[Shared decision-making using outcome information: qualitative research among patients]. / Samen beslissen met ROM als informatiebron: kwalitatief onderzoek onder cliënten.

BACKGROUND: In the period 2019-2022, eight mental health care organizations have been working on the development and implementation of shared decision-making (SDM) using routine outcome monitoring (ROM) as a source of information. AIM: To obtain insight in needs and experiences of patients among SDM using ROM, and to investigate which implementation approach this requires. METHOD: Explorative, qualitative research consisting of semi-structured interviews and focusgroups with patients (n = 101) treated by mental health care organizations across the Netherlands. RESULTS: Patients reported SDM as important. Generic aspects (listening, trust, complete information and equal input) and customization (connecting to the need for help, and for every decision meta-communication about the roles of patients, relatives and clinicians and the way of giving information) were equally important. Patients valued ROM as source of information during SDM, providing that questionnaires are not too long, are related to the problems and results are discussed. CONCLUSION: SDM using ROM is as yet not widely implemented in mental health care. This requires continuous stimulation and evaluation. Implementation requires (re)training clinicians and supporting patients by relatives, peer experts and psycho-education. Patients appreciate ROM as an aid in SDM; access to their own ROM is helpful here.

Evaluation of a face-to-face psychosocial screening intervention for cancer patients: acceptance and effects on quality of life.

OBJECTIVE: This study evaluated a psychosocial screening intervention that offers cancer patients counselling. The assumption underlying the intervention was that barriers are often present that hamper patients' awareness of and active request for psychosocial care. An active yet unobtrusive approach was hypothesized to improve accessibility to psychosocial services. METHODS: In a sequential cohort design, patients newly admitted to the oncology department of an academic hospital were assigned to a usual care group (n=50) or a screening group (n=79). A retrospective, medical records group (n=89) was also included. At baseline and 4 weeks following discharge, the usual care and screening groups completed mental health and quality of life questionnaires. RESULTS: Half the screening group actually wanted and received counselling. At follow-up, the screening group reported significantly less pain, better mental health and better physical and role functioning than the usual care group. CONCLUSION: The face-to-face screening intervention appears an effective means of identifying patients interested in obtaining formal psychosocial counselling, and may result in improvements in physical and mental health outcomes. PRACTICE IMPLICATIONS: This screening intervention may be particularly useful for hospitals that prefer a personal approach to psychosocial screening, but do not have sufficient resources to interview every new patient.

[Mental and physical health problems of, and the use of healthcare by, Afghan, Iranian and Somali asylum seekers and refugees]. / Psychische en lichamelijke gezondheidsproblemen van en gebruik van zorg door Afghaanse, Iraanse en Somalische asielzoekers en vluchtelingen.

OBJECTIVE: To estimate the prevalence rates of mental and physical health problems and the use of healthcare services among adult asylum seekers and recognised refugees from Afghanistan, Iran and Somalia in the Netherlands. DESIGN: Cross-sectional study. METHOD: Asylum seekers were approached in 14 reception centres and refugees were interviewed in 3 municipalities (Arnhem, Leiden and Zaanstad). Respondents were interviewed in their own language and asked questions pertaining to: general health, chronic complaints, symptoms of post-traumatic stress disorder (PTSD), symptoms of depression/ anxiety, the use of healthcare services (general practitioner, medical specialists, hospitalisation, mental-health services, medication) and background variables. RESULTS: A total of 232 asylum seekers and 178 refugees participated (response rates of89% and 59%, respectively). Of these, 142 (61%) and 99 (56%), respectively were males and the average age was 34.4 (SD: 11.o) and 40.3 (SD: 13.3) years, respectively. Compared to refugees, asylum seekers more often considered their health to be poor (42% and 59%, respectively), had more symptoms of depression/anxiety (39% and 68%, respectively), and had more symptoms of PTSD (11% and 28%, respectively). No differences were found between refugees and asylum seekers in the self-reported use of healthcare services. CONCLUSION: This study showed that asylum seekers have more health problems than refugees, but that there are no differences in the self-reported use of healthcare services. More research is needed to answer the question ifasylum seekers have sufficient access to the healthcare system.

