Worries about societal issues such as climate change, pandemics, geopolitical tensions, and economic instability may negatively impact mental health. However, few studies have assessed a broad range of worries within a single study, examining both individual and cumulative associations with mental disorders. In this cross-sectional analysis of wave 2 of NEMESIS-3, a population-based study conducted in 2023–2024 (n = 4,688; age 21–78) worries about climate, COVID-19, international tensions, energy supply/prices, daily living costs, and the housing market were each assessed with a single item and dichotomized (1 = "a lot" or "very much"; 0 = "not” or “a little"). Mental disorders were measured using the Composite International Diagnostic Interview 3.0. Logistic regression models estimated associations between worries and 12-month prevalence of mood, anxiety, and substance use disorders, adjusting for sociodemographic characteristics. 38.3

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.

OBJECTIVES:Longitudinal studies that visualise individual trajectories of depressive and/or anxiety disorders can inform prevention and treatment strategies. METHODS:Participants of the Netherlands Mental Health Survey and Incidence Study (NEMESIS) were assessed at four timepoints from 2007-2009 to 2016-2018 (N = 6646 at baseline). DSM-IV disorders were assessed using the Composite International Diagnostic Interview. Onset and course trajectories were visualised with Sankey diagrams and summarised in incidence, remission, recurrence, and persistency rates, considering presence of any depressive or anxiety disorder as outcome. RESULTS:Among those without a lifetime depressive or anxiety disorder at baseline, 13% developed a depressive and/or anxiety disorder over 9 years, with higher rates in women and younger adults. Recurrence rates over 9 years were 28% for depressive, 26% for anxiety, and 38% for comorbid disorders. For those with a current disorder at baseline, recurrence (including persistence) was 33%, 31%, and 51%, respectively. Course trajectories were similar across sexes but less favourable for younger adults with a disorder history. CONCLUSIONS:Between 31% and 51% of persons with a current depressive and/or anxiety disorder do not remit over 9 years. This highlights the need for long-term treatment strategies, including ongoing monitoring, management, and relapse prevention.

BACKGROUND:Recent increases in common mental disorder prevalence could partly reflect greater persistence of existing disorders. We examined 3-year persistence for anxiety, mood, and substance use disorders, defined as meeting diagnostic criteria at baseline and again during 3-year follow-up. We compared persistence rates with those observed 12 years earlier and investigated (changes in) determinants of persistence. METHODS:Data were from the third Netherlands Mental Health Survey and Incidence Study (NEMESIS-3), a population-based study (N = 6,194; 18-75 years; interviewed 2019-2022 and 2023-2024). A slightly modified Composite International Diagnostic Interview 3.0 assessed DSM-5 and DSM-IV diagnoses. Persistence was described from two perspectives: narrow (presence of a mental disorder of the same diagnostic category during follow-up) and broad (presence of any anxiety, mood, and/or substance use disorder during follow-up). Twelve-year trends were examined by comparing DSM-IV persistence in NEMESIS-3 with NEMESIS-2 (N = 6,646; interviewed 2007-2009 and 2010-2012) among adults aged 18-64 years. RESULTS:In NEMESIS-3, 3-year narrow persistence was 41.6% for anxiety, 48.0% for mood, and 40.3% for substance use disorders. Broad persistence was higher: 57.1%, 63.2%, and 55.1%, respectively. Persistence increased in 12 years across all disorder groups: broad persistence for any mental disorder was 42.7% in NEMESIS-2 and 57.9% in NEMESIS-3. Higher broad persistence was significantly associated with younger age, living in a city, childhood trauma, and near-daily drug use in multivariable analyses. These associations were stable over time. CONCLUSIONS:Three-year persistence of common mental disorders is substantial and has increased compared with 12 years earlier, suggesting growing challenges for treatment and long-term care.

