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Depression: HELP
Articles by Jack J. M. Dekker
Based on 57 articles published since 2008
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Between 2008 and 2019, Jack Dekker wrote the following 57 articles about Depression.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Review The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis update. 2015

Driessen, Ellen / Hegelmaier, Lisa M / Abbass, Allan A / Barber, Jacques P / Dekker, Jack J M / Van, Henricus L / Jansma, Elise P / Cuijpers, Pim. ·VU University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, The Netherlands. Electronic address: e.driessen@vu.nl. · VU University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands. · Dalhousie University, Centre for Emotions and Health, Halifax, NS, Canada. · Adelphi University, The Derner Institute of Advanced Psychological Studies, NY, USA. · VU University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands; Arkin Mental Health Care, Amsterdam, The Netherlands. · Arkin Mental Health Care, Amsterdam, The Netherlands. · VU University Amsterdam, University Library, Amsterdam, The Netherlands. · VU University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, The Netherlands. ·Clin Psychol Rev · Pubmed #26281018.

ABSTRACT: OBJECTIVES: The efficacy of short-term psychodynamic psychotherapy (STPP) for depression is debated. Recently, a number of large-scale and high-quality studies have been conducted. We examined the efficacy of STPP by updating our 2010 meta-analysis. RESULTS: After a thorough literature search, 54 studies (33 randomized clinical trials) totaling 3946 subjects were included. STPP was significantly more effective than control conditions at post-treatment on depression, general psychopathology and quality of life measures (d=0.49 to 0.69). STPP pre-treatment to post-treatment changes (d=0.57 to 1.18) indicated significant improvements on all outcome measures, which either significantly improved further (d=0.20 to 1.04) or were maintained from post-treatment to follow-up. No significant differences were found between individual STPP and other psychotherapies at post-treatment (d=-0.14) and follow-up (d=-0.06) in analyses that were adequately powered to detect a clinically relevant difference. STPP was significantly more efficacious than other psychotherapies on anxiety measures at both post-treatment (d=0.35) and follow-up (d=0.76). CONCLUSION: We found clear indications that STPP is effective in the treatment of depression in adults. Although more high-quality studies are needed, particularly to assess the efficacy of STPP compared to control conditions at follow-up and to antidepressants, these findings add to the evidence-base of STPP for depression.

2 Review [The efficacy of psychological treatments for depression: a review of recent research findings]. 2014

Driessen, E / Cuijpers, P / Hollon, S D / Van, H L / Dekker, J J M. · ·Tijdschr Psychiatr · Pubmed #25070570.

ABSTRACT: BACKGROUND: Psychological treatments for depression have been shown to be effective, but there is room for improvement. AIM: To summarise new research findings concerning the efficacy of psychological treatments for depression, as reported in a recent dissertation. METHOD: Four systematic reviews and meta-analyses and one randomised clinical trial are described. RESULTS: As has been shown in the case of patients treated with antidepressants, the efficacy of psychological treatments for depression when compared to strict control conditions, might be greater in patients with more severe depressive symptoms than in patients with milder symptoms. The efficacy of psychological treatments for depression when compared to control conditions is overestimated as a result of systematic publication of positive findings, as has been reported with regard to antidepressant medication too. There is increasing academic support for the efficacy of brief psychodynamic therapy for depression and there are no differences in the efficacy of short-term psychodynamic supportive psychotherapy and cognitive behavioural therapy for depression. Certain patient characteristics were found to be related to the differential efficacy of these two types of psychological treatments, but further validation is needed. A large number of patients with depression who seek help from second-line psychiatric clinics in the Netherlands fail to achieve remission following psychological treatment, irrespective of whether that treatment is combined with antidepressants. CONCLUSION: Improved efficacy of psychological treatments for depression is urgently needed and can be facilitated by means of high quality research.

3 Review Influence of personality on the outcome of treatment in depression: systematic review and meta-analysis. 2014

Newton-Howes, Giles / Tyrer, Peter / Johnson, Tony / Mulder, Roger / Kool, Simone / Dekker, Jack / Schoevers, Robert. · ·J Pers Disord · Pubmed #24256103.

ABSTRACT: There continues to be debate about the influence of personality disorder on the outcome of depressive disorders and is relative interactions with treatment. To determine whether personality disorder, both generically and in terms of individual clusters, leads to a worse outcome in patients with depressive disorders and whether this is influenced by type of treatment, a systematic electronic search of MEDLINE, CINAHL, and PsycINFO from 1966, 1982, and 1882, respectively, until February 2007 was undertaken. The keyword terms depression, mental illness, and personality disorder were used. All references were reviewed and personal correspondence was undertaken. Only English language papers were considered. Any English language paper studying a depressed adult population was considered for inclusion. Studies needed to clearly define depression and personality disorder using peer-reviewed instruments or International Classification of Disease/Diagnostic Statistical Manual criteria. Outcome assessment at greater than 3 weeks was necessary. Final inclusion papers were agreed on by consensus by at least two reviewers. All data were extracted using predetermined criteria for depression by at least two reviewers in parallel. Disagreement was settled by consensus. Complex data extraction was confirmed within the study group. Data were synthesized using log odds ratios in the Cochrane RevMan 5 program. The finding of comorbid personality disorder and depression was associated with a more than double the odds of a poor outcome for depression compared with those with no personality disorder (OR 2.16, CI 1.83-2.56). This effect was not ameliorated by the treatment modality used for the depressive disorder. This finding led to the conclusion that personality disorder has a negative impact on the outcome of depression. This finding is important in considering prognosis in depressive disorders.

4 Review Bridging the gap for ethnic minority adult outpatients with depression and anxiety disorders by culturally adapted treatments. 2013

van Loon, Annelies / van Schaik, Anneke / Dekker, Jack / Beekman, Aartjan. ·Research Department, GGZ inGeest, Amsterdam, The Netherlands. a.vanloon@ggzingeest.nl ·J Affect Disord · Pubmed #23351566.

ABSTRACT: BACKGROUND: Culturally adapted guideline driven depression and anxiety treatments have been developed for ethnic minority patients in Western countries to boost effectiveness for these growing and vulnerable groups. The aims of this study are to systematically review the empirical literature of outcomes associated with culturally adapted guideline driven depression and anxiety interventions, to describe the cultural adaptation and to identify the contribution of the cultural adaptation and approach as such. METHOD: Comprehensive search of the major bibliographical databases (Cochrane Central Register of Controlled Trials, Pubmed; Psychinfo) for randomized controlled trials. RESULTS: Nine eligible studies were identified and all were conducted in the USA. The pooled random standardized differences in means of the culturally adapted depression and anxiety treatment on clinical outcome was 1.06 (CI 95% 0.51-1.62, P=0.00). Two studies demonstrated effectiveness of the population specific cultural adaptation per se. All studies incorporated a focus on cultural values and beliefs as a cultural adaptation. LIMITATION: We only identified a small number of USA studies so generalisation of the findings to other western countries can be discussed. CONCLUSION: Culturally adapted guideline driven depression and anxiety treatment was effective for USA minority patients from different cultural backgrounds. There is some evidence for the effectiveness of the population specific cultural adaptation as such.

