Marlous Tuithof

Background: The prevalence of mood, anxiety, and substance use disorders has risen in the last decade. It is unclear to what extent this rise is also seen in the first-incidence of these disorders, even though this is relevant for prevention. We provide up-to-date information on the first-incidence of common mental disorders (mood, anxiety, and substance use disorders) and compare this with the first-incidence 12 years ago. Methods: First-incidence of DSM-5 common mental disorders was examined with a slightly modified version of the Composite International Diagnostic Interview (CIDI) 3.0 in 4,688 respondents (18–75 years; interviewed in 2019–2022 and 2023–2024) from the third Netherlands Mental Health Survey and Incidence Study (NEMESIS-3). The CIDI also assessed DSM-IV diagnoses and, therefore, 12-year changes could be examined by comparing first-incidence rates of DSM-IV mental disorders between NEMESIS-3 (3,687 respondents aged 18–64 years) and NEMESIS-2 (5,303 respondents aged 18–64 years; interviewed in 2007–2009 and 2010–2012). Results: In NEMESIS-3, 11.1% of adults without prior psychopathology experienced a DSM-5 common mental disorder over 3 years. First incidence was similar for any mood disorder (7.1%) and any anxiety disorder (6.9%), but lower for any substance use disorder (3.2%). From 2010-2012 to 2023-2024, the 3-year incidence of any DSM-IV disorder significantly increased from 8.5 to 14.0%. This change remained significant after controlling for differences in sociodemographic characteristics. Conclusions: The substantial rise in first incidence of mental disorders likely contributes to the previously observed rise in their prevalence. This implicates a need for enhanced preventive measures and early intervention initiatives.

Stressful life events (SLEs) are known to be associated with an increased prevalence of common mental disorders (CMDs), but the potential moderating role of psychological well‐being has not been comprehensively studied. In total, 6194 adults aged 18–75 years were interviewed for the third Netherlands Mental Health Survey and Incidence Study (NEMESIS‐3). Assessments included the adapted Composite International Diagnostic Interview (CIDI v3.0) to determine DSM‐5 mood, anxiety and substance use disorders, Brugha's List of Threatening Experiences for SLEs, and Brief INSPIRE‐O for psychological well‐being. Logistic regressions tested associations between having experienced at least two SLEs and the different CMDs and additive interactions with psychological well‐being. Having experienced ≥ 2 SLEs in the last year was associated with a higher prevalence of all CMDs in the last year, with adjusted odds ratios ranging from 1.71 (95% CI: 1.39; 2.10) for substance use disorders to 3.43 (95% CI: 2.73; 4.30) for mood disorders. The interaction effect of ≥ 2 SLEs and low psychological well‐being was statistically significant for any CMD (RERI = 5.64, 95% CI: 3.18; 8.10), mood disorder (RERI = 23.09, 95% CI: 10.10; 36.10) and anxiety disorder (RERI = 3.45, 95% CI: 1.27; 5.63), but not for substance use disorder (RERI = 0.21, 95% CI: −1.38; 1.80). The joint presence of ≥ 2 SLEs and poor psychological well‐being was associated with a higher prevalence of mood and anxiety disorders than would be expected from the sum of their individual associations. Promoting psychological well‐being may be a fruitful public mental health strategy to increase resilience against SLEs.

