Contribution of Alcohol and Nicotine Dependence to the Prevalence of Depressed Mood in Different Ethnic Groups in The Netherlands: The HELIUS Study.

Objective: Ethnic minorities report different levels of drinking and smoking and higher rates of depression compared to native populations. In this study we aimed to investigate in six ethnic groups whether tobacco and alcohol use were associated with depressive symptoms, which are more prevalent in ethnic minorities.Methods: Cross-sectional data from the multi-ethnic Healthy Life in an Urban Setting (HELIUS) study sample (N = 22,471) was used, comprising 4,580 native Dutch participants which were compared with participants from five ethnic minority groups (3,259 South Asian Surinamese, 4,292 African Surinamese, 2,262 Ghanaian, 3,891 Turkish, and 4,187 Moroccan).Results: Alcohol misuse was positively associated with depressed mood in all ethnic groups except for the Dutch and the Ghanaians. Nicotine dependence was positively associated with depressed mood in all ethnic groups except for the Ghanaian group.Conclusions: Alcohol misuse and nicotine dependence were significantly associated with depressed mood in most but not all ethnic groups and especially in men. However, across all groups the contribution of alcohol misuse and nicotine dependence to depressed mood was small. Prospective multi-ethnic studies should confirm whether the relations are causal and elucidate their direction.

Prevalence of and factors associated with adult-onset asthma in different ethnic groups: The HELIUS study.

Little is known about adult-onset asthma in different ethnic groups. The aim of this study was to examine ethnic differences in the prevalence of adult-onset asthma and factors associated with this phenotype. Cross-sectional data of 23,356 participants of the HELIUS study were used, including Dutch, South-Asian Surinamese, African Surinamese, Moroccan, Turkish and Ghanaian origin participants. Adult-onset asthma was defined as: self-reported asthma symptoms or start of asthma-medication at age ≥18 years combined with a smoking history <10 pack years. The prevalence of adult-onset asthma and its association with potential risk factors were assessed by logistic regression analyses. The adjusted prevalence of adult-onset asthma was higher in the Turkish, Moroccan and South-Asian Surinamese groups (4.9-6.0%) compared to the Dutch, Ghanaian and African Surinamese origin groups (2.4-2.6%). In addition to ethnicity, age, female sex, BMI, and doctors' diagnosis of nasal allergy/hay fever and chronic sinusitis/polyps were independently associated with adult-onset asthma. There are significant differences in the adjusted prevalence of adult-onset asthma among six ethnic groups.

Do ethnic inequalities in multimorbidity reflect ethnic differences in socioeconomic status? The HELIUS study.

BACKGROUND: The burden of multimorbidity is likely higher in ethnic minority populations, as most individual diseases are more prevalent in minority groups. However, information is scarce. We examined ethnic inequalities in multimorbidity, and investigated to what extent they reflect differences in socioeconomic status (SES). METHODS: We included Healthy Life in an Urban Setting study participants of Dutch (N = 4582), South-Asian Surinamese (N = 3258), African Surinamese (N = 4267), Ghanaian (N = 2282), Turkish (N = 3879) and Moroccan (N = 4094) origin (aged 18-70 years). Educational level, employment status, income situation and multimorbidity were defined based on questionnaires. We described the prevalence and examined age-adjusted ethnic inequalities in multimorbidity with logistic regression analyses. To assess the contribution of SES, we added SES indicators to the age-adjusted model. RESULTS: The prevalence of multimorbidity ranged from 27.1 to 53.4% in men and from 38.5 to 69.6% in women. The prevalence of multimorbidity in most ethnic minority groups was comparable to the prevalence among Dutch participants who were 1-3 decades older. After adjustment for SES, the odds of multimorbidity remained significantly higher in ethnic minority groups. For instance, age-adjusted OR for multimorbidity for the Turkish compared to the Dutch changed from 4.43 (3.84-5.13) to 2.34 (1.99-2.75) in men and from 5.35 (4.69-6.10) to 2.94 (2.54-3.41) in women after simultaneous adjustment for all SES indicators. CONCLUSIONS: We found a significantly higher prevalence of multimorbidity in ethnic minority men and women compared to Dutch, and results pointed to an earlier onset of multimorbidity in ethnic minority groups. These inequalities in multimorbidity were not fully accounted for by differences in SES.

Use of the Fagerström test to assess differences in the degree of nicotine dependence in smokers from five ethnic groups: The HELIUS study.

