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R V Bijl

Publications and source records attributed to R V Bijl.

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Psychiatric and sociodemographic predictors of attrition in a longitudinal study: The Netherlands Mental Health Survey and Incidence Study (NEMESIS).

This article discusses the effects of sociodemographics and the presence of psychiatric disorders diagnosed in the 12 months before the first interview by using the Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R, third edition, revised, on three types of attrition (failure to locate, refusal to participate, morbidity/mortality) in the second wave (1997-1998) of the Netherlands Mental Health Survey and Incidence Study, a longitudinal, general population survey of psychopathology among 7,076 subjects aged 18-64 years. Compared with those reinterviewed successfully, persons not located at the 1-year follow-up (n = 219) were more often younger, poorly educated, urban, not cohabiting with a steady partner, and born outside the Netherlands. Refusers (n = 923) had a lower educational level. Morbidity/mortality (n = 72) was associated with higher age, lower educational level, not being employed, and somatic disorders. After adjustment for sociodemographics, none of the disorders was positively associated with refusal. Failure to locate was linked to agoraphobia, alcohol abuse, and the categories of mood, substance use, and eating disorders. Morbidity/mortality was linked to dysthymia, agoraphobia, simple phobia, obsessive-compulsive disorder, and the category of anxiety disorders. Overall attrition was only slightly higher among respondents with one or more disorders (odds ratio = 1.20, 95% confidence interval: 1.04, 1.38). Thus, psychopathology has only weak-to-moderate effects on attrition and is mainly related to failure to locate and morbidity/mortality but not to refusal.

Adolescent↗

Strauss (1969) revisited: a psychosis continuum in the general population?

Although dichotomously defined for clinical purposes, psychosis may exist as a continuous phenotype in nature. A random sample of 7076 men and women aged 18-64years were interviewed by trained lay interviewers with the Composite International Diagnostic Interview (CIDI). Those with evidence of psychosis according to the CIDI were additionally interviewed by psychiatrists. For the 17 CIDI core psychosis items, we compared a psychiatrist's rating of hallucinations and/or delusions (Clinical Psychosis; sample prevalence 4.2%) with three other possible positive CIDI ratings of the same items: (i) symptom present, but not clinically relevant (NCR Symptom; sample prevalence 12.9%); (ii) symptom present, but the result of drugs or somatic disorder (Secondary Symptom; sample prevalence 0.6%); (iii) symptom appears present, but there is a plausible explanation (Plausible Symptom; sample prevalence 4.0%). Of the 1237 individuals with any type of positive psychosis rating (sample prevalence 17.5%), only 26 (2.1%) had a DSM-III-R diagnosis of non-affective psychosis. All the different types of psychosis ratings were strongly associated with the presence of psychiatrist-rated Clinical Psychosis (NCR Symptom: OR=3.4; 95% CI: 2.9-3.9; Secondary Symptom: OR=4.5; 95% CI: 2.7-7.7; Plausible Symptom: OR=5.8; 95% CI: 4.7-7.1). Associations with lower age, single marital status, urban dwelling, lower level of education, lower quality of life, depressive symptoms and blunting of affect did not differ qualitatively as a function of type of rating of the psychotic symptom, were similar in individuals with and without any CIDI lifetime diagnosis, and closely resembled those previously reported for schizophrenia. Presence of any rating of hallucinations was strongly associated with any rating of delusions (OR=6.7; 95% CI: 5.6-8.1), regardless of presence of any CIDI lifetime diagnosis. The observation by Strauss (1969. Hallucinations and delusions as points on continua function. Arch. Gen. Psychiatry 21, 581-586) that dichotomously diagnosed psychotic symptoms in clinical samples are, in fact, part of a continuum of experiences, may also apply to the general population. The boundaries of the psychosis phenotype may extend beyond the clinical concept of schizophrenia.

Adolescent↗

Income differences in persons seeking outpatient treatment for mental disorders: a comparison of the United States with Ontario and The Netherlands.