BACKGROUND:Psychosocial factors are argued to increase cancer risk. This study aims to clarify the association between various psychosocial factors and cancer incidence (including breast, lung, prostate, and colorectal cancers) via individual-participant data (IPD) meta-analysis. The psychosocial factors considered were perceived social support (PSS), loss, relationship status, neuroticism, and general distress. METHODS:The Psychosocial Factors and Cancer Incidence consortium used data from 22 cohorts with a measure of at least one psychosocial variable of interest at baseline (up to N = 421,799; cancer incidence, N = 35,319; person-years of follow-up, N = 4,378,582). In stage 1 of the IPD meta-analysis, Cox regression models were used with age as the timescale. In stage 2, results were pooled in random-effects meta-analyses. RESULTS:No psychosocial factors were associated with an increased risk of overall cancer and with breast, prostate, and colorectal cancers, as well as with cancers with alcohol as a common potential causal factor. PSS, currently not in a relationship, and a loss event were associated with an increased risk of lung cancer (hazard ratio [HR], 1.09-1.55). Estimates decreased for PSS and relationship status when adjusting for several known risk factors, such as a family history of cancer (HR, 1.05-1.08). Similar findings were observed for relationship status and cancers with tobacco smoking as a common potential causal factor. CONCLUSIONS:For most types of cancer, psychosocial factors (measured at a single point in time) were not associated with increased risk. PSS, currently not in a relationship, and loss were associated with an increased risk of lung cancer, although most effects attenuated when adjusting for several known risk factors.

Abstract Importance: Irregular sleep-wake patterns have been associated with poor health and cognitive outcomes, yet evidence linking 24-hour sleep-wake regularity to cognitive decline or dementia remains inconsistent. Particularly, regularity can be measured as regularity of rest-wake, sleep-wake or overall 24-hour activity, but it is unclear which aspects are most relevant for cognitive aging. Objective: To assess associations of rest-wake, sleep-wake, and 24-hour activity regularity with cognitive decline and dementia risk. Design: Observational prospective study comprised of six US and European cohorts: MrOS (sleep study between 2003-2005, mean follow-up: 7.1 years), Rotterdam Study (2004-2007, 11.6 years), MESA (2010-2013, 8.2 years), MAP (2005-2018, 7.2 years), Whitehall II (2012-2013, 6.9 years), and UKB (2013-2015, 7.9 years). Setting: Cohort-specific estimates were pooled using random-effects meta-analysis. Analyses were done between June 2025 and March 2026. Participants 74,733 dementia-free adults with multi-day actigraphy were included across cohorts: MrOS (age: 67-96 years, female:0%), MESA (54-95y, female:54.6%), Rotterdam Study (46-98y, female:55.0%), MAP (56-100y, female:77.1%), Whitehall II (59-83y, female:25.9%), and UKB (55-78y, female:55.5%). Exposure: Day-to-day rest-wake regularity (Rest Regularity Index, RRI), day-to-day sleep-wake regularity (Sleep Regularity Index, SRI), and 24-hour activity regularity (Interdaily Stability, IS) were derived from multi-day actigraphy. Main Outcome: Outcomes were risk of dementia and changes in global cognition. Results: Across six cohorts, 1,906 dementia cases occurred among 74,733 participants. After adjusting for demographics, health behaviors, depressive symptoms and cardiovascular comorbidities, each 1-SD higher regularity score was associated with an 9-14% lower dementia risk (pooled hazard ratios: RRI 0.86 95%CI: [0.79-0.95]; SRI 0.87[0.79-0.97]; IS: 0.91[0.88-0.95]). Associations were approximately linear. Age-stratified analyses showed directionally stronger associations among adults aged < 65, although meta-regression did not support an interaction(p > 0.55). Greater regularity was associated with modestly slower decline in global cognition (pooled β per 1-SD higher score of RRI per year: 0.003, 95%CI [0.001-0.006]). Conclusions & Relevance: Greater regularity of rest-wake, sleep-wake, and 24-hour activity rhythms was associated with lower dementia risk and modestly slower global cognitive decline. These findings suggest that 24-hour sleep-wake regularity is a relevant behavioral marker of cognitive aging and may inform future efforts to identify or intervene on early risk.

The major anxiety disorders (ANX; including generalized anxiety disorder, panic disorder and phobias) are highly prevalent, often onset early and cause substantial global disability. Although distinct in their clinical presentations, they probably represent differential expressions of a dysregulated threat-response system. Here, we present a genome-wide association meta-analysis comprising 122,341 European ancestry ANX cases and 729,881 controls. We identified 58 independent genome-wide significant risk variants and 66 genes with robust biological support. In an independent sample of 1,175,012 self-report ANX cases and 1,956,379 controls, 51 out of the 58 associations replicated. As predicted by twin studies, we found substantial genetic correlation between ANX and depression, neuroticism and other internalizing phenotypes. Follow-up analyses demonstrated enrichment in all major brain regions and highlighted GABAergic signaling as one potential mechanism implicated in ANX genetic risk. These results advance our understanding of the genetic architecture of ANX and prioritize genes for functional follow-up studies.