Long term health complaints following the Amsterdam Air Disaster in police officers and fire-fighters.

BACKGROUND: On 4 October 1992, a cargo aircraft crashed into apartment buildings in Amsterdam, the Netherlands. Fire-fighters and police officers assisted with the rescue work. OBJECTIVES: To examine the long term health complaints in rescue workers exposed to a disaster. METHODS: A historical cohort study was performed among police officers (n = 834) and fire-fighters (n = 334) who performed at least one disaster related task and reference groups of their non-exposed colleagues (n = 634 and n = 194, respectively). The main outcome measures included digestive, cardiovascular, musculoskeletal, nervous system, airway, skin, post-traumatic stress, fatigue, and general mental health complaints; haematological and biochemical laboratory values; and urinalysis outcomes. RESULTS: Police officers and fire-fighters who were professionally exposed to a disaster reported more physical and mental health complaints, compared to the reference groups. No clinically relevant statistically significant differences in laboratory outcomes were found. CONCLUSIONS: This study is the first to examine long term health complaints in a large sample of rescue workers exposed to a disaster in comparison to reference groups of non-exposed colleagues. Findings show that even in the long term, and in the absence of laboratory abnormalities, rescue workers report more health complaints.

Criterion validity of the self-rating inventory for posttraumatic stress disorder (SRIP) in the community of older adults.

BACKGROUND: A validated screening instrument for PTSD in community dwelling older people is lacking. This study evaluates a newly developed measure, the self-rating inventory for posttraumatic stress disorder (SRIP) on its usefulness in survey research. The predictive value of the SRIP in a community setting is investigated. METHODS: In a two-phase epidemiologic design the criterion validity of the SRIP was tested against diagnosis made with the comprehensive international diagnostic interview (CIDI) in 1721 older (55-90 years) inhabitants of the Netherlands. Optimal sensitivity and specificity was determined using a weighted receiver operator characteristic (ROC)-curve. RESULTS: Optimal sensitivity (74.2%) and specificity (81.4%) was reached with a cut-off of 39 points. LIMITATIONS: According to a strictly applied CIDI algorithm the number of 'true' cases was limited. CONCLUSION: Overall findings indicate that posttraumatic stress disorder can be identified adequately in a community-based population of older adults using the SRIP. Use of the SRIP may improve recognition and diagnosis of posttraumatic stress disorder in the community.

Preconception cystic fibrosis carrier couple screening: impact, understanding, and satisfaction.

The impact, understanding of test-results, and satisfaction among participating couples in a preconception cystic fibrosis (CF) carrier screening project were assessed 6 months after testing. Questionnaire data were obtained from 17/18 identified carriers, 15 partners of carriers with negative test results, and 794 (73%) other participants. None of the carriers changed their reproductive plans because of their test results. Eight participants were worried about their results, including four carriers. Those who attended a general practitioner (GP) consultation for pretest education were less worried than those who attended an educational session. Seven carriers felt less healthy. Predictors of a correct understanding of test results (correct in 62% of participants) were: positive test results, high level of knowledge of CF, high level of education, attending an educational session, and previously heard of CF. All participants who reported that they were worried, all carriers, and 95% of the other participants said that they would make the same decision to be tested again. Although couples who were educated during a GP consultation were less worried, the results of the study suggest that understanding is more correct in couples attending an educational session. The results further suggest that since satisfaction with the screening was high, worries and feeling less healthy due to the test results are probably not a great burden.

Self-rating inventory for posttraumatic stress disorder: review of the psychometric properties of a new brief Dutch screening instrument.