BACKGROUND: Variations in the relationships among income, use of mental health services, and sector of care are examined by comparing data from 3 countries that differ in the organization and financing of mental health services. METHODS: Data come from the 1990-1992 National Comorbidity Survey (n = 5,384), the 1990-1991 Mental Health Supplement to the Ontario Health Survey (n = 6,321), and the 1996 Netherlands Mental Health Survey and Incidence Study (n = 6031). Analysis of the association between income and use of mental health services was carried out for the population that was between ages 18 and 54 years. Differential use of mental health treatment was examined in 3 sectors: the general medical sector, the specialty sector, and the human services sector. RESULTS: No significant association between income and probability of any mental health treatment was observed for persons with psychiatric disorders in any of the 3 countries. However, there were significant differences among countries in the association between income and sector of mental health care treatment. In the United States, income is positively related to treatment being received in the specialty sector and negatively related to treatment being received in the human services sector. In the Netherlands, patients in the middle-income bracket are less likely to receive specialty care, while those in the high-income bracket are less likely to be seen in the human service sector. Income is unrelated to the sector of care for patients in Ontario. CONCLUSIONS: Future research should examine whether differential access to the specialty sector for low-income people in the United States is associated with worse mental health outcomes.

Adolescent↗

Mental disorders and employee sickness absence: the NEMESIS study. Netherlands Mental Health Survey and Incidence Study.

BACKGROUND: This study aimed to determine to what extent different forms of mental disorders are related to an increased likelihood of sickness absence and whether this increase depends on the employee's sex. METHODS: Data of 3,695 employed persons aged 18-64 years from a national sample of the Dutch population were derived from the first two waves of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Mental disorders (DSM-III-R) in the past 12 months were assessed at baseline (1996). Subsequent sickness absence was assessed at the follow-up 1 year later. Somatic illnesses and age were included as controlled confounders. RESULTS: Major depressive disorder, dysthymia, simple phobia and drug abuse/dependence were predictive of sickness absence in men. In women, the associations were weaker, and none of the 1-year DSM-III-R disorders was significantly related to the likelihood of sickness absence. CONCLUSIONS: Mental disorders are a more important risk factor for sickness absence for male employees than for female employees. Knowledge of this sex difference can be valuable for the development of interventions aiming at reducing sickness absence rates due to mental illness.

Adult↗

Which chronic conditions are associated with better or poorer quality of life?

The objective of the present study is to compare the QL of a wide range of chronic disease patients. Secondary analysis of eight existing data sets, including over 15,000 patients, was performed. The studies were conducted between 1993 and 1996 and included population-based samples, referred samples, consecutive samples, and/or consecutive samples. The SF-36 or SF-24 were employed as generic QL instruments. Patients who were older, female, had a low level of education, were not living with a partner, and had at least one comorbid condition, in general, reported the poorest level of QL. On the basis of rank ordering across the QL dimensions, three broad categories could be distinguished. Urogenital conditions, hearing impairments, psychiatric disorders, and dermatologic conditions were found to result in relatively favorable functioning. A group of disease clusters assuming an intermediate position encompassed cardiovascular conditions, cancer, endocrinologic conditions, visual impairments, and chronic respiratory diseases. Gastrointestinal conditions, cerebrovascular/neurologic conditions, renal diseases, and musculoskeletal conditions led to the most adverse sequelae. This categorization reflects the combined result of the diseases and comorbid conditions. If these results are replicated and validated in future studies, they can be considered in addition to information on the prevalence of the diseases, potential benefits of care, and current disease-specific expenditures. This combined information will help to better plan and allocate resources for research, training, and health care.

Chronic Disease↗

Current and residual functional disability associated with psychopathology: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS).

BACKGROUND: Few population studies have investigated the functional disabilities that accompany specific psychiatric diagnoses. This study assesses the nature and strength of current and residual impairments in various functional domains of life. METHODS: Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective study in the Dutch general population aged 18 to 64 (N = 7147). Psychiatric diagnoses were based on the Composite International Diagnostic Interview; functional disability was assessed on the basis of the Short-Form-36 and the number of disability days. RESULTS: Psychopathology was associated with increased disability in social, emotional and physical domains of life. Disability levels varied by psychiatric diagnosis, with mood disorders showing the poorest levels of functioning, especially for vitality and social functioning; alcohol-related disorders were associated with few disabilities. Co-morbidity strongly aggravated the disability. The effect of contextual factors on disability was limited, although somatic ill health, unemployment and adverse youth history increased the likelihood of functional disability. The findings indicate that psychopathology can also have residual debilitating effects. CONCLUSIONS: Mental health care providers should be aware that the extent and the type of disability may vary with the different types of disorders and among different groups within the population. Since recovery from functional limitations may not be complete or may take more time than the remission of the psychiatric symptomatology, non-psychiatric follow-up care is needed. The high number of lost work days is relevant from an economic perspective. There is a need for illness-specific disability assessment instruments.