BackgroundConsidering the multidimensional nature of self-report sleep health may improve identification of those at risk of accelerated cognitive decline and dementia.ObjectiveWe compared how composite measures of multidimensional sleep health relate to cognitive performance and the risk of dementia over time in older adults.MethodsSelf-reported indicators of sleep health domains (satisfaction, alertness, timing, efficiency, and duration) were measured in 7892 Rotterdam Study (RS) participants (mean ± SD age: 69.5 ± 8.9 years, 58.2% female) and 1601 Rush Memory and Aging Project and Minority Aging Research Project (MAP/MARS) participants (79.5 ± 7.9 years, 77.3% female). Sleep items were harmonized and used to derive a sleep health score (number of adverse sleep health items) and sleep health clusters (with latent class analysis). During follow-up, multiple cognitive tests were performed repeatedly and participants were followed for incident all-cause dementia. Relationships of sleep health with cognitive decline (linear mixed models) and risk of dementia (Cox proportional hazards models) were assessed in both samples, adjusting for covariates.ResultsThree sleep health clusters were identified: average sleep, inefficient sleep, and poor sleep. During follow-up of 10.6 ± 4.5 years in RS and 5.3 ± 2.9 years in MAP/MARS, 1148 (14.5%) and 286 (19.8%) participants developed dementia, respectively. Multidimensional sleep health scores and clusters were not significantly associated with accelerated cognitive decline or the risk of dementia in either sample (Hazard Ratios [HRs] between 0.72-1.15).ConclusionsFindings suggest composite measures of self-reported multidimensional sleep health need refinement to be useful in identifying older adults at risk of accelerated cognitive decline and dementia.

The 5-item Brief INSPIRE-O instrument, based on the Connectedness, Hope, Identity, Meaning in Life, and Empowerment framework, is a novel tool to assess personal recovery. Although initially developed for clinical populations, its conceptual alignment with core dimensions of psychological well-being suggests its potential applicability to a broader audience. The current study aimed to examine its validity, reliability, and measurement invariance across people with and without common mental disorders (CMDs). The scale was administered in a Dutch general population sample (n = 5,451). Confirmatory factor analyses supported a unidimensional structure with robust factor loadings and scalar invariance across individuals with and without CMDs in the past year. In addition, the Brief INPSIRE-O showed acceptable reliability (ω = .71-.78) and the expected pattern of correlations with other health indicators supported its construct validity. In conclusion, the Brief INSPIRE-O appears to be a psychometrically sound measure of positive psychological functioning that can be validly used and compared across people with and without CMDs.

The links between sleep disturbances, cognitive decline, and dementia are increasingly recognized, but few studies have considered that sleep health is multidimensional. We evaluated how multidimensional sleep health relates to cognitive decline and the risk of dementia in middle-aged and elderly populations. Self-reported sleep health indicators (satisfaction, alertness, timing, efficiency, and duration) were measured in 7892 participants in the Rotterdam Study (RS) (median [Q1-Q3] age: 68.5 [61.6-76.1] years, 58.2% female) and 1601 participants in the Rush Memory and Aging Project and Minority Aging Research Project (MAP/MARS) (79.2 [73.8-85.3] years, 77.3% female). A multidimensional sleep health score was calculated as the number of adverse sleep health indicators. Latent class analysis identified three multidimensional sleep health profiles: average sleep, inefficient sleep, and poor sleep. Sleep health scores, profiles, and individual indicators were related to five cognitive tests measured repeatedly over time (linear mixed effects models) and to risk of dementia (Cox proportional hazards models). In RS, 1148 (14.5%) participants developed dementia during a median of 11 (7.7-14.3) years. In MAP/MARS, 287 (17.9%) participants developed dementia during a median of 5.0 (3.0-8.0) years. Multidimensional sleep health scores and profiles were not associated with accelerated cognitive decline or the risk of dementia in either sample (Hazard Ratios [HRs] between 0.72-1.15). The individual indicators early timing (RS: HR 1.60; 95%CI [1.23-2.09]; MAP/MARS: HR 1.37 [0.95-2.00]) and long sleep duration (RS: HR 1.61, [1.34-1.94]; MAP/MARS: HR 1.23 [0.81-1.88]) were associated with a higher risk of dementia. Long sleep duration was associated with accelerated cognitive decline on word learning, substitution, and category fluency tasks in MAP/MARS. Self-reported multidimensional sleep health was not associated with cognitive decline and the risk of dementia in two samples of middle-aged and elderly persons. Individual sleep health indicators might be more informative than aggregate measures for predicting cognitive decline and dementia. Future research should consider more complex combinations of self-reported sleep health features and objective measures of sleep. RF1AG056331 (Wallace); R01AG017917 and R01AG022018 (Rush Alzheimer’s Disease Center); the ALIVE flagship, funded by the Convergence of Erasmus MC Rotterdam, Erasmus University Rotterdam and Delft University of Technology (Luik).

