COMMON MENTAL HEALTH CONDITIONS

A complex systems approach is applied to mental health research, focusing on the interaction of affective, psychological, neurobiological mechanisms, and environmental factors that contribute to the onset, maintenance, and relapse of depression, suicidality, and anxiety.

Complex Systems

Although many factors have been linked to common mental health outcomes, they are often examined in isolation. In reality, these conditions are shaped by a web of dynamic interactions and feedback processes that evolve over time. Viewing mental health through a complex systems lens can lead to more adaptive and holistic treatment strategies.

Scheffer, M., Bockting, C. L., Borsboom, D., Cools, R., Delecroix, C., Hartmann, J. A., Kendler, K. S., van de Leemput, I., van der Maas, H. L. J., van Nes, E., Mattson, M., McGorry, P. D., & Nelson, B. (2024). A dynamical systems view of psychiatric disorders—Practical implications: A review. JAMA Psychiatry, 81(6):624-630. https://doi.org/10.1001/jamapsychiatry.2024.0228
Scheffer, M., Bockting, C. L., Borsboom, D., Cools, R., Delecroix, C., Hartmann, J. A., Kendler, K. S., van de Leemput, I., van der Maas, H. L. J., van Nes, E., Mattson, M., McGorry, P. D., & Nelson, B. (2024). A dynamical systems view of psychiatric disorders—Theory: A review. JAMA Psychiatry., 81(6):618-623 https://doi.org/10.1001/jamapsychiatry.2024.0215
Bringmann, L. F., Albers, C., Bockting, C. L., Borsboom, D., Ceulemans, E., Cramer, A., Epskamp, S., Eronen, M. I., Hamaker, E., Kuppens, P., Lutz, W., McNally, R. J., Molenaar, P., Tio, P., Voelkle, M. C., & Wichers, M. (2022). Psychopathological networks: Theory, methods and practice. Behaviour Research and Therapy, 149, 104011. https://doi.org/10.1016/j.brat.2021.104011
van der Wal, J. M., van Borkulo, C. D., Deserno, M. K., Breedvelt, J. J. F., Lees, M., Lokman, J. C., Borsboom, D., Denys, D., van Holst, R. J., Smidt, M. P., Stronks, K., Lucassen, P. J., van Weert, J. C. M., Sloot, P. M. A., Bockting, C. L., & Wiers, R. W. (2021). Advancing urban mental health research: From complexity science to actionable targets for intervention. Lancet Psychiatry, 8(11), 991–1000. https://doi.org/10.1016/s2215-0366(21)00047-x
De Beurs, D., Bockting, C. L., Kerkhof, A., Scheepers, F., O’Connor, R., Penninx, B., & van de Leemput, I. (2020). A network perspective on suicidal behavior: Understanding suicidality as a complex system. Suicide and Life-Threatening Behavior, 0, 1-12. https://doi.org/10.1111/sltb.12676

Social & Environmental Factors

How does society, our environment and global events influence the onset and maintenance of common mental health disorders?