BACKGROUND: The prevalence of smoking varies across ethnic groups in developed countries, but little is known about ethnic variations in specific aspects of nicotine dependence (ND). We conducted item-response analyses in current smokers to compare ND factors across five ethnic groups. METHODS: Data were obtained from a population-based, multi-ethnic cohort study conducted in the Netherlands. The Fagerström Test for Nicotine Dependence (FTND) was assessed in 1147 Dutch, 991 South-Asian Surinamese, 1408 African Surinamese, 1396 Turkish, and 584 Moroccan smokers (N = 5526). We tested whether the factorial structure of the FTND was invariant across ethnic groups using a multi-group confirmatory factor analysis. FTND item and total scores and factor means were compared across groups. RESULTS: The two-factor model representing "morning smoking" and "smoking patterns" provided an adequate fit. The items "Cigarettes smoked daily" and "Time until first cigarette" showed differential item functioning (DIF) as a function of ethnicity. Three out of four ethnic minority groups scored significantly higher on both factors compared to the Dutch origin group (all p < 0.001) before and after taking DIF into account, while the African Surinamese scored higher only on "morning smoking" when DIF was accounted for. DISCUSSION: The factor structure of the FTND is not measurement invariant across ethnic groups in this population-based sample. Accounting for DIF affecting the nicotine dependence factor scores, although South-Asian Surinamese, Turkish, and Moroccan groups showed higher levels of dependence than the Dutch origin group, genetic as well as environmental factors may account for the observed differences.

The association of depression and posttraumatic stress disorder with the metabolic syndrome in a multi-ethnic cohort: the HELIUS study.

PURPOSE: Depression and posttraumatic stress disorder (PTSD) may be linked to the metabolic syndrome (MetS). Consistency of this association across ethnic groups and the influence of comorbidity of depression/PTSD were examined. METHODS: Cross-sectional baseline data from the HELIUS study were used (4527 Dutch, 2999 South-Asian Surinamese, 4058 African Surinamese, 2251 Ghanaian, 3522 Turkish and 3825 Moroccan participants). The Patient Health Questionnaire-9 (PHQ-9) (score range 0-27) measured depressive symptoms. A 9-item questionnaire (score range 0-9) measured PTSD symptoms. The MetS was defined according to the International Diabetes Federation. The association of a depressed mood (PHQ-9 sum score ≥ 10) and severe PTSD symptoms (sum score ≥ 7) with the MetS was examined using logistic regression. Interaction with ethnicity and between a depressed mood and severe PTSD symptoms was tested. RESULTS: A depressed mood was associated with the MetS [OR (95% CI) = 1.37 (1.24-1.51)] in the total sample and consistent across ethnic groups (p values for interaction all > 0.05). Severe PTSD symptoms were significantly associated with the MetS in the Dutch [OR (95% CI) = 1.71 (1.07-2.73)]. The South-Asian Surinamese, Turks and Moroccans showed weaker associations than the Dutch (p values for interaction all < 0.05). A depressed mood and severe PTSD symptoms did not interact in the association with the MetS (p values for interaction > 0.05). CONCLUSIONS: A depressed mood was consistently associated with the MetS across ethnic groups, but the association between severe PTSD symptoms and the MetS maybe ethnicity dependent. The association with the MetS was not different in case of depressed mood/severe PTSD symptoms comorbidity.

Explanatory models and openness about dementia in migrant communities: A qualitative study among female family carers.

Background The prevalence of dementia is increasing among people with a Turkish, Moroccan and Surinamese-Creole background. Because informal care is very important in these communities, it is pertinent to see what explanations female family carers have for dementia and whether they can discuss dementia openly within the community and the family. Method Forty-one individual interviews and six focus group interviews ( n = 28) were held with female Turkish, Moroccan and Surinamese Creole family carers who are looking after a close relative with dementia, and who live in The Netherlands. Qualitative analysis has been carried out, supported by the software MaxQda. Results The dominant explanations of dementia given by the female family carers interviewed are in line with what Downs et al. describe as the explanatory models 'dementia as a normal ageing process' and 'dementia as a spiritual experience'. In addition, some female family carers gave explanations that were about an interplay between various factors. Turkish and Moroccan informal caregivers ascribe the causes of dementia relatively often to life events or personality traits, whereas Surinamese Creole caregivers frequently mention physical aspects, such as past dehydration. However, the explanatory model 'dementia as a neuropsychiatric condition', which is dominant in Western cultures, was rarely expressed by the informal caregivers. The female family carers generally talked openly about the dementia with their close family, whereas particularly in the Turkish and Moroccan communities open communication within the broader communities was often hampered, e.g. by feelings of shame. Conclusions Female family carers of Turkish, Moroccan or Surinamese Creole backgrounds often consider dementia as a natural consequence of ageing, as a spiritual experience, and/or as an interplay between various factors. They feel they can talk openly about dementia within their close family, while outside the close family this is often more difficult.

