Introduction: Relatively little research has assessed predictors of both treatment outcomes and attrition in binge eating disorder (BED) treatment. Even fewer studies did so for digital forms of...Show moreIntroduction: Relatively little research has assessed predictors of both treatment outcomes and attrition in binge eating disorder (BED) treatment. Even fewer studies did so for digital forms of therapy. This study thus aims to contribute to the current pool of knowledge by examining the predictive value of various variables in a recently developed digital BED-treatment: BED-online. Methods: This study was part of a RCT into the effects of BED-online therapy. Participants were over the age of 18, Dutch-speaking and diagnosed with the DSM-V BED. A total of 180 participants were found to be eligible, of whom 40 (22.2%) dropped-out before the last session. Post-treatment measurements from an interview (EDE) and a self-report questionnaire (EDE-Q) were used to determine the immediate treatment effects. A follow-up (24 weeks post-treatment) EDE-Q measurement determined the long-term effects. These variables served as the dependent variables in three different hierarchical linear regression analyses. A fourth logistical regression analysis was conducted, where treatment-related drop-out formed the dependent variable. The following eight predictor variables were chosen based on literature research: ethnicity, age, gender, educational level, comorbidity, frequency of binge eating episodes, levels of BED pathology and treatment condition. The predictor variables served as the independent variables. Results: BED pathology at baseline was found to be the only significant predictor of treatment outcomes as measured by the EDE (β=.41, t=3.71, p<.001), EDE-Q (β=.57, t=8.23, p<.001) and at follow-up (β=.47, t= 6.24, p< .001). Attrition could be predicted by both ethnicity and gender, where males were 5.63 times more likely to discontinue treatment prematurely (OR=5.63, 95%CI [1.81, 17.53]) and participants born abroad were 3.91 times more likely to discontinue treatment (OR=3.91, 95%CI [1.43, 8.76]). Other independent variables did not significantly contribute to the final regression models. Discussion and conclusion: All predictor variables are discussed in detail, reflecting on the results found and comparing them to findings of previous studies. Limitations are elaborated in depth. Due to these limitations, and the modest number of previous studies, further research is encouraged, exploring both the current and other dependent variablesShow less
Psychological tests are often used to make important decisions about a patient’s trajectory. A high-quality test is characterized by norms that allow meaningful interpretation of the raw scores....Show morePsychological tests are often used to make important decisions about a patient’s trajectory. A high-quality test is characterized by norms that allow meaningful interpretation of the raw scores. With normed scores an individual’s performance can be evaluated properly by taking into account the influence of relevant individual characteristics, such as age, gender, education level or socio-economic status. From several norming techniques, regression-based norming has proven to be most efficient one and especially useful when including more than one demographical predictor variable. Recently, the R package GAMLSS has been proposed as a framework for this technique. It is an exhaustive family of flexible models that may fit a wide variety of empirical data. This research investigated the performance of GAMLSS compared to traditionally used approaches of multiple regression-based norming. Both techniques were applied to data of the Brief-Symptom Inventory, which was collected in a sample representative of the Dutch population (N = 1662). Age and gender were taken into account as normpredictors. The approaches showed very high correspondence, expect for a deviation of GAMLSS-based scores in the lower score ranges. None of the two approaches was able to properly capture the relationship between raw scores and age. GAMLSS-based norms did not outperform the regression-based approach. They can be considered equally suitable but in practice the complexity of the GAMLSS approach makes it less convenient. However, its flexibility could be advantageous when applied to tests that are heavily dependent on continuous norm predictors.Show less
