• No results found

Herstelde deelnemers met een of meerdere voorgaande depressieve stoornissen in het verleden laten een aandachtsbias zien voor negatieve stimuli (zoals “waardeloos”); zie hoofdstuk 4. Als vervolg stap hebben we onderzocht of deze AB ook voorspellend is voor toekomstige depressieve episoden en/of het hebben van depressieve symptomen

tijdens de follow up metingen 2 en 4 jaar later (hoofdstuk 5). In een longitudinale studie met behulp van data van de NESDA zijn deelnemers geselecteerd die waren hersteld van een depressieve stoornis (n=918). Aandachtsbias is gemeten met een verbale ECT; met 2 presentatietijden (500 en 1250 ms) en 3 stimulus typen (negatief, positief en neutraal). Na een tijdsperiode van 2 en van 4 jaar nadat de deelnemers de ECT hadden gedaan, zijn terugkerende depressieve stoornis en depressieve symptomen gemeten. De diagnose depressieve stoornis is gemeten met behulp van klinische beoordelingsschalen (CIDI) en depressieve symptomen met zelfrapportage vragenlijsten (IDS-SR). Een verhoogde kans op terugkeer was noch geassocieerd met (verhoogde) AB voor negatieve stimuli noch met (verlaagde) AB voor positieve stimuli. Kortom, de bevindingen bieden geen ondersteuning voor de hypothese dat een aandachtsbias richting negatieve stimuli of weg van positieve stimuli een kritische rol speelt in de terugkeer van depressie.

Op dit moment is echter een debat gaande over de betrouwbaarheid van prestatietaken; ook over de ECT. Om tot een meer finale conclusie te komen, is het van belang de huidige studie te repliceren met taken die gebruik maken van AB indices met geverifieerde psychometrische kwaliteiten. Voor deze studie zijn deelnemers geselecteerd waarbij het natuurlijk verloop van depressie kon worden gemeten. Het kan zijn dat juist AB gemeten na stemmingsinductie in het laboratorium voorspellende waarde heeft voor terugkeer van een depressieve episode. Ook kan een volgende stap in onderzoek zijn om het meemaken van belangrijke levensgebeurtenissen als moderator te onderzoeken op de relatie tussen AB en terugkeer van depressieve episoden.

Conclusie

Een depressieve stoornis is een veelvoorkomende psychische aandoening, die veel lijden met zich meebrengt. Vooral het terugkerende karakter van een depressie draagt bij aan het lijden van het individu en zijn/haar omgeving, en gaat gepaard met hoge gezondheidszorg- en maatschappelijke kosten. Geïnspireerd op het conceptuele kader om kwetsbaarheid voor terugkeer van depressieve episoden te voorspellen richtte dit proefschrift zich op drie kandidaat-factoren die mogelijk bijdragen aan het

177

Samenvatting

recidiverende karakter van depressie: negatieve zelf-associaties, cognitieve reactiviteit (in reactie op een sombere stemming) en aandachtsbias.

Al met al wijzen de cross-sectionele en prospectieve bevindingen in dit proefschrift naar negatieve zelf-associaties en (subjectieve) CR als belangrijke kandidaat factoren die kunnen bijdragen aan terugkeer van depressieve episoden. Een belangrijke volgende stap is om de veronderstelde causale rol van zelf-associaties en subjectieve CR te onderzoeken. Een manier op dit verder uit te zoeken is door vast te stellen of experimentele modificatie van zelf-associaties en/of subjectieve CR de kans op het terugkeren van depressie verlaagt. Vervolgens zou kunnen worden onderzocht of gerichte modificatie van zelf-associaties of CR een effectieve toegevoegde interventie kan zijn aan de huidige terugvalpreventie interventies, met als uiteindelijk doel het reduceren van het risico op terugval.

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