Objective Mental disorders impose a substantial economic burden, making updated cost estimates essential for informed policymaking. This study provides recent cost-ofillness estimates for mental disorders in the general population and examines trends over a 12-year period. Method The Netherlands Mental Health Survey and Incidence Study (NEMESIS) is a cohort representative for the Dutch population in which common DSM-IV/DSM-5 mental disorders (mood disorders, anxiety disorders, substance use disorders and attention-deficit/hyperactivity disorder) were diagnosed using the Composite International Diagnostic Interview 3.0. In baseline data of NEMESIS-3 (2019-2022, N=6,194, age 47.9±16.4 years, 50.4% women) we estimated healthcare, productivity, travel costs associated with mental disorders through weighted regression models and compared these estimates with baseline data from NEMESIS-2 (2007-2009; N=6,506, age 44.3±12.5 years, 55.2% women), assuming identical unit prices. Results Total annual per capita costs of any mental disorder were €5,630. Productivity costs comprised the largest share of total costs (61%-85%). In all conditions, except substance use disorder, both total annual costs and productivity costs were lower in 2019-2022 compared to 2007-2009. Healthcare costs were substantially lower for mood and substance use disorders in 2019- 2022, even though primary healthcare utilization was increased in 2019-2022. Discussion Productivity costs are the primary cost driver of mental disorders. While primary care utilization has increased– possibly due to the introduction of general practice mental health professionals– healthcare resource use has decreased over time. This may indicate a shift in service provision toward primary care from specialized mental healthcare, potentially contributing to more cost-effective mental healthcare delivery.

Purpose To guide formal healthcare resource allocation for common mental disorders (CMDs), this study updates and expands earlier findings on the associations of CMD severity with treatment contact and intensity. Methods Baseline data (2019–2022) of NEMESIS-3, a prospective study of a representative cohort of Dutch adults (18–75 years), were used. Severity of 12-month CMDs was assessed with the CIDI 3.0. Using multivariate analyses, its associations with 12-month treatment contact and intensity for emotional/substance-use problems were examined, both for general medical care (GMC) only and mental health care (MHC). Changes over time were identified by making comparisons with baseline data (2007–2009) of NEMESIS-2. Results Persons with severe CMDs were more likely to have made contact with GMC only or MHC compared to persons without CMDs. Between 2007–2009 and 2019–2022 there was a greater increase in the contact rate with GMC only for moderate cases compared to persons without CMDs, while the increasing contact rate with MHC did not vary by CMD severity. Both among users of GMC only and MHC, receiving high-intensity treatment was more likely among severe cases compared to persons without CMDs. Between 2007–2009 and 2019–2022 there was a greater increase in the rate of high-intensity treatment for severe cases using GMC only, while results tentatively indicate that this rate declined among severe cases using MHC. Conclusion Evidence was found that treatment of CMDs in GMC has been strengthened in the past twelve years. No indications were found that allocation of MHC resources to severe cases has improved.

Samenvatting: De afgelopen decennia is sterk ingezet op het terugdringen van tabaks- en alcoholgebruik onder jongeren. Monitoring is belangrijk om te toetsen of uitgezet beleid gepaard gaat met het gewenste resultaat. Met gegevens van het Peilstationsonderzoek Scholieren wordt onderzocht hoe het tabaks- en alcoholgebruik onder scholieren van twaalf tot en met zestien jaar tussen 1999 en 2019 veranderd is, met specifieke aandacht voor (1) verschillen naar geslacht en leeftijd, en (2) veranderingen in de populatiesamenstelling over tijd. Roken en alcoholgebruik zijn in deze periode sterk gedaald (lifetime-prevalentie roken van 53,9% in 1999 naar 17,0% in 2019; lifetime-prevalentie alcoholgebruik van 71,9% naar 46,6%). De daling heeft zich vooral tot 2015 voorgedaan en lijkt sindsdien tot stilstand gekomen. De trends zijn voor jongens en meisjes vrijwel hetzelfde, maar de daling is voor jongere leeftijdsgroepen groter dan voor oudere leeftijdsgroepen. Ook na controle voor sociaal-demografische kenmerken bleef de daling in roken en alcoholgebruik bestaan. Daarnaast is het drinken van vijf glazen of meer bij één gelegenheid (bingedrinken) onder degenen die de afgelopen maand dronken van 64,1% in 2003 gestegen naar 70,6% in 2019. Een nieuwe impuls lijkt nodig om het gebruik van tabak en alcohol onder scholieren verder terug te dringen.