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Towards a better understanding of the psychological processes which lead to the incidence of depressive disoders: a prospective study Schedule • Theoretical and practical framework • Research design • Discussion, remarks and questions Prevalence of mood disorders (%) Men Women Total Last year Ever Last year Ever Last year Ever Mood disorders 5,7 13,6 9,7 24,5 7.6 19,0 •Depressive disorder 4,1 10,9 7,5 20,1 5,8 15,4 •Dysthymic disorder 1,4 3,8 3,2 8,9 2,3 6,3 •Bipolar disorder 1,1 1,5 1,1 2,1 1,1 1,8 •Minor depression 7,5 Andrews et al. (2004) • Current situation in treatment mood disorder: – Coverage: 60%. – Effective coverage: 34% – Result: 15% YLD averted • Possible maximum with evidence based treatment – Coverage: 100% – Effective coverage: 100% – Result: 35% YLD averted Prevention • Prevention to reduce the burden of disease • Universal prevention seems to have little effect • Conclusion: selective prevention! – Selecting: who and when? – There’s a gap in emperical knowledge of processes which lead to the incidence of depression Alloy at al. (1999 & 2006) • Prospective study • Diagnostic interview • High Risk approach • But: – Just cognitive model – Participants with lifetime depressive disorder in study Research design • • • • • Testing different theoretical models High Risk approach Diagnostic interview First-ever incidence Prospective (longitudinal) study Theoretical models: crietria • De model should be clearly described in the existing literature. • There is (some) emperical support for the model. • It is possible to operationalize the key elements of the model. • Preferably, there’s an association between the model and an intervention for depression. Theoretical models • Learned helplessness-theory (Abramson et al., 1978) • Cognitive theory (Beck, 1967 & 1976) • Theory of the ruminating response style (Nolen-Hoeksema, 1993 & 2000) • Attachment theory (Bowlby, 1969 & 1988) • Behavioral theory (Lewinsohn, 1985) • Interpersonal theory (Joiner, 2002) High Risk approach • Large group of first-year students is invited to fill out an online questionnaire • High Risk-group is selected for participation in the study • Low Risk-group is selected as a controlgroup High Risk approach Measured concepts (risk): – – – – – – Self Esteem (RSES; Rosenberg, 1965) Mastery (Mastery Scale; Pearlin & Schooler, 1978) Automatic Thoughts (ATQ; Hollon & Kendall, 1990) Worrying (PSWQ; Meyer et al., 1990) Attachment Style (AAS; Collins & Read, 1990) Childhood trauma and parental psychopathology (Subscale of NEMESIS questionnaire; Bijl et al., 1998) High Risk approach • Measured concepts (other) – Depressive symptoms (CES-D; Ensel, 1986) – Anxiety symptoms (HADS; Zigmond & Snaith, 1983) – Neuroticism (NEO-FFI; Costa & McRea, 1992) – Demografic characteristics High Risk approach • Every concept is measured by a questionnaire • Of every ‘risk’questionnaire the 10% participants scoring highest is selected (HR-group, ±50% of respondents) • Participants scoring among the 60% lowest scores of every questionnaire are selected (LR-group, ±15% of respondents) Diagnostic interview • Depressive and anxiety disorders are measured with the CIDI-interview (WHO, 1997) • Interview at baseline Incidence Only first-ever cases are included. Participants without a current or lifetime diagnoses of depression are included in the study Research design: prospective study Participants will be followed for 2 years • Every 6 months a measurement (total of 5): – At baseline, after 1 and 2 years participants fill out a questionnaire and are interviewed – In between, participants fill out a questionnaire every 6 months Preliminary results • 481 of the 2815 invited students filled out the questionnaire • Of 481 participants ±50% are in the HR-group and ±15% in the LR-group • 214 partcipants were interviewed • 152 of the interviewed participants did not have a depressive disorder (current or lifetime) • 115 participants are included in the study up ‘till now Preliminary results • At this moment, we’re still including participants (participants are filling out questionnaires and are being interviewed) • We hope to include 300 participants and follow them for 2 years • First follow-up measurement: end of april Discussion Questions or remarks?