Anneloes Ravelli

Bio: Anneloes Ravelli is an academic researcher from Utrecht University. The author has contributed to research in topics: Population & Mental health. The author has an hindex of 6, co-authored 7 publications receiving 1940 citations.

Psychiatric morbidity, service use, and need for care in the general population: results of The Netherlands Mental Health Survey and Incidence Study.

Abstract: OBJECTIVES: This study examined the use of primary health care, mental health care, and informal care services, as well as unmet care needs, by individuals with different psychiatric diagnoses. METHODS: Data were derived from the Netherlands Mental Health Survey and Incidence Study and were based on a representative sample (n = 7147) of the general population (aged 18-64 years). RESULTS: In a 12-month period, 33.9% of those with a psychiatric disorder used some form of care; 27.2% used primary care, and 15.3% used mental health care. Patients with mood disorders were the most likely to enlist professional care; those with alcohol- and drug-related disorders were the least likely to do so. Higher educated persons who live alone, single parents, unemployed persons, and disabled persons were more likely to use mental health care. Unmet need for professional help was reported by 16.8% (men 9.9%, women 23.9%) of those with a disorder. CONCLUSIONS: Care use varies widely by diagnostic category. The role of general medical practitioners in treating persons with psychiatric disorders is more limited than was anticipated. Patients in categories associated with extensive use of professional care are more likely to have unmet care needs.

Psychiatric and Sociodemographic Predictors of Attrition in a Longitudinal Study The Netherlands Mental Health Survey and Incidence Study (NEMESIS)

Abstract: This article discusses the effects of sociodemographics and the presence of psychiatric disorders diagnosed in the 12 months before the first interview by using the Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R, third edition, revised, on three types of attrition (failure to locate, refusal to participate, morbidity/mortality) in the second wave (1997-1998) of the Netherlands Mental Health Survey and Incidence Study, a longitudinal, general population survey of psychopathology among 7,076 subjects aged 18-64 years. Compared with those reinterviewed successfully, persons not located at the 1-year follow-up (n = 219) were more often younger, poorly educated, urban, not cohabiting with a steady partner, and born outside the Netherlands. Refusers (n = 923) had a lower educational level. Morbidity/mortality (n = 72) was associated with higher age, lower educational level, not being employed, and somatic disorders. After adjustment for sociodemographics, none of the disorders was positively associated with refusal. Failure to locate was linked to agoraphobia, alcohol abuse, and the categories of mood, substance use, and eating disorders. Morbidity/mortality was linked to dysthymia, agoraphobia, simple phobia, obsessive-compulsive disorder, and the category of anxiety disorders. Overall attrition was only slightly higher among respondents with one or more disorders (odds ratio = 1.20, 95% confidence interval: 1.04, 1.38). Thus, psychopathology has only weak-to-moderate effects on attrition and is mainly related to failure to locate and morbidity/mortality but not to refusal.

Predictors of first incidence of DSM-III-R psychiatric disorders in the general population: findings from the Netherlands Mental Health Survey and Incidence Study.

Abstract: de Graaf R, Bijl RV, Ravelli A, Smit F, Vollebergh WAM. Predictors of first incidence of DSM-III-R psychiatric disorders in the general population: findings from the Netherlands Mental Health Survey and Incidence Study. Acta Psychiatr Scand 2002: 106: 303–313. © Blackwell Munksgaard 2002. Objective: To investigate determinants of 12-month first incidence of DSM-III-R mood disorder (MD), anxiety disorder (AD) and substance use disorder (SUD) in the general population. Method: Data are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective epidemiologic study in which a representative sample of 7076 adults aged 18–64 years were interviewed with the Composite International Diagnostic Interview. New cases diagnosed 12 months after baseline were compared with never diagnosed controls on sociodemographic and psychosocial variables. Results: Multivariate, the only demographic variable associated with incidence of MD was female gender. The strongest predictors were negative life events and ongoing difficulties. High level of neuroticism was also associated. Incidence of AD was likewise predicted by female gender. Negative life events and ongoing difficulties were also significant predictors, though weaker than for MD. Incidence of SUD was more common among males, young adults, people not living with a partner and those experiencing positive life events. Conclusion: Incident MD and AD were predicted more strongly by life events, and SUD more strongly by demographic factors.

Gender and age-specific first incidence of DSM-III-R psychiatric disorders in the general population. Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS).