Learn more about Urban Mental Health

Huth, K., Wal, J. van der, Zavlis, O., Luigjes, J., Lakerveld, J., Galenkamp, H., Lok, A., Stronks, K., Bockting, C. L., Marsman, M., Goudriaan, A., & Holst, R. van. (2025). Individual and neighborhood determinants of depressive symptoms in ethnic minorities in the urban HELIUS sample: A multi-level network perspective. Social Science & Medicine, 381, 118195. https://doi.org/10.1016/j.socscimed.2025.118195
van der Spek, N., Junus, A., van Ballengooijen, W., Wiers, R., & Bockting, C. L. (2025). Mental health symptom profiles and temporal trends in Dutch young people’s social and emotional wellbeing and suicidality, 2017–2023. Journal of Affective Disorders, 390, 119844. https://doi.org/10.1016/j.jad.2025.119844
Wiers, R. W., El Marroun, H., Bockting, C. L., & Krugers, H. (2025). Debate: Urban versus rural environments – which is better for mental health? The one good thing about a small town. Child and Adolescent Mental Health, 30(2), 189-191. https://doi.org/10.1111/camh.12771
van der Wal, J. M., Huth, K. B. S., Lok, A., Bockting, C. L., Stronks, K., & Nicolaou, M. (2024). Exploring the mechanisms underlying increased risk of depressive disorder in ethnic minority populations in Europe: A causal loop diagram. Social Science & Medicine, 351, 116977. https://doi.org/10.1016/j.socscimed.2024.116977
Franzoi, D., Bockting, C. L., Bennett, K. F., Odom, A., Lucassen, P. J., Pathania, A., Lee, A., Brouwer, M. E., van de Schoot, R., Wiers, R. W., & Breedvelt, J. J. F. (2023). Which individual, social, and urban factors in early childhood predict psychopathology in later childhood, adolescence and young adulthood? A systematic review. SSM - Population Health, 25, 101575. https://doi.org/10.1016/j.ssmph.2023.101575
Willemen, F. E. M., Heuschen, C. B. B. C. M., Zantvoord, J. B., Galenkamp, H., de Wit, M. A. S. Zwinderman, A. H., Denys, D. A. J. P., Bockting, C. L., Stronks, L., & Lok, A. (2023). Perceived ethnic discrimination, suicidal ideation and mastery in a multi-ethnic cohort: the HELIUS study. BJPsych Open, 9(1), e21. https://doi.org/10.1192/bjo.2022.640
Breedvelt, J. J., Tiemeier, H., Sharples, E., Galea, S., Niedzwiedz, C., Elliott, I., & Bockting, C. L. (2022). The effects of neighbourhood social cohesion on preventing depression and anxiety among adolescents and young adults: Rapid review. BJPsych open, 8(4). https://doi.org/10.1192/bjo.2022.57
Lokman, J. C., & Bockting, C. L. (2022). Pathways to depressive and anxiety disorders during and after the COVID-19 pandemic. Lancet Psychiatry, 9(7), 531–533. https://doi.org/10.1016/S2215-0366(22)00152-3
Van der Wal, J. M., Arjadi, R., Nauta, M. H., Burger, H., & Bockting, C. L. (2020). Guided internet interventions for depression: Impact of sociodemographic factors on treatment outcome in Indonesia. Behaviour Research and Therapy, 103589. https://doi.org/10.1016/j.brat.2020.103589
Verbeek, T., Bockting, C. L., Beijers, C., Meijer, J. L., van Pampus, M. G., & Burger, H. (2019). Low socioeconomic status increases effects of negative life events on antenatal anxiety and depression. Women and Birth, 32(1), e138-e143. https://doi.org/10.1016/j.wombi.2018.05.005

Neurobiological & Physiological Mechanisms

Although many factors have been linked to common mental health outcomes, they are often examined in isolation. In reality, these conditions are shaped by a web of dynamic interactions and feedback processes that evolve over time. Viewing mental health through a complex systems lens can lead to more adaptive and holistic treatment strategies.

