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Cadorin C, Purgato M, Turrini G, Prina E, Cabral Ferreira M, Cristofalo D, Bartucz MB, Witteveen AB, Sijbrandij M, Papola D, Barbui C. Mapping the evidence on psychosocial interventions for migrant populations: Descriptive analysis of a living database of randomized studies. Glob Ment Health (Camb) 2024; 11:e35. [PMID: 38572262 PMCID: PMC10988138 DOI: 10.1017/gmh.2024.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/21/2024] [Accepted: 03/02/2024] [Indexed: 04/05/2024] Open
Abstract
Migrant mental health is a pressing public health issue with wide-ranging implications. Many randomized controlled trials (RCTs) have been conducted in this population to assess the effects of psychosocial interventions. However, the available evidence is characterized by controversy and fragmentation, with studies focusing on different migrant populations, interventions, outcomes, delivery modalities and settings. Aiming to promote systematic reviews of the effectiveness of psychosocial interventions in different migrant groups, we have developed a living database of existing RCTs. The development of the database provides an opportunity to map the existing RCT evidence in this population. A total of 135 studies involving 24,859 participants were included in the living database. The distribution of studies by year of publication aligns with the increasing global migrant population in recent years. Most studies focus primarily on adult participants, with a limited representation of children and adolescents, and a prevalence of female participants, which is consistent with epidemiological data, except for older adults, who are underrepresented in research. Studies predominantly focus on refugees and asylum seekers, likely due to their elevated risk of mental health issues, despite the substantial presence of economic migrants worldwide. While studies mainly involve migrants from the Middle East and East Asia, epidemiological data suggest a broader geographic representation, with migrants coming from Eastern Europe, Latin America and South Asia. The present descriptive analysis of RCTs on mental health and psychosocial interventions for migrant populations provides valuable insights into the existing research landscape. It should be used to inform future research efforts, ensuring that studies are more representative of the global migrant population and more responsive to the mental health needs of migrants in different contexts.
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Affiliation(s)
- Camilla Cadorin
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Eleonora Prina
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Madalena Cabral Ferreira
- Public Health Unit of the Primary Care Cluster of Famalicão, Northern Region Health Administration, Famalicão, Portugal
| | - Doriana Cristofalo
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Monica B. Bartucz
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Anke B. Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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de Graaff AM, Cuijpers P, Boschloo L, Elsawy M, Hunaidy S, Seedat S, Witteveen AB, Huizink AC, Sijbrandij M. The associations of hair cortisol and DHEA with posttraumatic stress disorder symptoms in refugees. Compr Psychiatry 2024; 129:152438. [PMID: 38104462 DOI: 10.1016/j.comppsych.2023.152438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/09/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Exposure to traumatic events, ongoing adversity, and posttraumatic stress disorder (PTSD) are associated with altered activity of the hypothalamic-pituitary-adrenal (HPA) axis, but findings are mixed. This may be explained in part by heterogeneity in PTSD symptom profiles. AIM The aim of this study was to investigate the complex relationships between the number of traumatic events and post-displacement stressors, individual symptoms of PTSD, and HPA-axis hormones cortisol and dehydroepiandrosterone (DHEA) in refugees. METHODS Adult (18+ years) Syrian refugees with increased levels of distress participating in a randomized controlled trial completed baseline measures to assess traumatic events (trauma checklist), post-displacement stressors (Post-Migration Living Difficulties checklist), symptoms of PTSD (PTSD Checklist for DSM-5; PCL-5), and provided a hair sample for additional stress hormone analyses. We used R-packages qgraph and bootnet to perform network analysis on the number of traumatic events and post-displacement stressors, individual symptoms of PTSD, and HPA-axis hormones cortisol and DHEA. The final network model was corrected for depression severity. RESULTS 115 (53% male, M age = 36.9, SD = 12.7) of 206 participants provided a hair sample. A higher number of traumatic events was directly associated with three symptoms of the PTSD cluster arousal and reactivity, i.e., sleep disturbance, hypervigilance and physiological reactivity, and with three other PTSD symptoms, namely flashbacks, avoidance of reminders, and self-destructive behavior. A higher number of post-displacement stressors was associated with four symptoms of the PTSD cluster cognition and mood, i.e., trauma-related amnesia, negative beliefs, blaming of self/others, and detachment, as well as with intrusive thoughts, sleep disturbance, hypervigilance, and exaggerated startle response. The number of traumatic events and post-displacement stressors were not associated with cortisol or DHEA. Cortisol was positively associated with two symptoms of the PTSD cluster cognition and mood, i.e., negative beliefs and negative trauma-related emotions, and negatively associated with avoidance of reminders. DHEA was positively associated with restricted affect and with three symptoms of the PTSD symptom cluster arousal and reactivity, i.e., irritability/anger, sleep disturbance, and self-destructive behavior, and negatively associated with avoidance of thoughts. CONCLUSIONS This study demonstrated that exposure to traumatic events and post-displacement stressors is not related to cortisol and DHEA, but that cortisol and DHEA are differentially related to individual symptoms of PTSD. While lower levels of both cortisol and DHEA were associated with increased avoidance, higher levels of cortisol were mostly associated with symptoms of the PTSD cluster cognition and mood and higher levels of DHEA were mostly associated with symptoms of the PTSD cluster arousal and reactivity. These findings contribute to explaining the variability of findings in the literature on HPA-axis activity in PTSD. ETHICS The study was approved by the Research Ethics Review Committee at VU Medical Center, the Netherlands (Protocol ID: NL61361.029.17, 7 September 2017) and prospectively registered online (https://www.trialregister.nl/trial/6665).
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Affiliation(s)
- Anne M de Graaff
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands.
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Strada Mihail Kogălniceanu 1, Cluj-Napoca 400347, Romania
| | - Lynn Boschloo
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, Utrecht 3584 CS, the Netherlands
| | - Mariam Elsawy
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| | - Sam Hunaidy
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| | - Soraya Seedat
- SAMRC Genomics of Brain Disorders Unit, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Clinical Building, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Anke B Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| | - Anja C Huizink
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
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Roos R, Witteveen AB, Ayuso-Mateos JL, Barbui C, Bryant RA, Felez-Nobrega M, Figueiredo N, Kalisch R, Haro JM, McDaid D, Mediavilla R, Melchior M, Nicaise P, Park AL, Petri-Romão P, Purgato M, van Straten A, Tedeschi F, Underhill J, Sijbrandij M. Correction: Effectiveness of a scalable, remotely delivered stepped-care intervention to reduce symptoms of psychological distress among Polish migrant workers in the Netherlands: study protocol for the RESPOND randomised controlled trial. BMC Psychiatry 2024; 24:24. [PMID: 38178056 PMCID: PMC10768119 DOI: 10.1186/s12888-023-05475-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Affiliation(s)
- Rinske Roos
- Department of Clinical, Neuroand Developmental Psychology and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, Netherlands.
| | - Anke B Witteveen
- Department of Clinical, Neuroand Developmental Psychology and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, Netherlands
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Department of Psychiatry, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Mireia Felez-Nobrega
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Natasha Figueiredo
- Equipe de Recherche en Epidémiologie Sociale (ERES), Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), INSERM, Sorbonne Université Facult? de Médecine St Antoine, Paris, France
| | - Rafael Kalisch
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Focus Program Translational Neuroscience (FTN), Neuroimaging Center (NIC), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Department of Psychiatry, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Maria Melchior
- Equipe de Recherche en Epidémiologie Sociale (ERES), Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), INSERM, Sorbonne Université Facult? de Médecine St Antoine, Paris, France
| | - Pablo Nicaise
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Marianna Purgato
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Annemieke van Straten
- Department of Clinical, Neuroand Developmental Psychology and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, Netherlands
| | - Federico Tedeschi
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | | | - Marit Sijbrandij
- Department of Clinical, Neuroand Developmental Psychology and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, Netherlands
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Melchior M, Figueiredo N, Roversi A, Dubanchet A, Bui E, Vadell-Martínez J, Barbui C, Purgato M, Ayuso-Mateos JL, Mediavilla R, McDaid D, Park AL, Petri-Romão P, Kalisch R, Nicaise P, Lorant V, Sijbrandij M, Witteveen AB, Bryant R, Felez M, Underhill J, Pollice G, Tortelli A. Addressing mental health problems among persons without stable housing in the context of the COVID-19 pandemic: study protocol for a randomised trial. RESPOND - France. BMC Public Health 2023; 23:2275. [PMID: 37978577 PMCID: PMC10656934 DOI: 10.1186/s12889-023-17238-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/16/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had an impact on population-wide mental health and well-being. Although people experiencing socioeconomic disadvantage may be especially vulnerable, they experience barriers in accessing mental health care. To overcome these barriers, the World Health Organization (WHO) designed two scalable psychosocial interventions, namely the web-based Doing What Matters in Times of Stress (DWM) and the face-to-face Problem Management Plus (PM+), to help people manage stressful situations. Our study aims to test the effectiveness of a stepped-care program using DWM and PM + among individuals experiencing unstable housing in France - a majority of whom are migrant or have sought asylum. METHODS This is a randomised controlled trial to evaluate the effectiveness and cost effectiveness of a stepped-care program using DWM and PM + among persons with psychological distress and experiencing unstable housing, in comparison to enhanced care as usual (eCAU). Participants (N = 210) will be randomised to two parallel groups: eCAU or eCAU plus the stepped-care program. The main study outcomes are symptoms of depression and anxiety measured using the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). DISCUSSION This randomised controlled trial will contribute to a better understanding of effective community-based scalable strategies that can help address the mental health needs of persons experiencing socioeconomic disadvantage, whose needs are high yet who frequently have limited access to mental health care services. TRIAL REGISTRATION this randomised trial has been registered at ClinicalTrials.gov under the number NCT05033210.
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Affiliation(s)
- Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France.
| | - Natasha Figueiredo
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France
| | - Aurélia Roversi
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France
| | - Alexandre Dubanchet
- CHU Caen, & Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", NeuroPresage Team, Cyceron, Caen, 14000, France
| | - Eric Bui
- CHU Caen, & Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", NeuroPresage Team, Cyceron, Caen, 14000, France
| | - Julian Vadell-Martínez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Marianna Purgato
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Princesa, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Princesa, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Papoula Petri-Romão
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Pablo Nicaise
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
| | - Vincent Lorant
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
| | - Marit Sijbrandij
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Anke B Witteveen
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Mireia Felez
- Institut de recerca Sant Joan de Déu, Dr. Antoni Pujadas, Sant Boi de Llobregat (Barcelona), 4208830, Spain
| | | | - Giulia Pollice
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France
| | - Andrea Tortelli
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France
- GHU Paris, Psychiatrie & Neurosciences - Pôle Psychiatrie Précarité, Paris, France
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Roos R, Witteveen AB, Ayuso-Mateos JL, Barbui C, Bryant RA, Felez-Nobrega M, Figueiredo N, Kalisch R, Haro JM, McDaid D, Mediavilla R, Melchior M, Nicaise P, Park AL, Petri-Romão P, Purgato M, van Straten A, Tedeschi F, Underhill J, Sijbrandij M. Effectiveness of a scalable, remotely delivered stepped-care intervention to reduce symptoms of psychological distress among Polish migrant workers in the Netherlands: study protocol for the RESPOND randomised controlled trial. BMC Psychiatry 2023; 23:801. [PMID: 37919694 PMCID: PMC10623706 DOI: 10.1186/s12888-023-05288-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has negatively affected the mental health of international migrant workers (IMWs). IMWs experience multiple barriers to accessing mental health care. Two scalable interventions developed by the World Health Organization (WHO) were adapted to address some of these barriers: Doing What Matters in times of stress (DWM), a guided self-help web application, and Problem Management Plus (PM +), a brief facilitator-led program to enhance coping skills. This study examines whether DWM and PM + remotely delivered as a stepped-care programme (DWM/PM +) is effective and cost-effective in reducing psychological distress, among Polish migrant workers with psychological distress living in the Netherlands. METHODS The stepped-care DWM/PM + intervention will be tested in a two-arm, parallel-group, randomized controlled trial (RCT) among adult Polish migrant workers with self-reported psychological distress (Kessler Psychological Distress Scale; K10 > 15.9). Participants (n = 212) will be randomized into either the intervention group that receives DWM/PM + with psychological first aid (PFA) and care-as-usual (enhanced care-as-usual or eCAU), or into the control group that receives PFA and eCAU-only (1:1 allocation ratio). Baseline, 1-week post-DWM (week 7), 1-week post-PM + (week 13), and follow-up (week 21) self-reported assessments will be conducted. The primary outcome is psychological distress, assessed with the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). Secondary outcomes are self-reported symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), resilience, quality of life, and cost-effectiveness. In a process evaluation, stakeholders' views on barriers and facilitators to the implementation of DWM/PM + will be evaluated. DISCUSSION To our knowledge, this is one of the first RCTs that combines two scalable, psychosocial WHO interventions into a stepped-care programme for migrant populations. If proven to be effective, this may bridge the mental health treatment gap IMWs experience. TRIAL REGISTRATION Dutch trial register NL9630, 20/07/2021, https://www.onderzoekmetmensen.nl/en/trial/27052.
