (Study 2). Study 1 used data from the Netherlands Study of Depression and Anxiety (NESDA) and compared never-depressed participants (n=901) with remitted participants with either a single (n=336) or at least 2 previous episodes (n=273). Study 2 included only remitted participants with at least two previous episodes (n=273). The Leiden Index of Depression Sensitivity Revised (LEIDS-R) was used to index CR and an Implicit Association Test (IAT) to measure implicit self-associations. RESULTS: In Study 1, remitted depressed participants with multiple episodes had significantly higher CR than those with a single or no previous episode. The remitted individuals with multiple episodes of Study 2 had even higher CR scores than those of Study 1. Within the group of individuals with multiple episodes, CR was not heightened as a function of the number of episodes, even if individual differences in automatic negative self-associations were taken into account. LIMITATIONS: The study employed a cross-sectional design, which precludes a firm conclusion with regard to the direction of this relationship. CONCLUSIONS: The findings are consistent with the view that high CR puts people at risk for recurrent depression and is less relevant for the development of an incidental depressive episode. This suggests that CR is an important target for interventions that aim to prevent the recurrence of depression.

16 Article The scars of childhood adversity: minor stress sensitivity and depressive symptoms in remitted recurrently depressed adult patients. 2014

Kok, Gemma / van Rijsbergen, Gerard / Burger, Huibert / Elgersma, Hermien / Riper, Heleen / Cuijpers, Pim / Dekker, Jack / Smit, Filip / Bockting, Claudi. ·Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands. · Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Interdisciplinary Center for Psychiatric Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. · Department of Clinical Psychology and EMGO + Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, the Netherlands; Leuphana University, Lüneburg, Germany. · Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands; Department of Clinical Psychology, VU University, Amsterdam, The Netherlands. · Department of Clinical Psychology and EMGO + Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, EMGO + Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands; Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, the Netherlands. ·PLoS One · Pubmed #25393812.

ABSTRACT: BACKGROUND: Childhood adversity may lead to depressive relapse through its long-lasting influence on stress sensitivity. In line with the stress sensitization hypothesis, minor (daily) stress is associated with depressive relapse. Therefore, we examine the impact of childhood adversity on daily stress and its predictive value on prospectively assessed depressive symptoms in recurrently depressed patients. METHOD: Daily stress was assessed in recurrently depressed adult patients, enrolled into two randomized trials while remitted. The reported intensity and frequency of dependent and independent daily stress was assessed at baseline. Independent stress is externally generated, for example an accident happening to a friend, while dependent stress is internally generated, for example getting into a fight with a neighbor. Hierarchical regression analyses were performed with childhood adversity, independent and dependent daily stress as predictor variables of prospectively measured depressive symptoms after three months of follow-up (n = 138). RESULTS: We found that childhood adversity was not significantly associated with a higher frequency and intensity of daily stress. The intensity of both independent and dependent daily stress was predictive of depressive symptom levels at follow-up (unadjusted models respectively: B = 0.47, t = 2.05, p = 0.041, 95% CI = 0.02-0.92; B = 0.29, t = 2.20, p = 0.028, 95% CI = 0.03-0.55). No associations were found between childhood adversity and depressive symptoms at follow-up. CONCLUSION: No evidence was found supporting stress sensitization due to the experience of childhood adversity in this recurrently depressed but remitted patient group. Nevertheless, our research indicates that daily stress might be a target for preventive treatment. TRIAL REGISTRATION: Trial A: Nederlands Trial Register NTR1907 Trial B: Nederlands Trial Register NTR2503.

17 Article How do you feel? Detection of recurrent Major Depressive Disorder using a single-item screening tool. 2014

van Rijsbergen, Gerard D / Burger, Huibert / Hollon, Steven D / Elgersma, Hermien J / Kok, Gemma D / Dekker, Jack / de Jong, Peter J / Bockting, Claudi L H. ·Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands. · Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. · Vanderbilt University, Department of Psychology, Nashville, TN, United States. · Research Department, Arkin Mental Health Care, Amsterdam, The Netherlands; Department of Clinical Psychology, VU University, Amsterdam, The Netherlands. · Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands. Electronic address: C.L.H.Bockting@rug.nl. ·Psychiatry Res · Pubmed #25070177.