Bennebroek Evertsz, F., Goes, F. L. S., Stokkers, P. C. F., Sanderman, R., Verdam, M. G. E., Sprangers, M., & Bockting, C. L. (2025). IBD-specific behavioral therapy: Sustainability of effect after three years. Clinical Psychology in Europe, 7(3), e14717. https://doi.org/10.32872/cpe.14717
Bennebroek Evertsz’, F., Bockting, C. L., Braamse, A., Van Dissel, M. N. M., Duijvestein, M., Kager, L. M., Kool, M., Löwenberg, M., Mares, W., Nieuwkerk, P., Sipkema, H. A., Young, Z., & Knoop, H. (2024). Implementation of ‘IBD-Specific Cognitive Behavioural Therapy’ for patients with inflammatory bowel diseases with poor mental quality of life, Anxiety and Depression. Journal of Clinical Psychology in Medical Settings, 31, 258-278. https://doi.org/10.1007/s10880-023-09996-8
Korenblik, V., Brouwer, M., Korosi, A., Denys, D., Bockting, C. L., Brul, S., & Lok, A. (2023) Are neuromodulation interventions associated with changes in the gut microbiota? A systematic review. Neuropharmacology, 223,109318. https://doi.org/10.1016/j.neuropharm.2022.109318
Korenblick, V., Korosi, A., Nieuwdorp, M., Bockting, C. L., Brul, S., & Lock, A. (2023). Butyrate’s effects on depressive symptoms and affect in young adults with depression: study protocol for a pilot randomized controlled trial. Neuroscience Applied, 2(2), 102443. https://doi.org/10.1016/j.nsa.2023.102443
Cohen, S. E., Zantvoord, J. B., Wezenberg, B. N., Bockting, C. L., & van Wingen, G. A. (2021). Magnetic resonance imaging for individual prediction of treatment response in major depressive disorder: A systematic review and meta-analysis. Translational psychiatry, 11(1), 1-10. https://doi.org/10.1038/s41398-021-01286-x
Cohen, S., Zantvoord, J., Wezenberg, B., Daams, J., Bockting, C. L., Denys, D., & van Wingen, G. (2022). Electroencephalography for predicting antidepressant treatment success: A systematic review and meta-analysis. https://doi.org/10.31234/osf.io/mvnxa
Korenblik, V., Brouwer, M. E., Korosi, A., Denys, D., Bockting, C. L., Brul, S., & Lok, A. (2023). Are neuromodulation interventions associated with changes in the gut microbiota? A systematic review. Neuropharmacology, 223, 109318. https://doi.org/10.1016/j.neuropharm.2022.109318
van Kleef, R. S., Marsman, J. C., van Valen, E., Bockting, C. L., Aleman, A., & van Tol, M. J. (2022). Neural basis of positive and negative emotion regulation in remitted depression. NeuroImage. Clinical, 34, 102988. https://doi.org/10.1016/j.nicl.2022.102988
Bennebroek Evertsz, F., Sprangers, M. A. G., de Vries, L. M., Sanderman, R., Stokkers, P. C. F., Verdam, M. G. E., Burger, H., & Bockting, C. L. (2020). I am a total failure: Associations between beliefs and anxiety and depression in patients with inflammatory bowel disease with poor mental quality of life. Behavioural and Cognitive Psychotherapy, 48(1), 91-102. https://doi.org/10.1017/s1352465819000444
Kennis, M., Gerritsen, L., van Dalen, M., Williams, A., Cuijpers, P., & Bockting, C. L. (2020). Prospective biomarkers of major depressive disorder: A systematic review and meta-analysis. Molecular Psychiatry, 25(2), 321-338. https://doi.org/10.1038/s41380-019-0585-z