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Affiliation(s)
- Rinske Roos
- Department of Clinical, Neuro- and Developmental Psychology and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, Netherlands.
| | - Anke B Witteveen
- Department of Clinical, Neuro- and Developmental Psychology and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, Netherlands
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Department of Psychiatry, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Mireia Felez-Nobrega
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Natasha Figueiredo
- Equipe de Recherche en Epidémiologie Sociale (ERES), Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), INSERM, Sorbonne Université, Faculté de Médecine St Antoine, Paris, France
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Focus Program Translational Neuroscience (FTN), Neuroimaging Center (NIC), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Department of Psychiatry, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Maria Melchior
- Equipe de Recherche en Epidémiologie Sociale (ERES), Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), INSERM, Sorbonne Université, Faculté de Médecine St Antoine, Paris, France
| | - Pablo Nicaise
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Marianna Purgato
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Annemieke van Straten
- Department of Clinical, Neuro- and Developmental Psychology and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, Netherlands
| | - Federico Tedeschi
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | | | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, Netherlands
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Mediavilla R, Felez-Nobrega M, McGreevy KR, Monistrol-Mula A, Bravo-Ortiz MF, Bayón C, Giné-Vázquez I, Villaescusa R, Muñoz-Sanjosé A, Aguilar-Ortiz S, Figueiredo N, Nicaise P, Park AL, Petri-Romão P, Purgato M, Witteveen AB, Underhill J, Barbui C, Bryant R, Kalisch R, Lorant V, McDaid D, Melchior M, Sijbrandij M, Haro JM, Ayuso-Mateos JL. Effectiveness of a mental health stepped-care programme for healthcare workers with psychological distress in crisis settings: a multicentre randomised controlled trial. BMJ Ment Health 2023; 26:e300697. [PMID: 37263708 PMCID: PMC10254812 DOI: 10.1136/bmjment-2023-300697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/25/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Evidence-based mental health interventions to support healthcare workers (HCWs) in crisis settings are scarce. OBJECTIVE To evaluate the capacity of a mental health intervention in reducing anxiety and depression symptoms in HCWs, relative to enhanced care as usual (eCAU), amidst the COVID-19 pandemic. METHODS We conducted an analyst-blind, parallel, multicentre, randomised controlled trial. We recruited HCWs with psychological distress from Madrid and Catalonia (Spain). The intervention arm received a stepped-care programme consisting of two WHO-developed interventions adapted for HCWs: Doing What Matters in Times of Stress (DWM) and Problem Management Plus (PM+). Each intervention lasted 5 weeks and was delivered remotely by non-specialist mental health providers. HCWs reporting psychological distress after DWM completion were invited to continue to PM+. The primary endpoint was self-reported anxiety/depression symptoms (Patient Health Questionnaire-Anxiety and Depression Scale) at week 21. FINDINGS Between 3 November 2021 and 31 March 2022, 115 participants were randomised to stepped care and 117 to eCAU (86% women, mean age 37.5). The intervention showed a greater decrease in anxiety/depression symptoms compared with eCAU at the primary endpoint (baseline-adjusted difference 4.4, 95% CI 2.1 to 6.7; standardised effect size 0.8, 95% CI 0.4 to 1.2). No serious adverse events occurred. CONCLUSIONS Brief stepped-care psychological interventions reduce anxiety and depression during a period of stress among HCWs. CLINICAL IMPLICATIONS Our results can inform policies and actions to protect the mental health of HCWs during major health crises and are potentially rapidly replicable in other settings where workers are affected by global emergencies. TRIAL REGISTRATION NUMBER NCT04980326.
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Affiliation(s)
- Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Consorcio de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Princesa (IIS-Princesa), Madrid, Spain
- Leibniz Institute for Resilience Research, Mainz, Germany
| | - Mireia Felez-Nobrega
- Consorcio de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Spain
| | - Kerry R McGreevy
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Consorcio de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Anna Monistrol-Mula
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - María-Fe Bravo-Ortiz
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Consorcio de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Hospital Universitario La Paz - IdiPAZ, Madrid, Spain
| | - Carmen Bayón
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Consorcio de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Hospital Universitario La Paz - IdiPAZ, Madrid, Spain
| | - Iago Giné-Vázquez
- Consorcio de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Rut Villaescusa
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Ainoa Muñoz-Sanjosé
- Department of Psychiatry, Hospital Universitario La Paz - IdiPAZ, Madrid, Spain
| | | | - Natasha Figueiredo
- Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Institut national de la santé et de la recherche médicale (INSERM), Paris, France
| | - Pablo Nicaise
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
| | - A-La Park
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation - Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Anke B Witteveen
- Department of Clinical Neuro- and Developmental Psychology - WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije University, Amsterdam, Netherlands
| | - James Underhill
- Department of Clinical Neuro- and Developmental Psychology - WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije University, Amsterdam, Netherlands
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation - Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Richard Bryant
- School of Psychology, UNSW, Sydney, New South Wales, Australia
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research, Mainz, Germany
- Neuroimaging Center (NIC) - Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Vincent Lorant
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
| | - David McDaid
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Maria Melchior
- Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Institut national de la santé et de la recherche médicale (INSERM), Paris, France
| | - Marit Sijbrandij
- Department of Clinical Neuro- and Developmental Psychology - WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije University, Amsterdam, Netherlands
| | - Josep Maria Haro
- Consorcio de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Jose Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Consorcio de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Princesa (IIS-Princesa), Madrid, Spain
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Witteveen AB, Young SY, Cuijpers P, Ayuso-Mateos JL, Barbui C, Bertolini F, Cabello M, Cadorin C, Downes N, Franzoi D, Gasior M, Gray B, Melchior M, van Ommeren M, Palantza C, Purgato M, van der Waerden J, Wang S, Sijbrandij M. COVID-19 and common mental health symptoms in the early phase of the pandemic: An umbrella review of the evidence. PLoS Med 2023; 20:e1004206. [PMID: 37098048 PMCID: PMC10129001 DOI: 10.1371/journal.pmed.1004206] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 02/21/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND There remains uncertainty about the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on mental health. This umbrella review provides a comprehensive overview of the association between the pandemic and common mental disorders. We qualitatively summarized evidence from reviews with meta-analyses of individual study-data in the general population, healthcare workers, and specific at-risk populations. METHODS AND FINDINGS A systematic search was carried out in 5 databases for peer-reviewed systematic reviews with meta-analyses of prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms during the pandemic published between December 31, 2019 until August 12, 2022. We identified 123 reviews of which 7 provided standardized mean differences (SMDs) either from longitudinal pre- to during pandemic study-data or from cross-sectional study-data compared to matched pre-pandemic data. Methodological quality rated with the Assessment of Multiple Systematic Reviews checklist scores (AMSTAR 2) instrument was generally low to moderate. Small but significant increases of depression, anxiety, and/or general mental health symptoms were reported in the general population, in people with preexisting physical health conditions, and in children (3 reviews; SMDs ranged from 0.11 to 0.28). Mental health and depression symptoms significantly increased during periods of social restrictions (1 review; SMDs of 0.41 and 0.83, respectively) but anxiety symptoms did not (SMD: 0.26). Increases of depression symptoms were generally larger and longer-lasting during the pandemic (3 reviews; SMDs depression ranged from 0.16 to 0.23) than those of anxiety (2 reviews: SMDs 0.12 and 0.18). Females showed a significantly larger increase in anxiety symptoms than males (1 review: SMD 0.15). In healthcare workers, people with preexisting mental disorders, any patient group, children and adolescents, and in students, no significant differences from pre- to during pandemic were found (2 reviews; SMD's ranging from -0.16 to 0.48). In 116 reviews pooled cross-sectional prevalence rates of depression, anxiety, and PTSD symptoms ranged from 9% to 48% across populations. Although heterogeneity between studies was high and largely unexplained, assessment tools and cut-offs used, age, sex or gender, and COVID-19 exposure factors were found to be moderators in some reviews. The major limitations are the inability to quantify and explain the high heterogeneity across reviews included and the shortage of within-person data from multiple longitudinal studies. CONCLUSIONS A small but consistent deterioration of mental health and particularly depression during early pandemic and during social restrictions has been found in the general population and in people with chronic somatic disorders. Also, associations between mental health and the pandemic were stronger in females and younger age groups than in others. Explanatory individual-level, COVID-19 exposure, and time-course factors were scarce and showed inconsistencies across reviews. For policy and research, repeated assessments of mental health in population panels including vulnerable individuals are recommended to respond to current and future health crises.
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Affiliation(s)
- Anke B. Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
| | - Susanne Y. Young
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
- South African PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autonoma de Madrid, WHO Collaborating Center for Research and Training in Mental Health Services at the Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Bertolini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Cabello
- Department of Psychiatry, Universidad Autonoma de Madrid, WHO Collaborating Center for Research and Training in Mental Health Services at the Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Camilla Cadorin
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Naomi Downes
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe de Recherche en Epidémiologie Sociale, Paris, France
| | - Daniele Franzoi
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
| | - Michael Gasior
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
| | - Brandon Gray
- World Health Organization, Department of Mental Health and Substance Use, Geneva, Switzerland
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe de Recherche en Epidémiologie Sociale, Paris, France
| | - Mark van Ommeren
- World Health Organization, Department of Mental Health and Substance Use, Geneva, Switzerland
| | - Christina Palantza
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Judith van der Waerden
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe de Recherche en Epidémiologie Sociale, Paris, France
| | - Siyuan Wang
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
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Bertolini F, Witteveen AB, Young S, Cuijpers P, Ayuso-Mateos JL, Barbui C, Cabello M, Cadorin C, Downes N, Franzoi D, Gasior ME, Gray B, John A, Melchior M, van Ommeren M, Palantza C, Purgato M, Van der Waerden J, Wang S, Sijbrandij M. Risk of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 mortality in people with pre-existing mental disorders: an umbrella review. BMC Psychiatry 2023; 23:181. [PMID: 36941591 PMCID: PMC10026202 DOI: 10.1186/s12888-023-04641-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/28/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has posed a serious health risk, especially in vulnerable populations. Even before the pandemic, people with mental disorders had worse physical health outcomes compared to the general population. This umbrella review investigated whether having a pre-pandemic mental disorder was associated with worse physical health outcomes due to the COVID-19 pandemic. METHODS Following a pre-registered protocol available on the Open Science Framework platform, we searched Ovid MEDLINE All, Embase (Ovid), PsycINFO (Ovid), CINAHL, and Web of Science up to the 6th of October 2021 for systematic reviews on the impact of COVID-19 on people with pre-existing mental disorders. The following outcomes were considered: risk of contracting the SARS-CoV-2 infection, risk of severe illness, COVID-19 related mortality risk, risk of long-term physical symptoms after COVID-19. For meta-analyses, we considered adjusted odds ratio (OR) as effect size measure. Screening, data extraction and quality assessment with the AMSTAR 2 tool have been done in parallel and duplicate. RESULTS We included five meta-analyses and four narrative reviews. The meta-analyses reported that people with any mental disorder had an increased risk of SARS-CoV-2 infection (OR: 1.71, 95% CI 1.09-2.69), severe illness course (OR from 1.32 to 1.77, 95%CI between 1.19-1.46 and 1.29-2.42, respectively) and COVID-19 related mortality (OR from 1.38 to 1.52, 95%CI between 1.15-1.65 and 1.20-1.93, respectively) as compared to the general population. People with anxiety disorders had an increased risk of SAR-CoV-2 infection, but not increased mortality. People with mood and schizophrenia spectrum disorders had an increased COVID-19 related mortality but without evidence of increased risk of severe COVID-19 illness. Narrative reviews were consistent with findings from the meta-analyses. DISCUSSION AND CONCLUSIONS As compared to the general population, there is strong evidence showing that people with pre-existing mental disorders suffered from worse physical health outcomes due to the COVID-19 pandemic and may therefore be considered a risk group similar to people with underlying physical conditions. Factors likely involved include living accommodations with barriers to social distancing, cardiovascular comorbidities, psychotropic medications and difficulties in accessing high-intensity medical care.