5 Review Managing the patient with co-morbid depression and an anxiety disorder. 2008

Schoevers, Robert A / Van, Henricus L / Koppelmans, Vincent / Kool, Simone / Dekker, Jack J. ·JellinekMentrum Mental Health Care Amsterdam, Amsterdam, the NetherlandsDepartment of Psychiatry, Medical Center, VU University, Amsterdam, the Netherlands. robert.schoevers@mentrum.nl ·Drugs · Pubmed #18681487.

ABSTRACT: Depression and anxiety disorders frequently co-occur. This type of co-morbidity is associated with higher severity, suicidality, chronicity and treatment resistance. However, available treatment guidelines mainly focus on treatment for singular disorders. The current paper describes diagnostic and treatment issues relevant for adequately addressing patients with depression and an anxiety disorder, using information from both guidelines and a search of recent literature. Apart from differential diagnosis, the diagnostic evaluation should include a thorough assessment of the symptoms of both disorders, preferably by using a structured clinical interview, and an assessment of depression severity in terms of suicidality, psychotic symptoms and impairment. Treatment should first address the primary disorder in terms of severity and risk. As a rule, severe depression should be treated before the anxiety disorder, using antidepressant medication or combined treatment (plus psychotherapy). In less severe pathology, the primary focus may be determined by examining the temporal pattern and the subjective burden of each disorder as experienced by the patient. Treatment is often sequential. Treatment of the primary disorder may or may not relieve the co-morbid disorder as well. If the primary disorder is an anxiety disorder, co-morbid depression generally implies earlier use of an antidepressant. Co-morbid mild depression may also react favourably to psychotherapeutic treatment of the anxiety disorder. Recent literature on concurrent treatment of both depression and anxiety shows that modern antidepressants such as sertraline, paroxetine, fluoxetine, venlafaxine, nefazodone and bupropion have demonstrated efficacy in relieving both depressive and anxiety symptoms compared with placebo. Head-to-head comparisons, although relatively scarce, tend to show superiority over tricyclic antidepressants. Venlafaxine was found to be more effective than fluoxetine in some studies. However, these results should be interpreted with caution because studies vary considerably in terms of patient selection, assessment of anxiety and primary outcome measures. Only one randomized controlled trial compared atypical antipsychotics with placebo. Psychotherapy was generally shown to have a beneficial effect on the co-morbid conditions, and available evidence appears to favour combined treatment. The results should be interpreted with caution because the number of studies on this issue was relatively small, with considerable clinical and methodological heterogeneity.

6 Review Predicting the outcome of antidepressants and psychotherapy for depression: a qualitative, systematic review. 2008

Van, Henricus L / Schoevers, Robert A / Dekker, Jack. ·Depression Research Group, Mentrum Mental Health Care, Amsterdam, The Netherlands. rien.van@mentrum.nl ·Harv Rev Psychiatry · Pubmed #18661365.

ABSTRACT: As treatment outcome in depression varies widely, it is important to understand better the predictive value of particular patient characteristics. However, qualitative systematic reviews of the association between easily identifiable patient characteristics and outcome for commonly used treatment options have been unavailable. This article provides an overview of the consistency of findings on the association between sociodemographic factors and depression characteristics, on the one hand, and outcomes of pharmacotherapy, cognitive-behavioral therapy, and interpersonal/psychodynamic psychotherapy for major depression, on the other. There were no findings indicating that gender was associated with treatment outcome in the case of tricyclic antidepressants. There are some indications that younger patients respond worse to tricyclics, whereas especially women appeared to have better outcomes with modern antidepressants (selective serotonin/norepinephrine reuptake inhibitors). Marital status may be related to better outcome in the case of antidepressants and cognitive-behavioral therapy. Longer duration of depression was identified as a negative predictor, most consistently in psychotherapy. In none of the treatment modalities was recurrence a negative predictor. The relation between severity of depression and outcome appeared to be complex, precluding any straightforward inferences.

7 Article The association between the number of previous episodes and modifiable vulnerability factors in remitted patients with recurrent depression. 2018

de Jonge, Margo / Bockting, Claudi L H / van Oppen, Patricia / Van, Henricus L / Peen, Jaap / Kikkert, Martijn J / Dekker, Jack J M. ·Department of Research, Arkin, Amsterdam, The Netherlands. · Department of Clinical Psychiatry, University of Amsterdam, Amsterdam, The Netherlands. · Department of Research, GGZ inGeest, Amsterdam, The Netherlands. · Department of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands. ·PLoS One · Pubmed #30388131.

ABSTRACT: OBJECTIVE: Remitted patients with a history of several previous major depressive episodes have a higher risk of relapse/recurrence than patients with fewer previous episodes, and the probability of another episode increases progressively with each successive episode. This study examines the association between the number of previous episodes and modifiable vulnerability factors in remitted patients with recurrent depression. METHODS: Patients with recurrent depression (DSM-IV-diagnosed) who were in remission (N = 214) were recruited between September 2011 and July 2016. The association was examined between the number of previous episodes and the following factors: i.e. interpersonal functioning, daily stress, sense of mastery, coping and dysfunctional beliefs. RESULTS: A history of more previous episodes was associated with higher levels of interpersonal problems (P < .001), daily stress (P = .04) and a lower sense of mastery (P = .05). Interpersonal problems were most strongly associated with more previous episodes in a Generalized Linear Regression model. In the domain of interpersonal problems, the subscales that showed the strongest relationship were domineering/controlling, vindictive/self-centred, socially inhibited and self-sacrificing. CONCLUSIONS: Patients with a history of more depressive episodes reported higher levels of interpersonal problems, daily stress and a lower sense of mastery. Future studies should examine these factors in a longitudinal cohort and look at whether the effect of interventions to prevent relapse can be explained by targeting these psychological factors. TRIAL REGISTRATION: Netherlands Trial Register: 2599.

8 Article Optimizing psychotherapy dosage for comorbid depression and personality disorders (PsyDos): a pragmatic randomized factorial trial using schema therapy and short-term psychodynamic psychotherapy. 2018

Kool, Marit / Van, Henricus L / Bartak, Anna / de Maat, Saskia C M / Arntz, Arnoud / van den Eshof, Johanna W / Peen, Jaap / Blankers, Matthijs / Bosmans, Judith E / Dekker, Jack J M. ·Arkin Mental Health Care, Domselaerstraat 128, 1093, MB, Amsterdam, the Netherlands. Marit.Kool@arkin.nl. · Arkin Mental Health Care, Domselaerstraat 128, 1093, MB, Amsterdam, the Netherlands. · Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands. · Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands. · Amsterdam UMC, Location AMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands. · Trimbos Institute - Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands. · Department of Health Sciences, Faculty of Earth & Life Sciences, Free University Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. · Department of Clinical Psychology, VU University of Amsterdam, Amsterdam, the Netherlands. ·BMC Psychiatry · Pubmed #30086730.