Nieman, D. H., Chavez-Baldini, U., Vulink, N. C., Smit, D. J. A., van Wingen, G., de Koning, P., Sutterland, A., Mocking, R., Bockting, C. L., Verweij, K., Lok, A., & Denys, D. (2020). Protocol Across study: Longitudinal transdiagnostic cognitive functioning, psychiatric symptoms, and biological parameters in patients with a psychiatric disorder. BMC Psychiatry, 20(1), 212. https://doi.org/10.1186/s12888-020-02624-x
Van Tol, M. J., Eike, R., Van Kleef, R., Marsman, J. B., Van Valen, E., Aleman, A., & Bockting, C. L. (2020). P.348 Understanding neurocognitive working mechanisms of relapse prevention – the role of emotion regulation in remitted major depressive disorder. European Neuropsychopharmacology, 40, S202-S203. https://doi.org/10.1016/j.euroneuro.2020.09.264
Ahern, E., Bockting, C. L., & Semkovska, M. (2019). A hot-cold cognitive model of depression: Integrating the neuropsychological approach into the cognitive theory framework. Clinical Psychology in Europe, 1(3), 1-35. https://doi.org/10.32872/cpe.v1i3.34396
Ter Horst, D. M., Schene, A. H., Figueroa, C. A., Assies, J., Lok, A., Bockting, C. L., Ruhé, H., & Mocking, R. J. T. (2019). Cortisol, dehydroepiandrosterone sulfate, fatty acids, and their relation in recurrent depression. Psychoneuroendocrinology, 100, 203-212. https://doi.org/10.1016/j.psyneuen.2018.10.012
Thesing, C. S., Lok, A., Milaneschi, Y., Assies, J., Bockting, C. L., Figueroa, C. A., Giltay, E. J., Penninx, B. W. J. H., Ruhé, H., Schene, A. H., Bot, M., & Mocking, R. J. T. (2019). Fatty acids and recurrence of major depressive disorder: Combined analysis of two Dutch clinical cohorts. Acta Psychiatrica Scandinavica. https://doi.org/10.1111/acps.13136
van Kleef, R. S., Bockting, C. L., van Valen, E., Aleman, A., Marsman, J. C., & van Tol, M. J. (2019). Neurocognitive working mechanisms of the prevention of relapse in remitted recurrent depression (NEWPRIDE): Protocol of a randomized controlled neuroimaging trial of preventive cognitive therapy. BMC Psychiatry, 19(1), 409. https://doi.org/10.1186/s12888-019-2384-0
Kennis, M., Gerritsen, L., van Dalen, M., Williams, A., Cuijpers, P., & Bockting, C. L. (2018). T149. Do we have evidence for predictive biomarkers for major depressive disorder? A meta-analysis and systematic review of prospective studies. Biological Psychiatry, 83(9), S186. https://doi.org/10.1016/j.biopsych.2018.02.486
Bennebroek Evertsz', F., Sprangers, M. A. G., Sitnikova, K., Stokkers, P. C. F., Ponsioen, C. Y., Bartelsman, J. F. W. M., van Bodegraven, A. A., Fischer, S., Depla, A. C. T. M., Mallant, R. C., Sanderman, R., Burger, H., & Bockting, C. L. (2017). Effectiveness of cognitive-behavioral therapy on quality of life, anxiety, and depressive symptoms among patients with inflammatory bowel disease: A multicenter randomized controlled trial. Journal of Consulting and Clinical Psychology. 85(9), 918-925. https://doi.org/10.1037/ccp0000227
De Boer, A.G., Bennebroek Evertsz, F., Stokkers, P. C., Bockting, C. L.,Sanderman, R., Hommes, D. W., Sprangers, M. A. & Frings-Dresen, M. H. (2016). Employment status, difficulties at work and quality of life in inflammatory bowel disease patients. European Journal of Gastroenterology & Hepatology, 28(10), 1130-1136.https://doi.org/10.1097/MEG.0000000000000685.