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Affiliation(s)
- Federico Bertolini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Anke B Witteveen
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Susanne Young
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
- International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Jose Luis Ayuso-Mateos
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - María Cabello
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Camilla Cadorin
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Naomi Downes
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Social Epidemiology Research Team (ERES), Paris, F75012, France
| | - Daniele Franzoi
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Michael Elizabeth Gasior
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Brandon Gray
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Ann John
- Population Psychiatry, Suicide and Informatics, Medical School, Swansea University, Swansea, UK
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Social Epidemiology Research Team (ERES), Paris, F75012, France
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Christina Palantza
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Judith Van der Waerden
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Social Epidemiology Research Team (ERES), Paris, F75012, France
| | - Siyuan Wang
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Marit Sijbrandij
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
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Purgato M, Turrini G, Tedeschi F, Serra R, Tarsitani L, Compri B, Muriago G, Cadorin C, Ostuzzi G, Nicaise P, Lorant V, Sijbrandij M, Witteveen AB, Ayuso-Mateos JL, Mediavilla R, Haro JM, Felez-Nobrega M, Figueiredo N, Pollice G, McDaid D, Park AL, Kalisch R, Petri-Romão P, Underhill J, Bryant RA, Nosè M, Barbui C. Effectiveness of a stepped-care programme of WHO psychological interventions in migrant populations resettled in Italy: Study protocol for the RESPOND randomized controlled trial. Front Public Health 2023; 11:1100546. [PMID: 36761135 PMCID: PMC9905848 DOI: 10.3389/fpubh.2023.1100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction Migrant populations, including workers, undocumented migrants, asylum seekers, refugees, internationally displaced persons, and other populations on the move, are exposed to a variety of stressors and potentially traumatic events before, during, and after the migration process. In recent years, the COVID-19 pandemic has represented an additional stressor, especially for migrants on the move. As a consequence, migration may increase vulnerability of individuals toward a worsening of subjective wellbeing, quality of life, and mental health, which, in turn, may increase the risk of developing mental health conditions. Against this background, we designed a stepped-care programme consisting of two scalable psychological interventions developed by the World Health Organization and locally adapted for migrant populations. The effectiveness and cost-effectiveness of this stepped-care programme will be assessed in terms of mental health outcomes, resilience, wellbeing, and costs to healthcare systems. Methods and analysis We present the study protocol for a pragmatic randomized study with a parallel-group design that will enroll participants with a migrant background and elevated level of psychological distress. Participants will be randomized to care as usual only or to care a usual plus a guided self-help stress management guide (Doing What Matters in Times of Stress, DWM) and a five-session cognitive behavioral intervention (Problem Management Plus, PM+). Participants will self-report all measures at baseline before random allocation, 2 weeks after DWM delivery, 1 week after PM+ delivery and 2 months after PM+ delivery. All participants will receive a single-session of a support intervention, namely Psychological First Aid. We will include 212 participants. An intention-to-treat analysis using linear mixed models will be conducted to explore the programme's effect on anxiety and depression symptoms, as measured by the Patient Health Questionnaire-Anxiety and Depression Scale summary score 2 months after PM+ delivery. Secondary outcomes include post-traumatic stress disorder symptoms, resilience, quality of life, resource utilization, cost, and cost-effectiveness. Discussion This study is the first randomized controlled trial that combines two World Health Organization psychological interventions tailored for migrant populations with an elevated level of psychological distress. The present study will make available DWM/PM+ packages adapted for remote delivery following a task-shifting approach, and will generate evidence to inform policy responses based on a more efficient use of resources for improving resilience, wellbeing and mental health. Clinical trial registration ClinicalTrials.gov, identifier: NCT04993534.
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Affiliation(s)
- Marianna Purgato
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Giulia Turrini
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Federico Tedeschi
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Riccardo Serra
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Beatrice Compri
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Giulia Muriago
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Camilla Cadorin
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Giovanni Ostuzzi
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Pablo Nicaise
- Institute of Health and Society (IRSS) - UCLouvain, Brussels, Belgium
| | - Vincent Lorant
- Institute of Health and Society (IRSS) - UCLouvain, Brussels, Belgium
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, Netherlands
| | - Anke B. Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, Netherlands
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, La Princesa University Hospital, Instituto de Investigación Sanitaria La Princesa (IIS-Princesa), Madrid, Spain
| | - Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Mireia Felez-Nobrega
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Natasha Figueiredo
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, ERES, Paris, France
| | - Giulia Pollice
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, ERES, Paris, France
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Raffael Kalisch
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
- Leibniz Institute for Resilience Research, Mainz, Germany
| | | | | | - Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Michela Nosè
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
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Henrichs J, Witteveen AB. Commentary: Promoting positive mental health during pregnancy-reflections on Lähdepuro et al. (2022). J Child Psychol Psychiatry 2022; 64:817-819. [PMID: 36411741 DOI: 10.1111/jcpp.13727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/23/2022]
Abstract
Lähdepuro et al. performed a sound large-scale prospective pregnancy cohort study showing an association between positive maternal prenatal mental health and a reduced risk of developing clinically diagnosed childhood mental and behavioral disorders. Beneficial effects were also observed among the offspring of mothers experiencing mental health problems before and during pregnancy. The pathbreaking findings of Lähdepuro et al. set the stage for future research to shed more light on the so far almost unknown (neuro)biological mechanisms underlying the link between positive maternal prenatal mental health and child outcomes. More knowledge is needed about prenatal psychological and social factors enacting the potential of positive mental health as a resilience source buffering against maternal prenatal mental health problems and by this protecting subsequent child development. This also calls for further development, optimization, and evaluation of positive mental health-enhancing interventions during pregnancy, especially for future mothers having mental health problems.
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Affiliation(s)
- Jens Henrichs
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands.,Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, The Netherlands.,Amsterdam Public Health, Mental Health, Amsterdam, The Netherlands.,Department of General Practice & Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anke B Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, The Netherlands
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11
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Mediavilla R, McGreevy KR, Felez-Nobrega M, Monistrol-Mula A, Bravo-Ortiz MF, Bayón C, Rodríguez-Vega B, Nicaise P, Delaire A, Sijbrandij M, Witteveen AB, Purgato M, Barbui C, Tedeschi F, Melchior M, van der Waerden J, McDaid D, Park AL, Kalisch R, Petri-Romão P, Underhill J, Bryant RA, Haro JM, Ayuso-Mateos JL. Effectiveness of a stepped-care programme of internet-based psychological interventions for healthcare workers with psychological distress: Study protocol for the RESPOND healthcare workers randomised controlled trial. Digit Health 2022; 8:20552076221129084. [PMID: 36211795 PMCID: PMC9537484 DOI: 10.1177/20552076221129084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/11/2022] [Indexed: 11/05/2022] Open
Abstract
Background and aims The coronavirus disease 2019 pandemic has challenged health services worldwide, with a worsening of healthcare workers' mental health within initial pandemic hotspots. In early 2022, the Omicron variant is spreading rapidly around the world. This study explores the effectiveness and cost-effectiveness of a stepped-care programme of scalable, internet-based psychological interventions for distressed health workers on self-reported anxiety and depression symptoms. Methods We present the study protocol for a multicentre (two sites), parallel-group (1:1 allocation ratio), analyst-blinded, superiority, randomised controlled trial. Healthcare workers with psychological distress will be allocated either to care as usual only or to care as usual plus a stepped-care programme that includes two scalable psychological interventions developed by the World Health Organization: A guided self-help stress management guide (Doing What Matters in Times of Stress) and a five-session cognitive behavioural intervention (Problem Management Plus). All participants will receive a single-session emotional support intervention, namely psychological first aid. We will include 212 participants. An intention-to-treat analysis using linear mixed models will be conducted to explore the programme's effect on anxiety and depression symptoms, as measured by the Patient Health Questionnaire - Anxiety and Depression Scale summary score at 21 weeks from baseline. Secondary outcomes include post-traumatic stress disorder symptoms, resilience, quality of life, cost impact and cost-effectiveness. Conclusions This study is the first randomised trial that combines two World Health Organization psychological interventions tailored for health workers into one stepped-care programme. Results will inform occupational and mental health prevention, treatment, and recovery strategies. Registration details ClinicalTrials.gov Identifier: NCT04980326.
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Affiliation(s)
- Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain
| | - Kerry R McGreevy
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain,Kerry R. McGreevy, Department of
Psychiatry, Universidad Autónoma de Madrid, Arzobispo Morcillo, 4, 28029,
Madrid, Spain.
| | - Mireia Felez-Nobrega
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain,Research and Development Unit, Parc Sanitari Sant Joan de
Déu, Barcelona, Spain
| | - Anna Monistrol-Mula
- Research and Development Unit, Parc Sanitari Sant Joan de
Déu, Barcelona, Spain
| | - María-Fe Bravo-Ortiz
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain,Department of Psychiatry, Clinical Psychology and Mental Health,
Hospital Univeristario La Paz, Madrid, Spain,Instituto de Investigación del Hospital
Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Carmen Bayón
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain,Department of Psychiatry, Clinical Psychology and Mental Health,
Hospital Univeristario La Paz, Madrid, Spain,Instituto de Investigación del Hospital
Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Beatriz Rodríguez-Vega
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain,Department of Psychiatry, Clinical Psychology and Mental Health,
Hospital Univeristario La Paz, Madrid, Spain,Instituto de Investigación del Hospital
Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Pablo Nicaise
- Institute of Health & Society (IRSS), Université Catholique de
Louvain, Brussels, Belgium
| | - Audrey Delaire
- Institute of Health & Society (IRSS), Université Catholique de
Louvain, Brussels, Belgium
| | - Marit Sijbrandij
- Clinical, Neuro- and Developmental Psychology, WHO Collaborating
Centre for Research and Dissemination of Psychological Interventions, Amsterdam
Public Health Institute, Vrije Universiteit
Amsterdam, Amsterdam, the Netherlands
| | - Anke B. Witteveen
- Clinical, Neuro- and Developmental Psychology, WHO Collaborating
Centre for Research and Dissemination of Psychological Interventions, Amsterdam
Public Health Institute, Vrije Universiteit
Amsterdam, Amsterdam, the Netherlands
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health
and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement
Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health
and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement
Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health
and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement
Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé
Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Faculté de
Médecine St Antoine, , Paris, France
| | - Judith van der Waerden
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé
Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Faculté de
Médecine St Antoine, , Paris, France
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political
Science, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political
Science, London, UK
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research
(LIR), Mainz, Germany,Neuroimaging Center (NIC), Focus Program Translational Neuroscience
(FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | | | | | - Richard A. Bryant
- School of Psychology, University of New
South Wales, Sydney, NSW, Australia
| | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain,Research and Development Unit, Parc Sanitari Sant Joan de
Déu, Barcelona, Spain
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain,Department of Psychiatry, La Princesa University
Hospital, Instituto de Investigación Sanitaria Princesa (IIS-Princesa),
Madrid, Spain
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Abstract
BACKGROUND Antepartum depressive symptoms (ADS) are highly prevalent and may affect the mother and child. Cognitive-behavioural therapy and interpersonal therapy are effective psychological interventions for depression. However, low adherence and high attrition rates in studies of prevention and treatment of antepartum depression suggest that these approaches might not be entirely suitable for women with mild/moderate ADS. Considering the protective association between resilience and ADS, women with ADS might benefit more from interventions focusing on promotion of mental well-being and resilience. AIMS We aimed to provide an overview of studies evaluating the effectiveness of antepartum resilience-enhancing interventions targeting the improvement of ante- and postpartum depressive symptoms. We also investigated whether these interventions improve resilience and resilience factors in the peripartum period. METHOD We conducted a systematic review, using PRISMA guidelines. Studies were eligible for inclusion when they utilised a randomised controlled trial or quasi-experimental design, studied pregnant women with ADS, and implemented psychological interventions that (a) aimed to reduce maternal ADS and/or prevent peripartum major depression, and (b) addressed one or more psychological resilience factors. RESULTS Five of the six included cognitive-behavioural therapy interventions and all four mindfulness-based interventions were effective in reducing peripartum depressive symptoms and/or the incidence of depression. However, the methodological quality of most of the included studies was low to moderate. Only three studies assessed change in resilience factors. CONCLUSIONS Resilience-enhancing interventions might be beneficial for mental well-being of pregnant women with ADS, although more rigorously designed intervention studies are needed.
