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Articles by F Smit
Total Records ( 4 ) for F Smit
  P Cuijpers , F Smit , B. W. J. H Penninx , R de Graaf , M ten Have and A. T. F. Beekman
 

Context  The importance of neuroticism for mental health care use and public health is well established. However, most research has focused on the association between neuroticism and a single specific disorder or health outcome, and the overall effect of neuroticism on use of somatic and mental health care and on society is not clear.

Objective  To examine the economic costs of neuroticism to get an impression of the overall effect of neuroticism on mental health care and on society in general.

Design  Cross-sectional population-based study.

Setting  General population.

Participants  A large representative sample (N = 5504) of the Dutch general population.

Main Outcome Measures  The costs (health service uptake in primary and secondary mental health care, out-of-pocket costs, and production losses) associated with neuroticism.

Results  The total per capita excess costs were $12 362 per year for the reference year 2007 in the 5% highest scorers of neuroticism, $8243 in the 10% highest scorers, and $5572 in the 25% highest scorers. The per capita excess costs of neuroticism are considerably higher than those of mental disorders. The total excess costs of neuroticism per 1 million inhabitants resulting from the 25% highest scorers ($1.393 billion) were approximately 2.5 times as high as the excess costs of common mental disorders ($585 million).

Conclusions  The economic costs of neuroticism are enormous and exceed those of common mental disorders. We should start thinking about interventions that focus not on each of the specific negative outcomes of neuroticism but rather on the starting point itself.

  P Cuijpers , F Smit , E Bohlmeijer , S. D Hollon and G. Andersson
 

Background

It is not clear whether the effects of cognitive–behavioural therapy and other psychotherapies have been overestimated because of publication bias.

Aims

To examine indicators of publication bias in randomised controlled trials of psychotherapy for adult depression.

Method

We examined effect sizes of 117 trials with 175 comparisons between psychotherapy and control conditions. As indicators of publication bias we examined funnel plots, calculated adjusted effect sizes after publication had been taken into account using Duval & Tweedie’s procedure, and tested the symmetry of the funnel plots using the Begg & Mazumdar rank correlation test and Egger’s test.

Results

The mean effect size was 0.67, which was reduced after adjustment for publication bias to 0.42 (51 imputed studies). Both Begg & Mazumbar’s test and Egger’s test were highly significant (P<0.001).

Conclusions

The effects of psychotherapy for adult depression seem to be overestimated considerably because of publication bias.

  P van't Veer Tazelaar , F Smit , H van Hout , P van Oppen , H van der Horst , A Beekman and H. van Marwijk
 

Background

There is an urgent need for the development of cost-effective preventive strategies to reduce the onset of mental disorders.

Aims

To establish the cost-effectiveness of a stepped care preventive intervention for depression and anxiety disorders in older people at high risk of these conditions, compared with routine primary care.

Method

An economic evaluation was conducted alongside a pragmatic randomised controlled trial (ISRCTN26474556). Consenting individuals presenting with subthreshold levels of depressive or anxiety symptoms were randomly assigned to a preventive stepped care programme (n = 86) or to routine primary care (n = 84).

Results

The intervention was successful in halving the incidence rate of depression and anxiety at 563 (£412) per recipient and 4367 (£3196) per disorder-free year gained, compared with routine primary care. The latter would represent good value for money if the willingness to pay for a disorder-free year is at least 5000.

Conclusions

The prevention programme generated depression- and anxiety-free survival years in the older population at affordable cost.

  P Meulenbeek , G Willemse , F Smit , A van Balkom , P Spinhoven and P. Cuijpers
 

Background

Many people suffer from subthreshold and mild panic disorder and are at risk of developing more severe panic disorder.

Aims

This study (trial registration: ISRCTN33407455) was conducted to evaluate the effectiveness of an early group intervention based on cognitive–behavioural principles to reduce panic disorder symptomatology.

Method

Participants with subthreshold or mild panic disorder were recruited from the general population and randomised to the intervention (n = 109) or a waiting-list control group (n = 108). The course was offered by 17 community mental health centres.

Results

In the early intervention group, 43/109 (39%) participants presented with a clinically significant change on the Panic Disorder Severity Scale–Self Report (PDSS–SR) v. 17/108 (16%) in the control group (odds ratio (OR) for favourable treatment response 3.49, 95% CI 1.77–6.88, P = 0.001). The course also had a positive effect on DSM–IV panic disorder status (OR = 1.96, 95% CI=1.05–3.66, P = 0.037). The PDSS–SR symptom reduction was also substantial (between-group standardised mean difference of 0.68). The effects were maintained at 6-month follow-up.

Conclusions

People presenting with subthreshold and mild panic disorder benefit from this brief intervention.

 
 
 
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