Assies, J., Mocking, R. J., Lok, A., Koeter, M. W., Bockting, C. L.,Visser, I., Pouwer, F., Ruhé, H.G., & Schene, A. H. (2015). Erythrocyte fatty acid profiles and plasma homocysteine, folate and vitamin B6 and B12 in recurrent depression: Implications for comorbidity with cardiovascular disease. Psychiatry Research, 229, 992-998. https://doi.org/10.1016/j.psychres.2015.06.025
Bockting, C. L.,Mocking, R. J. T., Lok, A., Koeter, M. W. J., & Schene, A. H. (2013). Therapygenetics: The 5HTTLPR as a biomarker for response to psychological therapy? Molecular Psychiatry, 18, 744-745. https://doi.org/10.1038/mp.2012.92
Mocking, R. J. T., Lok, A., Assies, J., Koeter, M. W. J., Visser, I., Ruhé, H. G., Bockting, C. L.,& Schene, A. H. (2013). Ala54Thr fatty acid-binding protein 2 (FABP2) polymorphism in recurrent depression: Associations with fatty acid concentrations and waist circumference. PLoS ONE,8, e82980. https://doi.org/10.1371/journal.pone.0082980
Mocking, R.J.T., Ruhé, H.G., Assies, J., Lok, A., Koeter, M.W.J., Visser, I., Bockting, C. L.,& Schene, A.H. (2013). Relationship between the hypothalamic-pituitary-adrenal axis and fatty acid metabolism in recurrent depression. Psychoneuroendocrinology, 38, 1607-1617. https://doi.org/10.1016/j.psyneuen.2013.01.013
Bennebroek-Evertsz, F., Thijssens, N. A. M., Stokkers, P. C. F., Grootenhuis, M. A., Bockting, C. L.,Nieuwkerk, P. T., & Sprangers, M. A. G. (2012). Do inflammatory bowel disease patients with anxiety and depressive symptoms receive the care they need? Journal of Crohn's and Colitis, 6, 68-76. https://doi.org/10.1016/j.crohns.2011.07.006
Bockting, C. L.,Lok, A., Visser, I., Assies, J., Koeter, M. W., Schene, A. H., & The DELTA study group (2012). Lower cortisol levels predict recurrence in remitted patients with recurrent depression: A 5.5 year prospective study. Psychiatry research, 200, 281-287. https://doi.org/10.1016/j.psychres.2012.03.044
Lok, A., Assies, J., Koeter, M. W. J., Bockting, C. L.,Wouters, L. F., Mocking, R. J. T., & Schene, A. H. (2012). Sustained medically unexplained physical symptoms in euthymic patients with recurrent depression: Predictive value for recurrence and associations with omega 3- and 6 fatty acids and 5-HTTLPR? Journal of Affective Disorders, 136, 604-611. https://doi.org/10.1016/j.jad.2011.10.024
Lok A., Mocking, R. J. T., Ruhé, H. G., Visser, I., Koeter, M. W., Assies, J., Bockting, C. L.,Olff, M., & Schene, A. H. (2012). Longitudinal hypothalamic-pituitary-adrenal axis trait and state effects in recurrent depression. Psychoneuroendocrinology, 37, 892-902. https://doi.org/10.1016/j.psyneuen.2011.10.005
Mocking, R. J. T., Assies, J., Lok, A., Ruhé, H. G., Koeter, M. W. J., Visser, I., Bockting, C. L.,& Schene, A. H. (2012). Statistical methodological issues in handling data of fatty acid data: Percentages or concentration, imputation and indices. Lipids, 47, 541-547. https://doi.org/10.1007/s11745-012-3665-2
Assies, J., Pouwer, F., Lok, A., Mocking, R. J. T., Bockting, C. L.,Visser, I., Abeling, N. G. G. M., Duran, M., & Schene, A. H. (2010). Plasma and erythrocyte fatty acid patterns in patients with recurrent depression: A matched case-control study. PLoS ONE, 5, e10635. https://doi.org/10.1371/journal.pone.0010635