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Affiliation(s)
- Annika L Walker
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Anke B Witteveen
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - René H J Otten
- Medical Library, Vrije Universiteit Amsterdam, The Netherlands
| | - Corine J Verhoeven
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Jens Henrichs
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
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13
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de Graaff AM, Cuijpers P, Acarturk C, Akhtar A, Alkneme MS, Aoun M, Awwad M, Bawaneh AY, Brown FL, Bryant R, Burchert S, Carswell K, Drogendijk A, Engels M, Fuhr DC, Hansen P, van 't Hof E, Giardinelli L, Hemmo M, Hessling JM, Ilkkursun Z, Jordans MJD, Kiselev N, Knaevelsrud C, Kurt G, Martinmäki S, McDaid D, Morina N, Naser H, Park AL, Pfaltz MC, Roberts B, Schick M, Schnyder U, Spaaij J, Steen F, Taha K, Uygun E, Ventevogel P, Whitney C, Witteveen AB, Sijbrandij M. Scalable psychological interventions for Syrian refugees in Europe and the Middle East: STRENGTHS study protocol for a prospective individual participant data meta-analysis. BMJ Open 2022; 12:e058101. [PMID: 35443961 PMCID: PMC9021771 DOI: 10.1136/bmjopen-2021-058101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The World Health Organization's (WHO) scalable psychological interventions, such as Problem Management Plus (PM+) and Step-by-Step (SbS) are designed to be cost-effective non-specialist delivered interventions to reduce symptoms of common mental disorders, such as anxiety, depression and post-traumatic stress disorder (PTSD). The STRENGTHS consortium aims to evaluate the effectiveness, cost-effectiveness and implementation of the individual format of PM+ and its group version (gPM+), as well as of the digital SbS intervention among Syrian refugees in seven countries in Europe and the Middle East. This is a study protocol for a prospective individual participant data (IPD) meta-analysis to evaluate (1) overall effectiveness and cost-effectiveness and (2) treatment moderators of PM+, gPM+ and SbS with Syrian refugees. METHODS AND ANALYSIS Five pilot randomised controlled trials (RCTs) and seven fully powered RCTs conducted within STRENGTHS will be combined into one IPD meta-analytic dataset. The RCTs include Syrian refugees of 18 years and above with elevated psychological distress (Kessler Psychological Distress Scale (K10>15)) and impaired daily functioning (WHO Disability Assessment Schedule 2.0 (WHODAS 2.0>16)). Participants are randomised into the intervention or care as usual control group, and complete follow-up assessments at 1-week, 3-month and 12-month follow-up. Primary outcomes are symptoms of depression and anxiety (25-item Hopkins Symptom Checklist). Secondary outcomes include daily functioning (WHODAS 2.0), PTSD symptoms (PTSD Checklist for DSM-5) and self-identified problems (PSYCHLOPS). We will conduct a one-stage IPD meta-analysis using linear mixed models. Quality of evidence will be assessed using the GRADE approach, and the economic evaluation approach will be assessed using the CHEC-list. ETHICS AND DISSEMINATION Local ethical approval has been obtained for each RCT. This IPD meta-analysis does not require ethical approval. The results of this study will be published in international peer-reviewed journals.
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Affiliation(s)
- Anne M de Graaff
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ceren Acarturk
- Department of Psychology, Koç University, Istanbul, Turkey
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Mhd Salem Alkneme
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universitat Berlin, Berlin, Germany
| | - May Aoun
- Research and Development Department, War Child, Amsterdam, The Netherlands
| | - Manar Awwad
- Technical Unit, International Medical Corps, London, UK
| | | | - Felicity L Brown
- Research and Development Department, War Child, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Sebastian Burchert
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universitat Berlin, Berlin, Germany
| | - Kenneth Carswell
- Department of Mental Health and Substance Abuse, World Health Organization, Geneve, Switzerland
| | | | - Michelle Engels
- International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Daniela C Fuhr
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Pernille Hansen
- International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Edith van 't Hof
- Department of Mental Health and Substance Abuse, World Health Organization, Geneve, Switzerland
| | | | - Mahmoud Hemmo
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Jonas M Hessling
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universitat Berlin, Berlin, Germany
| | | | - Mark J D Jordans
- Research and Development Department, War Child, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Nikolai Kiselev
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Christine Knaevelsrud
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universitat Berlin, Berlin, Germany
| | - Gülsah Kurt
- Department of Psychology, Koç University, Istanbul, Turkey
| | - Saara Martinmäki
- ARQ International, ARQ National Psychotrauma Centre, Amsterdam, The Netherlands
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Hadeel Naser
- Technical Unit, International Medical Corps, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Department of Psychology and Social Work, Mid Sweden University, Sundsvall, Sweden
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthis Schick
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Julia Spaaij
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Frederik Steen
- Research and Development Department, War Child, Amsterdam, The Netherlands
| | - Karine Taha
- Research and Development Department, War Child, Amsterdam, The Netherlands
| | - Ersin Uygun
- Trauma and Disaster Mental Health Master Programme, Istanbul Bilgi University, Istanbul, İstanbul, Turkey
| | - Peter Ventevogel
- Public Health, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | | | - Anke B Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Westerneng M, de Jonge A, van Baar AL, Witteveen AB, Jellema P, Paarlberg KM, Rijnders M, van der Horst HE. The effect of offering a third-trimester routine ultrasound on pregnancy-specific anxiety and mother-to-infant bonding in low-risk women: A pragmatic cluster-randomized controlled trial. Birth 2022; 49:61-70. [PMID: 34288070 PMCID: PMC9290476 DOI: 10.1111/birt.12573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Third-trimester routine ultrasounds are increasingly offered to monitor fetal growth. In addition to limited evidence for its clinical effectiveness, little is known about its importance for pregnancy-specific anxiety and mother-to-infant bonding. METHODS 1275 low-risk women participated in a Dutch nationwide pragmatic cluster-randomized trial and answered questionnaires on pregnancy-specific anxiety (PRAQ-R) and prenatal mother-to-infant bonding (MAAS) before and after a third-trimester routine ultrasound was offered to the intervention group. Linear mixed model regression analyses were performed to examine the effect of offering a third-trimester routine ultrasound on pregnancy-specific anxiety and mother-to-infant bonding. In addition, we examined whether the effect depended on maternal background characteristics and level of satisfaction with the ultrasound procedure. RESULTS We found no effect of offering a third-trimester routine ultrasound on pregnancy-specific anxiety and mother-to-infant bonding. However, interaction analyses showed that women with high levels of depressive symptoms at baseline and women who were very satisfied with the ultrasound procedure benefited somewhat more from offering a third-trimester routine ultrasound in terms of mother-to-infant bonding compared with women with low or no depressive symptoms, or less satisfied women. CONCLUSIONS The relationship between offering a third-trimester routine ultrasound with pregnancy-specific anxiety and mother-to-infant bonding is limited. A beneficial effect only applies to some subgroups of women. This implies that, in terms of psychological outcomes, there are no counterarguments to implementing a third-trimester routine ultrasound. Strong evidence for offering all pregnant women a third-trimester routine ultrasound for psychological reasons, however, is lacking.
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Affiliation(s)
- Myrte Westerneng
- Midwifery ScienceAVAGAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ank de Jonge
- Midwifery ScienceAVAGAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | - Anke B. Witteveen
- Midwifery ScienceAVAGAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Petra Jellema
- Midwifery ScienceAVAGAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | | | - Henriëtte E. van der Horst
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
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15
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Wright SL, Karyotaki E, Bisson JI, Cuijpers P, Papola D, Witteveen AB, Seedat S, Sijbrandij M. Protocol for individual participant data meta-analysis of interventions for post-traumatic stress. BMJ Open 2022; 12:e054830. [PMID: 35168977 PMCID: PMC8852733 DOI: 10.1136/bmjopen-2021-054830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Several evidence-based treatments are effective for post-traumatic stress disorder (PTSD), yet a substantial proportion of patients do not respond or dropout of treatment. We describe the protocol for a systematic review and individual participant data meta-analysis (IPD-MA) aimed at assessing the effectiveness and adverse effects of psychotherapy and pharmacotherapy interventions for treating PTSD. Additionally, we seek to examine moderators and predictors of treatment outcomes. METHOD AND ANALYSIS This IPD-MA includes randomised controlled trials comparing psychotherapy and pharmacotherapy interventions for PTSD. PubMed, Embase, PsycINFO, PTSDpubs and CENTRAL will be screened up till the 11th of January 2021. The target population is adults with above-threshold baseline PTSD symptoms on any standardised self-report measure. Trials will only be eligible if at least 70% of the study sample have been diagnosed with PTSD by means of a structured clinical interview. The primary outcomes of this IPD-MA are PTSD symptom severity, and response rate. Secondary outcomes include treatment dropout and adverse effects. Two independent reviewers will screen major bibliographic databases and past reviews. Authors will be contacted to contribute their participant-level datasets. Datasets will be merged into a master dataset. A one-stage IPD-MA will be conducted focusing on the effects of psychological and pharmacological interventions on PTSD symptom severity, response rate, treatment dropout and adverse effects. Subsequent analyses will focus on examining the effect of moderators and predictors of treatment outcomes. These will include sociodemographic, treatment-related, symptom-related, resilience, intervention, trauma and combat-related characteristics. By determining the individual factors that influence the effectiveness of specific PTSD treatments, we will gain insight into personalised treatment options for PTSD. ETHICS AND DISSEMINATION Specific ethics approval for an IPD-MA is not required as this study entails secondary analysis of existing anonymised data. The results of this study will be published in peer-reviewed scientific journals and presentations.
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Affiliation(s)
- Simonne Lesley Wright
- Department of Clinical, Neuro- and Developmental Psychology and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Davide Papola
- WHO Collaborating Centre for Research and Training In Mental Health and Service Evaluation, and Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Anke B Witteveen
- Department of Clinical, Neuro- and Developmental Psychology and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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16
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Walker AL, de Rooij SR, Dimitrova MV, Witteveen AB, Verhoeven CJ, de Jonge A, Vrijkotte TGM, Henrichs J. Psychosocial and peripartum determinants of postpartum depression: Findings from a prospective population-based cohort. The ABCD study. Compr Psychiatry 2021; 108:152239. [PMID: 33905988 DOI: 10.1016/j.comppsych.2021.152239] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/07/2021] [Accepted: 03/13/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Postpartum depression is prevalent and concerns a serious health problem for women and their families. The current large-scale birth cohort study investigated: (1) the associations of various potential determinants of postpartum depression using a multidimensional approach, and (2) the individual contribution of obstetric and perinatal determinants and pregnancy-specific anxiety to the risk of postpartum depression. METHODS This study was based on a large-scale birth cohort study in Amsterdam, the Netherlands (ABCD-study). In 5109 women depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (cut-off ≥16 indicating high risk of postpartum depression). Determinants were assessed using self-report or perinatal registries. RESULTS In the final multivariable model, other-Western and non-Western ethnic background, increased antepartum depressive symptoms, increased antepartum anxiety, increased pregnancy-specific anxiety, being unemployed, poor sleep quality, unwanted pregnancy, abuse, multiparity, and congenital abnormality were all independently related to an increased risk of postpartum depression. The strongest risk factors for postpartum depression were antepartum depressive symptoms (adjusted odds ratio (AOR) = 3.86, 95% confidence interval (CI) 3.02-4.92), having a baby with a congenital abnormality (AOR = 2.33, 95% CI 1.46-3.73), and abuse (AOR = 1.95, 95% CI 1.02-3.73). The final model accounted for 24.5% of the variance. LIMITATIONS Our dataset did not provide information on social support or maternal and family history of depression. Next to these determinants, future research should include biological factors. CONCLUSIONS The determinants identified provide opportunities for the development of multidimensional early screening and early intervention strategies for women with an increased risk of postpartum depression.