Waiting time for treatment in Dutch mental healthcare is increasing. General practitioners substantially deviate from the allocation guideline which seems to contribute to the increase of waiting...Show moreWaiting time for treatment in Dutch mental healthcare is increasing. General practitioners substantially deviate from the allocation guideline which seems to contribute to the increase of waiting time. This study aimed to investigate whether undertreatment can be beneficial for patients and the MHC system. In addition, this study aimed to identify characteristics of undertreated patients that suffered unfavorable undertreatment based on clinical data and clinical judgement by general practitioners. Data was obtained in a naturalistic environment in a mental healthcare institution in the Netherlands and patients received treatment as usual. A total of 6193 electronic patient records were included. Exclusion criteria and missing data left 1057 cases eligible for analyses. A one-way ANOVA and a forward hierarchical binary logistic regression were conducted to investigate both aims. Results showed that undertreatment relates to worse treatment outcomes in comparison to patients in S-MHC. Unfavorable undertreatment was best predicted by waiting time and level of pre-treatment functioning. Longer waiting time is related to the need for more specialized care. Also, lower levels of pre-treatment functioning is related to the need for more specialized care. B-MHC care for undertreated patients must be improved. GPs seem to have valid reason to deviate from the allocation guideline. The allocation guideline could benefit from the addition of variables based on clinical judgement. To provide the care that undertreated patients need, treatment in B-MHC could be prolonged to match outcomes in S-MHC. Another solution could be to limit the negative effects during waiting time for patients.Show less
Background: The societal lockdown due to COVID-19 forced a change from in-person therapy to videoconferencing, which was introduced on March 16, 2020. Swift implementation of telehealth care was...Show moreBackground: The societal lockdown due to COVID-19 forced a change from in-person therapy to videoconferencing, which was introduced on March 16, 2020. Swift implementation of telehealth care was asked of therapists all over the country. Aim: To investigate whether the effects of treatment for personality disorders through videoconferencing were lower than through in-person therapy. Method: Patients who received treatment between January 2018 and May 2021 were divided into three groups, before (1), partially (2) and entirely during COVID-19 (3). With the ROM score OQ-45 SD as pre- and posttest measurements, a general linear model repeated ANOVA was conducted. We controlled for other variables that were potentially of influence on the achieved outcomes. Results: The hypothesis was not confirmed by the results. The results rather suggested that treatment through videoconferencing was more effective than treatment (predominantly) conducted through in-person. Conclusion: No evidence was found supporting the hypothesized diminished effects of treatment for personality disorder through videoconferencing. Videoconference therapy appeared non-inferior to face-to-face therapy for the treatment of personality disorders. The groups did not differ at the onset. However, treatments were shorter and the dropout rate was 15% higher in the videoconferencing group, which could have led to selection bias. Keywords: Personality disorder; COVID-19; treatment outcome; videoconference therapy; face-to-face therapy; observational design.Show less
Empathic accuracy and eye contact form the foundation of everyday human social interaction. Here, the association between the duration of eye gaze fixation of the perceiver on the eye region of the...Show moreEmpathic accuracy and eye contact form the foundation of everyday human social interaction. Here, the association between the duration of eye gaze fixation of the perceiver on the eye region of the target and the level of empathic accuracy when presented with dynamic emotional video stimuli was examined and it was determined whether gender plays a role in this association. In this study, 110 participants had their gaze behavior tracked while watching ten 180-seconds during videoclips of strangers telling an emotional autobiographical story. Participants had to rate the target’s feelings at the moment of recording the videoclip and their own feelings. It was hypothesized that people that spend more time fixating on the eye region of strangers have a higher level of empathic accuracy than people that spend less time fixating on the eye region of strangers and that this relationship differs between males and females. Linear regression analyses did not reveal significant evidence for a relationship between eye gaze behavior and empathic accuracy that is moderated by gender. Gaining more insight in the topic of eye gaze behavior, gender and empathic accuracy is still so valuable for the improvement in treatment for empathy-related difficulties and atypical gaze patterns that some individuals have to deal with in their daily life.Show less
