Trimbos Institute

Introduction: Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for depression of which the acute and short-term effects have been studied extensively.However, much J o u r n a l P r e -p r o o f less is known about the long-term effectiveness of rTMS.This paper aims to investigate the long-term effects of rTMS and antidepressant medication in patients with moderate treatment-resistant depression (2 treatment trials).Methods: Naturalistic follow-up data was collected for twelve months as part of a clinical trial comparing rTMS and antidepressant medication.Response and remission based on the Hamilton Depression Rating Scale (HDRS-17) were calculated for both groups at end of treatment, as well as at four-, six-, nine-and twelve-months follow-up.Furthermore, the sustained effects of both treatments on anxiety, anhedonia, and rumination were investigated.Results: At the end of treatment, response and remission rates were higher in the rTMS group (40.9% and 29.5%) than in the medication group (18.8% and 6.3%).69% of the patients in the medication group received treatment with rTMS at some point during the follow-up period.Response and remission remained relatively stable over 12 months in both groups.Sustained response was observed in the majority of rTMS and medication responders for whom data was available for the full follow-up period.Conclusion: Our findings provide insights into the naturalistic long-term effects of rTMS and antidepressant medication in patients with moderate treatment-resistant depression.

Longitudinal studies that visualise individual trajectories of depressive and/or anxiety disorders can inform prevention and treatment strategies. Participants of the Netherlands Mental Health Survey and Incidence Study (NEMESIS) were assessed at four timepoints from 2007-2009 to 2016-2018 (N=6646 at baseline). DSM-IV disorders were assessed using the Composite International Diagnostic Interview. Onset and course trajectories were visualised with Sankey diagrams and summarised in incidence, remission, recurrence, and persistency rates, considering presence of any depressive or anxiety disorder as outcome. Among those without a lifetime depressive or anxiety disorder at baseline, 13% developed a depressive and/or anxiety disorder over 9years, with higher rates in women and younger adults. Recurrence rates over 9years were 28% for depressive, 26% for anxiety, and 38% for comorbid disorders. For those with a current disorder at baseline, recurrence (including persistence) was 33%, 31%, and 51%, respectively. Course trajectories were similar across sexes but less favourable for younger adults with a disorder history. Between 31% and 51% of persons with a current depressive and/or anxiety disorder do not remit over 9years. This highlights the need for long-term treatment strategies, including ongoing monitoring, management, and relapse prevention.

ABSTRACT Depression is a mental disorder with a high lifetime prevalence and one of the leading causes of disability worldwide. As many patients experience another depressive episode after being treated, predictive monitoring for the risk of relapse is essential for healthcare professionals to be able to follow up on patients and intervene early. However, automatically monitoring these large groups requires additional considerations going beyond predictive performance, such as data availability and interpretability. In the present paper, we study the suitability of using readily available administrative data for this prediction task. We contrast a logistic regression model containing only a small number of predictors on demographics, medication, and estimated depression severity with regularized regression and XGBoost models incorporating a large number of predictors describing individual treatment and social information. Our results demonstrate that the inclusion of more detailed input does not result in a significant improvement in performance when compared to simpler regression models. In similar data types, we therefore recommend to primarily focus on a small interpretable model.

IntroductionSuicide has a substantial economic burden, yet in low- or middle-income countries, the analysis is constrained by the absence of disaggregated economic data. Existing studies primarily rely on gross costing methods, overlooking sector-specific costs such as healthcare, law enforcement and productivity losses at the family and community levels. Furthermore, the societal perspective, essential for understanding the multifaceted economic impacts of suicide, remains insufficiently explored in the Indian context.Methods and analysisThis study will quantify the economic burden of suicide and suicide attempts in India. The initial phase will involve developing a resource-use measure instrument to capture the societal costs associated with suicide. Subsequently, a retrospective, incidence-based study will be conducted in India using the developed instrument. This will also be complemented with the Health-Related Quality of Life Assessment using EuroQOL (EQ-5D-5L). Exploratory subgroup cost comparisons (eg, suicide methods, healthcare facility type) will use non-parametric tests, including the Mann–Whitney U and Kruskal–Wallis tests. Generalised linear mixed models (gamma distribution and log link) will analyse longitudinal cost and HRQoL data, besides bootstrapping techniques and sensitivity analyses.Ethics and disseminationEthics approval was obtained for the study from the institutional review board of the Indian Law Society (ILS/141/2024). All data collected during the study will adhere to ethical guidelines, taking informed consent. The findings of the study will be disseminated through peer-reviewed journals to aid data-driven decision-making.Trial registrationClinical Trial Registry of India (CTRI/2025/02/080380), date of registration: 12/02/2025.

BackgroundAfter remission of a first-episode psychosis (FEP), antipsychotic discontinuation is associated with an increased risk of relapse compared to maintenance treatment. We studied short and longer-term effects of discontinuation of D2 receptor (D2R) antagonist and partial agonist antipsychotics on striatal dopamine D2/3R availability in FEP patients.MethodsRemitted FEP patients underwent two [11C]raclopride PET scans to measure striatal D2/3R availability: 1 week after antipsychotic discontinuation (n = 16 antagonist users, n = 6 partial agonist users) and after being medication free for 6–8 weeks (n = 8 antagonist users, n = 5 partial agonist users). Fifteen matched healthy controls were scanned once. Psychotic relapse was monitored up to 12 months after discontinuation.ResultsOne week after discontinuation, D2R antagonist discontinuers showed higher striatal binding potential (BPND) than partial D2R agonist discontinuers (p < 0.001, CI = 0.749 to 1.681) and controls (p = 0.045, CI = 0.008 to 0.708), while partial agonist discontinuers had significantly lower BPND than controls (p = 0.001, CI = -1.326 to -0.386). 6-8 weeks after discontinuation, former antagonist users showed similar BPND to controls (p > 0.25), whereas former partial agonist users had higher BPND than controls (p = 0.027, CI = 0.069 to 1.085). Participants who discontinued antagonists relapsed more often (81%) than those who discontinued partial agonists (17%)(χ2 = 5.32, p = 0.021).ConclusionsDiscontinuation of partial D2R agonists may affect D2/3R availability differently than discontinuation of antagonists, which might explain the greater relapse risk after tapering antagonists than partial agonist antipsychotics.