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Affiliation(s)
- Annika L Walker
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG - Amsterdam Public Health, De Boelelaan 1117, Amsterdam, Netherlands.
| | - Susanne R de Rooij
- Amsterdam University Medical Center, University of Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam University Medical Center, University of Amsterdam, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Academic UMC, Meibergdreef 9, Amsterdam, Netherlands; Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
| | - Marta V Dimitrova
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG - Amsterdam Public Health, De Boelelaan 1117, Amsterdam, Netherlands
| | - Anke B Witteveen
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG - Amsterdam Public Health, De Boelelaan 1117, Amsterdam, Netherlands
| | - Corine J Verhoeven
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG - Amsterdam Public Health, De Boelelaan 1117, Amsterdam, Netherlands; Department of Obstetrics and Gynecology, Maxima Medical Centre, Veldhoven, Netherlands; Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Ank de Jonge
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG - Amsterdam Public Health, De Boelelaan 1117, Amsterdam, Netherlands
| | - Tanja G M Vrijkotte
- Amsterdam University Medical Center, University of Amsterdam, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Academic UMC, Meibergdreef 9, Amsterdam, Netherlands
| | - Jens Henrichs
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG - Amsterdam Public Health, De Boelelaan 1117, Amsterdam, Netherlands
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Witteveen AB, Henrichs J, Walker AL, Bohlmeijer ET, Burger H, Fontein-Kuipers Y, Schellevis FG, Stramrood CAI, Olff M, Verhoeven CJ, de Jonge A. Effectiveness of a guided ACT-based self-help resilience training for depressive symptoms during pregnancy: Study protocol of a randomized controlled trial embedded in a prospective cohort. BMC Pregnancy Childbirth 2020; 20:705. [PMID: 33213400 PMCID: PMC7676420 DOI: 10.1186/s12884-020-03395-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/04/2020] [Indexed: 01/30/2023] Open
Abstract
Background During pregnancy, about 10 to 20% of women experience depressive symptoms. Subclinical depression increases the risk of peripartum depression, maternal neuro-endocrine dysregulations, and adverse birth and infant outcomes. Current treatments often comprise face-to-face psychological or pharmacological treatments that may be too intensive for women with subclinical depression leading to drop-out and moderate effectiveness. Therefore, easily accessible, resilience enhancing and less stigmatizing interventions are needed to prevent the development of clinical depression. This paper describes the protocol of a prospective cohort study with an embedded randomized controlled trial (RCT) that aims to improve mental resilience in a sample of pregnant women through a self-help program based on the principles of Acceptance and Commitment Therapy (ACT). Maternal and offspring correlates of the trajectories of peripartum depressive symptoms will also be studied. Methods Pregnant women (≥ 18 years) receiving care in Dutch midwifery practices will participate in a prospective cohort study (n ~ 3500). Between 12 and 18 weeks of pregnancy, all women will be screened for depression with the Edinburgh Postnatal Depression Scale (EPDS). Women with an EPDS score ≥ 11 will be evaluated with a structured clinical interview. Participants with subclinical depression (n = 290) will be randomized to a 9-week guided self-help ACT-training or to care as usual (CAU). Primary outcomes (depressive symptoms and resilience) and secondary outcomes (e.g. anxiety and PTSD, bonding, infant development) will be collected via online questionnaires at four prospective assessments around 20 weeks and 30 weeks gestation and at 6 weeks and 4 months postpartum. Maternal hair cortisol concentrations will be assessed in a subsample of women with a range of depressive symptoms (n = 300). The intervention’s feasibility will be assessed through qualitative interviews in a subsample of participants (n = 20). Discussion This is the first study to assess the effectiveness of an easy to administer intervention strategy to prevent adverse mental health effects through enhancing resilience in pregnant women with antepartum depressive symptomatology. This longitudinal study will provide insights into trajectories of peripartum depressive symptoms in relation to resilience, maternal cortisol, psychological outcomes, and infant developmental milestones. Trial registration Netherlands Trial Register (NTR), NL7499. Registered 5 February 2019.
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Affiliation(s)
- Anke B Witteveen
- Department of Midwifery Science, AVAG/Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Jens Henrichs
- Department of Midwifery Science, AVAG/Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Annika L Walker
- Department of Midwifery Science, AVAG/Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Ernst T Bohlmeijer
- Department of Psychology, Health and Technology , University of Twente , Drienerlolaan 5, 7522 NB, Enschede, Netherlands
| | - Huibert Burger
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713GZ, Netherlands
| | - Yvonne Fontein-Kuipers
- Institute for Healthcare - School of Midwifery , Rotterdam University of Applied Sciences , Rochussenstraat 198, 3015 EK, Rotterdam, Netherlands
| | - Francois G Schellevis
- Department of General Practice , Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam Public Health Research Institute , Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands.,NIVEL Netherlands Institute for Health Services Research , Otterstraat 118, 3513 CR, Utrecht, Netherlands
| | - Claire A I Stramrood
- Department of Obstetrics and Gynaecology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, Netherlands
| | - Miranda Olff
- Department of Psychiatry UMC, location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.,ARQ National Psychotrauma Centre , Nienoord 5, 1112 XE, Diemen, Netherlands
| | - Corine J Verhoeven
- Department of Midwifery Science, AVAG/Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Department of Obstetrics and Gynecology Maxima Medical Centre , Veldhoven, Netherlands.,Division of Midwifery School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Ank de Jonge
- Department of Midwifery Science, AVAG/Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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18
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Witteveen AB, Henrichs J, Bellers M, van Oenen E, Verhoeven CJ, Vrijkotte TGM. Mediating role of C-reactive protein in associations between pre-pregnancy BMI and adverse maternal and neonatal outcomes: the ABCD-study cohort. J Matern Fetal Neonatal Med 2020; 35:2867-2875. [PMID: 32838637 DOI: 10.1080/14767058.2020.1807510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Increased body mass index (BMI) is associated with several adverse pregnancy outcomes, though the underlying mechanism of this association has not been fully elucidated. A mediating role of low-grade systemic inflammation in these associations is suspected but has been understudied. Our objective was to examine the effect of pre-pregnancy BMI (pBMI) on maternal and neonatal pregnancy outcomes and to explore potential mediation of these effects by C-reactive protein (CRP), a first trimester peripheral marker of inflammation. METHODS Data from the prospective community-based ABCD-study cohort (n = 3547) was used to assess associations between self-reported continuous and categorized pBMI and outcome measures gestational hypertension (GH) and preeclampsia (PE), preterm birth (PTB) and small for gestational age (SGA) based on national perinatal registration linkage data. High-sensitivity CRP concentrations determined in serum were used to explore potential mediation of these associations by inflammation. RESULTS Multivariable logistic regression analyses, adjusted for confounders, showed that pBMI was significantly related to gestational hypertensive disorders (odds ratio (OR) per standard deviation (SD) 1.66, 95% confidence interval (CI) 1.51-1.83) and PTB (OR 1.20, 95% CI 1.05-1.37). Dose-response relationships between categorical pBMI and gestational hypertensive disorders (overweight OR 2.37, 95% CI 1.85-3.03 and obese OR 4.45, 95% CI 2.93-6.72) and PTB (obese OR 2.12, 95% CI 1.16-3.87) were found as well. SGA was only significantly more prevalent in the underweight BMI category (OR 2.06, 95% CI 1.33-3.19). Mediation analyses revealed small but significant indirect effects of pBMI on overall PTB (0.037, bootstrapped 95% CI 0.005-0.065) and spontaneous PTB (0.038, bootstrapped 95% CI 0.002-0.069) through higher CRP. CRP was not a significant mediator of associations between BMI and gestational hypertensive disorders although larger mediation was found for GH than for PE. CONCLUSION Our findings provide additional evidence that high(er) pBMI increases the risk of adverse maternal and neonatal outcomes and that systemic inflammation mediates some of these risks. Further research in large cohorts including (morbidly) obese women is warranted to identify pathways that may be incorporated in future interventions to reduce the risk of adverse pregnancy outcomes due to maternal obesity.
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Affiliation(s)
- Anke B Witteveen
- Department of Midwifery Science and AVAG, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,AVAG Amsterdam Groningen Midwifery Academy, University of Applied Sciences Inholland, Amsterdam, The Netherlands
| | - Jens Henrichs
- Department of Midwifery Science and AVAG, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Mirthe Bellers
- AVAG Amsterdam Groningen Midwifery Academy, University of Applied Sciences Inholland, Amsterdam, The Netherlands
| | - Esmée van Oenen
- AVAG Amsterdam Groningen Midwifery Academy, University of Applied Sciences Inholland, Amsterdam, The Netherlands
| | - Corine J Verhoeven
- Department of Midwifery Science and AVAG, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Tanja G M Vrijkotte
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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19
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Walker AL, Peters PH, de Rooij SR, Henrichs J, Witteveen AB, Verhoeven CJM, Vrijkotte TGM, de Jonge A. The Long-Term Impact of Maternal Anxiety and Depression Postpartum and in Early Childhood on Child and Paternal Mental Health at 11-12 Years Follow-Up. Front Psychiatry 2020; 11:562237. [PMID: 33192681 PMCID: PMC7531027 DOI: 10.3389/fpsyt.2020.562237] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/18/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Postpartum maternal anxiety and depression can affect child development and family functioning. However, the long-term impact of postpartum maternal anxiety and depression on child and paternal mental health is understudied. The present large-scale prospective cohort study is one of the first to investigate whether maternal anxiety and depressive symptoms postpartum and at child age 5-6 years separately and synergistically increase paternal anxiety and depressive symptoms and child emotional problems in early adolescence at age 11-12 years. Secondly, we investigated whether concurrent paternal anxiety and depressive symptoms at child age 11-12 years moderated the association between maternal anxiety and depressive symptoms in the postpartum period and at child age 5-6 years with child emotional problems at age 11-12 years. METHODS This study is part of the Amsterdam Born Children and Development (ABCD) cohort study, the Netherlands (N = 2.298). Maternal postpartum anxiety and depressive symptoms were assessed using the State-Trait Anxiety Inventory (STAI) and the Center for Epidemiologic Studies Depression Scale (CES-D) at 13 weeks postpartum. Maternal anxiety and depressive symptoms at child age 5-6 years and parental anxiety and depressive symptoms at 11-12 years were assessed using the Depression Anxiety Stress Scale (DASS-21). Child emotional problems were reported by the child and a teacher using the Strengths and Difficulties Questionnaire (SDQ). Multivariable linear regression was conducted, adjusted for demographic, perinatal/obstetric confounders, and affective symptoms of the other family members at 11-12 years. RESULTS Neither maternal anxiety nor depressive symptoms were related to paternal depressive symptoms at child age 11-12 years, while maternal postpartum depressive symptoms, depressive symptoms at 5-6 years and maternal anxiety at 5-6 years were positively related to paternal anxiety at 11-12 years. However, effect sizes were small. Only maternal postpartum depression was positively but weakly associated with more child emotional problems at 11-12 years. Although paternal concurrent affective symptoms were positively related to more child emotional problems in early adolescence, they did not moderate the association between maternal symptoms and child emotional problems. CONCLUSIONS Our results indicate that fathers and children seem to be affected only to a small extent by maternal postpartum anxiety or depression.