ABSTRACT: BACKGROUND: Patients with comorbid depression and personality disorders suffer from a heavy disease burden while tailored treatment options are limited, accounting for a high psychological and economic burden. Little is known about the effect of treatment dosage and type of psychotherapy for this specific co-morbid patient population, in terms of treatment-effect and cost-effectiveness. This study aims to compare treatment outcome of 25 versus 50 individual therapy sessions in a year. We expect the 50-session condition to be more effective in treating depression and maintaining the effect. Secondary objectives will be addressed in order to find therapy-specific and non-specific mechanisms of change. METHODS: In a mono-center pragmatic randomized controlled trial with a 2 × 2 factorial design, 200 patients with a depressive disorder and personality disorder(s) will be included. Patients will be recruited from a Dutch mental health care institute for personality disorders. They will be randomized over therapy dosage (25 vs 50 sessions in a year) and type of therapy (schema therapy vs short-term psychodynamic supportive psychotherapy). The primary clinical outcome measure will be depression severity and remission. Changes in personality functioning and quality of life will be investigated as secondary outcomes. A priori postulated effect moderators and mediators will be collected as well. All patients are assessed at baseline and at 1, 2, 3, 6, 9-12 months (end of therapy) and at follow up (6 and 12 months after end of treatment). Alongside the trial, an economic evaluation will be conducted. Costs will be collected from a societal perspective. DISCUSSION: This trial will be the first to compare two psychotherapy dosages in patients with both depression and personality disorders. Insight in the effect of treatment dosage for this patient group will contribute to both higher treatment effectiveness and lower costs. In addition, this study will contribute to the limited evidence base on treating patients with both depression and personality disorders. Understanding the processes that account for the therapeutic changes could help to gain insight in what works for whom. TRIAL REGISTRATION: This trial has been registered on July 20th 2016, Netherlands Trial Register, part of the Dutch Cochrane Centre ( NTR5941 ).

9 Article Prevalence and predictors of violent victimization in remitted patients with recurrent depression. 2018

Christ, C / de Jonge, M / Bockting, C L H / Kikkert, M J / van Schaik, D J F / Beekman, A T F / Dekker, J J M. ·Department of Research, Arkin Mental Health Care, Klaprozenweg 111, Amsterdam 1033 NN, The Netherlands; Department of Psychiatry, VU University Medical Center/GGZ inGeest, The Netherlands; Amsterdam Public Health research institute, VUmc, Amsterdam, The Netherlands. Electronic address: carolien.christ@arkin.nl. · Department of Research, Arkin Mental Health Care, Klaprozenweg 111, Amsterdam 1033 NN, The Netherlands. · Academic Medical Center, Department Psychiatry, University of Amsterdam, Amsterdam, The Netherlands. · Department of Psychiatry, VU University Medical Center/GGZ inGeest, The Netherlands; Amsterdam Public Health research institute, VUmc, Amsterdam, The Netherlands. · Department of Research, Arkin Mental Health Care, Klaprozenweg 111, Amsterdam 1033 NN, The Netherlands; Vrije Universiteit Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands. ·J Affect Disord · Pubmed #29909304.

ABSTRACT: BACKGROUND: Depressed patients are at increased risk to fall victim to a violent crime compared to the general population. It remains unknown whether their increased risk persists after remission. This study compared victimization rates of remitted patients with both a random general population sample and a group of currently depressed patients. Furthermore, this study aimed to identify predictors of future violent victimization. METHODS: In this longitudinal study conducted in the Netherlands, 12-month prevalence rates of sexual assaults, physical assaults, and threats were assessed with the Safety Monitor in 140 currently remitted patients with recurrent depression, and compared to those of a weighted general population sample (N = 9.175) and a weighted sample of currently depressed outpatients (N = 102) using Chi-square tests. Logistic regression analyses were performed to identify baseline predictors of future victimization. RESULTS: The prevalence of violent victimization did not differ between remitted patients and the general population (12.1 vs. 11.7%). Remitted patients were significantly less likely to have been victimized over the past 12 months than currently depressed patients (12.1 vs. 35.5%). In remitted patients, living alone and low sense of mastery at baseline predicted future violent victimization. However, when combined in a multiple model, only living alone was independently associated with violent victimization (χ LIMITATIONS: Our comparison of victimization rates across samples was cross-sectional. CONCLUSIONS: Since the increased risk of victimization appears to be specific for the acute depressive state, preventive interventions should target victimization in currently depressed patients. TRIAL REGISTRATION: Netherlands Trial Register (NTR): 2599.

10 Article Which patients benefit specifically from short-term psychodynamic psychotherapy (STPP) for depression? Study protocol of a systematic review and meta-analysis of individual participant data. 2018

Driessen, Ellen / Abbass, Allan A / Barber, Jacques P / Connolly Gibbons, Mary Beth / Dekker, Jack J M / Fokkema, Marjolein / Fonagy, Peter / Hollon, Steven D / Jansma, Elise P / de Maat, Saskia C M / Town, Joel M / Twisk, Jos W R / Van, Henricus L / Weitz, Erica / Cuijpers, Pim. ·Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands. · Centre for Emotions & Health, Dalhousie University, Halifax, Nova Scotia, Canada. · Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York, USA. · Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands. · Department of Methodology and Statistics, Leiden University, Leiden, Netherlands. · Department of Clinical, Educational and Health Psychology, University College London, London, UK. · Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA. · University Library, Vrije Universiteit Amsterdam, Amsterdam, Netherlands. · Dutch Psychoanalytic Institute, Arkin Mental Health Care, Amsterdam, Netherlands. · Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands. · Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Amsterdam, Netherlands. ·BMJ Open · Pubmed #29463590.

ABSTRACT: INTRODUCTION: Short-term psychodynamic psychotherapy (STPP) is an empirically supported treatment that is often used to treat depression. However, it is largely unclear if certain subgroups of depressed patients can benefit specifically from this treatment method. We describe the protocol for a systematic review and meta-analysis of individual participant data (IPD) aimed at identifying predictors and moderators of STPP for depression efficacy. METHOD AND ANALYSIS: We will conduct a systematic literature search in multiple bibliographic databases (PubMed, PsycINFO, Embase.com, Web of Science and Cochrane's Central Register of Controlled Trials), 'grey literature' databases (GLIN and UMI ProQuest) and a prospective trial register (http://www.controlled-trials.com). We will include studies reporting (a) outcomes on standardised measures of (b) depressed (c) adult patients (d) receiving STPP. We will next invite the authors of these studies to share the participant-level data of their trials and combine these data to conduct IPD meta-analyses. The primary outcome for this study is post-treatment efficacy as assessed by a continuous depression measure. Potential predictors and moderators include all sociodemographic variables, clinical variables and psychological patient characteristics that are measured before the start of treatment and are assessed consistently across studies. One-stage IPD meta-analyses will be conducted using mixed-effects models. ETHICS AND DISSEMINATION: Institutional review board approval is not required for this study. We intend to submit reports of the outcomes of this study for publication to international peer-reviewed journals in the fields of psychiatry or clinical psychology. We also intend to present the outcomes at international scientific conferences aimed at psychotherapy researchers and clinicians. The findings of this study can have important clinical implications, as they can inform expectations of STPP efficacy for individual patients, and help to make an informed choice concerning the best treatment option for a given patient. PROSPERO REGISTRATION NUMBER: CRD42017056029.

