http://repub.eur.nl/res/aut/20682/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/34185/ 2011-07-01T00:00:00Z Background: Utilities are often a main outcome parameter in economic evaluations. Because depression has a large influence on quality of life, it is expected that utilities are responsive to changes in depression. Objective: To evaluate the change in utility derived from different instruments in depression, including the Short Form 6D (SF-6D), the Euroqol based on the UK (EQ-5DUK), the Euroqol based on the Dutch tariff (EQ-5DNL), and utilities derived from Beck Depression Inventory Second Edition (BDI-II) using the Depression-Free-Day method. Method: This study evaluated the responsiveness, the minimally important difference, and the agreement in utility change derived from the different instruments. Results: The SF-6D, EQ-5DUK, and EQ-5DNLwere responsive. The minimally important difference values are in line with previous studies, about 0.3. The Depression-Free-Day method nearly always resulted in positive utility changes, even for subgroups that had no change or deterioration in health status or depression. There was poor agreement between utility changes of the SF-6D, EQ-5D (either EQ-5DUKor EQ-5DNL), and DFDu. Conclusions: The SF-6D, EQ-5DUK, and EQ-5DNLseem responsive and thus adequate for estimating utility in depression treatment. We do not recommend the use of the Depression-Fee-Day method. The low agreement between utility changes indicates that outcomes of the different instruments are incomparable. http://repub.eur.nl/res/pub/23071/ 2011-03-01T00:00:00Z Background: Several studies have evaluated the efficacy and effectiveness of computerized cognitive behavioural therapy (CCBT) for depression, but research on the patient perspective is limited. Aims: To gain knowledge on patient experiences with the online self-help CCBT program Colour Your Life (CYL) for depression, and find explanations for the low treatment adherence and effectiveness. Method: Qualitative data were collected through semi-structured interviews with 18 patients. Interviewees were selected from a CCBT trial. An inductive, content analysis of the interviews was performed. Results: The main theme throughout the interviews concerns barriers and motivators experienced with CCBT. The most important barriers included experiences of a lack of identification with and applicability of CCBT-CYL, lack of support to adhere with the program or to gain deeper understanding, and inadequate computer/Internet skills, equipment, or location. Confusion between CCBT and Internet questionnaires resulted in no CCBT uptake of some study participants. Motivators included experiencing self-identification and improvement through CCBT-CYL, participating in a scientific study, and the freedom and anonymity associated with online computer self-help. The addition of support to CCBT was suggested as an improvement towards adherence and the course content. Conclusion: The CCBT program CYL in its current form does not work for a large group of people with depressive symptoms. More tailoring, the provision of support (professional or lay) and good computer conditions could improve CCBT. http://repub.eur.nl/res/pub/31763/ 2011-01-12T00:00:00Z Background: Maintenance treatment with antidepressants is the leading strategy to prevent relapse and recurrence in patients with recurrent major depressive disorder (MDD) who have responded to acute treatment with antidepressants (AD). However, in clinical practice most patients (up to 70-80%) are not willing to take this medication after remission or take too low dosages. Moreover, as patients need to take medication for several years, it may not be the most cost-effective strategy. The best established effective and available alternative is brief cognitive therapy (CT). However, it is unclear whether brief CT while tapering antidepressants (AD) is an effective alternative for long term use of AD in recurrent depression. In addition, it is unclear whether the combination of AD to brief CT is beneficial.Methods/design: Therefore, we will compare the effectiveness and cost-effectiveness of brief CT while tapering AD to maintenance AD and the combination of CT with maintenance AD. In addition, we examine whether the prophylactic effect of CT was due to CT tackling illness related risk factors for recurrence such as residual symptoms or to its efficacy to modify presumed vulnerability factors of recurrence (e.g. rigid explicit and/or implicit dysfunctional attitudes). This is a multicenter RCT comparing the above treatment scenarios. Remitted patients on AD with at least two previous depressive episodes in the past five years (n = 276) will be recruited. The primary outcome is time related proportion of depression relapse/recurrence during minimal 15 months using DSM-IV-R criteria as assessed by the Structural Clinical Interview for Depression. Secondary outcome: economic evaluation (using a societal perspective) and number, duration and severity of relapses/recurrences.Discussion: This will be the first trial to investigate whether CT is effective in preventing relapse to depression in recurrent depression while tapering antidepressant treatment compared to antidepressant treatment alone and the combination of both. In addition, we explore explicit and implicit mediators of CT.Trial registration: Netherlands Trial Register (NTR): NTR1907. http://repub.eur.nl/res/pub/27359/ 2010-05-01T00:00:00Z Background: Although most research suggests that minor depression is part of a depression continuum, conflicting results have also been found. Moreover, little is known about dysfunctional thinking in minor depression and how this varies along the continuum. Especially, research on the form of dysfunctional thinking (ie, extreme responding) is lacking. We have addressed these issues by reporting results from a large community sample. Methods: Demographic, clinical, and cognitive factors (ie, content and form of dysfunctional thinking) were compared between minor depression (ie, 2-4 symptoms), major depression with 5 to 6 symptoms, and major depression with 7 to 9 symptoms. A large community sample (N = 1129) was used. Differences between the 3 subgroups were examined as well as linear relations between number of symptoms and factors marking the severity. Results: Most demographic variables did not distinguish the 3 depression status categories from each other. Clinical and cognitive factors acted in synchrony with the depression continuum. Conclusions: Minor depression should be considered as part of continuum together with major depression. Not only the content but also the form of dysfunctional thinking seems to play a major role in depression. Extreme positive responding is more prominent in mild depression, whereas more severely depressed individuals