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Affiliation(s)
- Annika L Walker
- Department of Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam, AVAG-Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Priya H Peters
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
| | - Susanne R de Rooij
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands.,Department of Clinical Epidemiology, Amsterdam UMC, University of Amsterdam, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jens Henrichs
- Department of Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam, AVAG-Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Anke B Witteveen
- Department of Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam, AVAG-Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Corine J M Verhoeven
- Department of Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam, AVAG-Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Tanja G M Vrijkotte
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam, AVAG-Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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20
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Tichelman E, Westerneng M, Witteveen AB, van Baar AL, van der Horst HE, de Jonge A, Berger MY, Schellevis FG, Burger H, Peters LL. Correlates of prenatal and postnatal mother-to-infant bonding quality: A systematic review. PLoS One 2019; 14:e0222998. [PMID: 31550274 PMCID: PMC6759162 DOI: 10.1371/journal.pone.0222998] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 09/11/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Mother-to-infant bonding is defined as the emotional tie experienced by a mother towards her child, which is considered to be important for the socio-emotional development of the child. Numerous studies on the correlates of both prenatal and postnatal mother-to-infant bonding quality have been published over the last decades. An up-to-date systematic review of these correlates is lacking, however. OBJECTIVE To systematically review correlates of prenatal and postnatal mother-to-infant bonding quality in the general population, in order to enable targeted interventions. METHODS MEDLINE, Embase, CINAHL, and PsychINFO were searched through May 2018. Reference checks were performed. Case-control, cross-sectional or longitudinal cohort studies written in English, German, Swedish, Spanish, Norwegian, French or Dutch defining mother-to-infant bonding quality as stipulated in the protocol (PROSPERO CRD42016040183) were included. Two investigators independently reviewed abstracts, full-text articles and extracted data. Methodological quality was assessed using the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-sectional studies and was rated accordingly as poor, fair or good. Clinical and methodological heterogeneity were examined. MAIN RESULTS 131 studies were included. Quality was fair for 20 studies, and poor for 111 studies. Among 123 correlates identified, 3 were consistently associated with mother-to-infant bonding quality: 1) duration of gestation at assessment was positively associated with prenatal bonding quality, 2) depressive symptoms were negatively associated with postnatal mother-to-infant bonding quality, and 3) mother-to-infant bonding quality earlier in pregnancy or postpartum was positively associated with mother-to-infant bonding quality later in time. CONCLUSION Our review suggests that professionals involved in maternal health care should consider monitoring mother-to-infant bonding already during pregnancy. Future research should evaluate whether interventions aimed at depressive symptoms help to promote mother-to-infant bonding quality. More high-quality research on correlates for which inconsistent results were found is needed.
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Affiliation(s)
- Elke Tichelman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- University of Groningen, University Medical Centre Groningen, Department of General Practice & Elderly Care Medicine, Groningen, the Netherlands
| | - Myrte Westerneng
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Anke B. Witteveen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | | | - Henriëtte E. van der Horst
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Ank de Jonge
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Marjolein Y. Berger
- University of Groningen, University Medical Centre Groningen, Department of General Practice & Elderly Care Medicine, Groningen, the Netherlands
| | - François G. Schellevis
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Huibert Burger
- University of Groningen, University Medical Centre Groningen, Department of General Practice & Elderly Care Medicine, Groningen, the Netherlands
| | - Lilian L. Peters
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- University of Groningen, University Medical Centre Groningen, Department of General Practice & Elderly Care Medicine, Groningen, the Netherlands
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21
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Westerneng M, Diepeveen M, Witteveen AB, Westerman MJ, van der Horst HE, van Baar AL, de Jonge A. Experiences of pregnant women with a third trimester routine ultrasound - a qualitative study. BMC Pregnancy Childbirth 2019; 19:319. [PMID: 31477046 PMCID: PMC6720093 DOI: 10.1186/s12884-019-2470-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 08/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background Studies showed that pregnant women generally value routine ultrasounds in the first two trimesters because these provide reassurance and a chance to see their unborn baby. This, in turn, might help to decrease maternal anxiety levels and increase the bond with the baby. However, it is unclear whether pregnant women hold the same positive views about a third trimester routine ultrasound, which is increasingly being used in the Netherlands as a screening tool to monitor fetal growth. The aim of this study was to explore pregnant women’s experiences with a third trimester routine ultrasound. Methods We held semi-structured interviews with fifteen low-risk pregnant women who received a third trimester routine ultrasound in the context of the Dutch IUGR RIsk Selection (IRIS) study. The IRIS study is a nationwide cluster randomized controlled trial carried out among more than 13,000 women to examine the effectiveness of a third trimester routine ultrasound to monitor fetal growth. For the interviews, participants were purposively selected based on parity, age, ethnicity, and educational level. We performed thematic content analysis using MAXQDA. Results Most pregnant women appreciated a third trimester routine ultrasound because it provided them confirmation that their baby was fine and an extra opportunity to see their baby. At the same time they expressed that they already felt confident about the health of their baby, and did not feel that their bond with their baby had increased after the third trimester ultrasound. Women also reported that they were getting used to routine ultrasounds throughout their pregnancy, and that this increased their need for another one. Conclusions Pregnant women seem to appreciate a third trimester routine ultrasound, but it does not seem to reduce anxiety or to improve bonding with their baby. Women’s appreciation of a third trimester routine ultrasound might arise from getting used to routine ultrasounds throughout pregnancy. We recommend to examine the psychological impact of third trimester routine ultrasounds in future studies. Results should be taken into consideration when balancing the gains, which are as yet not clear, of introducing a third trimester routine ultrasound against unwanted side effects and costs.
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Affiliation(s)
- Myrte Westerneng
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands.
| | - Mariëlle Diepeveen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Humanities and the Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Anke B Witteveen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Marjan J Westerman
- Department of Methodology and Statistics, Institute of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Henriette E van der Horst
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | | | - Ank de Jonge
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
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Dückers MLA, Witteveen AB, Bisson JI, Olff M. The Association Between Disaster Vulnerability and Post-disaster Psychosocial Service Delivery Across Europe. Adm Policy Ment Health 2018. [PMID: 26198628 DOI: 10.1007/s10488-015-0671-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study confirms that the developmental stage of post-disaster psychosocial support planning and delivery systems in Europe is associated with countries' level of disaster vulnerability. Lower vulnerability is accompanied by more evolved planning and delivery systems. Countries in north, west and central regions have more developed planning and delivery systems and lower vulnerability levels than those in the south, southeast and east. The highest proportion of variance in vulnerability is located at the regional level, most of the variance in planning and delivery systems is at the individual level. Possible implications and chances for the optimization of psychosocial services are discussed.
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Affiliation(s)
- Michel L A Dückers
- Impact - National Knowledge and Advice Centre for Psychosocial Care Concerning Critical Incidents, Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE, Diemen, The Netherlands.
| | - Anke B Witteveen
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jonathan I Bisson
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
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Klomp T, Witteveen AB, de Jonge A, Hutton EK, Lagro-Janssen ALM. A qualitative interview study into experiences of management of labor pain among women in midwife-led care in the Netherlands. J Psychosom Obstet Gynaecol 2017; 38:94-102. [PMID: 27778527 DOI: 10.1080/0167482x.2016.1244522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Many pregnant women are concerned about the pain they will experience in labor and how to deal with this. This study's objective was to explore women's postpartum perception and view of how they dealt with labor pain. METHODS Semistructured postpartum interviews were analyzed using the constant comparison method. Using purposive sampling, we selected 17 women from five midwifery practices across the Netherlands, from August 2009 to September 2010. RESULTS Women reported that control over decision making during labor (about dealing with pain) helped them to deal with labor pain, as did continuous midwife support at home and in hospital, and effective childbirth preparation. Some of these women implicitly or explicitly indicated that midwives should know which method of pain management they need during labor and arrange this in good time. DISCUSSION It may be difficult for midwives to discriminate between women who need continuous support through labor without pain medication and those who genuinely desire pain medication at a certain point in labor, and who will be dissatisfied postpartum if this need is unrecognized and unfulfilled.
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Affiliation(s)
- Trudy Klomp
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands
| | - Anke B Witteveen
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands
| | - Ank de Jonge
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands
| | - Eileen K Hutton
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands.,c Midwifery Education Program , McMaster University Hamilton , Ontario , Canada
| | - Antoine L M Lagro-Janssen
- b Department of Primary Care and Community Care, Women's Studies Medicine , Radboud University Medical Center Nijmegen , the Netherlands
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24
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Witteveen AB, De Cock P, Huizink AC, De Jonge A, Klomp T, Westerneng M, Geerts CC. Pregnancy related anxiety and general anxious or depressed mood and the choice for birth setting: a secondary data-analysis of the DELIVER study. BMC Pregnancy Childbirth 2016; 16:363. [PMID: 27871257 PMCID: PMC5118894 DOI: 10.1186/s12884-016-1158-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background In several developed countries women with a low risk of complications during pregnancy and childbirth can make choices regarding place of birth. In the Netherlands, these women receive midwife-led care and can choose between a home or hospital birth. The declining rate of midwife-led home births alongside the recent debate on safety of home births in the Netherlands, however, suggest an association of choice of birth place with psychological factors related to safety and risk perception. In this study associations of pregnancy related anxiety and general anxious or depressed mood with (changes in) planned place of birth were explored in low risk women in midwife-led care until the start of labour. Methods Data (n = 2854 low risk women in midwife-led care at the onset of labour) were selected from the prospective multicenter DELIVER study. Women completed the Pregnancy Related Anxiety Questionnaire-Revised (PRAQ-R) to assess pregnancy related anxiety and the EuroQol-6D (EQ-6D) for an anxious and/or depressed mood. Results A high PRAQ-R score was associated with planned hospital birth in nulliparous (aOR 1.92; 95% CI 1.32–2.81) and parous women (aOR 2.08; 95% CI 1.55–2.80). An anxious or depressed mood was associated with planned hospital birth (aOR 1.58; 95% CI 1.20–2.08) and with being undecided (aOR 1.99; 95% CI 1.23–2.99) in parous women only. The majority of women did not change their planned place of birth. Changing from an initially planned home birth to a hospital birth later in pregnancy was, however, associated with becoming anxious or depressed after 35 weeks gestation in nulliparous women (aOR 4.17; 95% CI 1.35–12.89) and with pregnancy related anxiety at 20 weeks gestation in parous women (aOR 3.91; 95% CI 1.32–11.61). Conclusion Low risk women who planned hospital birth (or who were undecided) more often reported pregnancy related anxiety or an anxious or depressed mood. Women who changed from home to hospital birth during pregnancy more often reported pregnancy related anxiety or an anxious or depressed mood in late pregnancy. Anxiety should be adequately addressed in the process of informed decision-making regarding planned place of birth in low risk women.
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Affiliation(s)
- A B Witteveen
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - P De Cock
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - A C Huizink
- Department of Developmental Psychology, VU University Amsterdam, Amsterdam, The Netherlands.,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands.,Department of Clinical Child and Family Studies, VU University Amsterdam, Amsterdam, The Netherlands
| | - A De Jonge
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - T Klomp
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - M Westerneng
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - C C Geerts
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Polak AR, Witteveen AB, Mantione M, Figee M, de Koning P, Olff M, van den Munckhof P, Schuurman PR, Denys D. Deep Brain Stimulation for Obsessive-Compulsive Disorder Affects Language. Neurosurgery 2013; 73:E907-10; discussion E910. [DOI: 10.1227/neu.0000000000000022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
Deep brain stimulation (DBS) is an effective treatment for patients with refractory neuropsychiatric disorders. Along with symptom improvement, DBS may have concurrent behavioral effects that help to unravel the role of specific brain circuitries in complex human behavior.
CLINICAL PRESENTATION:
This article reports on 2 patients with obsessive-compulsive disorder who received DBS targeted at the nucleus accumbens that resulted in a temporary change of accent and use of vocabulary.
CONCLUSION:
Changes in accent and speaking manners are most likely related to direct DBS stimulation effects of the electrode targeted at the nucleus accumbens. The shift in accent, resembling foreign accent syndrome after injuries in brain language centers, has not been reported before in the course of DBS. Induction of aggressive vocabulary may be related to transient hypomanic behavior after DBS.