Recent research has only shown little evidence for a relationship between patient characteristics and treatment outcome. It is proposed that patients with a higher need of Mental Health Care due to...Show moreRecent research has only shown little evidence for a relationship between patient characteristics and treatment outcome. It is proposed that patients with a higher need of Mental Health Care due to higher psychopathologic complexity receive more treatment compared to others to reach a comparatively good treatment result. The treatment dose in more complex patients might therefore be significantly higher than in less complex patients. According to that, treatment dose should mediate the relationship between complexity and outcome. Thereby, the main purpose of this study is the investigation of a proposed mediation effect by treatment dose, operationalized as treatment duration in minutes and treatment length in days. Clinical Complexity was based on the degree of psychopathological severity and treatment outcome was measured with the self-report questionnaire Outcome Questionnaire-45. This investigation is based on a sample of patients in ambulatory treatment, who suffer from anxiety disorders, originated from the GGZ institution Arkin, an MHC provider in the Netherlands. Finally, no mediation effect has been shown and no evidence for an existent triadic relationship between complexity, outcome and treatment dose has been found. Besides, treatment duration correlated positively with complexity. Patients with higher complexity also tend to have a less favorable treatment outcome compared with patients of lower complexity. The results of this study should be interpreted and dealt with caution due to potential threats to internal and external validity. In future research alternative complexity and treatment dose indicators need further investigation to assess the prognostic value of patient characteristics for treatment outcome.Show less
Background: Questionnaires for anxiety disorders come in different lengths, scales and with varying interpretation guidelines. This may hamper therapist-patient communication when discussing the...Show moreBackground: Questionnaires for anxiety disorders come in different lengths, scales and with varying interpretation guidelines. This may hamper therapist-patient communication when discussing the score and the interpretation of where a patient can be placed on a severity scale. Expressing scores on a standardized common metric can facilitate the communication between therapist and patient. This thesis aims for a method that enables an easier interpretation of scores and in addition produces scores with a normal distribution. Method: Using the data of four anxiety questionnaires, namely the Brief Scale for Anxiety (BSA), the PADUA Inventory Revised (PI-R), the Panic Appraisal Inventory (POL/PAI) and the Impact of Events Scale Revised (IES-R), theta-based T-scores were calculated with the Item-Response Theory and deployed as a basis for crosswalk tables to look up T-scores from raw scores. Based on these crosswalk tables, transformation formulas were established to calculate T-scores. To validate these, calculated T-scores were compared to theta-based T-scores. Results: Most of the calculated T-scores had a normal distribution and the correlations between both methods to arrive at the T-scores were significant, the highest correlation was found for the BSA and the IES-R. Discussion: Due to a significant correlation and a large sample size a new method to arrive at a common metric was established by linking every raw score on a T-score metric. This provides a way to facilitate the interpretation and discussion of outcome scores. Further, with this new method disorder severity can be calculated and looked up due to tangible cut-off scores.Show less
Background: Brua is an Afro-Caribbean set of spiritual beliefs found on the ABC Islands (Aruba, Bonaire, and Curaçao), which are part of the Dutch Antilles. Psychiatric patients from these islands...Show moreBackground: Brua is an Afro-Caribbean set of spiritual beliefs found on the ABC Islands (Aruba, Bonaire, and Curaçao), which are part of the Dutch Antilles. Psychiatric patients from these islands may believe that their mental health is influenced by Brua-related practices. It is therefore important that mental health professionals are knowledgeable of Brua, but it is not yet known to what extent they are. Goal: This study investigated the knowledge of Brua among psychologists, psychiatrists, and psychiatrists in training in The Netherlands. Methods: All psychologists, psychiatrists, and psychiatrists in training in the service of Parnassia Psychiatric Institute were contacted to fill out a tailor-made survey on knowledge of Brua. Sufficient knowledge of Brua was defined as a score of 6 or higher out of 10. Three potential predictors of knowledge of Brua were investigated, namely work experience, ethnicity, and inquiry into religious beliefs in the clinical practice. Results: Out of the 152 participants, 13.2% scored a sufficient score on knowledge of Brua. Work experience did not predict total score on the survey. There were too few participants of non-Caucasian ethnicities to investigate the relationship between ethnicity and knowledge of Brua. Practitioners who often inquired into religious beliefs in the clinical practice did not score higher than practitioners who sometimes inquired into religious beliefs. Conclusion: Knowledge of Brua among psychologists, psychiatrists, and psychiatrists in training in The Netherlands is limited. Informational or educational campaigns on how to assess the role of Brua in clinical practice are recommended.Show less
