Towards a better understanding of the psychological processes which lead to the incidence of depressive disoders: a prospective study Ik ben Marjolein Fokkema, ik werk bij Klinische Psychologie bij de VU. Ik heb me sinds het afgelopen jaar onder andere bezig gehouden met dit onderzoek. Het onderzoek komt er in het kort op neer dat we een groep studenten in het onderzoek gedurende twee jaar volgen om meer inzicht te krijgen in het proces dat aan een depressie voorafgaat.

Schedule Theoretical and practical framework Research design Discussion, remarks and questions Hebben aanwezige studenten het vak preventie gevolgd?

Prevalence of mood disorders (%) Men Women Total Last year Ever Mood disorders 5,7 13,6 9,7 24,5 7.6 19,0 Depressive disorder 4,1 10,9 7,5 20,1 5,8 15,4 Dysthymic disorder 1,4 3,8 3,2 8,9 2,3 6,3 Bipolar disorder 1,1 1,5 2,1 1,8 Minor depression Depressie komt veel voor, heeft een hoge ziektelast en brengt hoge maatschappelijke kosten met zich mee. Er zijn echter goede behandelingen voor depressie.

Andrews et al. (2004) Current situation in treatment mood disorder: Coverage: 60%. Effective coverage: 34% Result: 15% YLD averted Possible maximum with evidence based treatment Coverage: 100% Effective coverage: 100% Result: 35% YLD averted

Prevention Prevention to reduce the burden of disease Universal prevention seems to have little effect Conclusion: selective prevention! Selecting: who and when? There’s a gap in emperical knowledge of processes which lead to the incidence of depression Beperkingen bestaande studies over ontstaan van een depressie: crossectioneel; uitgevoerd onder patienten met een bestaande depressie; maken gebruik van een zelfbeoordelingsinstrument (vragenlijst) om de aanwezigheid van een depressieve studie vas te stellen.

Alloy at al. (1999 & 2006) Prospective study Diagnostic interview High Risk approach But: Just cognitive model Participants with lifetime depressive disorder in study Enkele studies voorhanden die prospectief de incidentie van depressie onderzoeken (dus langere tijd respondenten zonder eerdere depressieve stoornis volgen) en gebruik maken van een diagnostisch interview.

Research design Testing different theoretical models High Risk approach Diagnostic interview First-ever incidence Prospective (longitudinal) study

Theoretical models: crietria De model should be clearly described in the existing literature. There is (some) emperical support for the model. It is possible to operationalize the key elements of the model. Preferably, there’s an association between the model and an intervention for depression.

Theoretical models Learned helplessness-theory (Abramson et al., 1978) Cognitive theory (Beck, 1967 & 1976) Theory of the ruminating response style (Nolen-Hoeksema, 1993 & 2000) Attachment theory (Bowlby, 1969 & 1988) Behavioral theory (Lewinsohn, 1985) Interpersonal theory (Joiner, 2002)

High Risk approach Large group of first-year students is invited to fill out an online questionnaire High Risk-group is selected for participation in the study Low Risk-group is selected as a controlgroup

High Risk approach Measured concepts (risk): Self Esteem (RSES; Rosenberg, 1965) Mastery (Mastery Scale; Pearlin & Schooler, 1978) Automatic Thoughts (ATQ; Hollon & Kendall, 1990) Worrying (PSWQ; Meyer et al., 1990) Attachment Style (AAS; Collins & Read, 1990) Childhood trauma and parental psychopathology (Subscale of NEMESIS questionnaire; Bijl et al., 1998)

High Risk approach Measured concepts (other) Depressive symptoms (CES-D; Ensel, 1986) Anxiety symptoms (HADS; Zigmond & Snaith, 1983) Neuroticism (NEO-FFI; Costa & McRea, 1992) Demografic characteristics

High Risk approach Every concept is measured by a questionnaire Of every ‘risk’questionnaire the 10% participants scoring highest is selected (HR-group, ±50% of respondents) Participants scoring among the 60% lowest scores of every questionnaire are selected (LR-group, ±15% of respondents)

Diagnostic interview Depressive and anxiety disorders are measured with the CIDI-interview (WHO, 1997) Interview at baseline

Incidence Only first-ever cases are included. Participants without a current or lifetime diagnoses of depression are included in the study

Research design: prospective study Participants will be followed for 2 years Every 6 months a measurement (total of 5): At baseline, after 1 and 2 years participants fill out a questionnaire and are interviewed In between, participants fill out a questionnaire every 6 months

Preliminary results 481 of the 2815 invited students filled out the questionnaire Of 481 participants ±50% are in the HR-group and ±15% in the LR-group 214 partcipants were interviewed 152 of the interviewed participants did not have a depressive disorder (current or lifetime) 115 participants are included in the study up ‘till now

Preliminary results At this moment, we’re still including participants (participants are filling out questionnaires and are being interviewed) We hope to include 300 participants and follow them for 2 years First follow-up measurement: end of april

Discussion Questions or remarks?