The Self-rating Inventory for Posttraumatic Stress Disorder of 22 items was developed for use with populations without identified traumatic experiences. The inventory has been used extensively in survey research in The Netherlands. This paper examines the psychometric properties. In four different groups (trauma and psychiatric patients, elderly Dutch subjects, former peacekeepers, and medical students) internal consistency, test-retest reliability, concurrent and discriminant validity, and sensitivity and specificity are analyzed. The inventory showed good internal consistency, test-retest reliability, concurrent and discriminant validity, and high sensitivity and specificity. It appears to be valuable for survey research on posttraumatic stress in nonselected populations. As a screening device, high sensitivity for PTSD symptoms is evident even when the traumatic event has not been defined.

Attitudes towards reproductive issues and carrier testing among adult patients and parents of children with cystic fibrosis (CF).

Assessing the reproductive choices of parents of children with cystic fibrosis (CF) is important in getting a greater insight into the possible needs for counselling of carrier couples in the reproductive decision-making process. Also, parents' reproductive attitudes might indicate critical issues for discussion with regard to introducing general population screening programmes. Data were available from two groups of subjects: 287 adult patients with CF (mean age 27.5 years) and 288 parents of a child with CF (mean age of child 7.7 years) who participated in a Dutch national survey. Attitudes towards reproductive issues and carrier screening and parents' reproductive behaviour were analysed in terms of responses to questionnaires. To avoid having another child with CF, most parents decided against further pregnancies or used other reproductive options. Prenatal diagnosis was used by 72% of parents, whereas 76% of parents planning more children intended using this option. Intention to use prenatal diagnosis was associated with the strength of religious conviction, and was not associated with perceived severity of CF, health of the child, or future therapeutic possibilities. Respondents demonstrated difficulties in deciding to abort for CF. A majority of parents and adult patients supported carrier couple identification within CF families. The results suggest that those most closely involved with CF will accept the reproductive choices of carrier couples identified in population screening programmes.

Consistency of self-reports of traumatic events in a population of Dutch peacekeepers: reason for optimism?

Doubts have been raised concerning the reliability and the validity of self-reports of traumatic events. A correlation between the number of inconsistencies in self-reports and the level of PTSD symptoms has been found. We examine whether these results can be generalized to a population of 137 Dutch peacekeepers who took part in operation UNTAC (United Nations Transitional Authority in Cambodia). The peacekeepers completed a 16-item trauma checklist, 3 and 4 years after their return from UNTAC. The test-retest reliability of the trauma checklist was adequate. Inconsistencies were randomly divided over all respondents and all items and were not correlated with symptoms of PTSD. No increase in the number of reported events over time was found. Earlier findings raising doubts concerning the reliability and validity of self-report measures of exposure were not replicated in this sample of Dutch peacekeepers.

The longitudinal course of posttraumatic stress disorder symptoms among aging military veterans.

This study examined the longitudinal course of posttraumatic stress disorder (PTSD) among two samples of Dutch aging military veterans: 576 veterans with a military disability pension and 198 community sample veterans, who fought in World War II, the former Dutch East Indies, and Korea. Both samples were investigated in 1992 and in 1998 with a standardized and validated instrument measuring PTSD symptoms. In 1992, 27% of the veterans with a military disability pension met the criteria for a PTSD diagnosis; in 1998, this was 29%. Of the community sample veterans, 9% reported a PTSD diagnosis in 1992, in 1998 this was 8%. The results provide strong support for the long-term persistence of PTSD symptoms. In addition, PTSD caseness at one time point was associated with significantly elevated PTSD symptom severity at the time of no PTSD diagnosis. No evidence was found for an aggravation of PTSD due to stressors associated with aging.

A cross-national study of posttraumatic stress disorder in Dutch-Australian immigrants.