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Affiliation(s)
- A. Rosaura Polak
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Anke B. Witteveen
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Mariska Mantione
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Martijn Figee
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Pelle de Koning
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Arq Psychotrauma Expert Group, Diemen, the Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - P. Richard Schuurman
- Department of Neurosurgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Damiaan Denys
- Netherlands Institute for Neuroscience, an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
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Polak AR, Witteveen AB, Reitsma JB, Olff M. The role of executive function in posttraumatic stress disorder: a systematic review. J Affect Disord 2012; 141:11-21. [PMID: 22310036 DOI: 10.1016/j.jad.2012.01.001] [Citation(s) in RCA: 169] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 12/31/2011] [Accepted: 01/01/2012] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although posttraumatic stress disorder (PTSD) has been associated with disturbances in verbal memory, studies examining executive functioning in PTSD show mixed results. METHODS A systematic review and meta-analysis were performed to compare executive functioning in patients with current PTSD and controls without any psychiatric disorder. Standard mean differences (SMD) in executive functioning scores were calculated using random-effects models. Covariates were added to examine whether differences exist between subgroups. RESULTS Across 18 studies, 1080 subjects were included. In comparison with 431 exposed controls and 227 healthy controls, 422 people with PTSD showed significantly impaired executive functioning. Subgroup analyses revealed more pronounced differences between PTSD patients and exposed controls than healthy controls. Male gender, higher age, war trauma, and higher severity of co-morbid depressive symptoms were related to poorer executive functioning in PTSD patients compared to exposed controls. LIMITATIONS Due to insufficient data and heterogeneity, not all subgroup differences or characteristics could be taken into account. CONCLUSIONS Overall, PTSD patients were found to show impaired executive functioning. Future research should further elucidate the subgroup effects and focus on clinical implications with regard to daily functioning and treatment outcome.
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Affiliation(s)
- A Rosaura Polak
- Academic Medical Centre (AMC), Department of Anxiety Disorders, University of Amsterdam, The Netherlands.
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27
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Polak AR, Witteveen AB, Visser RS, Opmeer BC, Vulink N, Figee M, Denys D, Olff M. Comparison of the effectiveness of trauma-focused cognitive behavioral therapy and paroxetine treatment in PTSD patients: design of a randomized controlled trial. BMC Psychiatry 2012; 12:166. [PMID: 23046608 PMCID: PMC3539952 DOI: 10.1186/1471-244x-12-166] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 09/27/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The two most common interventions for Posttraumatic Stress Disorder (PTSD) are pharmacological treatment with SSRIs such as paroxetine and psychological treatment such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). International guidelines recommend trauma-focused psychological interventions for all PTSD patients as first-line treatment (NICE). However, no clear-cut evidence is available to support this recommendation. METHODS/DESIGN In order to compare pharmacological treatment (paroxetine) and psychological treatment (TF-CBT) in (cost-) effectiveness on the short and the long term, we will randomize 90 patients with chronic PTSD to either paroxetine (24 weeks) or TF-CBT (10-12 weeks). We will assess symptom severity and costs before and after the intervention with the Clinician Administered PTSD Scale (CAPS), the Clinical Global Impression Scale (CGI) and the Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness (TiC-P). DISCUSSION This study is unique for its direct comparison of the most commonly used psychological intervention (TF-CBT) and pharmacological intervention (paroxetine) on (cost-) effectiveness on the short and the long term. The anticipated results will provide relevant evidence concerning long-term effects and relapse rates and will be beneficial in reducing societal costs. It may also provide information on who may benefit most from which type of intervention. Some methodological issues will be discussed. TRIAL REGISTRATION Dutch Trial registration: NTR2235.
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Affiliation(s)
- A Rosaura Polak
- Academic Medical Center, Department of Anxiety Disorders, University of Amsterdam, Meibergdreef 5, Amsterdam 1105 AZ, The Netherlands.
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Pearce J, Jones C, Morrison S, Olff M, van Buschbach S, Witteveen AB, Williams R, Orengo-García F, Ajdukovic D, Aker AT, Nordanger D, Lueger-Schuster B, Bisson JI. Using a Delphi process to develop an effective train-the-trainers program to train health and social care professionals throughout Europe. J Trauma Stress 2012; 25:337-43. [PMID: 22648660 DOI: 10.1002/jts.21705] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Research has shown that developing a Train-the-Trainers (TTT) program is important if agencies are to implement guidelines, but the most effective way to deliver a TTT program remains unanswered. This article presents data from a 3-round Internet-based Delphi process, which was used to help develop consensus-based guidelines for a TTT programme to deliver to health and social care professionals throughout Europe a curriculum on traumatic stress. In Round 1, 74 experts rated the importance of statements relating to the TTT field and then reassessed their scores in the light of others' responses in subsequent rounds. Forty-one (67%) of 61 statements achieved consensus (defined as having a mean score >7 or < 3 on the 0-9 rating scales used and 70% of participants scoring 7 and above or 3 and below) for inclusion. Key TTT components included interactive and practical presentations, delivery to groups of 7-12 people over 2 days, external and local expert facilitation, course manuals, refresher courses, and supervision. The Delphi process allowed a consensus to be achieved in an area in which there are limitations in the current evidence.
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Affiliation(s)
- Jennifer Pearce
- Department of Psychological Medicine, Cardiff University, Wales, United Kingdom
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29
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Witteveen AB, Huizink AC, Slottje P, Bramsen I, Smid T, van der Ploeg HM. Associations of cortisol with posttraumatic stress symptoms and negative life events: a study of police officers and firefighters. Psychoneuroendocrinology 2010; 35:1113-8. [PMID: 20083359 DOI: 10.1016/j.psyneuen.2009.12.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 11/20/2009] [Accepted: 12/17/2009] [Indexed: 11/18/2022]
Abstract
Given the inconsistent associations of cortisol with posttraumatic stress disorder (PTSD), analysis of basal functioning of the hypothalamic-pituitary-adrenal (HPA) axis in subjects frequently exposed to trauma and critical incidents with a range of PTSD symptomatology, may be valuable. In an epidemiological sample of 1880 police officers and firefighters, associations of salivary cortisol with PTSD, negative life events (NLE) and exposure to a major air disaster more than 8 years earlier, was explored. Probable PTSD was unrelated to cortisol level while past (>8 years earlier) and more recently experienced NLE were associated with lower cortisol levels even after adjustment for confounders. Disaster exposure interacted significantly with PTSD symptoms on cortisol level. In the disaster-exposed subgroup, PTSD symptomclusters of intrusion and hyperarousal (in particular sleep disturbances), were associated with lower and higher cortisol levels, respectively. A final model using backward elimination strategy, retained time of saliva sampling, smoking, gender, and NLE>8 years earlier in the total sample, and additionally symptomclusters of intrusion and hyperarousal in the disaster-exposed subgroup. The final model explained 10% of the variance in cortisol. The findings are discussed in relation to literature on posttraumatic stress and basal functioning of the HPA-axis.
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Affiliation(s)
- Anke B Witteveen
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
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30
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Bisson JI, Tavakoly B, Witteveen AB, Ajdukovic D, Jehel L, Johansen VJ, Nordanger D, Orengo Garcia F, Punamaki RL, Schnyder U, Sezgin AU, Wittmann L, Olff M. TENTS guidelines: development of post-disaster psychosocial care guidelines through a Delphi process. Br J Psychiatry 2010; 196:69-74. [PMID: 20044665 DOI: 10.1192/bjp.bp.109.066266] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND How best to plan and provide psychosocial care following disasters remains keenly debated. AIMS To develop evidence-informed post-disaster psychosocial management guidelines. METHOD A three-round web-based Delphi process was conducted. One hundred and six experts rated the importance of statements generated from existing evidence using a one to nine scale. Participants reassessed their original scores in the light of others' responses in the subsequent rounds. RESULTS A total of 80 (72%) of 111 statements achieved consensus for inclusion. The statement 'all responses should provide access to pharmacological assessment and management' did not achieve consensus. The final guidelines recommend that every area has a multi-agency psychosocial care planning group, that responses provide general support, access to social, physical and psychological support and that specific mental health interventions are only provided if indicated by a comprehensive assessment. Trauma-focused cognitive-behavioural therapy (CBT) is recommended for acute stress disorder or acute post-traumatic stress disorder, with other treatments with an evidence base for chronic post-traumatic stress disorder being made available if trauma-focused CBT is not tolerated. CONCLUSIONS The Delphi process allowed a consensus to be achieved in an area where there are limitations to the current evidence.
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Affiliation(s)
- Jonathan I Bisson
- Department of Psychological Medicine and Neurology, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, UK.
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Slottje P, Smidt N, Twisk JWR, Huizink AC, Witteveen AB, van Mechelen W, Smid T. Use of health care and drugs by police officers 8.5. years after the air disaster in Amsterdam. Eur J Public Health 2007; 18:92-4. [PMID: 17644527 DOI: 10.1093/eurpub/ckm078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study examined the use of health care by police officers after the air disaster in Amsterdam. On average 8.5 years post-disaster, involved police officers (n = 834, who reported disaster-related tasks), and their non-involved colleagues (n = 634) completed questionnaires on disaster involvement and health care in the preceding 12 months. Logistic regression showed that involved police officers more often used drugs on their own initiative, sleeping pills or tranquillisers, and consulted a general practitioner or medical specialist, a paramedical specialist, and a privately practicing psychologist or psychiatrist. Thus, even after years, police officers involved in disaster work may use more self-initiated health care.
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Affiliation(s)
- Pauline Slottje
- VU University Medical Center, EMGO Institute and Department of Public and Occupational Health, Amsterdam, The Netherlands
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32
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Slottje P, Witteveen AB, Twisk JWR, Smidt N, Huizink AC, van Mechelen W, Smid T. Post-disaster physical symptoms of firefighters and police officers: role of types of exposure and post-traumatic stress symptoms. Br J Health Psychol 2007; 13:327-42. [PMID: 17535500 DOI: 10.1348/135910707x198793] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine the relationships between exposure to the air disaster in Amsterdam and multiple physical symptoms among firefighters and police officers, and to explore the role of post-traumatic stress symptoms (PTSS) herein. DESIGN Historic cohort study. METHODS On average 8.5 years post-disaster, exposed professional firefighters (N=334) and police officers (N=834) and their nonexposed colleagues (N=194 and N=634, respectively) completed questionnaires on disaster exposure and current symptoms. Logistic regression with adjustment for background characteristics was used to compare exposed and nonexposed workers. PTSS were added to these models, as was the interaction between exposure and PTSS, to explore potential mediating and modifying effects, respectively. RESULTS Exposed workers reported multiple physical symptoms significantly more often. Multiple physical symptoms seemed to have particularly affected the exposed firefighters who rescued people, and the exposed police officers who supported injured victims and workers, who were involved in the identification of or search for victims and human remains, who witnessed the immediate disaster scene or had a close one affected by the disaster. These exposure effects were essentially independent of PTSS, and no significant interactions between exposure and PTSS were found. CONCLUSIONS In conclusion, the excess in post-disaster multiple physical symptoms in exposed workers could not be attributed to PTSS.
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Affiliation(s)
- Pauline Slottje
- EMGO Institute, Department of Public and Occupational Health, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, The Netherlands
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Witteveen AB, Bramsen I, Twisk JWR, Huizink AC, Slottje P, Smid T, Van Der Ploeg HM. Psychological distress of rescue workers eight and one-half years after professional involvement in the Amsterdam air disaster. J Nerv Ment Dis 2007; 195:31-40. [PMID: 17220737 DOI: 10.1097/01.nmd.0000252010.19753.19] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined specific and general psychological distress 8.5 years following the 1992 cargo aircraft crash in Amsterdam. Participants included 334 occupationally exposed fire fighters and 834 occupationally exposed police officers compared with reference groups of 194 fire fighters and 634 police officers who were exposed to duty-related stressors other than the disaster. On the standardized instruments of psychological distress, exposed fire fighters reported more somatic complaints and fatigue, while exposed police officers reported higher psychological distress on all aspects. The degree and type of exposure at the disaster site and other background factors were associated with several outcomes of psychological distress levels of exposed rescue workers. The disasters' aftermath of rumors about potential health consequences due to toxic exposure likely contributed to the long-lasting psychological distress of some of the rescue workers as well.