Activities of Daily Living↗

Psychiatric morbidity, service use, and need for care in the general population: results of The Netherlands Mental Health Survey and Incidence Study.

OBJECTIVES: This study examined the use of primary health care, mental health care, and informal care services, as well as unmet care needs, by individuals with different psychiatric diagnoses. METHODS: Data were derived from the Netherlands Mental Health Survey and Incidence Study and were based on a representative sample (n = 7147) of the general population (aged 18-64 years). RESULTS: In a 12-month period, 33.9% of those with a psychiatric disorder used some form of care; 27.2% used primary care, and 15.3% used mental health care. Patients with mood disorders were the most likely to enlist professional care; those with alcohol- and drug-related disorders were the least likely to do so. Higher educated persons who live alone, single parents, unemployed persons, and disabled persons were more likely to use mental health care. Unmet need for professional help was reported by 16.8% (men 9.9%, women 23.9%) of those with a disorder. CONCLUSIONS: Care use varies widely by diagnostic category. The role of general medical practitioners in treating persons with psychiatric disorders is more limited than was anticipated. Patients in categories associated with extensive use of professional care are more likely to have unmet care needs.

Adolescent↗

Psychiatric disorders in adult children of problem drinkers: prevalence, first onset and comparison with other risk factors.

AIMS: (1) To confirm the increased risk of psychiatric disorders in Adult Children of Alcoholics (ACOAs); (2) to test if the age of onset of the disorders differs for ACOAs versus non-ACOAs; (3) to estimate the weight of being an ACOA compared to other risk factors including childhood traumas, other parental problem behaviours and current risk factors. DESIGN, SETTING, AND PARTICIPANTS: A random sample of the Dutch population (N = 7147) was interviewed (response rate: 69.7%). MEASUREMENTS: Psychiatric disorders were assessed using the CIDI. Parental problem drinking, other parental problem behaviours and childhood traumas were assessed using self-report measures. FINDINGS: (1) ACOAs had a significantly higher life-time, 12-month and 1-month prevalence of mood, anxiety and abuse/dependence disorders. Sons of problem drinkers also had a higher prevalence of eating disorders and schizophrenia. The prevalence rates were particularly high for the children of fathers with drinking problems. (2) The first onset of the mood and anxiety disorders took place at a younger age in ACOAs than in non-ACOAs. (3) Relative to other parental problem behaviours and childhood traumas, parental problem drinking is a strong predictor of psychiatric disorders, in particular abuse/dependence disorders. CONCLUSIONS: Children of fathers with a drinking problem are a high-risk group for psychiatric disorder. From a public health perspective it is an important target to break through this continuing circle. The further development of prevention and early treatment interventions at schools, youth care and addiction treatment centres is an important issue.

Adolescent↗

[Prevalence and relevant background characteristics of deafness and severe hearing loss in the Netherlands].

OBJECTIVE: To determine the prevalence of deafness and severe hardness of hearing among the Dutch population and of some relevant background characteristics. DESIGN: Study of documents. SETTING: Dutch schools for deaf and hard-of-hearing children. METHOD: The number of deaf and severely hard-of-hearing children of 6-12 years who received education or ambulatory supervision at schools for deaf and hard-of-hearing children was counted in the period November 1996-April 1997, and a number of relevant background characteristics were collected. By means of consultation with experts, this number was corrected for children who could not be retrieved by means of the inventory at these schools. To estimate the total number of deaf and severely hard-of-hearing people in the Dutch population, this adjusted number was extrapolated to older and younger year cohorts. RESULTS: The number of deaf and hard-of-hearing children of 6-12 years, after correction for missing groups, was 0.74 (95% confidence interval (95% CI): 0.69-0.78) per 1000 persons. In 9% the age of onset of the handicap was postlingual; they more often received ambulatory supervision and more often received education at a school for hard-of-hearing children than those with a prelingual auditive handicap. Of the children 29% had a non-Western origin; they less often received ambulatory supervision, and more often received education from a school for deaf children than indigenous pupils. Among the total Dutch population, the number of deaf and hard-of-hearing persons in 1996 was estimated to be 11,400 persons (95% CI: 10,690-12,110). CONCLUSION: The prevalence of deafness and severe hardness of hearing in the Netherlands (15,490,000 inhabitants in 1996) was 11,400 persons (95% CI: 10,690-12,110).