ABSTRACT: Mood is a key element of Major Depressive Disorder (MDD), and is perceived as a highly dynamic construct. The aim of the current study was to examine whether a single-item mood scale can be used for mood monitoring. One hundred thirty remitted out-patients were assessed using the Structured Clinical Interview for DSM-IV Axis-I Disorders (SCID-I), Visual Analogue Mood Scale (VAMS), 17-item Hamilton Depression Rating Scale (HAM-D17), and Inventory of Depressive Symptomatology-Self Report (IDS-SR). Of all patients, 13.8% relapsed during follow-up assessments. Area under the curves (AUCs) for the VAMS, HAM-D17 and IDS-SR were 0.94, 0.91, and, 0.86, respectively. The VAMS had the highest positive predictive value (PPV) without any false negatives at score 55 (PPV=0.53; NPV=1.0) and was the best predictor of current relapse status (variance explained for VAMS: 60%; for HAM-D17: 49%; for IDS-SR: 34%). Only the HAM-D17 added significant variance to the model (7%). Assessing sad mood with a single-item mood scale seems to be a straightforward and patient-friendly avenue for life-long mood monitoring. Using a diagnostic interview (e.g., the SCID) in case of a positive screen is warranted. Repeated assessment of the VAMS using Ecological Momentary Assessment (EMA) might reduce false positives.

18 Article Continued smoking and continued alcohol consumption during early pregnancy distinctively associated with personality. 2014

Beijers, Chantal / Burger, Huibert / Verbeek, Tjitte / Bockting, Claudi L H / Ormel, Johan. ·University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology and Emotion Regulation, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. Electronic address: c.beijers@umcg.nl. · University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology and Emotion Regulation, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. · University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. · University of Groningen, Department of Clinical Psychology, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands. · University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology and Emotion Regulation, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. ·Addict Behav · Pubmed #24556156.

ABSTRACT: Pregnancy is a unique period to quit smoking and alcohol consumption and although motivated, not all women succeed at this. We investigated the associations of personality with continued smoking and continued alcohol consumption during early pregnancy. In addition, we studied whether antenatal anxiety and depressive symptoms can explain these associations. Two antenatal measurements from the population-based Pregnancy Anxiety and Depression cohort study were used. Pregnant women in their first trimester were recruited via midwifery practices and hospitals. We analyzed a sample of women who continued (n=101) or quit smoking (n=254), and a sample of women who continued (n=110) or quit alcohol consumption (n=1230). Measures included questions about smoking, alcohol consumption, the NEO-Five Factor Inventory (personality), the State Trait Anxiety Inventory, and the Edinburgh Postnatal Depression Scale. We found associations between continued alcohol consumption and higher levels of openness to experience, and lower levels of conscientiousness (p<0.05). The association between conscientiousness and continued alcohol consumption was partly explained by both anxiety and depressive symptoms. No associations between personality and continued smoking emerged. This study contributes to the limited literature on personality differences between women who continue and quit smoking and alcohol consumption during early pregnancy. General population studies have not confirmed the association between openness to experience and alcohol consumption which implies that pregnancy is indeed a unique period. Increased insight in how personality influences continued smoking and alcohol consumption during pregnancy can help health professionals to improve lifestyle interventions targeted at pregnant women.

19 Article Stressful events and continued smoking and continued alcohol consumption during mid-pregnancy. 2014

Beijers, Chantal / Ormel, Johan / Meijer, Judith L / Verbeek, Tjitte / Bockting, Claudi L H / Burger, Huibert. ·University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology and Emotion regulation, Groningen, The Netherlands. · University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands. · University of Groningen, Department of Clinical Psychology, Groningen, The Netherlands. · University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology and Emotion regulation, Groningen, The Netherlands ; University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands. ·PLoS One · Pubmed #24466052.