11 Article Prevention of violent revictimization in depressed patients with an add-on internet-based emotion regulation training (iERT): study protocol for a multicenter randomized controlled trial. 2018

Christ, Carolien / de Waal, Marleen M / van Schaik, Digna J F / Kikkert, Martijn J / Blankers, Matthijs / Bockting, Claudi L H / Beekman, Aartjan T F / Dekker, Jack J M. ·Department of Psychiatry, VU University Medical Center/ GGZ inGeest, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. c.christ@ggzingeest.nl. · Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands. c.christ@ggzingeest.nl. · Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. c.christ@ggzingeest.nl. · Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands. · Academic Medical Center, Department of Psychiatry, Amsterdam Institute for Addiction Research, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. · Department of Psychiatry, VU University Medical Center/ GGZ inGeest, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. · Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. · Trimbos Institute - Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS, Utrecht, The Netherlands. · Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, University Utrecht, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands. · Department of Clinical Psychology, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, BT 1081, Amsterdam, The Netherlands. ·BMC Psychiatry · Pubmed #29394919.

ABSTRACT: BACKGROUND: Psychiatric patients are at high risk of becoming victim of a violent crime compared to the general population. Although most research has focused on patients with severe mental illness, depressed patients have been demonstrated to be prone to victimization as well. Victimization is associated with more severe symptomatology, decreased quality of life, and high risk of revictimization. Hence, there is a strong need for interventions that focus on preventing violent revictimization. Since emotion dysregulation is associated with both victimization and depression, we developed an internet-based Emotion Regulation Training (iERT) to reduce revictimization in depressed patients. This study aims to evaluate the clinical and cost-effectiveness of iERT added to Treatment As Usual (TAU) in reducing incidents of violent revictimization among depressed patients with a recent history of victimization. Furthermore, this study aims to examine secondary clinical outcomes, and moderators and mediators that may be associated with treatment outcomes. METHODS: In a multicenter randomized controlled trial with parallel group design, patients with a major depressive disorder and a history of violent victimization over the past three years (N = 200) will be allocated to either TAU + iERT (N = 100) or TAU only (N = 100), based on computer-generated stratified block randomization. Assessments will take place at baseline, 8 weeks, 14 weeks, and 6 months after start of treatment, and 12, 24, and 36 months after baseline. The primary outcome measure is the total number of violent victimization incidents at 12 months after baseline, measured with the Safety Monitor: an adequate self-report questionnaire that assesses victimization over the preceding 12 months. Secondary outcome measures and mediators include emotion dysregulation and depressive symptomatology. An economic evaluation with the societal perspective will be performed alongside the trial. DISCUSSION: This study is the first to examine the effectiveness of an intervention aimed at reducing violent revictimization in depressed patients. If effective, iERT can be implemented in mental health care, and contribute to the well-being of depressed patients. Furthermore, the results will provide insight into underlying mechanisms of revictimization. TRIAL REGISTRATION: The study is registered at the Netherlands Trial Register ( NTR5822 ). Date of registration: 4 April 2016.

12 Article Loneliness and cardiovascular disease and the role of late-life depression. 2018

Hegeman, Annette / Schutter, Natasja / Comijs, Hannie / Holwerda, Tjalling / Dekker, Jack / Stek, Max / van der Mast, Roos. ·Department of Psychiatry, St. Antonius Ziekenhuis, Utrecht, The Netherlands. · Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands. · Department of Geriatric Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands. · Department of Psychiatry, EMGO Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. · Department of Psychiatry PuntP, Arkin Mental Health Care, Amsterdam. · Department of Psychology, VU University Medical Center, Amsterdam, The Netherlands. · Department of Clinical Research, Arkin Mental Health Care, Amsterdam, The Netherlands. · Department of Psychiatry, CAPRI, University of Antwerp, Antwerp, Belgium. ·Int J Geriatr Psychiatry · Pubmed #28418079.

ABSTRACT: OBJECTIVE: Loneliness and depression have a strong reciprocal influence, and both predict adverse health outcomes at old age. Therefore, this study examines whether loneliness is associated with the presence of cardiovascular diseases taking into account the role of late-life depression. METHODS: Cross-sectional data of 477 older adults in the Netherlands Study of Depressed Older Persons were used. Logistic regression analysis was performed to examine the relation between loneliness and cardiovascular disease. Depression was added to the regression model to examine whether depression is an explanatory factor in the association between loneliness and cardiovascular disease. Interaction terms between loneliness and depression and between loneliness and sex were introduced in the regression model to investigate whether depressed and non-depressed participants, and men and women differed in their association between loneliness and cardiovascular disease. RESULTS: Of the overall group, 61% were lonely, 28% had a history of cardiovascular disease and 74% were depressed. Loneliness and cardiovascular disease were not associated in the overall group after adjustment for confounders (continuous: odds ratio [OR] = 1.04, 95% confidence interval [CI] = 0.98-1.10), p = 0.25; dichotomous: OR = 1.27, 95% CI = 0.80-2.03, p = 0.32). For women, there was an association between loneliness and cardiovascular diseases (continuous: OR = 1.13, 95% CI = 1.06-1.21, p < 0.001; dichotomous: OR = 2.64, 95% CI = 1.50-4.65, p = 0.001), but this association was not present in men (OR = 0.96, 95% CI = 0.88-1.05, p = 0.38). This association remained significant after adjustment for confounders, but it lost significance after adding depression to the model. CONCLUSION: For women only, there was an association between loneliness and cardiovascular disease. However, this association was explained by depression, indicating that loneliness in its own right seems not related with cardiovascular disease. Copyright © 2017 John Wiley & Sons, Ltd.

13 Article Moderation of the Alliance-Outcome Association by Prior Depressive Episodes: Differential Effects in Cognitive-Behavioral Therapy and Short-Term Psychodynamic Supportive Psychotherapy. 2017

Lorenzo-Luaces, Lorenzo / Driessen, Ellen / DeRubeis, Robert J / Van, Henricus L / Keefe, John R / Hendriksen, Mariëlle / Dekker, Jack. ·University of Pennsylvania, Brown University. Electronic address: lorenzl@sas.upenn.edu. · VU University Amsterdam. · University of Pennsylvania. · Arkin Mental Health Care, Amsterdam. · VU University Amsterdam, Arkin Mental Health Care, Amsterdam. ·Behav Ther · Pubmed #28711109.