Background Genetic risk scores hold potential for predicting depression in the general population. These scores must be validated for their associations with relevant characteristics of depression-related phenotypes, such as severity. We validated a genome-wide risk score (GRS) and a restricted polygenic risk score (PRS) for depression based on a meta-analysis of three genome-wide association studies and assessed their associations with depression in three subcohorts of middle-aged and older adults from the Dutch population-based Rotterdam Study.Methods Of participants with genotype data, 9,198 had longitudinally measured data (mean follow-up: 11.3 years) on three depression-related phenotypes (depressive symptoms, depressive syndrome, and major depressive disorder). Generalized linear models estimated the associations of standardized GRS and PRS with depression phenotypes per subcohort and were then meta-analyzed. One unit of the GRS/PRS represents 1 standard deviation, following z-transformation per cohort.Results A one unit higher GRS and PRS were associated with any longitudinally measured depression phenotype (odds ratio (OR)GRS = 1.20 [1.15-1.26], ORPRS = 1.10 [1.05-1.16]). Effect sizes were highest for episodes of major depressive disorder: for individuals with the 10% highest GRS and PRS, the ORs were 1.99 [1.53-2.57] and 1.51 [1.13-1.99], respectively, compared to the middle 50% of the distribution.Conclusions The GRS and PRS for depression showed modest associations across multiple depression-related phenotypes in a population-based setting. The strength of associations generally increased with the severity of the phenotype. While effect sizes were generally larger for GRS compared to PRS, the difference was mostly not statistically significant.

Objectives Sleep is known to change around pregnancy. Yet current studies often do not take into account the multidimensionality of sleep and its changes from preconception to postpartum. Therefore, this study aims to explore maternal multivariate sleep trajectory from preconception to 6 months postpartum and related determinants. Methods We included 556 women of the Generation R Next Study with sleep measurements between preconception and postpartum at ≥2 time points, and 850 women with sleep measurements at ≥2 time points from pregnancy onwards. Sleep duration, sleep midpoint, sleep latency, sleep quality, and general sleep disturbance were assessed at preconception (or inclusion), first trimester, third trimester, and 6 months postpartum with the Munich Chronotype Questionnaire and General Sleep Disturbance Scale. We used multivariate and univariate latent class models to identify multidimensional and unidimensional sleep trajectories. Associations of sociodemographic, lifestyle and psychopathological factors with sleep trajectories were assessed with multinomial regressions. Results We identified three multivariate sleep trajectories, labelled as ‘good’, ‘average’ and ‘poor’ sleep health. All trajectories were relatively stable over time and with similar sleep duration, but with a different midpoint (03:00, 03:20, 03:40), latency (7.5, 16, 37.5 min), and quality (good, moderate, poor) respectively. Women born outside the Netherlands, with lower socioeconomic status, smoking, using illicit substances, or with depression/anxious symptoms had more poor sleep trajectories. Conclusion Maternal sleep trajectories varied in individuals from preconception to postpartum. Comprehensively considering multiple sleep components, rather than a single sleep component, could provide more insights for prevention of poor maternal sleep.