ABSTRACT: AIM: to examine whether the severity of different categories of stressful events is associated with continued smoking and alcohol consumption during mid-pregnancy. Also, we explored the explanation of these associations by anxiety and depressive symptoms during pregnancy. Finally, we studied whether the severity of stressful events was associated with the amount of cigarettes and alcohol used by continued users. METHOD: We conducted a cross-sectional analysis using data from a population-based prospective cohort study. Pregnant women were recruited via midwifery practices throughout The Netherlands. We analyzed women who continued smoking (n = 113) or quit (n = 290), and women who continued alcohol consumption (n = 124) or quit (n = 1403) during pregnancy. Smoking, alcohol consumption, and perceived severity of stressful events were measured at 19 weeks of gestation. The State Trait Anxiety Inventory and the Edinburgh Postnatal Depression Scale were filled out at 14 weeks of gestation. Odds ratios were calculated as association measures and indicated the relative increase for the odds of continuation of smoking and alcohol consumption for the maximum severity score compared to the minimum score. FINDINGS: Severity of the following stressful event categories was associated with continued alcohol consumption: 'conflict with loved ones' (OR = 10.4, p<0.01), 'crime related' (OR= 35.7, p<0.05), 'pregnancy-specific' (OR = 13.4, p<0.05), and the total including all events (OR = 17.2, p<0.05). Adjustment for potential confounders (age, parity and educational level) did not notably change the estimates. There was no association of anxiety and depressive symptoms with continued smoking or alcohol consumption. No associations emerged for continued smoking and severity of stressful events. The amount of cigarettes and alcohol consumption among continued users was not associated with severity of stressful events. CONCLUSIONS: Our findings may be relevant for health care providers, in particular midwives and general practitioners. The impact of stressful events may be considered when advising pregnant women on smoking and alcohol consumption.

20 Article Associations of life events during pregnancy with longitudinal change in symptoms of antenatal anxiety and depression. 2014

Meijer, Judith L / Bockting, Claudi L H / Stolk, Ronald P / Kotov, Roman / Ormel, Johan / Burger, Huibert. ·Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. · Department of Clinical and Developmental Psychology, University of Groningen, Groningen, The Netherlands. · Department of Psychiatry, Stony Brook University Medical Center, Stony Brook, NY, USA. · Interdisciplinary Center Psychopathology and Emotion regulation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. · Department of General Practice, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands. Electronic address: h.burger@umcg.nl. ·Midwifery · Pubmed #23870748.

ABSTRACT: OBJECTIVE: to investigate the association of life events during pregnancy with change in antenatal anxiety and depression symptoms. We distinguished pregnancy related and non-pregnancy related events and assessed specificity of these associations for depressive or anxious symptoms. In addition, we investigated whether the associations were affected by personality or childhood adversities. DESIGN: observational prospective cohort study SETTING: primary and secondary obstetric care centres in the Netherlands PARTICIPANTS: 1603 women during their first trimester of pregnancy between May 2010 and May 2012 MEASUREMENTS AND FINDINGS: we performed linear regression analyses to test the associations of pregnancy related, non-pregnancy related life events, childhood adversities and the personality traits neuroticism and extraversion with the change in symptoms of anxiety (State Trait Anxiety Inventory) and depression (Edinburgh Postnatal Depression Scale) from week 12 to week 36. Life events during pregnancy were associated with increasing antenatal symptoms of anxiety and depression. Effect sizes associated with the highest numbers of events observed ranged from 0.59 to 1.31. Pregnancy related events were specifically associated with increasing symptoms of anxiety (p=0.009), whereas non-pregnancy related events were merely associated with an increase in symptoms of depression (p<0.001). Neither personality traits nor childhood trauma influenced the associations under study. KEY CONCLUSIONS: the most important finding is that pregnancy related life events during pregnancy increase levels of antenatal anxiety, whereas depression levels increase when women experience life events that are unrelated to pregnancy. Furthermore, non-pregnancy related events show stronger associations with increases in symptoms of anxiety or depression compared to pregnancy related events. IMPLICATIONS FOR PRACTICE: our findings may help midwives to tailor psychosocial care to the specific risks of the pregnant woman which may eventually have a positive impact on the health of mother and child.

21 Article Mood reactivity rather than cognitive reactivity is predictive of depressive relapse: a randomized study with 5.5-year follow-up. 2013

van Rijsbergen, Gerard D / Bockting, Claudi L H / Burger, Huibert / Spinhoven, Philip / Koeter, Maarten W J / Ruhé, Henricus G / Hollon, Steven D / Schene, Aart H. ·Department of Clinical Psychology, University of Groningen, The Netherlands. ·J Consult Clin Psychol · Pubmed #23477478.