ABSTRACT: Prior studies have suggested that the association between the alliance and depression improvement varies as a function of prior history of depression. We sought to replicate these findings and extend them to short-term psychodynamic supportive psychotherapy (SPSP) in a sample of patients who were randomized to one of these treatments and were administered the Helping Alliance Questionnaire (N=282) at Week 5 of treatment. Overall, the alliance was a predictor of symptom change (d=0.33). In SPSP, the alliance was a modest but robust predictor of change, irrespective of prior episodes (d=0.25-0.33). By contrast, in CBT, the effects of the alliance on symptom change were large for patients with 0 prior episodes (d=0.86), moderate for those with 1 prior episode (d=0.49), and small for those with 2+ prior episodes (d=0.12). These findings suggest a complex interaction between patient features and common vs. specific therapy processes. In CBT, the alliance relates to change for patients with less recurrent depression whereas other CBT-specific processes may account for change for patients with more recurrent depression.

14 Article Cognitive-behavioral versus psychodynamic therapy for major depression: Secondary outcomes of a randomized clinical trial. 2017

Driessen, Ellen / Van, Henricus L / Peen, Jaap / Don, Frank J / Twisk, Jos W R / Cuijpers, Pim / Dekker, Jack J M. ·Amsterdam Public Health Research Institute, Section Clinical Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam. · Arkin Mental Health Care. · Department of Health Sciences, Vrije Universiteit Amsterdam. ·J Consult Clin Psychol · Pubmed #28627912.

ABSTRACT: OBJECTIVE: In a randomized clinical trial, we compared the efficacy of cognitive-behavioral therapy (CBT) and psychodynamic therapy for adult outpatient depression on measures of psychopathology, interpersonal functioning, pain, and quality of life. METHOD: There were 341 Dutch adults (70.1% female, mean age = 38.9, SD = 10.3) meeting RESULTS: Across treatment conditions, 45-60% of the patients who completed posttreatment assessment showed clinically meaningful change for most outcome measures. We found no significant differences between the treatment conditions on any of the outcome measures at both posttreatment and follow-up. Noninferiority of psychodynamic therapy to CBT was shown for posttreatment and follow-up anxiety measures as well as for posttreatment pain and quality of life measures, but could not be consistently demonstrated for the other outcomes. CONCLUSIONS: This is the first study that shows that psychodynamic therapy can be at least as efficacious as CBT for depression on important aspects of patient functioning other than depressive symptom reduction. These findings extend the evidence-base of psychodynamic therapy for depression, but replication is needed by means of rigorously designed noninferiority trials. (PsycINFO Database Record

15 Article Loneliness in older adults is associated with diminished cortisol output. 2017

Schutter, N / Holwerda, T J / Stek, M L / Dekker, J J M / Rhebergen, D / Comijs, H C. ·Arkin Mental Health Care, Department of Geriatric Psychiatry, Nieuwe Kerkstraat 156, 1018 VM Amsterdam, The Netherlands. Electronic address: natasja.schutter@mentrum.nl. · Arkin Mental Health Care, Department of Geriatric Psychiatry, Nieuwe Kerkstraat 156, 1018 VM Amsterdam, The Netherlands. · GGZ InGeest, Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, The Netherlands. · Department of Psychology, VU University Amsterdam, Amsterdam, The Netherlands; Department of Clinical Research, Arkin Mental Health Care, Amsterdam, The Netherlands. ·J Psychosom Res · Pubmed #28314545.

ABSTRACT: OBJECTIVE: Loneliness in older adults has been associated with increased mortality and health problems. One of the assumed underlying mechanisms is dysregulation of the hypothalamic-pituitary-adrenocortical axis (HPA-axis). The purpose of this study was to investigate whether loneliness in older adults is associated with HPA-axis dysregulation and whether this association differs between depressed and non-depressed persons. METHODS: Cross-sectional data of 426 lonely and non-lonely older adults in the Netherlands Study of Depression in Older Persons (NESDO) were used. Linear regression analyses and multinominal logistic regression analyses were performed to examine the association between loneliness and morning cortisol, cortisol awakening response, diurnal slope and dexamethasone suppression ratio. In all analyses, confounders were introduced. In order to examine whether the association between loneliness and cortisol measures is different in depressed versus non-depressed persons, an interaction term for loneliness x depression diagnosis was tested. RESULTS: Cortisol output in the first hour after awakening and dexamethasone suppression ratio was lower in lonely participants. There were no significant interactions between loneliness and depression diagnosis in the association with the cortisol measures. CONCLUSION: This study is the first to investigate the association between the HPA-axis and loneliness in a large group of older adults aged 60-93years. We found lower cortisol output in the first hour after awakening and lower dexamethasone suppression ratio in lonely older depressed and non-depressed adults. Whether diminished cortisol output is the underlying mechanism that leads to health problems in lonely older adults is an interesting object for further study.

16 Article The role of affect in predicting depressive symptomatology in remitted recurrently depressed patients. 2017

de Jonge, M / Dekker, J J M / Kikkert, M J / Peen, J / van Rijsbergen, G D / Bockting, C L H. ·Department of Research Arkin, Amsterdam, The Netherlands. Electronic address: margo.de.jonge@arkin.nl. · Department of Research Arkin, Amsterdam, The Netherlands; Department of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands. · Department of Research Arkin, Amsterdam, The Netherlands. · Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands. · Department of Clinical Psychology, University Utrecht, Utrecht, The Netherlands. ·J Affect Disord · Pubmed #28013124.

ABSTRACT: BACKGROUND: Major depressive disorder is an emotional disorder. It is important to improve our understanding of the role of affect in relapse/recurrence of depression. Therefore, this study examines whether affect plays a role in prospectively predicting depressive symptomatology and if there are indications for emotional scarring as a consequence of undergoing depressive episodes. METHODS: In 107 patients remitted from recurrent depression affect was examined in predicting depressive symptomatology as measured with the Inventory of Depressive Symptomatology - Self Report. Affect was measured with the Positive and Negative Affect Schedule and with a one item Visual Analogue Mood Scale. Indication of emotional scarring was examined by comparing number of previous depressive episodes to levels of affect. RESULTS: Less positive affect as assessed after remission predicted increased depressive symptomatology six months later, even after we controlled for baseline symptomatology. Negative affect also predicted depressive symptomatology six months later, but not after controlling for baseline depressive symptomatology. No relationship was found between affect and number of previous episodes. LIMITATIONS: All participants in this study had two or more previous depressive episodes and received CBT during the acute phase of their depression. The instruments that measured mood and affect were administered within 4 weeks of each other. CONCLUSIONS: Positive affect and negative affect as assessed after remission in recurrent depression can predict depressive symptomatology. Especially positive affect seems to play an independent role in predicting depressive symptomatology. Directly targeting positive affect in relapse prevention during remission might be a way to enhance treatment effects.