OBJECTIVE: Studying the rates of posttraumatic stress disorder (PTSD) in people who experienced World War II, but who have subsequently lived in different environments is a way of looking at the impact of recovery environment on PTSD. Immigrants had less support in terms of the social cohesion in their home country, but were not subjected to the same triggers of war-related intrusions. METHOD: Posttraumatic stress disorder was investigated in citizens from the Netherlands who emigrated to Australia in the post-World War II years (n = 251). Immigrants born between 1920 and 1930 (n = 171) were compared with a same-aged group living in Holland (n = 1461) for stressful war experiences and the extent of PTSD. RESULTS: Those who had been exposed to the most severe war stress were overrepresented in the immigrant group. Immigrants with current PTSD more often stated that motives for migration were threat of a third world war, disappointment with Dutch society and personal problems. We were unable to demonstrate specific effects of emigration on the prevalence of current PTSD. CONCLUSIONS: This study suggests that exposure to severe war stress promoted the need to emigrate. The comparable PTSD scores of the groups of war victims living in Australia and the Netherlands support the notion that extreme war stress may be considered the primary determining factor in the development of PTSD, and that actual post-war living circumstances are, in the long term, of subordinate importance.

[Indirect traumatization of spouses of Dutch war victims]. / Indirecte traumatisering bij partners van oorlogsgetroffenen.

OBJECTIVE: To determine the specific problems experienced by spouses of Dutch war victims. DESIGN: Cross-sectional written questionnaire investigation. METHOD: A written questionnaire was sent to 382 supporters of a foundation for spouses of war victims (Stichting Partners van Oorlogsgetroffenen (SPO)). This organization facilitates contact between fellow sufferers. The questionnaire incorporated elements from the 'Symptom checklist'-90, the 'Impact of event scale', and the 'Maudsley marital questionnaire'. The data obtained were compared to those from previous investigations. The first of these was among 346 spouses of veterans, members of a veteran organization (Bond van Nederlandse Militaire Oorlogs- en Dienstslachtoffers), who were subdivided into two groups, married to veterans with post-traumatic stress disorder (PTSS) (n = 76) and married to veterans without PTSS (n = 264). The second was with 555 women who had participated in a study, carried out in 1992, concerning the long-term effects of severe war experiences among elderly Dutch people. RESULTS: The response rate was 161/382 (42%). The spouses experienced a high burden of care. All of their symptoms were significantly more severe than in the two comparison groups, but equalled those in the partners of veterans with PTSS, with the exception of the quality of the partner relation. This was significantly less than in the partners of veterans with PTSS. In particular, the spouses reported having problems with the war victim being uncommunicative, emotionally numb, sad, and irritable. Spouses themselves also reported posttraumatic reactions such as re-experiencing and avoidance that could not be explained by their own exposure to war and violence. CONCLUSION: The results confirm the theory that by their close contact with the war victim spouses are indirectly traumatized. It is recommended that the physician who has traumatized patients in his or her practice actively inquiries as to whether the spouse can cope with the situation and to what extent.

Predeployment personality traits and exposure to trauma as predictors of posttraumatic stress symptoms: a prospective study of former peacekeepers.

OBJECTIVE: The authors' goal was to study the contribution of predeployment personality traits and exposure to traumatic events during deployment to the development of symptoms of posttraumatic stress disorder (PTSD) in individuals involved in military peacekeeping activities. METHOD: Five hundred seventy-two male veterans who participated in the United Nations Protection Force mission in the former Yugoslavia completed a short form of the Dutch MMPI before deployment. Following deployment, they participated in a survey of all Dutch military veterans who had been deployed in the years 1990-1995 and completed the Self-Rating Inventory for PTSD. RESULTS: Exposure to traumatic events during deployment had the highest unique contribution to the prediction of PTSD symptom severity, followed by the personality traits of negativism and psychopathology, followed by age. CONCLUSIONS: Both pretrauma vulnerabilities and exposure to traumatic events were found to be important factors in the etiology of posttraumatic stress symptoms. The current study replicates in a non-American sample of peacekeepers findings obtained among American Vietnam veterans. Particularly, there is accumulating evidence for an etiological role of the personality trait of psychoneuroticism in the development of posttraumatic stress symptoms.