have a general tendency toward extreme negative responding. This finding, if replicated, may have important implications for the cognitive theory of depression. http://repub.eur.nl/res/pub/23170/ 2010-04-01T00:00:00Z BACKGROUND: Evidence about the cost-effectiveness and cost utility of computerised cognitive-behavioural therapy (CCBT) is still limited. Recently, we compared the clinical effectiveness of unsupported, online CCBT with treatment as usual (TAU) and a combination of CCBT and TAU (CCBT plus TAU) for depression. The study is registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236). AIMS: To assess the cost-effectiveness of CCBT compared with TAU and CCBT plus TAU. METHOD: Costs, depression severity and quality of life were measured for 12 months. Cost-effectiveness and cost-utility analyses were performed from a societal perspective. Uncertainty was dealt with by bootstrap replications and sensitivity analyses. RESULTS: Costs were lowest for the CCBT group. There are no significant group differences in effectiveness or quality of life. Cost-utility and cost-effectiveness analyses tend to be in favour of CCBT. CONCLUSIONS: On balance, CCBT constitutes the most efficient treatment strategy, although all treatments showed low adherence rates and modest improvements in depression and quality of life. http://repub.eur.nl/res/pub/21001/ 2010-01-01T00:00:00Z Objective: To report the one-year follow-up results of computerized cognitive behavioural therapy (CCBT), offered online without professional support, for depression compared with usual GP care and a combination of both treatments. To explore potential relapse prevention effects of CCBT. Methods: 303 depressed patients were randomly allocated to (a) unsupported online CCBT (b) treatment as usual (TAU), or (c) CCBT and TAU combined. We had a 12-month follow-up period. Primary outcome measure was the Beck Depression Inventory II. Self-reported health care use was also measured. Key findings: At 12 months, no statistically significant differences between the three interventions are found in the intention-to-treat population for depressive severity, reliable improvement, remission, and relapse. In the first quarter, differences in health care consumption between the three interventions are significant (i.e. less GP contacts, less antidepressant medication, and less specialist mental health care in the CCBT group), but these differences disappear over time. Conclusions: Unsupported online CCBT is not superior to TAU by a GP for depression. With equal effects, CCBT alone leads to less health care consumption than TAU and CCBT&TAU. Overall effects are modest in all interventions, which can be explained by the finding that the use of health care services decreases despite the lack of substantial improvements. http://repub.eur.nl/res/pub/25358/ 2009-07-01T00:00:00Z Background: Computerised cognitive-behavioural therapy (CCBT) might offer a solution to the current undertreatment of depression. Aims: To determine the clinical effectiveness of online, unsupported CCBT for depression in primary care. Method: Three hundred and three people with depression were randomly allocated to one of three groups: Colour Your Life; treatment as usual (TAU) by a general practitioner; or Colour Your Life and TAU combined. Colour Your Life is an online, multimedia, interactive CCBT programme. No assistance was offered. We had a 6-month follow-up period. Results: No significant differences in outcome between the three interventions were found in the intention-to-treat and per protocol analyses. Conclusions: Online, unsupported CCBT did not outperform usual care, and the combination of both did not have additional effects. Decrease in depressive symptoms in people with moderate to severe depression was moderate in all three interventions. Online CCBT without support is not beneficial for all individuals with depression. http://repub.eur.nl/res/pub/17201/ 2009-01-01T00:00:00Z BACKGROUND: The Diagnostic Inventory for Depression (DID) is a new self-report questionnaire based on the DSM-IV inclusion criteria for a major depressive disorder. AIM: To analyse the Dutch translation of the DID and examine the psychometric properties of the inventory. METHODS: We conducted a large-scale internet-based screening among the general population. RESULTS: Reliability, convergent validity and factor structure were good. The DID-NL may classify participants accurately. CONCLUSION: The results look promising and the DID-NL can give added value to existing questionnaires. However, since the classification potential has not yet been sufficiently demonstrated, a clinical interview will still be needed. http://repub.eur.nl/res/pub/17940/ 2009-01-01T00:00:00Z BACKGROUND: The Diagnostic Inventory for Depression (DID) is a new self-report questionnaire based on the DSM-IV inclusion criteria for a major depressive disorder. AIM: To analyse the Dutch translation of the DID and examine the psychometric properties of the inventory. METHODS: We conducted a large-scale internet-based screening among the general population. RESULTS: Reliability, convergent validity and factor structure were good. The DID-NL may classify participants accurately. CONCLUSION: The results look promising and the DID-NL can give added value to existing questionnaires. However, since the classification potential has not yet been sufficiently demonstrated, a clinical interview will still be needed. http://repub.eur.nl/res/pub/36260/ 2007-08-01T00:00:00Z Objective: Research in general practice has grown considerably over the past decades, but many projects face problems when recruiting patients. Lasagna's Law states that medical investigators overestimate the number of patients available for a research study. We aimed to assess factors related to success or failure of recruitment in general practice research. Study Design and Setting: Survey among investigators involved in primary care research in The Netherlands. Face-to-face interviews were held with investigators of 78 projects, assessing study design and fieldwork characteristics as well as success of patient recruitment. Results: Studies that focused on prevalent cases were more successful than studies that required incident cases. Studies in which the general practitioner (GP) had to be alert during consultations were less successful. When the GP or practice assistant was the first to inform the patient about the study, patient recruitment was less successful than when the patient received a letter by mail. There was a strong association among these three factors. Conclusion: Lasagna's Law also holds in Dutch primary care research: many studies face recruitment problems. Awareness of study characteristics affecting participation of GPs and patients may help investigators to improve their study design.