Prevention of Depression
نویسندگان
چکیده
We never know self-realisation. We are two abysses – a well staring at the sky. Utrecht) is gratefully acknowledged. The Trimbos Institute and the Department of Clinical Psychology of the Vrije Universiteit Amsterdam are acknowledged, with many thanks, for granting the author sabbatical leave. The Museum Boijmans van Beuningen in Rotterdam is acknowledged for kindly giving permission to make use of Albrecht Dürer's copperplate " Melencolia I ". In dedication to the people who kindly participated in these studies – It is their altruism that furthers science The plates at the beginning of each chapter represent St George – no doubt a historical figure who died in Lydda in 303, where his alleged tomb can be found. He became a figurehead of chivalry among the crusaders. This gave great impetus to the veneration of St George across Europe. He was adopted patron saint to England and Portugal, and to the Knights of the Garter under King Edward III. His well-known battle with the dragon is shrouded by fable, but might be traced to the myth of Perseus, and could, in the context of this thesis, be interpreted as an emblem of courageous determination, elsewhere called " mastery " , in the face of adversity. 7 Contents Antithesis: A note to Albrecht Dürder's Melancholia 9 General introduction 11 Part 1: Do we need it? 19 1.1 Prevention of depression, rationale 21 1.2 Costs of common mental disorders 27 Part 2: Do we know where to begin? 41 2.1 Selecting key-variables for depression prevention 43 2.2 Opportunities for cost-effective prevention of late-life depression 53 2.3 Prevention of late-life depression in primary care, where to begin? 69 Part 3: Is it effective? 85 3.1 A guided self-help intervention to prevent depression, randomised trial 87 3.2 Psychological treatment of subthreshold depression, meta-analysis 99 Part 4: Is it affordable? 111 4.1 Cost-effectiveness of preventing depression, randomised trial 113 4.2 A risk-factor epidemiology of costs in mental health 125 Summary and general discussion 139 5.1 Summary of preceding chapters 141 5.2 General discussion 151 5.3 Summary in Dutch 163 References 185 Acknowledgement 205
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