OBJECTIVES:Understanding economic benefits associated with improved mental well-being in the general population is important for informing population-level strategies. We aimed to estimate the economic impact associated with changes in mental well-being in the Dutch adult population. STUDY DESIGN:This study was based on a longitudinal cohort (the Netherlands Mental Health Survey and Incidence Study-2) METHODS: 5303 adults aged 18-64 years. Were included. Three measurements, each separated by a time interval of three years, were used to evaluate how a change in well-being predicts a change in costs. Well-being was measured using the Mental Health Continuum-Short Form. Societal costs encompassed three cost categories: 1) healthcare costs; 2) productivity losses; and 3) patient and family costs. Main analysis was based on a model where a change in costs Y(t2-t1) was regressed on a synchronically occurring change in well-being X(t2-t1). Additionally, this model was compared with a diachronic model where a subsequent change in costs was regressed on a preceding change in well-being, i.e. Y(t3-t2) on X(t2-t1). RESULTS: Each %-point increase in mental well-being reduced societal costs by -€50.74 (95 %CI: €78.72; -€22.76) per person, which was statistically significant (SE = 14.27, t = -3.56, p < 0.001). The majority of these savings (89 %) were attributable to increased productivity. In the diachronic model, no significant difference between wellbeing and subsequent costs was found. CONCLUSION:This study demonstrated that improvements in mental well-being are potentially associated with simultaneously occurring cost reductions, primarily through increased productivity. Hence, there may be potential for mental well-being interventions to reduce societal costs and enhance productivity at a population level.

BACKGROUND AND AIMS:Deviations from the population mean in sleep duration have been associated with increased risk for developing dyslipidemia and atherosclerotic cardiovascular disease, but the mechanism of effect is poorly characterized. We performed large-scale genome-wide gene-sleep interaction analyses of lipid levels to identify genetic variants underpinning the biomolecular pathways of sleep-associated lipid disturbances and to suggest possible druggable targets. METHODS:We collected data from 55 cohorts with a combined sample size of 732,564 participants (87 % European ancestry) with data on lipid traits (high-density lipoprotein [HDL-c] and low-density lipoprotein [LDL-c] cholesterol and triglycerides [TG]). Short (STST) and long (LTST) total sleep time were defined by the extreme 20 % of the age- and sex-standardized values within each cohort. Based on cohort-level summary statistics data, we performed meta-analyses for one-degree of freedom tests of interaction and two-degree of freedom joint tests of the SNP-main and -interaction effect on lipid levels. RESULTS:The one-degree of freedom variant-sleep interaction test identified 10 novel loci (Pint<5.0e-9), and we additionally identify 7 loci within the two-degree of freedom analyses (Pjoint<5.0e-9 in combination with Pint<6.6e-6). Multiple loci, including those mapped to APSH (target for aspartic and succinic acid) and SLC8A1 showed biological plausibility and druggability potential based on literature. CONCLUSIONS:Collectively, the 17 (9 with short and 8 with long sleep) loci provided evidence into the biomolecular mechanisms underlying sleep-associated lipid changes, including potential involvement of the vitamin D receptor pathway. Collectively, these findings may contribute developing novel interventions for treating dyslipidemia in people with sleep disturbances.

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.

Insomnia disorder is a significant public health issue, but the prevalence estimates vary widely. We performed a meta-analysis aiming to pool prevalence rates in studies (1) carried out in the general population (2) using a true random sample (3) and using a diagnostic interview, DSM based self-report questions, or a questionnaire with a cut-off established against the DSM criteria. A literature search (in PubMed, Embase, APA PsycInfo) was performed up to April 2024. Two independent reviewers assessed title and abstracts (n = 6732), full-text manuscripts (n = 621) and extracted the data of the 47 included studies. Prevalence rates were pooled using a three-level hierarchical random-effects model, stratified by diagnosis type and adjusted for gender distribution and mean sample age. The pooled prevalence of all studies using an interview to establish the DSM criteria was 12.4% (95% CI: 9.0-16.8%), and of self-report questions assessing the DSM diagnosis 16.3% (95% CI: 11.3%-23.0%). There were 27 studies using different insomnia questionnaires with different cut-offs (prevalence range 7.5%-32.3%). The prevalences differed significantly across regions and high quality studies yielded a lower prevalence rates than lower quality studies. This meta-analysis confirms that insomnia is a common disorder with a prevalence of 12.4 as the most accurate estimate. It also shows the need for standardised ways of assessing insomnia. We think the golden standard is using standardised structured clinical interviews. However, if this is not feasible, we recommend using well validated questionnaires such as the Sleep Condition Indicator or the Insomnia Severity Index. Trial Registration: PROSPERO CRD42023402745.