17 Article The role of avoidant and obsessive-compulsive personality disorder traits in matching patients with major depression to cognitive behavioral and psychodynamic therapy: A replication study. 2016

Kikkert, Martijn J / Driessen, Ellen / Peen, Jaap / Barber, Jacques P / Bockting, Claudi / Schalkwijk, Frans / Dekker, Jeff / Dekker, Jack J M. ·Arkin Mental Health Care, Amsterdam, The Netherlands. · Arkin Mental Health Care, Amsterdam, The Netherlands; VU University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, The Netherlands. · Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY, USA. · Universiteit Utrecht, Department of Clinical & Health Psychology, Utrecht, The Netherlands. · VU University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands. ·J Affect Disord · Pubmed #27598693.

ABSTRACT: BACKGROUND: Barber and Muenz (1996) reported that cognitive behavior therapy (CBT) was more effective than interpersonal therapy (IPT) for depressed patients with elevated levels of avoidant personality disorder, while IPT was more effective than CBT in patients with elevated levels of obsessive-compulsive personality disorder. These findings may have important clinical implications, but have not yet been replicated. METHODS: We conducted a study using data from a randomized clinical trial comparing the efficacy of CBT and short-term psychodynamic supportive psychotherapy in the outpatient treatment of depression. RESULTS: We found no evidence indicating that avoidant patients may benefit more from CBT compared to short-term psychodynamic supportive therapy (SPSP). CONCLUSIONS: Our results indicate that treatment effect does not depend on the level of avoidance, or obsessive-compulsiveness personality disorders further examine the influence of personality disorders on the effectiveness of CBT or psychodynamic therapy in the treatment of depression.

18 Article Efficacy of an internet-based self-help intervention to reduce co-occurring alcohol misuse and depression symptoms in adults: study protocol of a three-arm randomised controlled trial. 2016

Schaub, Michael P / Blankers, Matthijs / Lehr, Dirk / Boss, Leif / Riper, Heleen / Dekker, Jack / Goudriaan, Anna E / Maier, Larissa J / Haug, Severin / Amann, Manuel / Dey, Michelle / Wenger, Andreas / Ebert, David D. ·Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland. · Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. · Department of Health Psychology and Applied Biological Psychology, Leuphana University Lueneburg, Lueneburg, Germany. · Division of Health Training Online, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany. · Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. · Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany. ·BMJ Open · Pubmed #27225652.

ABSTRACT: INTRODUCTION: In the general population, alcohol use disorder and depression more often occur together than any other combination of a mental illness with a substance use disorder. It is important to have a cost-effective intervention that is able to reach at-risk individuals in the early stages of developing alcohol use disorders and depression disorders. METHODS AND ANALYSIS: This paper presents the protocol for a 3-arm multicentre randomised controlled trial (RCT) to test the efficacy and cost-effectiveness of the combined internet-based self-help intervention Take Care of You (TCOY) to reduce alcohol misuse and depression symptoms in comparison with a waiting list control group and a comparable intervention focusing on problematic alcohol use only. The active interventions consist of modules designed to reduce alcohol use, based on the principles of motivational interviewing and methods of cognitive behavioural therapy, together with additional modules in the combined study arm to reduce symptoms of depression. Data will be collected at baseline, as well as at 3 and 6 months postrandomisation. The primary outcome is the quantity of alcohol used in the past 7 days. A number of secondary outcome measures will be studied. These include the Centre of Epidemiologic Studies of Depression Scale (CES-D) and a combined measure with the criteria of values below the cut-off for severe alcohol use disorder and for CES-D. Data analysis will follow the intention-to-treat principle using (generalised) linear mixed models. In order to investigate the interventions' cost-utility and cost-effectiveness, a full economic evaluation will be performed. ETHICS AND DISSEMINATION: This RCT will be executed in compliance with the Helsinki Declaration and has been approved by 2 local Ethics Committees. Results will be reported at conferences and in peer-reviewed publications. Participant-friendly summaries of trial findings will be published on the TCOY websites. TRIAL REGISTRATION NUMBER: ISRCTN10323951.

19 Article Impact of loneliness and depression on mortality: results from the Longitudinal Ageing Study Amsterdam. 2016

Holwerda, Tjalling J / van Tilburg, Theo G / Deeg, Dorly J H / Schutter, Natasja / Van, Rien / Dekker, Jack / Stek, Max L / Beekman, Aartjan T F / Schoevers, Robert A. ·Tjalling J. Holwerda, MD, Department of Psychiatry, ARKIN Institute of Mental Health Care and EMGO Institute, VU University Medical Centre Amsterdam (VUMC), Longitudinal Ageing Study Amsterdam (LASA), Amsterdam; Theo G. van Tilburg, PhD, EMGO Institute, VU University Medical Centre Amsterdam (VUMC), Longitudinal Ageing Study Amsterdam (LASA) and Department of Sociology, VU University Amsterdam, Amsterdam; Dorly J. H. Deeg, PhD, EMGO Institute, VU University Medical Centre Amsterdam (VUMC), Longitudinal Ageing Study Amsterdam (LASA), Amsterdam; Natasja Schutter, MD, Rien Van, MD, PhD, Department of Psychiatry, ARKIN Institute of Mental Health Care, Amsterdam; Jack Dekker, PhD, Department of Psychology & Department of Research, ARKIN Institute of Mental Health Care, Amsterdam; Max L. Stek, MD, PhD, Department of Psychiatry GGZ INGEEST, Amsterdam; Aartjan T. F. Beekman, MD, PhD, EMGO Institute, VU University Medical Centre Amsterdam (VUMC), Longitudinal Ageing Study Amsterdam (LASA), Amsterdam and Department of Psychiatry GGZ INGEEST, Amsterdam; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University of Groningen and Interdisciplinary Center for Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands tj.holwerda@vumc.nl. · Tjalling J. Holwerda, MD, Department of Psychiatry, ARKIN Institute of Mental Health Care and EMGO Institute, VU University Medical Centre Amsterdam (VUMC), Longitudinal Ageing Study Amsterdam (LASA), Amsterdam; Theo G. van Tilburg, PhD, EMGO Institute, VU University Medical Centre Amsterdam (VUMC), Longitudinal Ageing Study Amsterdam (LASA) and Department of Sociology, VU University Amsterdam, Amsterdam; Dorly J. H. Deeg, PhD, EMGO Institute, VU University Medical Centre Amsterdam (VUMC), Longitudinal Ageing Study Amsterdam (LASA), Amsterdam; Natasja Schutter, MD, Rien Van, MD, PhD, Department of Psychiatry, ARKIN Institute of Mental Health Care, Amsterdam; Jack Dekker, PhD, Department of Psychology & Department of Research, ARKIN Institute of Mental Health Care, Amsterdam; Max L. Stek, MD, PhD, Department of Psychiatry GGZ INGEEST, Amsterdam; Aartjan T. F. Beekman, MD, PhD, EMGO Institute, VU University Medical Centre Amsterdam (VUMC), Longitudinal Ageing Study Amsterdam (LASA), Amsterdam and Department of Psychiatry GGZ INGEEST, Amsterdam; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University of Groningen and Interdisciplinary Center for Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands. ·Br J Psychiatry · Pubmed #27103680.