Pregnancy & Generational Mental Health

How does pregnancy and post-partum influence maternal and offspring mental health? What role do broader generational trends play in shaping mental well-being?

Broeks, C. W., Molenaar, N., Brouwer, M., van den Akker, E. L. T., van Rossum, E. F. C., Van, R., van den Berg, S. A. A., Hillegers, M., Hoogendijk, W. J. G., Burger, H., Bockting, C. L., Kamperman, A. M., & Lambregtse-Van den Berg, M. P. (2023). Intergenerational impact of childhood trauma on hair cortisol concentrations in mothers and their young infants. Comprehensive Psychonuroendocrinology, 14, 100167. https://doi.org/10.1016/j.cpnec.2023.100167
Brouwer, M. E., Molenaar, N. M., Burger, H., Williams, A. D., Albers, C., Lambregtse-van den Berg, M., & Bockting, C. L. (2020). Tapering antidepressants while receiving digital Preventive Cognitive Therapy during pregnancy: An experience sampling methodology trial. Frontiers in Psychiatry, 11, 574357. https://doi.org/10.3389/fpsyt.2020.574357
Burger, H., Verbeek, T., Aris-Meijer, J. L., Beijers, C., Mol, B. W., Hollon, S. D., OrmeL, J., van Pampus, M., & Bockting, C. L. (2020). Effects of psychological treatment of mental health problems in pregnant women to protect their offspring: Randomised controlled trial. The British Journal of Psychiatry, 216(4), 182-188. https://doi.org/10.1192/bjp.2019.260
Molenaar, N. M., Brouwer, M. E., Burger, H., Kamperman, A. M., Bergink, V., Hoogendijk, W. J. G., Williams, A., Bockting, C. L., & Lambregtse-van den Berg, M. P. (2020). Preventive cognitive therapy with antidepressant discontinuation during pregnancy: Results from a randomized controlled trial. Journal of Clinical Psychiatry, 81(4). https://doi.org/10.4088/JCP.19l13099
Molenaar, N. M., Houtman, D., Bijma, H. H., Brouwer, M. E., Burger, H., Hoogendijk, W. J. G., Bockting, C. L., Kampermen, A., & Lambregtse-van den Berg, M. P. (2020). Dose-effect of maternal serotonin reuptake inhibitor use during pregnancy on birth outcomes: A prospective cohort study. Journal of Affective Disorders, 267, 57-62. https://doi.org/10.1016/j.jad.2020.02.003
Nieman, D. H., Chavez-Baldini, U., Vulink, N. C., Smit, D. J. A., van Wingen, G., de Koning, P., Sutterland, A., Mocking, R., Bockting, C. L., Verweij, K., Lok, A., & Denys, D. (2020). Protocol Across study: Longitudinal transdiagnostic cognitive functioning, psychiatric symptoms, and biological parameters in patients with a psychiatric disorder. BMC Psychiatry, 20(1), 212. https://doi.org/10.1186/s12888-020-02624-x
Aris-Meijer, J., Bockting, C. L., Stolk, R., Verbeek, T., Beijers, C., van Pampus, M., & Burger, H. (2019). What if pregnancy is not seventh heaven? The influence of specific life events during pregnancy and delivery on the transition of antenatal into postpartum anxiety and depression. Int. J. Environ. Res. Public Health, 16(16), 2851. https://doi.org/10.3390/ijerph16162851
Molenaar, N. M., Brouwer, M. E., Kamperman, A. M., Burger, H., Williams, A. D., Hoogendijk, W. J. G., Bockting, C. L., & Lambregtse-van den Berg, M. P. (2019). Recurrence of depression in the perinatal period: Clinical features and associated vulnerability markers in an observational cohort. PLOS One, 14(2), e0212964. https://doi.org/10.1371/journal.pone.0212964
Molenaar, N. M., Tiemeier, H., van Rossum, E. F. C., Hillegers, M. H. J., Bockting, C. L., Hoogendijk, W. J. G., van den Akker, E., Lambregtse-van den Berg, M. P., & El Marroun, H. (2019). Prenatal maternal psychopathology and stress and offspring HPA axis function at 6 years. Psychoneuroendocrinology, 99, 120-127. https://doi.org/10.1016/j.psyneuen.2018.09.003