BACKGROUND:Anxiety and depression are common in prodromal dementia, possibly due to changes in subcortical grey matter structures involved in emotion regulation. We aimed to determine the association between subcortical grey matter volumes and depression and anxiety symptoms. METHODS:We included dementia-free participants from the population-based Rotterdam Study, who underwent brain MRI between 2009 and 2015. Depression and anxiety symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale and the Hospital Anxiety and Depression scale- Anxiety subscale (HADS-A). We determined cross-sectional associations of standardized volumes with log-transformed CES-D and HADS scores using multivariable linear regression models. We repeated analyses among outpatients who attended the Alzheimer Center Erasmus Medical Center between 2016 and 2021. RESULTS:Among 3451 community-dwelling participants (mean age 69.3 years, 55.2 % women), median CES-D score was 3 (IQR:1-7) and HADS-A score 2 (IQR:0-4). Clinically relevant depressive symptoms (CES-D ≥ 16) were present in 284 (8.2 %) participants, and anxiety (HADS≥8) in 270 (8.2 %). Lower volumes of the caudate and pallidum were associated with fewer depressive symptoms (mean difference [95 %CI] for the caudate: -0.06[-0.10;-0.02], pallidum: -0.04[-0.08;0.00]), and less anxiety (caudate: -0.04[-0.07;-0.01], pallidum: -0.05[-0.09;-0.02]). Lower hippocampal volume was associated with higher odds of clinical depressive symptoms (OR: 1.27[1.05-1.52]), albeit not significant after multiple testing correction. We observed no associations for other structures. Among 315 memory clinic patients, (mean age 68.9 years, 43.5 % women), no associations were observed after multiple testing correction. CONCLUSION:Volumes of the caudate and pallidum are inversely associated with depression and anxiety symptoms in community-dwelling older adults, but not in a memory clinic population.

Bright light therapy (BLT) is a potential treatment for depression during pregnancy, which may also improve sleep. We investigated whether BLT has an effect on self-reported and actigraphy-estimated sleep in pregnant women diagnosed with depressive disorder. Sixty-seven pregnant women with a DSM-5 diagnosis of depressive disorder during pregnancy were randomly allocated to treatment with BLT (9,000 lx, 5,000 K) or dim red light therapy (DRLT, 100 lx, 2,700 K), which is considered placebo. For six weeks, both groups were treated daily at home for 30 min upon awakening. Follow-up took place at various time points. We collected data on sleep with the Pittsburgh Sleep Quality Index and with actigraphy wearables. We found no statistically significant differences in treatment groups across any of the sleep parameters measured, namely sleep efficiency, duration, onset latency, fragmentation, and total sleep health as measured by self-report and actigraphy. Moreover, we observed no overall improvements in sleep during the treatment period. The results suggest that any potential therapeutic effects of BLT might have on sleep are too small for the current study to detect. NTR5476; November 5th, 2015 Bright light therapy had no detectable effect on subjective sleep health in pregnant women with depression. Bright light therapy also had no detectable effect on actigraphy-estimated sleep parameters. Other forms of intervention may be more suited to address highly prevalent sleep problems in this population.

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.

Sleep, sedentary behaviour, and physical activity (PA) are important for brain health. Spending more time in one behaviour always substitutes time in another, which may affect associations and should be considered in prevention strategies. We assessed how substitutions of sleep, sedentary behaviour, and PA are associated with incident dementia and stroke, using compositional analysis. Participants (mean age: 71.3 ± 9.26 years, 51.6% female) without prevalent dementia (N = 1899) or stroke (N = 1854) from the Rotterdam Study wore an accelerometer for ≥ 4 days to estimate the duration of sleep, sedentary behaviour, light PA, and moderate-to-vigorous PA. Participants were continuously followed up for dementia (median: 4.5 years) and stroke (median: 5.1 years). Compositional Cox regression with isotemporal substitution analysis was used to assess associations of 30-min pair-wise substitutions with dementia and stroke. In total, 50 (2.6%) participants were diagnosed with dementia and 75 (4.0%) with a first-time stroke. Spending more time in moderate-to-vigorous PA and less in other behaviours was associated with a lower risk of dementia (Hazard Ratio [HR] for 30 min less sedentary behaviour 0.36; 95% CI: 0.24-0.55) and so was more sleep and less sedentary behaviour (HR: 0.87; 0.79-0.97) or light PA (HR: 0.43; 0.27-0.68). Those with more light PA and less sedentary behaviour had a higher risk of dementia (HR: 1.78; 1.19-2.66). Only having more sleep and less sedentary behaviour was associated with having a stroke (HR: 1.14; 1.03-1.27). More time in sleep and moderate-to-vigorous PA, substituting particularly sedentary behaviour, may be a modifiable risk factor for dementia. No consistent effects for stroke were found, warranting future research.