ABSTRACT: OBJECTIVE: The current study examined whether cognitive reactivity, cognitive extremity reactivity, and mood reactivity following mood provocation predicted relapse in depression over 5.5 years. Additionally, this study was the 1st to examine whether changes in cognitive reactivity and mood reactivity following preventive cognitive therapy (PCT) mediated the preventive effect of PCT on relapse. METHOD: One hundred eighty-seven remitted recurrently depressed outpatients were randomized over treatment as usual (TAU) versus TAU + PCT with 5.5-year follow-up. Relapse in depression was assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (Spitzer, Williams, Gibbon, & First, 1990). RESULTS: Mood reactivity predicted time to relapse over 5.5 years. We found no evidence that cognitive reactivity was a risk factor for relapse in depression. Moreover, unprimed dysfunctional beliefs predicted relapse directly. There was no indication of mediation by changes in cognitive reactivity (including extremity of the beliefs and unprimed beliefs) or mood reactivity on the preventive effect of PCT. Further, explorative analyses revealed that increases in cognitive and mood reactivity over time also predicted time to relapse. CONCLUSIONS: Our findings highlight a need to focus on mood reactivity instead of beliefs as a risk factor for relapse in depression. Similar to a previous study, we found no indications that cognitive therapy after remission reduced dysfunctional beliefs, cognitive reactivity, or extremity. Future studies should examine cognitive reactivity and mood reactivity in daily life as predictors of relapse.

22 Article The temporal relation between pain and depression: results from the longitudinal aging study Amsterdam. 2012

Hilderink, Peter H / Burger, Huibert / Deeg, Dorly J / Beekman, Aartjan T / Oude Voshaar, Richard C. ·Department of Old Age Psychiatry, Center for Integrative Mental Health Care, Pro Persona, Nijmegen, the Netherlands. p.hilderink@propersona.nl ·Psychosom Med · Pubmed #23115345.

ABSTRACT: OBJECTIVE: Pain and depression are both common in old age, but their (long-term) temporal relationship remains unknown. This study is designed to determine whether pain predicts the onset of depression and vice versa. METHODS: This is a prospective, population-based cohort study with 12-year follow-up and 3-year intervals in the Netherlands (Longitudinal Aging Study Amsterdam). At baseline, participants were aged 55 to 85 years (n = 2028). Main measurements outcomes were incident depression defined as crossing the cutoff of 16 and showing a relevant change (≥ 5 points) on the Center for Epidemiological Studies-Depression Scale among nondepressed participants and incident pain defined as a score of 2 or higher on the pain scale of the 5-item Nottingham Health Profile in pain-free participants. Multiple imputations were adopted to estimate missing values. RESULTS: In nondepressed participants (n = 1769), a higher level of pain was predictive of incident depression in multiple extended Cox regression analyses (hazard rate [HR] = 1.13 [95% confidence interval {CI}: 1.05-1.22], p = .001), which all remained significant after correction for sociodemographic characteristics, life-style characteristics, functional limitations, and chronic diseases (HR = 1.09 [95% CI = 1.01-1.18], p = .035). In the pain-free participants (n = 1420), depressive symptoms at baseline predicted incident pain (HR = 1.02 [95% CI: 1.01-1.04], p = .006). This depression measure did not independently predicted the onset of pain in the fully adjusted models. CONCLUSIONS: As pain precedes the onset of depression, strategies to prevent depression in chronic pain patients are warranted. In contrast, no effects of depression on the development of subsequent pain were found when adjusting for covariates.

23 Article Can variation in hypothalamic-pituitary-adrenal (HPA)-axis activity explain the relationship between depression and cognition in bipolar patients? 2012

van der Werf-Eldering, Marieke J / Riemersma-van der Lek, Rixt F / Burger, Huibert / Holthausen, Esther A E / Aleman, André / Nolen, Willem A. ·Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. m.j.van.der.werf@umcg.nl ·PLoS One · Pubmed #22606339.

ABSTRACT: BACKGROUND: Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is thought to be associated with more mood symptoms and worse cognitive functioning. This study examined whether variation in HPA axis activity underlies the association between mood symptoms and cognitive functioning. METHODOLOGY/PRINCIPAL FINDINGS: In 65 bipolar patients cognitive functioning was measured in domains of psychomotor speed, speed of information processing, attentional switching, verbal memory, visual memory, executive functioning and an overall mean score. Severity of depression was assessed by the Inventory of Depressive Symptomatology-self rating version. Saliva cortisol measurements were performed to calculate HPA axis indicators: cortisol awakening response, diurnal slope, the evening cortisol level and the cortisol suppression on the dexamethasone suppression test. Regression analyses of depressive symptoms and cognitive functioning on each HPA axis indicator were performed. In addition we calculated percentages explanation of the association between depressive symptoms and cognition by HPA axis indicators. Depressive symptoms were associated with dysfunction in psychomotor speed, attentional switching and the mean score, as well as with attenuation in diurnal slope value. No association was found between HPA axis activity and cognitive functioning and HPA axis activity did not explain the associations between depressive symptoms and cognition. CONCLUSIONS/SIGNIFICANCE: As our study is the first one in this field specific for bipolar patients and changes in HPA-axis activity did not seem to explain the association between severity of depressive symptoms and cognitive functioning in bipolar patients, future studies are needed to evaluate other factors that might explain this relationship.

