Understanding Depression as a
Continuum and a Process:
Hoe gek is Nederland?
How Nuts are the Dutch?
Peter de Jonge, prof Psychiatric Epidemiology
[email protected]
Interests
Vici grant “Deconstructing Depression”
(NWO/ZonMW)
Unstrestricted grant “Leefplezier bij ouderen”
(Espria)
Nemesis
All disorders
Lifetime:
Past year:
41.2%
23.3%
Mood disorders
Lifetime:
19.0%
Past year:
7.6%
Bijl et al. Soc Psych Psych Epi 1998
Mood
All
Colombia
6.8%
17.8%
Mexico
4.8%
12.2%
USA
9.6%
26.4%
Belgie
6.2%
12.0%
Frankrijk
8.5%
18.4%
Duitsland
3.6%
9.1%
Italie
3.8%
8.2%
Nederland
6.9%
14.9%
Spanje
4.9%
9.2%
Oekraine
9.1%
20.5%
Libanon
6.6%
16.9%
Nigeria
0.8%
4.7%
Japan
3.1%
8.8%
China
2.5%
9.1%
Sjanghai
1.7%
4.3%
Demyttenaere et al. JAMA2004
Nemesis and Nemesis II
All disorders:
Mood disorders:
De Graaf et al. Soc Psych Psych Epi 2012
1996
2008
23.3%
7.6%
18.0%
6.1%
Predicted global burden of disease (Lancet, 1998)
disease
DALYs
%
1
ischaemic heart disease
82.3
5.9
2
depression
78.7
5.7
3
traffic
71.2
5.1
4
cerebrovascular
61.4
4.4
5
COPD
57.6
4.2
6
Airway infections
42.7
3.1
7
tuberculosis
42.5
3.0
8
war
41.3
3.0
9
diarrhea
37.1
2.7
10
HIV
36.3
2.6
Operationalisation of depression according to DSM-IV and V
227 profiles fulfilling DSM criteria
DSM-IV / ICD-10
Depressed mood
Diminished interest
Why distinguish between core
and other?
Core: at least 1
Weight loss or weight gain
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss or energy
Worthlessness or guilt
Concentration problems
Suicidal ideation
Total: at least 5
APA, 1980.
Is a sumscore useful?
Why cut-off at 5, and not 4 or 6?
Should we want to use a cut-off
at all?
Why not rumination?
How can 1 single disease produce
such contradicting symptoms?
GROMGAV methode
Groep Respectabele Oudere Mannen Gezeten Aan
Vergadertafel
BOGSAT. Kendler 2012.
For science:
SSRIs/SNRIs
MDD
Apparent effect
0.41 (0.36-0.45)
MDD
Real effect
0.32 (0.27-0.35)
Small and overestimated…
Turner EH et al. N Engl J Med 2008.
% explained variance
Effect size (d)
% explained var
% overlap
0.2
1%
92%
0.3
2%
88%
0.4
4%
84%
0.5
6%
80%
1.0
20%
62%
2.0
50%
32%
3.0
68%
13%
From study to guideline/ approval
• Richtlijn: depressie => ssri
FDA: at least 2 positive trials
Positive trial: significant better than placebo (depends on N
and effectsize)
Example: dubbelblind trial (N=91; 44 placebo, 47
antidepressant
After 8 weeks: difference in HAM-D: 2,6 (s.d =7) cohen’s D
0.37
Visual, aggregated
Visual, disaggregated
V
SSRIs/SNRIs
MDD
Apparent efficacy
0.41 (0.36-0.45)
MDD
Real efficacy
0.32 (0.27-0.35)
GAD
PD
SAD
PTSD
OCD
0.34
0.35
0.42
0.32
0.45
GAD
PD
SAD
PTSD
OCD
0.32
0.28
0.39
0.27
0.39
(0.28-0.43)
(0.25-0.45)
(0.35-0.49)
(0.14-0.50)
(0.30-0.51)
(turner et al 2008)
(0.25-0.39)
(0.19-0.36)
(0.30-0.49)
(0.11-0.44)
(0.30-0.49)
Small, over-rated and Interchangeable
accross disorders
Roest AM, Jonge P, Williams CD, de Vries YA, Schoevers RA, Turner EH. JAMA
Psychiatry. In Press.
Rethink mental health
• Not GROMGAV
• Not only based on complaints but also on
strengths
• Personalised and transdiagnostic
Structure internalising symptoms – LifeLines
(N=75.000)
57.0%
14.8%
11.6%
8.4%
4.9%
3.2%
Wanders RBK et al. In Prep.
SSRIs/SNRIs
MDD
Schijnbaar effect
0.41 (0.36-0.45)
MDD
Werkelijk effect
0.32 (0.27-0.35)
GAD
PD
SAD
PTSD
OCD
0.35
0.35
0.42
0.32
0.41
GAD
PD
SAD
PTSD
OCD
0.32
0.28
0.39
0.27
0.39
(0.28-0.43)
(0.25-0.45)
(0.35-0.49)
(0.14-0.50)
(0.30-0.51)
(turner et al 2008)
(0.25-0.39)
(0.19-0.36)
(0.30-0.49)
(0.11-0.44)
(0.30-0.49)
Klein, overschat en uitwisselbaar over
stoornissen
Roest AM, Jonge P, Williams CD, de Vries YA, Schoevers RA, Turner EH. JAMA
Psych, in press.
HoeGekIsNL / HowNutsAreTheDutch
– 12.781 participants (62.307 questionnaires)
– 302 at least 60 assessments (>22.000
questionnaires)
– 17 approved proposals
24-2-2015
24
Positive affect
Mental problems are
gradual and
multidimensional
Negative affect
Activity
Depression
Interindividual ≠ Intraindividual
Personal etiological models
Thank you for your attention
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Understanding Depression as a Continuum and a