Adolescent↗

[Prevalence of mental disorders in persons with Parkinson's disease].

OBJECTIVE: To determine the prevalence of cognitive disorder, depression, anxiety and psychotic symptoms in persons with Parkinson's disease in the general population. DESIGN: Cross-sectional study. SETTING: The Netherlands. METHOD: Between May and September 1995, a random sample of 384 persons with Parkinson's disease (members of the Parkinson's disease patient organisation plus 24 Dutch nursing home patients) were investigated with the Composite International Diagnostic Interview (CIDI) and the General Health Questionnaire (GHQ-12). RESULTS: The 1-month prevalence of DSM-III-R psychiatric disorder was 39.1%, of which 13.3% cognitive impairment, 5.5% depression (2.3% major depression and 4.7% dysthymia), and 24.5% anxiety disorder (4.9% agoraphobia and 11.5% social phobia). Psychiatric comorbidity mainly concerned anxiety disorder, in combination with depression (21%) or cognitive disorder (28%). Four out of ten persons who ever had a depression or anxiety disorder, developed the first episode after the onset of Parkinson's disease. CONCLUSION: The prevalence of psychiatric disorder in persons with Parkinson's disease was high, compared with figures of the general population, notably for anxiety and cognitive disorder, but not for depression.

Aged↗

The Netherlands Mental Health Survey and Incidence Study (NEMESIS): objectives and design.

The article describes the objectives and design of a prospective study of the prevalence, incidence and course of psychiatric disorders in a representative sample of non-institutionalized Dutch adults. A total of 7146 men and women aged 18-64, contacted through a multistage sample of municipalities and households, were interviewed at home in 1996. The primary diagnostic instrument was the CIDI, which determines the lifetime occurrence of DSM-III-R disorders. The disorders included were: mood disorders, anxiety disorders, eating disorders, schizophrenia and other non-affective psychotic disorders, and dependence and abuse of psychoactive substances. Follow-up measurements in the same sample were scheduled at 12 and 36 months. The net response to the first measurement was 69.7%. Poststratification weightings were applied for gender, age, marital status and degree of urbanization. Limitations and advantages of the study design are discussed. Findings are reported elsewhere in this issue.

Adolescent↗

Prevalence of psychiatric disorder in the general population: results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS).

This article reports the initial results of a prospective study on the prevalence of psychiatric disorders in the Dutch population aged 18-64. The objectives and the design of the study are described elsewhere in this issue. A total of 7076 people were interviewed in person in 1996. The presence of the following disorders was determined by means of the CIDI: mood disorders, anxiety disorders, eating disorders, schizophrenia and other non-affective psychoses, and substance use disorders. Psychiatric disorders were found to be quite common. Some 41.2% of the adult population under 65 had experienced at least one DSM-III-R disorder in their lifetime, among them 23.3% within the preceding year. No gender differences were found in overall morbidity. Depression, anxiety, and alcohol abuse and dependence were most prevalent, and there was a high degree of comorbidity between them. The prevalence rate encountered for schizophrenia was lower (0.4% lifetime) than generally presumed. A comparison with findings from other countries is made. Relevant determinants of psychiatric morbidity were analysed.

Adolescent↗

[Psychiatric morbidity among adults in The Netherlands: the NEMESIS-Study. I. Objectives, design and methods. Netherlands Mental Health Survey and Incidence Study].