24 Article An efficient way to detect poststroke depression by subsequent administration of a 9-item and a 2-item Patient Health Questionnaire. 2012

de Man-van Ginkel, Janneke M / Hafsteinsdóttir, Thóra / Lindeman, Eline / Burger, Huibert / Grobbee, Diederick / Schuurmans, Marieke. ·Department of Rehabilitation, Nursing Science and Sports, University Medical Centre Utrecht, Utrecht, The Netherlands. J.M.deMan@umcutrecht.nl ·Stroke · Pubmed #22156689.

ABSTRACT: BACKGROUND AND PURPOSE: The early detection of poststroke depression is essential for optimizing recovery after stroke. A prospective study was conducted to investigate the diagnostic value of the 9-item and the 2-item Patient Health Questionnaire (PHQ-9, PHQ-2). METHODS: One hundred seventy-one consecutive patients with stroke who could communicate adequately were included. In the 6th to 8th weeks after stroke, depression was measured using the PHQ-9 and PHQ-2 and diagnosed using the Composite International Diagnostic Interview. RESULTS: Of the participating patients, 20 (12.2%) were depressed. The PHQ-9 performed best at a score ≥10, a sensitivity of 0.80 (95% CI, 0.62-0.98), and a specificity of 0.78 (95% CI, 0.72-0.85) and the PHQ-2 at a score ≥2 with a sensitivity of 0.75 (95% CI, 0.56-0.94) and a specificity of 0.76 (95% CI, 0.69-0.83). Administering the PHQ-9 only to patients who scored ≥2 on the PHQ-2 improved the identification of depression (sensitivity, 0.87; 95% CI, 0.69-1.04). CONCLUSIONS: The diagnostic value is acceptable to good for PHQ-9 scores ≥10 and PHQ-2 scores ≥2. Conducting a PHQ-9 only in patients with a PHQ-2 score ≥2 generates the best results.

25 Article Postpartum depression predicts offspring mental health problems in adolescence independently of parental lifetime psychopathology. 2012

Verbeek, Tjitte / Bockting, Claudi L H / van Pampus, Mariëlle G / Ormel, Johan / Meijer, Judith L / Hartman, Catharina A / Burger, Huibert. ·Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands. t.verbeek@umcg.nl ·J Affect Disord · Pubmed #21930302.

ABSTRACT: BACKGROUND: Postpartum depression (PPD) follows 5-15% of the life births and forms a major threat to the child's mental health and psychosocial development. However, the nature, continuance, and mediators of the association of postpartum depression (PPD) with the child's mental health are not well understood. The aim of this study was to investigate whether an association between PPD and adolescent mental problems is explained by parental psychopathology and whether the association shows specificity to the internalizing or externalizing domain. METHODS: 2729 adolescents aged 10-15 years from the TRacking Adolescents' Individual Life Survey (TRAILS) were included. Both PPD and parental lifetime history of psychopathology were assessed by parent report. Adolescents' psychopathology was assessed using the Achenbach scales (parent, teacher and self report). Linear regression was used to examine the association between PPD and adolescent mental health. RESULTS: We found a statistically significant association of adolescents' internalizing problems with maternal PPD, which remained when adjusted for parental psychopathology. We found no association for externalizing problems. LIMITATIONS: Underreporting of both PPD and lifetime parental psychopathology may have occurred due to their retrospective assessment. CONCLUSIONS: The association of PPD with internalizing but not externalizing problems extends into adolescence. Parental psychopathology does not explain this association suggesting a direct psychological effect on the child postpartum. If this effect appears causal, early treatment of parental psychopathology may prevent internalizing psychopathology in the offspring, ultimately in adolescence.

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