ABSTRACT: BACKGROUND: Loneliness is highly prevalent among older people, has serious health consequences and is an important predictor of mortality. Loneliness and depression may unfavourably interact with each other over time but data on this topic are scarce. AIMS: To determine whether loneliness is associated with excess mortality after 19 years of follow-up and whether the joint effect with depression confers further excess mortality. METHOD: Different aspects of loneliness were measured with the De Jong Gierveld scale and depression with the Centre for Epidemiologic Studies Depression Scale in a cohort of 2878 people aged 55-85 with 19 years of follow-up. Excess mortality hypotheses were tested with Kaplan-Meier and Cox proportional hazard analyses controlling for potential confounders. RESULTS: At follow-up loneliness and depression were associated with excess mortality in older men and women in bivariate analysis but not in multivariate analysis. In multivariate analysis, severe depression was associated with excess mortality in men who were lonely but not in women. CONCLUSIONS: Loneliness and depression are important predictors of early death in older adults. Severe depression has a strong association with excess mortality in older men who were lonely, indicating a lethal combination in this group.

20 Article Differential efficacy of cognitive behavioral therapy and psychodynamic therapy for major depression: a study of prescriptive factors. 2016

Driessen, E / Smits, N / Dekker, J J M / Peen, J / Don, F J / Kool, S / Westra, D / Hendriksen, M / Cuijpers, P / Van, H L. ·Department of Clinical Psychology,VU University Amsterdam,Amsterdam,The Netherlands. · Arkin Mental Health Care,Amsterdam,The Netherlands. ·Psychol Med · Pubmed #26750445.

ABSTRACT: BACKGROUND: Minimal efficacy differences have been found between cognitive behavioral therapy (CBT) and psychodynamic therapies for depression, but little is known about patient characteristics that might moderate differential treatment effects. We aimed to generate hypotheses regarding such potential prescriptive factors. METHOD: We conducted post-hoc model-based recursive partitioning analyses alongside a randomized clinical trial comparing the efficacy of CBT and short-term psychodynamic supportive psychotherapy (SPSP). Severely depressed patients received additional antidepressant medication. We included 233 adults seeking treatment for a major depressive episode in psychiatric outpatient clinics, who completed post-treatment assessment. Post-treatment mean Hamilton Depression Rating Scale scores constituted the main outcome measure. RESULTS: While treatment differences (CBT v. SPSP) were minimal in the total sample of patients (d = 0.04), model-based recursive partitioning indicated differential treatment efficacy in certain subgroups of patients. SPSP was found more efficacious among moderately depressed patients receiving psychotherapy only who showed low baseline co-morbid anxiety levels (d = -0.40) and among severely depressed patients receiving psychotherapy and antidepressant medication who reported a duration of the depressive episode of ⩾1 year (d = -0.31), while CBT was found more efficacious for such patients reporting a duration <1 year (d = 0.83). CONCLUSIONS: Our findings are observational and need validation before they can be used to guide treatment selection, but suggest that knowledge of prescriptive factors can help improve the efficacy of psychotherapy for depression. Depressive episode duration and co-morbid anxiety level should be included as stratification variables in future randomized clinical trials comparing CBT and psychodynamic therapy.

21 Article Preventive Cognitive Therapy versus Treatment as Usual in preventing recurrence of depression: protocol of a multi-centered randomized controlled trial. 2015

de Jonge, Margo / Bockting, Claudi L H / Kikkert, Martijn J / Bosmans, Judith E / Dekker, Jack J M. ·Department of research Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands. margo.de.jonge@arkin.nl. · Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands. c.l.h.bockting@uu.nl. · Department of research Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands. martijn.kikkert@arkin.nl. · Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, Vrije Universiteit, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands. j.e.bosmans@vu.nl. · Department of research Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands. jack.dekker@arkin.nl. ·BMC Psychiatry · Pubmed #26129694.

ABSTRACT: BACKGROUND: Major depressive disorder (MDD) is projected to rank second on a list of 15 major diseases in terms of burden in 2030. The contribution of MDD to disability and health care costs is largely due to its highly recurrent nature. Therefore, part of the efforts to reduce the disabling effects of depression should focus on preventing recurrence, especially in patients at high risk of recurrence. The best established effective psychological intervention is cognitive therapy, with indications for prophylactic effects after remission. METHODS/DESIGN: In this randomized controlled trial (cost-) effectiveness of Preventive Cognitive Therapy (PCT) after response to Acute Cognitive Therapy (A-CT) will be evaluated in comparison with Treatment As Usual (TAU). Remitted patients that responded to A-CT treatment with at least two previous depressive episodes will be recruited. Randomization will be stratified for number of previous episodes. Follow-ups are at 3, 6, 12 and 15 months. The primary outcome measure will be the time to relapse or recurrence of depression meeting DSM-IV criteria for a major depressive episode on the Structured Clinical Interview for DSM-VI Axis I Disorders (SCID-I). Costs will be measured from a societal perspective. DISCUSSION: This study is the first to examine the addition of PCT to TAU, compared to TAU alone in patients that recovered from depressive disorder with A-CT. Alongside this effect study a cost effectiveness analysis will be conducted. Furthermore, the study explores potential moderators to examine what works for whom. TRIAL REGISTRATION: Netherlands Trial Register (NTR): 2599 , date of registration: 11-11-2010.

22 Article Understanding emotion and emotional scarring in recurrent depression. 2015

van Rijsbergen, Gerard D / Hollon, Steven D / Elgersma, Hermien J / Kok, Gemma D / Dekker, Jack / Schene, Aart H / Bockting, Claudi L H. ·Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands. · Vanderbilt University, Department of Psychology, Nashville, TN, USA. · Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands; Department of Clinical Psychology, VU University, Amsterdam, The Netherlands. · Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands. · Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands; Department of Clinical Health Psychology, Utrecht University, Utrecht University, Utrecht, The Netherlands. Electronic address: C.L.H.Bockting@uu.nl. ·Compr Psychiatry · Pubmed #25749480.