OBJECTIVE: To determine prevalence, incidence and course of psychiatric disorders in non-institutionalised Dutch adults. DESIGN: Prospective and cross-sectional. SETTING: Trimbos Institute, Utrecht, the Netherlands. METHOD: A multistage, stratified random sampling procedure was used to obtain a sample of 7076 adults (18-64 years). Respondents were interviewed throughout 1996 in their homes. The main diagnostic instrument was the 'Composite international diagnostic interview' (CIDI), designed to assess lifetime prevalence of mental disorders according to Diagnostic and statistical manual of mental disorders, 3rd revised edition (DSM-III-R). The diagnostic categories were: affective disorders, anxiety disorders, eating disorders, schizophrenia and other non-affective psychoses, and substance use disorders (dependence and abuse). The sample was weighted towards national census data on sex, age, marital status and urbanicity. RESULTS: The results of the first measurement (1996) will be described in the next article (1997:2353-60). The response rate was 64.2%. There were no indications that the psychiatric morbidity of non-respondents differed from respondents. The same respondents will be interviewed again after 12 (1997) and after 36 months (1999).

Adolescent↗

[Psychiatric morbidity among adults in The Netherlands: the NEMESIS-Study. II. Prevalence of psychiatric disorders. Netherlands Mental Health Survey and Incidence Study].

OBJECTIVE: To determine the prevalence of psychiatric disorders in non-institutionalised Dutch adults. DESIGN: Cross-sectional. SETTING: Trimbos Institute, Utrecht, the Netherlands. METHODS: A representative sample of 7076 adults (18-64 years) in the Netherlands' population were interviewed in 1996 to determine the prevalence of mental disorders ever, in the previous 12 months and in the previous month. Objectives and study design are described in the previous article (1997: 2448-52). The 'Composite international diagnostic interview' (CIDI) was used to assess the following mental disorders according to Diagnostic and statistical manual of mental disorders, 3rd revised edition (DSM-III-R): affective disorders, anxiety disorders, eating disorders, schizophrenia and other non-affective psychoses, substance dependence and substance abuse. RESULTS: Mental disorders were common in the general population: the prevalence 'ever' of all disorders was 41.2%, the 12-month prevalence 23.5%, without sex differences. Depression, anxiety disorders and alcohol abuse and dependence showed high prevalence and comorbidity. The prevalence 'ever' of schizophrenia and other non-affective psychoses was low (0.4%).

Adolescent↗

[Future scenario's Dementia 1990-2010--various major points from the scenario report 'Care for mental health in the future'].

This paper describes major points of a study on the future of dementia in the period 1990-2010. By means of a literature review and consultation of experts in a Delphi-study exploratory scenarios and a target-setting scenario were constructed. The paper delineates the exploratory reference-scenario, which includes the most probable processes and developments according to the majority of the experts. Furthermore necessary measures and strategies are described to increase the quality of care to demented elderly in the next twenty years.

Aged↗

The distribution of psychiatric and somatic III health: associations with personality and socioeconomic status.

OBJECTIVE: Psychiatric and somatic disorders frequently co-occur in the same individuals. We examined whether this happens because these types of morbidity share risk factors or because they are risk factors for each other. METHODS: Negative binomial regression was used to examine, in a random sample of Dutch adults (N = 7076), cross-sectional associations of sociodemographic and personality variables like income and neuroticism with the presence, over 1 year, of 30 somatic and 13 psychiatric disorders, with the latter diagnosed by structured interview. We examined to what extent the links of these variables with these two morbidity types were independent of each other. RESULTS: This population experienced 5050 somatic and 2438 psychiatric disorders during the preceding year. Subjects reporting more somatic disorders had more psychiatric disorders. Neuroticism, followed closely by low educational attainment, was the strongest correlate of both morbidity types. After adjustment for all other covariates including somatic morbidity, the number of psychiatric diagnoses rose 1.84-fold (95% confidence interval = 1.74-1.94) per standard deviation increase in neuroticism. Likewise, adjusted for all other covariates including psychiatric diagnoses, 1.42 (95% confidence interval = 1.35-1.50) times more somatic disorders were reported per standard deviation increase in neuroticism. CONCLUSIONS: Personal features like neuroticism and low educational attainment are linked with psychiatric and with somatic morbidity. These links are largely independent. Although this study was cross-sectional, the results suggest that these different types of morbidity may have overlapping etiologies. Key words: Comorbidity, multimorbidity coefficient, negative binomial regression, epidemiology, neuroticism, social class.

Adult↗