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Affiliation(s)
- Anke B Witteveen
- Institute for Research in Extramural Medicine and Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
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Slottje P, Slottje PL, Twisk JWR, Smidt N, Huizink AC, Witteveen AB, van Mechelen W, Smid T. Health-related quality of life of firefighters and police officers 8.5 years after the air disaster in Amsterdam. Qual Life Res 2006; 16:239-52. [PMID: 17091369 DOI: 10.1007/s11136-006-9006-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 1992 a cargo aircraft crashed into apartment buildings in Amsterdam. In the troublesome aftermath rumours emerged on potential toxic exposures and health consequences. The aim of this study is to assess the long-term impact of this disaster on the health-related quality of life (HRQoL) of professional assistance workers. METHODS Historic cohort study, using questionnaires to assess occupational disaster exposure, HRQoL (SF36), and background variables, at on average 8.5 years post-disaster. Participating were the exposed professional firefighters (n = 334) and police officers (n = 834) who reported disaster-related task(s), and their non-exposed colleagues who did not report such tasks (n = 194, and n = 634, respectively). RESULTS Multivariate logistic regression analysis showed that exposed workers reported a significantly lower physical HRQoL and vitality than non-exposed workers. Exposed police officers also reported a lower mental HRQoL. Among exposed workers, a lower HRQoL was reported significantly more often by workers who had a close one affected by the disaster; by firefighters who rescued people, cleaned-up, or witnessed the immediate disaster scene; and by police officers who supported the injured. Exposed police officers who perceived the disaster as 'not bad' reported a lower HRQoL less often than those to whom it was 'the worst ever'. CONCLUSIONS This study demonstrates that professional disaster assistance workers are at risk for a lower HRQoL, even after years.
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Affiliation(s)
- Pauline Slottje
- EMGO Institute, VU University Medical Center, Amsterdam, the Netherlands
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35
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Slottje P, Smidt N, Twisk JWR, Huizink AC, Witteveen AB, van Mechelen W, Smid T. Attribution of physical complaints to the air disaster in Amsterdam by exposed rescue workers: an epidemiological study using historic cohorts. BMC Public Health 2006; 6:142. [PMID: 16734887 PMCID: PMC1513385 DOI: 10.1186/1471-2458-6-142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 05/30/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 1992 a cargo aircraft crashed into a residential area of Amsterdam. A troublesome aftermath followed, with rumors on potential toxic exposures and health consequences. Health concerns remained even though no excess morbidity was predicted in retrospective risk evaluations. This study aimed to assess to what extent the rescue workers attribute long-term physical complaints to this disaster, including its aftermath, and to examine associations between such attribution and types of exposure and background variables. METHODS Historic cohort study that collected questionnaire data on occupational disaster exposure, attribution of physical complaints, and background variables on average 8.5 years post-disaster. For the present study the workers who were exposed to the disaster were selected from the historic cohort, i.e. the professional firefighters (n = 334), police officers (n = 834), and accident and wreckage investigators (n = 241) who performed disaster-related tasks. RESULTS Across the three occupational groups, a consistent percentage (ranging from 43% to 49%) of exposed workers with long-term physical complaints attributed these to the disaster, including its aftermath. Those with more physical complaints attributed these to a stronger degree. Multivariate logistic regression analyses showed that attribution was significantly more often reported by firefighters who rescued people, and by police officers who reported the identification and recovery of or search for victims and human remains, clean-up, or security and surveillance of the disaster area; who witnessed the immediate disaster scene; who had a close one affected by the disaster; and who perceived the disaster as the worst thing that ever happened to them. Age, sex and educational level were not significantly associated with attribution. CONCLUSION This study provides further cross-sectional evidence for the role of causal attribution in post-disaster subjective physical health problems. After on average 8.5 years, almost a third (32%) of all the exposed workers, and almost half (45%) of the exposed workers with physical complaints, attributed these complaints to the disaster, including its aftermath. The similarity of the results across the occupational groups suggests a general rather than an occupation-specific attribution process. Longitudinal studies are needed to determine whether causal disaster attribution leads to persistence of post-disaster complaints and health care utilization.
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Affiliation(s)
- Pauline Slottje
- EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Nynke Smidt
- EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Jos WR Twisk
- EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Anja C Huizink
- EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anke B Witteveen
- EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Willem van Mechelen
- EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Tjabe Smid
- EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- KLM Health Services, Schiphol, The Netherlands
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Huizink AC, Slottje P, Witteveen AB, Bijlsma JA, Twisk JWR, Smidt N, Bramsen I, van Mechelen W, van der Ploeg HM, Bouter LM, Smid T. Long term health complaints following the Amsterdam Air Disaster in police officers and fire-fighters. Occup Environ Med 2006; 63:657-62. [PMID: 16644894 PMCID: PMC2078049 DOI: 10.1136/oem.2005.024687] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND On 4 October 1992, a cargo aircraft crashed into apartment buildings in Amsterdam, the Netherlands. Fire-fighters and police officers assisted with the rescue work. OBJECTIVES To examine the long term health complaints in rescue workers exposed to a disaster. METHODS A historical cohort study was performed among police officers (n = 834) and fire-fighters (n = 334) who performed at least one disaster related task and reference groups of their non-exposed colleagues (n = 634 and n = 194, respectively). The main outcome measures included digestive, cardiovascular, musculoskeletal, nervous system, airway, skin, post-traumatic stress, fatigue, and general mental health complaints; haematological and biochemical laboratory values; and urinalysis outcomes. RESULTS Police officers and fire-fighters who were professionally exposed to a disaster reported more physical and mental health complaints, compared to the reference groups. No clinically relevant statistically significant differences in laboratory outcomes were found. CONCLUSIONS This study is the first to examine long term health complaints in a large sample of rescue workers exposed to a disaster in comparison to reference groups of non-exposed colleagues. Findings show that even in the long term, and in the absence of laboratory abnormalities, rescue workers report more health complaints.
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Affiliation(s)
- A C Huizink
- Erasmus Medical Center, Department of Child and Adolescent Psychiatry, Rotterdam, Netherlands.
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Witteveen AB, Van der Ploeg E, Bramsen I, Huizink AC, Slottje P, Smid T, Van der Ploeg HM. Dimensionality of the posttraumatic stress response among police officers and fire fighters: an evaluation of two self-report scales. Psychiatry Res 2006; 141:213-28. [PMID: 16343644 DOI: 10.1016/j.psychres.2005.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Revised: 08/22/2005] [Accepted: 09/16/2005] [Indexed: 11/28/2022]
Abstract
Confirmatory factor analyses were done to assess the dimensionality of the stress response in a sample of police officers and fire fighters (n = 1,168) involved in the 1992 air disaster in Amsterdam. The confirmatory factor analyses were applied to the responses on two psychometrically different instruments, i.e., the Self-Rating Inventory for Posttraumatic Stress Disorder (SRIP) and the Impact of Event Scale (IES). The previously found distinction between (active) avoidance and numbing in samples highly affected by posttraumatic stress disorder appears to be applicable to the stress response of a less affected sample. For the SRIP, a five-factor structure (i.e., intrusion, avoidance, hyperarousal, emotional numbing and sleep disturbance) appeared to fit slightly better than the four-factor structures from previous findings. For the IES, our results replicated findings of a four-dimensional structure (i.e., intrusion, avoidance, numbing and sleep disturbance) underlying the posttraumatic stress response. The factors of the best-fitting structure of both instruments proved reliable. Due to the psychometric properties of the two instruments, the relationship between similar factors in both instruments was only low to moderate. Compared with the IES, factors of the SRIP were, however, less discriminative from other symptoms of psychopathology. Replication in different traumatized or community samples is recommended.
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Affiliation(s)
- Anke B Witteveen
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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Witteveen AB, Bramsen I, Hovens JE, van der Ploeg HM. Utility of the impact of event scale in screening for posttraumatic stress disorder. Psychol Rep 2005; 97:297-308. [PMID: 16279338 DOI: 10.2466/pr0.97.1.297-308] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study assesses the optimal cut-off point for the Impact of Event Scale and compares its screening properties with those of the Self-rating Inventory for Posttraumatic Stress Disorder among war-related trauma victims. 74 patients with war-related trauma were administered the Impact of Event Scale and the Self-rating Inventory for Posttraumatic Stress Disorder, followed 1 wk. later by the Clinician-administered PTSD Scale. Receiver operating characteristic analysis indicated for the Impact of Event Scale a sensitivity of .77 and a specificity of .51 at a cut-off value of 36. For the Self-rating Inventory for Posttraumatic Stress Disorder a sensitivity of .86 and a specificity of .69 were found at a cut-off value of 52. The authors conclude that careful use of the Impact of Event Scale as a screening measure for Posttraumatic Stress Disorder is warranted.
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Affiliation(s)
- Anke B Witteveen
- Department of Medical Psychology, VU University Medical Center, Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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Slottje P, Bijlsma JA, Smidt N, Twisk JWR, Huizink AC, Lems WF, van Hoogstraten I, Witteveen AB, van Mechelen W, Smid T. Epidemiologic Study of the Autoimmune Health Effects of a Cargo Aircraft Disaster. ACTA ACUST UNITED AC 2005; 165:2278-85. [PMID: 16246995 DOI: 10.1001/archinte.165.19.2278] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND In the aftermath of a cargo aircraft crash in Amsterdam in 1992, indications of autoimmune disorders appeared in some of the affected population. METHODS This epidemiologic study sought to determine the possible long-term autoimmune health effects of the aircraft disaster on professional assistance workers. Exposed professional firefighters (n = 334) and police officers (n = 834) who performed at least 1 disaster-related task and hangar workers who sorted and investigated the wreckage (n = 241) were compared with reference groups of nonexposed colleagues who did not perform any disaster-related tasks (n = 194, n = 634, and n = 104, respectively). Data were collected a mean of 8.5 years after the disaster. Questionnaires were used to assess disaster-related tasks and 11 autoimmune-like symptoms. All serum samples were tested for the presence of antinuclear antibodies, rheumatoid factor, and antineutrophil cytoplasmic and anticardiolipin antibodies. RESULTS Compared with nonexposed colleagues, exposed workers reported significantly more autoimmune-like symptoms. They reported the following symptoms significantly more often: tingling sensations, myalgia, loss of strength, easily fatigued, and a feeling of sand in the eyes (all groups); infection proneness (firefighters); skin abnormalities and nocturnal transpiration (police officers and hangar workers); and vasculitis-like symptoms and Raynaud discoloring (police officers). In contrast, we found no significant difference between exposed and nonexposed workers in autoantibody prevalence. CONCLUSION Occupational exposure to the aircraft disaster resulted in an excess of long-term self-reported autoimmune-like symptoms in exposed professional assistance workers, but there was no difference between exposed and nonexposed workers in the prevalence of autoantibodies.
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Affiliation(s)
- Pauline Slottje
- Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Slottje P, Huizink AC, Twisk JWR, Witteveen AB, van der Ploeg HM, Bramsen I, Smidt N, Bijlsma JA, Bouter LM, van Mechelen W, Smid T. Epidemiological study air disaster in Amsterdam (ESADA): study design. BMC Public Health 2005; 5:54. [PMID: 15921536 PMCID: PMC1173116 DOI: 10.1186/1471-2458-5-54] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Accepted: 05/30/2005] [Indexed: 11/28/2022] Open
Abstract
Background In 1992, a cargo aircraft crashed into apartment buildings in Amsterdam, killing 43 victims and destroying 266 apartments. In the aftermath there were speculations about the cause of the crash, potential exposures to hazardous materials due to the disaster and the health consequences. Starting in 2000, the Epidemiological Study Air Disaster in Amsterdam (ESADA) aimed to assess the long-term health effects of occupational exposure to this disaster on professional assistance workers. Methods/Design Epidemiological study among all the exposed professional fire-fighters and police officers who performed disaster-related task(s), and hangar workers who sorted the wreckage of the aircraft, as well as reference groups of their non-exposed colleagues who did not perform any disaster-related tasks. The study took place, on average, 8.5 years after the disaster. Questionnaires were used to assess details on occupational exposure to the disaster. Health measures comprised laboratory assessments in urine, blood and saliva, as well as self-reported current health measures, including health-related quality of life, and various physical and psychological symptoms. Discussion In this paper we describe and discuss the design of the ESADA. The ESADA will provide additional scientific knowledge on the long-term health effects of technological disasters on professional workers.
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Affiliation(s)
- Pauline Slottje
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
| | - Anja C Huizink
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jos WR Twisk
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Anke B Witteveen
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
| | - Henk M van der Ploeg
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
| | - Inge Bramsen
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
| | - Nynke Smidt
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Joost A Bijlsma
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Lex M Bouter
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Willem van Mechelen
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
| | - Tjabe Smid
- Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
- KLM Health Services, Schiphol Airport, the Netherlands
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