One-sided premature termination of the treatment may generate serious implications to patients and health system in general. Patients not recover fully or sufficiently to qualify for good end-state...Show moreOne-sided premature termination of the treatment may generate serious implications to patients and health system in general. Patients not recover fully or sufficiently to qualify for good end-state criteria; treatments that did not work or had to be repeated because of insufficient sessions attended increase waiting list times; early phases of treatment cost a considerable amount of money and resources. All this is likely to not pay off, since a larger number of sessions significantly correlates with improvement from PTSD and depression and an average number of sessions attended by early responders is between 6-7. The aim of this study is to investigate in which phase of the treatment do most of the dropouts occur, which patient and clinical factors are associated with the dropout and whether various types of treatment modality have different dropout rates. Sample contains 3084 patients getting treatment for post-traumatic stress disorder in Sinai center in Amsterdam. Bivariate regression analyses were conducted to examine relationship between demographic, clinical ant treatment variables in treatment dropouts and completers. Out of 3084 patients 2369 (76.8%) patients successfully completed the treatment, 715 (23.2%) dropped out, from those, 78 patients dropped out early. Contrary to predictions, more dropouts took place in later stages. Analysis showed that age was the only significant predictor variable of dropout.Show less
Although there are indications that parental anxiety is related to the development of anxiety among children, direct evidence for the specific mechanisms that underlie the parent-child transmission...Show moreAlthough there are indications that parental anxiety is related to the development of anxiety among children, direct evidence for the specific mechanisms that underlie the parent-child transmission of anxiety is limited. The interaction between anxious parents and their infant is a potentially important mechanism for the transmission of fear from the parent to the infant. This study aims to investigate the relationship between parental anxiety (mothers and fathers) and infants’ attention bias towards fearful faces (vs. happy faces). Both mothers (N = 155) and fathers (N = 74) were included in the study and parental anxiety was measured with the DASS questionnaire. Attention bias towards fearful faces (vs. happy faces) was measured with an eye-tracker in infants between 5 and 19 months old (N = 220; 112 girls, 108 boys). Results show that infants looked longer at fearful faces than at happy faces. However, no relation between parental anxiety and infants’ attention bias towards fearful faces was found. Moreover, the gender of the parent did not influence the relationship between parental anxiety and an infant’s attention bias. The findings do not support the notion that attention bias in infants is a mechanism that could explain the transmission of anxiety from parents to their children. Our study contributes to the literature about the transmission of anxiety from parents to their children and the role of infants’ attention bias in this transmission.Show less
Background: Translating scores to a common metric provides advantages that support the applied collaborative care model in the Netherlands. McCall's T-score is frequently used, and the optimal...Show moreBackground: Translating scores to a common metric provides advantages that support the applied collaborative care model in the Netherlands. McCall's T-score is frequently used, and the optimal approach to obtain this score is through Item Response Theory (IRT). However, IRT is complicated, requires dedicated software, and a large dataset. This study aimed to validate an alternative procedure to obtain T-scores from IRT. Methods: This study used data from an existing study, which comprised a population-based sample and a patient sample. We estimated the relation between raw scores and IRT-based T-scores with curve fitting and established conversion formulas to transform raw scores into calculated T-scores. We illustrated the process with raw scores from the Beck Depression Inventory, the Inventory of Depressive Symptomatology - Self Rated, and the Montgomery-Åsberg Depression Rating Scale. We performed a correlational analysis to assess the validity of the calculated T-scores. We also determined cut-off values using ROC analysis. Results: The curve-fitting procedure resulted in third-order polynomial regression equations to use as conversion formulas. The validity of calculated T-scores was supported by their high correlation with theta-based T-scores. ROC analysis provided cut-off values, which were comparable to the previous studies, using raw scale scores. Conclusion: The curve-fitting procedure yielded sufficiently valid calculated T-scores for all instruments in comparison to the theta-based T-scores from IRT. The resulting cut-off values demonstrated that calculated T-scores were able to distinguish patients from the general population. The practical use of the results is discussed.Show less