The mechanisms behind the formation of a strong Sense of Coherence (SOC): The role of migration and integration.

Considering how much we know about the impact of the Sense of Coherence (SOC) on different health-related outcomes, we know surprisingly little about how a strong SOC actually develops. In this study we examine the mechanisms behind the formation of a strong SOC and study the role of migration, integration and general resistance resources (GRRs) in this process. We held 46 life-story interviews with women of Turkish, Moroccan and Surinamese descent. We divided the respondents in a relatively strong and weak SOC group in order to discern patterns of life experiences associated with SOC development. We find that, as Antonovsky predicted, experiencing consistency and load balance are associated with a strong SOC. In opposition to Antonovsky's claims, decision making power is not a necessary condition to develop meaningfulness. Moreover, the women's life narratives show that migration and integration are related to the mechanisms shaping SOC, yet, the impact is subjective and depends on the availability and use of GRRs. Our findings provide improvements to Antonovsky's salutogenic theory and provide suggestions for interventions aimed at strengthening SOC.

Perceived Ethnic Discrimination and the Metabolic Syndrome in Ethnic Minority Groups: The Healthy Life in an Urban Setting Study.

OBJECTIVE: Ethnic differences in the metabolic syndrome could be explained by perceived ethnic discrimination (PED). It is unclear whether PED is associated with the metabolic syndrome. We assessed this association and quantified the contribution of PED to the metabolic syndrome. METHODS: Baseline data were used from the Healthy Life in an Urban Setting study collected in the Netherlands from 2011 to 2014. The population-based sample included South-Asian Surinamese, African Surinamese, Ghanaian, Turkish, and Moroccan participants (aged 18 to 70 years). PED was measured using the Everyday Discrimination Scale. The metabolic syndrome was determined according to the harmonized definition of the International Diabetes Federation, American Heart Association, and others. Logistic regression was used for analysis. population-attributable fraction was used to calculate the contribution of PED. RESULTS: PED was positively associated with the metabolic syndrome in South-Asian Surinamese, African Surinamese, and Moroccan participants (odds ratio [95% confidence interval] = 1.13 [0.99-1.30], 1.15 [1.00-1.32], and 1.19 [1.03-1.38], respectively) after adjusting for potential confounders and mediators. No significant association was observed among Ghanaian and Turkish participants. For the individual components, the associations were statistically significant for blood pressure, fasting glucose, and waist circumference among Surinamese participants. PED was associated with dyslipidemia in Moroccan participants. The population-attributable fractions were 5% for South-Asian Surinamese and Moroccan participants, and 7% for African Surinamese participants. CONCLUSIONS: We found a positive association of PED with the metabolic syndrome in some ethnic groups, with PED contributing around 5% to 7% to the metabolic syndrome among Surinamese and Moroccans. This suggests that PED might contribute to ethnic differences in the metabolic syndrome.

High prevalence of previous dengue virus infection among first-generation Surinamese immigrants in the Netherlands.

BACKGROUND: A substantial portion of Dutch travellers is comprised of immigrants returning to their country of origin to visit friends and relatives (VFRs), including VFRs returning to dengue-endemic areas such as Suriname. Limited attention has been focused on dengue among immigrants, therefore it is unknown whether immigration has effect on the epidemiology of (severe) dengue among VFRs.To get more insight in the seroprevalence of dengue among Surinamese immigrants, we conducted a seroprevalence study on a convenience sample of first-generation Surinamese immigrants living in the Netherlands. METHODS: Blood samples were tested for IgG antibodies to DENV antigen serotypes (1, 2, 3 and 4). Gender, age, years lived in Suriname before immigration, history of yellow fever vaccination, and time between yellow fever vaccination and blood sample collection were examined as possible predictors for previous infection. RESULTS: Of the studied 400 Surinamese travellers with a mean age of 52 years (range 18-89), 37% were male. Serology suggestive of past DENV infection was found in 325 individuals (81.3%; 95% CI: 77-85%). The time lived in Suriname before immigration was the only significant predictor for previous DENV infection. CONCLUSIONS: Most first-generation Surinamese immigrants have evidence of past DENV infection, probably comparable to Surinamese inhabitants. Whether this influences the number of cases of (severe) dengue when travelling requires more study.