Previous cross-sectional research provided evidence for a relationship between environmental tobacco smoke (ETS) exposure and symptoms indicative of nicotine dependence in adolescent never- and experimental smokers. This study aims to examine temporal associations between nicotine dependence-like symptoms and ETS exposure, and whether this differs between never- and experimental smokers. Ecological momentary assessment data were collected in a sample of Dutch adolescent never-smokers (n=105; Mage=14.48; 30.5% male) and experimental smokers (n=72; Mage=16.57; 30.6% male). Participants self-rated dependence-related symptoms (pleasant, unpleasant, autonomy over smoking, dizziness, wanting, withdrawal-related symptoms) and ETS exposure three times a day for three weeks. Binomial generalized linear mixed effects models were applied examining 1) the association between ETS exposure and symptoms within the same interval, 2) whether ETS exposure precedes symptoms, and 3) vice versa. Analyses revealed a positive association between unpleasant symptoms and ETS exposure during ETS exposure for never-smokers. The experimental smokers experienced less autonomy over smoking within the same time interval, less wanting shortly after ETS exposure and fewer pleasant symptoms in the interval preceding ETS exposure. We did not find that ETS exposure precedes dependence-like symptoms. Temporal effects of ETS exposure differ between never- and experimental smokers. ETS exposure has a potentially aversive effect in never-smokers, while in experimental smokers may potentially contribute to developing nicotine dependence. Future research should increase the frequency of momentary assessments to investigate the processes in more detail.

Objectives Transitioning into adulthood (including adult healthcare) is challenging for adolescents with mild intellectual disability (MID) and mental health problems. This qualitative study investigates the transition experiences of these youths and their parents’, in order to optimize support. Methods Nine youths (aged 16–28) and four parents were interviewed. Questions concerned expectations of, or experiences with, the transition and associated problems or positive aspects. Inductive thematic analysis was used. Results Youths and parents described many changes across various life domains, which caused high levels of stress. Timely preparations, information, and practical support facilitated a successful transition. Participants emphasized the need for continuity of care and autonomy. Conclusions Preparations for the transition are recommended to be initiated at the age of 16. These should include: providing practical information, discussing changes in responsibilities, and engagement of the support network. Youths with MID and mental health problems prefer to be involved in decision making after being properly informed by professionals.

BackgroundPeople with severe mental illness (SMI) commonly have chronic physical illnesses (CPI) and multimorbidity (CPM). The study aimed to investigate the association between mental health, healthcare utilization, and physical comorbidities in SMI patients affected by the double disasters in Croatia (two earthquakes and the COVID-19 pandemic), and identify predictors of CPI and CPM in this population.MethodA prospective study was conducted among 90 SMI patients at two-time points: May/June, 2020 (first COVID-19 wave and earthquake) and December, 2020/January, 2021 (second COVID-19 wave and earthquake).ResultsAt the first study point, the CPM group showed significantly higher severity of insomnia (p=.003; mean ISI scores (SD): 5.60(4.360), 9.47(6.802), and 10.83(8.026) for no-comorbidity group, CPI and CPM respectively), while CPI group showed higher perceived stress levels (p=.026; mean PSS scores (SD): 18.21(6.882), 22.32(4.619) and 21.67(3.343) for no-comorbidity group, CPI and CPM respectively) compared to the no-comorbidity group. CPI (5/18) and CPM (10/23) groups visited other specialized non-mental health care services significantly more frequently than those without comorbidity (7/46) (χ2 = 6.557, p=.038). A lower score of perceived social support by friends predicted CPI (OR=0.549; 95% CI:0.349-0.864; p=.010, corrected p=.04), but a higher score on alexithymia subscale “difficulty identifying feelings” predicted CPM (OR=1.235; 95% CI:1.071-1.424; p=.002, corrected p=.004).ConclusionPeople with SMI and CPI are especially vulnerable during the COVID-19 pandemic and disasters, as it affects their mental and physical health, leading to increased healthcare utilization. An integrated approach to treating SMI and CPI is necessary for the emergency health response.

Our aim was to find out which social and psychological factors characterize forensic psychiatric patients who have committed family homicide with revenge as a reason as compared to subjects who committed family homicide with other motives. Qualitative research was carried out on the basis of pre-trial forensic assessment reports of existing cases (N=20), divided between Revenge and No-Revenge cases. In case of revenge, violence was almost always a sort of settling of an interpersonal score. Psychotic symptomatology was absent in the Revenge cases, personality problems (particularly borderline and narcissistic traits) were common. Demoralization because of a decline of well-being seems to be an important factor pushing some persons with such vulnerabilities over the edge. Our expectation is that, at least in a certain proportion of (non-psychotic) patients, there will be more brooding on revenge than the psychotherapist suspects.