ABSTRACT: BACKGROUND: A single-item assessment of sad mood after remission from MDD is predictive of relapse, yet the mechanisms that play a role in depressive relapse remain poorly understood. METHODS: In 283 patients, remitted from recurrent depression (DSM-IV-TR criteria; HAM-D17 score ≤ 10), we examined emotional scarring, that is, whether the number of previous depressive episodes was associated with higher levels of sad mood as assessed with a 1-item Visual Analogue Mood Scale (VAMS). We then fitted a cross-sectional multivariate regression model to predict sad mood levels, including the Dysfunctional Attitude Scale Version-A, cognitive reactivity (Leiden Index of Depression Sensitivity), Ruminative Response Scale, and Everyday Problem Checklist. RESULTS: Patients with greater numbers of prior episodes experienced higher levels of sad mood after remission. In multivariate regression, intensity of daily stress and dysfunctional beliefs were associated with the VAMS (Adj. R(2)=.091) although not over and above depressive symptomatology (Adj. R(2)=.114). Cognitive reactivity was not associated with sadness. CONCLUSIONS: Our finding that patients with more previous MDEs reported higher levels of sad mood while remitted could be indicative of emotional scarring. Dysfunctional beliefs and intensity of daily stress were associated with sad mood but not over and above residual symptoms. Thus, illness related characteristics especially are associated with sad mood after remission. More negative affect after remission could result in lower stress tolerance or more stress intensity could result in negative affect. Future studies should examine premorbid sadness in a longitudinal cohort, and should study the exact pathway from stress, affect, and cognition to relapse.

23 Article Therapist-rated outcomes in a randomized clinical trial comparing cognitive behavioral therapy and psychodynamic therapy for major depression. 2015

Driessen, Ellen / Van Henricus, L / Peen, Jaap / Don, Frank J / Kool, Simone / Westra, Dieuwertje / Hendriksen, Mariëlle / Cuijpers, Pim / Twisk, Jos W R / Dekker, Jack J M. ·VU University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, The Netherlands. Electronic address: e.driessen@vu.nl. · Arkin Mental Health Care, Amsterdam, The Netherlands. · Arkin Mental Health Care, Amsterdam, The Netherlands; ProPersona Mental Health, Nijmegen, The Netherlands. · VU University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, The Netherlands. · VU University Amsterdam, Department of Health Sciences, Amsterdam, The Netherlands; VU University Medical Center Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, The Netherlands. · VU University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, The Netherlands; Arkin Mental Health Care, Amsterdam, The Netherlands. ·J Affect Disord · Pubmed #25240140.

ABSTRACT: BACKGROUND: The efficacy of psychodynamic therapy (PDT) for depression is debated due to a paucity of high-quality studies. We compared short psychodynamic supportive psychotherapy (SPSP) to cognitive behavioral therapy (CBT) in a randomized clinical trial. We used therapist-rated outcomes to examine how the course of change during treatment could be best represented and to compare treatment efficacy, hypothesizing non-significant differences. METHODS: Three hundred and forty-one adults meeting DSM-IV criteria for a depressive episode and with Hamilton Depression Rating Scale (HAM-D) scores ≥14 were randomized to 16 sessions of individual manualized CBT or SPSP. Severely depressed patients (HAM-D>24) received additional antidepressant medication. After each session, therapists rated the Clinical Global Impression Scale subscales 'Severity of Illness' (CGI-S) and 'Global Improvement' (CGI-I), and the DSM-IV Axis V Global Assessment of Functioning Scale (GAF). We fitted growth curves using mixed model analyses with intention-to-treat samples. RESULTS: CGI-S and GAF scores during treatment were best represented by a linear symptom decrease. CGI-I scores were best represented by an S-shaped curve with relative more improvement in the first and last phases than in the middle phase of treatment. No significant post-treatment treatment differences were found. A non-significant trend for a treatment effect on CGI-S scores vanished when controlling for therapist gender and profession. LIMITATIONS: Therapists were not specifically trained for CGI and GAF assessments. CONCLUSIONS: These findings add to the evidence-base of PDT for depression. Therapist characteristics and differences between severity and improvement measures might influence ratings and need to be taken into account when using therapist-rated outcome measures.

24 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.

25 Article The association of depression and anxiety with pain: a study from NESDA. 2014

de Heer, Eric W / Gerrits, Marloes M J G / Beekman, Aartjan T F / Dekker, Jack / van Marwijk, Harm W J / de Waal, Margot W M / Spinhoven, Philip / Penninx, Brenda W J H / van der Feltz-Cornelis, Christina M. ·TopClinical Center for Body, Mind, and Health, GGz Breburg Tilburg, Tilburg, The Netherlands; Tilburg School of Behavioral and Social Sciences, Tranzo Department, University of Tilburg, Tilburg, The Netherlands. · Department of Psychiatry, EMGO Institute for Health and Care research, VU University Medical Centre, Amsterdam, The Netherlands. · Department of Psychiatry, EMGO Institute for Health and Care research, VU University Medical Centre, Amsterdam, The Netherlands; GGZ inGeest, Mental Health Institute, Amsterdam, The Netherlands. · Arkin, Mental Health Institute, Amsterdam, The Netherlands; Department of Clinical Psychology, VU University, Amsterdam, The Netherlands. · Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. · Department of Public Health and Primary Care, Leiden university Medical Centre, Leiden, The Netherlands. · Institute of Psychology, Leiden University, Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands. · TopClinical Center for Body, Mind, and Health, GGz Breburg Tilburg, Tilburg, The Netherlands; Tilburg School of Behavioral and Social Sciences, Tranzo Department, University of Tilburg, Tilburg, The Netherlands; Trimbos Institute, Utrecht, the Netherlands. ·PLoS One · Pubmed #25330004.

ABSTRACT: Chronic pain is commonly co-morbid with a depressive or anxiety disorder. Objective of this study is to examine the influence of depression, along with anxiety, on pain-related disability, pain intensity, and pain location in a large sample of adults with and without a depressive and/or anxiety disorder. The study population consisted of 2981 participants with a depressive, anxiety, co-morbid depressive and anxiety disorder, remitted disorder or no current disorder (controls). Severity of depressive and anxiety symptoms was also assessed. In separate multinomial regression analyses, the association of presence of depressive or anxiety disorders and symptom severity with the Chronic Pain Grade and location of pain was explored. Presence of a depressive (OR = 6.67; P<.001), anxiety (OR = 4.84; P<.001), or co-morbid depressive and anxiety disorder (OR = 30.26; P<.001) was associated with the Chronic Pain Grade. Moreover, symptom severity was associated with more disabling and severely limiting pain. Also, a remitted depressive or anxiety disorder showed more disabling and severely limiting pain (OR = 3.53; P<.001) as compared to controls. A current anxiety disorder (OR = 2.96; p<.001) and a co-morbid depressive and anxiety disorder (OR = 5.15; P<.001) were more strongly associated with cardio-respiratory pain, than gastro-intestinal or musculoskeletal pain. These findings remain after adjustment for chronic cardio respiratory illness. Patients with a current and remitted depressive and/or anxiety disorder and those with more severe symptoms have more disabling pain and pain of cardio-respiratory nature, than persons without a depressive or anxiety disorder. This warrants further research.

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