Verbeek, T., Quittner, L., de Cock, P., de Groot, N., Bockting, C. L., & Burger, H. (2019). Personality traits predict meeting the WHO recommendation of 6 months' breastfeeding: A prospective general population cohort study. Advances in Neonatal Care, 19(2), 118-126. https://doi.org/10.1097/anc.0000000000000547
Brouwer, M. E., Williams, A. D., van Grinsven, S. E., Cuijpers, P., Lambregtse-van den Berg, M. P., Burger, H., & Bockting, C. L. (2018). Offspring outcomes after prenatal interventions for common mental disorders: A meta-analysis. BMC Medicine, 16, 208. https://doi.org/10.1186/s12916-018-1192-6
Molenaar, N. M., Brouwer, M. E., Duvekot, J. J., Burger, H., Knijff, E. M., Hoogendijk, W. J., Bockting, C. L., de Wolf, G. S., & Lambregtse-van den Berg, M. P. (2018). Antidepressants during pregnancy: Guideline adherence and current practice amongst Dutch gynaecologists and midwives. Midwifery, 61, 29-35. https://doi.org/10.1016/j.midw.2018.02.018
Beijers, C., Burger, H., Verbeek, T., Bockting, C. L.,& Ormel, J. (2014). Continued smoking and continued alcohol consumption during early pregnancy distinctively associated with personality. Addictive Behaviors, 39, 980-986. https://doi.org/10.1016/j.addbeh.2014.01.022
Beijers, C., Ormel, J., Meijer, J. L., Verbeek, T., Bockting, C. L.,& Burger, H. (2014). Stressful events and continued smoking and continued alcohol consumption during mid-pregnancy. PloS ONE, 9,e86359. https://doi.org/10.1371/journal.pone.0086359
Meijer, J. L., Beijers, C., van Pampus, M. G., Verbeek, T., Stolk, R. P., Milgrom, J., Bockting, C. L.,& Burger, H. (2014). Predictive accuracy of Edinburgh Postnatal Depression Scale assessment during pregnancy for the risk of developing postpartum depressive symptoms: A prospective cohort study. BJOG : An International Journal of Obstetrics and Gynaecology, 121, 1604-1610. https://doi.org/10.1111/1471-0528.12759
Meijer, J. L., Bockting, C. L.,Stolk, R. P., Kotov, R., Ormel, J., & Burger, H. (2014). Associations of life events during pregnancy with longitudinal change in symptoms of antenatal anxiety and depression. Midwifery, 30, 526-531. https://doi.org/10.1016/j.midw.2013.06.008
Aris-Meijer, J., Bockting, C. L., StolK, R. P., Kotov, R., Ormel, J., & Berger, H. (2013). Associations of life events during pregnancy with longitudinal change in symptoms of antenatal anxiety and depression. Midwifery, 30(5), 526-531. https://doi.org/10.1016/j.midw.2013.06.008
Nauta, M. H., Festen, H., Reichart, C. G., Nolen, W. A., Stant, A. D., Bockting, C. L.,van der Wee, N. J. A., Beekman, A., Doreleijers, T. A. H., Hartman, C. A., de Jong, P. J., & de Vries, S. O. (2012). Preventing mood and anxiety disorders in youth: A multi-centre RCT in the high risk offspring of depressed and anxious patients. BMC Psychiatry, 12,1. https://doi.org/10.1186/1471-244X-12-31
Verbeek, T., Bockting, C. L.,van Pampus, M. G., Ormel, J., Meijer, J. L., Hartman, C. A., & Burger, H. (2012). Postpartum depression predicts offspring mental health problems in adolescence independently of parental lifetime psychopathology. Journal of Affective Disorders, 136, 948-954. https://doi.org/10.1016/j.jad.2011.08.035
Meijer, J. L., Bockting, C. L., Beijers, C., Verbeek, T., Stant, A. D., Ormel, J., Stolk, R. P., de Jonge, P., van Pampus, M. G., & Burger, H. (2011). Pregnancy Outcomes after a Maternity Intervention for Stressful EmotionS (PROMISES): Study protocol for a randomised controlled trial. Trials, 12, 1. https://doi.org/10.1186/1745-6215-12-157