Test-retest reliability of the self-rating inventory for posttraumatic stress disorder.

The Self-rating Inventory for Posttraumatic Stress Disorder is a 22-item self-report questionnaire to give a diagnosis for PTSD based on DSM-IV criteria. Originally, the questionnaire was standardized with trauma survivors and psychiatric patients. Here test-retest reliabilities with 90 medial students are reported for 15 (.79) and 19 days (.97). As expected, the stability was slightly less for 34 days (.60).

Test-retest reliability of the trauma and life events self-report inventory.

Three groups of first-year male and female medical students (total N = 90) completed the Trauma and Life Events Self-report Inventory twice. Test-retest reliability for the three different time periods was .82, .89, and .75, respectively.

Fifty years later: the long-term psychological adjustment of ageing World War II survivors.

OBJECTIVE: Most studies of the long-term after-effects of war have focused on survivors seeking treatment or financial compensation. The present study examined the current psychological adjustment of a community sample of ageing World War II (WW II) survivors, including survivors of bombardments, persecution, resistance, combat and other violence. METHOD: A community sample of 4057 Dutch WW II survivors answered a 4-page postal questionnaire. Of these, 1461 survivors answered a second follow-up questionnaire. RESULTS: Even 50 years after World War II, a statistically significant but modest relationship was found to exist between exposure to shocking war events and current psychological adjustment in terms of symptoms of post-traumatic stress disorder (PTSD), anxiety and anger. A total of 66 respondents (4.6%) met the criteria for PTSD. The highest level of current PTSD (13%) was found among survivors of persecution. The lowest level of PTSD (4%) was found among civilian war victims and resistance participants, while military veterans had an intermediate score (7%). With regard to absolute numbers, civilian war victims represented the largest proportion of PTSD sufferers. CONCLUSION: In a study of a community sample of WW II survivors, we found that most of these survivors had no severe symptoms of PTSD. Nevertheless, probably tens of thousands of Dutch individuals are still suffering from long-term after-effects from World War II. For these vulnerable survivors, the ageing process will complicate the coping process.

A health-related quality of life questionnaire for multiple sclerosis patients.

OBJECTIVE: The construction of a brief, valid and reliable HRQoL questionnaire for use in multiple sclerosis patients based on generic and disease-specific HRQoL measures. MATERIAL AND METHODS: The Medical Outcomes Study 36-item Short Form Health Survey (SF-36), COOP/ WONCA Charts, and Disability & Impact Profile (DIP) were used in a longitudinal study in 162 patients with multiple sclerosis. RESULTS: Factor analyses identified 2 underlying dimensions of HRQoL, relating to "physical functioning" and "psychological functioning". Selection of the 3 highest loading reliable scales on each factor resulted in a final questionnaire consisting of 3 scales of the SF-36 and 3 scales of the DIP. In total 40 items were selected; completion time is about 10 min. CONCLUSION: The final questionnaire adequately measured 2 dimensions of HRQoL. The length of the questionnaire is acceptable for patients with MS in view of respondent burden.

Use of medical and mental health care by World War II survivors in The Netherlands.

This study examined the mental and medical health care utilization of World War II (WW II) survivors and the characteristics of survivors seeking professional health care. Forty seven years after the end of WW II, a random sample of 4,057 Dutch WW II survivors answered a four-page questionnaire; 1,461 persons subsequently answered an extensive follow-up questionnaire. Twenty-two percent had sought some form of health care for war-related complaints at some time since WW II. Most consultations were made in the 1940s. More consultations were made to general practitioners or to medical specialists as opposed to mental health specialists. Although the level of posttraumatic stress disorder (PTSD) symptoms was most important for discriminating between help-seeking and non-help-seeking respondents, 59% of the highly-exposed respondents with PTSD had not sought professional help in the years 1990-1992. The results show the importance of primary health care in recognizing PTSD symptoms and referring survivors to the appropriate professional helper.