Abstract: Background Prospective studies in the general population are needed to identify risk factors for mental disorders. Samples of sufficient size are needed, but large-scale studies that assess the incidence of psychopathology are rare. Aims The aim of this study was to investigate the 12-month first incidence rates (IR) by age and gender for 15 specified DSM-III-R disorders in the general population. Methods The study was based on a representative sample (N = 5618) of the Dutch population aged 18–64. Results The IR for any disorder was 5.68 per 100 person-years at risk (men 4.45, women 6.94). IRs for both men and women were highest in the youngest age category. The most common 12-month incident disorders in men were alcohol abuse (IR = 4.09) and major depression (1.72). In women, the most common incident disorders were major depression (IR = 3.90) and simple phobia (3.17). Conclusions The results show the rarity of first-onset of mental disorders. IRs vary strongly between the different life phases, as well as between men and women. This suggests potential target areas for age-specific and gender-specific prevention.

A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder

Abstract: A systematic review of all reported incidence and prevalence studies of population rates of subclinical psychotic experiences reveals a median prevalence rate of around 5% and a median incidence rate of around 3%. A meta-analysis of risk factors reveals associations with developmental stage, child and adult social adversity, psychoactive drug use, and also male sex and migrant status. The small difference between prevalence and incidence rates, together with data from follow-up studies, indicates that approximately 75-90% of developmental psychotic experiences are transitory and disappear over time. There is evidence, however, that transitory developmental expression of psychosis (psychosis proneness) may become abnormally persistent (persistence) and subsequently clinically relevant (impairment), depending on the degree of environmental risk the person is additionally exposed to. The psychosis proneness-persistence-impairment model considers genetic background factors impacting on a broadly distributed and transitory population expression of psychosis during development, poor prognosis of which, in terms of persistence and clinical need, is predicted by environmental exposure interacting with genetic risk.

Prevalence of mental disorders in Europe: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project

Abstract: Objective: To describe the 12-month and lifetime prevalence rates of mood, anxiety and alcohol disorders in six European countries. Method: A representative random sample of non-institutionalized inhabitants from Belgium, France, Germany, Italy, the Netherlands and Spain aged 18 or older (n = 21425) were interviewed between January 2001 and August 2003. DSM-IV disorders were assessed by lay interviewers using a revised version of the Composite International Diagnostic Interview (WMH-CIDI). Results: Fourteen per cent reported a lifetime history of any mood disorder, 13.6% any anxiety disorder and 5.2% a lifetime history of any alcohol disorder. More than 6% reported any anxiety disorder, 4.2% any mood disorder, and 1.0% any alcohol disorder in the last year. Major depression and specific phobia were the most common single mental disorders. Women were twice as likely to suffer 12-month mood and anxiety disorders as men, while men were more likely to suffer alcohol abuse disorders. Conclusion: ESEMeD is the first study to highlight the magnitude of mental disorders in the six European countries studied. Mental disorders were frequent, more common in female, unemployed, disabled persons, or persons who were never married or previously married. Younger persons were also more likely to have mental disorders, indicating an early age of onset for mood, anxiety and alcohol disorders.

The treatment gap in mental health care.

Abstract: Mental disorders are highly prevalent and cause considerable suffering and disease burden. To compound this public health problem, many individuals with psychiatric disorders remain untreated although effective treatments exist. We examine the extent of this treatment gap. We reviewed community-based psychiatric epidemiology studies that used standardized diagnostic instruments and included data on the percentage of individuals receiving care for schizophrenia and other non-affective psychotic disorders, major depression, dysthymia, bipolar disorder, generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), and alcohol abuse or dependence. The median rates of untreated cases of these disorders were calculated across the studies. Examples of the estimation of the treatment gap for WHO regions are also presented. Thirty-seven studies had information on service utilization. The median treatment gap for schizophrenia, including other non-affective psychosis, was 32.2%. For other disorders the gap was: depression, 56.3%; dysthymia, 56.0%; bipolar disorder, 50.2%; panic disorder, 55.9%; GAD, 57.5%; and OCD, 57.3%. Alcohol abuse and dependence had the widest treatment gap at 78.1%. The treatment gap for mental disorders is universally large, though it varies across regions. It is likely that the gap reported here is an underestimate due to the unavailability of community-based data from developing countries where services are scarcer. To address this major public health challenge, WHO has adopted in 2002 a global action programme that has been endorsed by the Member States.