Craniovertebral junction malformation in Northeastern Brazil: the myth of the Dutch colonization.

The high prevalence of craniovertebral junction malformation in Northeastern Brazil is historically associated with brachycephalic biotype (flat head), also common in this region. It has been postulated that this trait was introduced to this region by the Dutch during the colonial period in Brazil's history. Based on the confrontation of this paradigm against some historical facts, the authors concluded that the brachycephalic phenotype was inherited from prehistoric ancestors (Amerindians) who were already living in this region when white European men arrived.

Craniovertebral junction malformation in Northeastern Brazil: the myth of the Dutch colonization / Malformação da junção craniovertebral no Nordeste do Brasil: o mito da colonização Holandesa

The high prevalence of craniovertebral junction malformation in Northeastern Brazil is historically associated with brachycephalic biotype (flat head), also common in this region. It has been postulated that this trait was introduced to this region by the Dutch during the colonial period in Brazil's history. Based on the confrontation of this paradigm against some historical facts, the authors concluded that the brachycephalic phenotype was inherited from prehistoric ancestors (Amerindians) who were already living in this region when white European men arrived.

A alta prevalência de malformação da junção craniovertebral no Nordeste do Brasil é historicamente associada ao biótipo braquicefálico (cabeça chata), também comum nessa região. Postula-se que essa característica tenha sido introduzida na região pelos holandeses durante o período colonial da história do Brasil. Com base na confrontação desse paradigma com alguns fatos históricos, os autores concluem que o fenótipo braquicefálico foi herdado de ancestrais pré-históricos (ameríndios) que já habitavam a região no momento da chegada do homem branco europeu.

Mental health problems and recidivism among detained male adolescents from various ethnic origins.

This study examines differences in self-reported mental health problems between detained youths from Dutch, Moroccan, and Surinamese origin and the usefulness of mental health problems to predict violent and property recidivism in these juveniles. A sample of 296 detained boys aged between 12 and 18 years were assessed by means of the Strengths and Difficulties Questionnaire (SDQ). Official information regarding criminal history and recidivism was collected 3-6 years later. In general, Dutch youths and Surinamese youths reported more conduct problems than Moroccan youths, while Dutch youths also reported more hyperactivity than Surinamese youths. Mental health problems were not predictive of violent recidivism in any of the ethnic groups, while being related with property recidivism in Dutch and Surinamese youths. The current study showed that Moroccan youths present themselves on the SDQ as a less seriously disturbed group of youths than their Dutch and Surinamese counterparts. Our results also clearly showed that SDQ self-report scores are not predictive of future violent crimes in any of the three ethnic groups. Implications of the findings and limitations of the current study are discussed.

Spiritual and religious beliefs as risk factors for the onset of major depression: an international cohort study.

BACKGROUND: Several studies have reported weak associations between religious or spiritual belief and psychological health. However, most have been cross-sectional surveys in the U.S.A., limiting inference about generalizability. An international longitudinal study of incidence of major depression gave us the opportunity to investigate this relationship further. METHOD: Data were collected in a prospective cohort study of adult general practice attendees across seven countries. Participants were followed at 6 and 12 months. Spiritual and religious beliefs were assessed using a standardized questionnaire, and DSM-IV diagnosis of major depression was made using the Composite International Diagnostic Interview (CIDI). Logistic regression was used to estimate incidence rates and odds ratios (ORs), after multiple imputation of missing data. RESULTS: The analyses included 8318 attendees. Of participants reporting a spiritual understanding of life at baseline, 10.5% had an episode of depression in the following year compared to 10.3% of religious participants and 7.0% of the secular group (p<0.001). However, the findings varied significantly across countries, with the difference being significant only in the U.K., where spiritual participants were nearly three times more likely to experience an episode of depression than the secular group [OR 2.73, 95% confidence interval (CI) 1.59­4.68]. The strength of belief also had an effect, with participants with strong belief having twice the risk of participants with weak belief. There was no evidence of religion acting as a buffer to prevent depression after a serious life event. CONCLUSIONS: These results do not support the notion that religious and spiritual life views enhance psychological well-being.

Sociocultural settings influence the emergence of prelinguistic deictic gestures.

Daily activities of forty-eight 8- to 15-month-olds and their interlocutors were observed to test for the presence and frequency of triadic joint actions and deictic gestures across three different cultures: Yucatec-Mayans (Mexico), Dutch (Netherlands), and Shanghai-Chinese (China). The amount of joint action and deictic gestures to which infants were exposed differed systematically across settings, allowing testing for the role of social-interactional input in the ontogeny of prelinguistic gestures. Infants gestured more and at an earlier age depending on the amount of joint action and gestures infants were exposed to, revealing early prelinguistic sociocultural differences. The study shows that the emergence of basic prelinguistic gestures is socially mediated, suggesting that others' actions structure the ontogeny of human communication from early on.

Paternal age and risk of autism in an ethnically diverse, non-industrialized setting: Aruba.

OBJECTIVE: The aim of this study was to examine paternal age in relation to risk of autism spectrum disorders (ASDs) in a setting other than the industrialized west. DESIGN: A case-control study of Aruban-born children (1990-2003). Cases (N = 95) were identified at the Child and Adolescent Psychiatry Clinic, the only such clinic in Aruba; gender and age matched controls (N = 347) were gathered from public health records. Parental age was defined categorically (≤ 29, 30-39, 40-49, ≥ 50 y). The analysis was made, using conditional logistic regression. RESULTS: Advanced paternal age was associated with increased risk of ASDs in offspring. In comparison to the youngest paternal age group (≤ 29 y), risk of autism increased 2.18 times for children born from fathers in their thirties, 2.71 times for fathers in their forties, and 3.22 thereafter. CONCLUSION: This study, part of the first epidemiologic study of autism in the Caribbean, contributes additional evidence, from a distinctive sociocultural setting, of the risk of ASD associated with increased paternal age.

Risk of psychiatric treatment for mood disorders and psychotic disorders among migrants and Dutch nationals in Utrecht, The Netherlands.

PURPOSE: While there are consistent reports of a high psychosis rate among certain groups of migrants in Europe, there is little information on their risk for mood disorders. The aim of this study was to investigate the risk of receiving psychiatric treatment for mood disorders or psychotic disorders, comparing migrants and Dutch nationals in an ethnically mixed catchment area. A second aim was to calculate the 1-year prevalence rates of psychotic disorders in first-generation migrants. METHOD: A psychiatric registry provided information on treatments at all in- and outpatient facilities. Statistics Netherlands provided annual population figures. RESULTS: The risk of receiving treatment for unipolar depressive disorder was increased for the Turkish-Dutch (first and second generation combined; age- and sex-adjusted relative risk 4.9; 95% CI: 4.4-5.5), Moroccan-Dutch (RR = 3.6; 3.3-4.0) and Surinamese-Dutch (RR=1.8; 1.5-2.2). The risk of being treated for bipolar disorder was not significantly increased for any group, except for the Turkish-Dutch of the second generation. The risk of treatment for non-affective psychotic disorder was very high for the Turkish-Dutch, Moroccan-Dutch and Surinamese-Dutch of the second generation. There was a large difference in the relative risk of this disorder between the Turkish-Dutch of the first (RR = 1.3; 1.0-1.8) and the second generation (RR = 8.7; 5.5-13.9). The 1-year prevalence rates of treated psychotic disorders were highest for Surinamese-Dutch (2.1%) and Moroccan-Dutch males (1.2%) of the first generation. Migrants from western-European countries were not at increased risk for any of these disorders. CONCLUSIONS: The stressful position of non-Western migrants in Dutch society has negative consequences on their mental health.

Cutaneous leishmaniasis in three Dutch military cohorts following jungle training in Belize.

Skin lesions occur frequently in travelers to tropical countries. Military personnel acquire skin lesions regularly during jungle training as did Dutch troops who trained in the jungle of Belize in 1998, 2004 and 2009, in an area endemic for cutaneous leishmaniasis. Demographic and clinical data were collected retrospectively. Diagnostic investigations for cutaneous leishmaniasis included Giemsa stain, culture, PCR and NASBA and histopathology of biopsies. Treatment of leishmaniasis was with sodium stibogluconate, given intravenously or intralesionally, the latter with cryotherapy. In 1998 and 2004 cutaneous leishmaniasis due to Leishmania braziliensis and Leishmania mexicana infection was diagnosed in 25 persons out of 99 (attack rate 25.2%) and 14 persons out of 80 (attack rate 17.5%) respectively. In 2009 cutaneous leishmaniasis was not acquired. Skin problems were common during and after jungle training. Cutaneous leishmaniasis was important in the first two cohorts but not observed in the third cohort. Factors that could have played a role in the absence of cutaneous leishmaniasis in the third cohort include variability in transmission and availability of better preventive measures and adherence to these. Sodium stibogluconate treatment, intralesional or intravenous, was effective.