Relapse Factors

Relapse is a common challenge for individuals who have recovered from depression and anxiety. This research investigates the factors that contribute to relapse during the recovery process.

Learn more about relapse prevention

Learn more about interventions

Besten, M. E., van Vugt, M., Riese, H., Bockting, C. L., Ostafin, B. D., Aleman, A., & van Tol, M.-J. (2024). Understanding mechanisms of depression prevention: Study protocol of a randomized cross-over trial to investigate mechanisms of mindfulness and positive fantasizing as intervention techniques for reducing perseverative cognition in remitted depressed individuals. BMC Psychiatry, 24(1), 141. https://doi.org/10.1186/s12888-024-05592-8
Breedvelt, J. J. F., Karyotaki, E., Warren, F. C., Brouwer, M. E., Jermann, F., Hollandare, F., Klein, N., de Jonge, M., Klein, D. N., Farb, N., Segal, Z., Biesheuvel Leliefeld, K. E. M., Jarrett, R., Vittengl, J., Thase, M., Ma, H., Kuyken, W., Shallcross, A. J., van Heeringen, C., … Bockting, C. L. (2024). An individual participant data meta-analysis of psychological interventions for preventing depression relapse. Nature Mental Health, 2(2), 154–163. https://doi.org/10.1038/s44220-023-00178-x
Böttcher, L., Breedvelt, J. J. F., Warren, F. C., Segal, Z., Kuyken, W., & Bockting, C. L. (2023). Identifying relapse predictors in individual participant data with decision trees. BMC Psychiatry, 23(1), 835. https://doi.org/10.1186/s12888-023-05214-9
Gülpen, J., Brouwer, M. E., Geurtsen, G. J., van Dis, E. A. M., Denys, D. A. J. P., & Bockting, C. L. (2023). Treatments for partial remission of major depressive disorder: A systematic review and meta-analysis. BMJ Mental Health, 26(1), 1–9. https://doi.org/10.1136/bmjment-2023-300827
Robberegt, S. J., Brouwer, M. E., Kooiman, B. E., Stikkelbroek, Y. A., Nauta, M. H., & Bockting, C. L. (2023). Meta-analysis: Relapse prevention strategies for depression and anxiety in remitted adolescents and young adults. Journal of the American Academy of Child & Adolescent Psychiatry, 62(3), 306-317. https://doi.org/10.1016/j.jaac.2022.04.014
Teijema, J. J., Hofstee, L., Brouwer, M., de Bruin, J., Ferdinands, G., de Boer, J., Vizan, P., van den Brand, S., Bockting, C. L., van de Schoot, R., & Bagheri, A. (2023). Active learning-based systematic reviewing using switching classification models: The case of the onset, maintenance, and relapse of depressive disorders. Frontiers in Research Metrics and Analytics, 8, 1178181. https://doi.org/10.3389/frma.2023.1178181
van Kleef, R., Kaushik, P., Besten, M., Marsman, J., Bockting, C. L., van Vugt, M., Aleman, A., van Tol, M. (2023). Understanding and predicting future relapse in depression from resting state functional connectivity and self-referential processing. Journal of Psychiatric Research, 165, 305-314. https://doi.org/10.1016/j.jpsychires.2023.07.034
Vuuregge, A., Kooiman, B. E. A. M., Robberegt, S. J., Nauta, M. H., Stikkelbroek, Y. A. J., Lucassen, P. J., Bockting, C. L., Mul, J. D., & Scharantee, A. Interactions between daily physical activity and depressive and anxiety-related symptoms in adolescents remitted from depression and anxiety disorders. Neuroscience Applied, 2(2), 102787. https://doi.org/10.1016/j.nsa.2023.102787
Heuschen, C. B., Mocking, R. J., Zantvoord, J. B., Figueroa, C. A., Schene, A. H., Denys, D. A., Ruhé, H. G., Bockting, C. L., & Lok, A. (2022). Suicidal ideation in remitted major depressive disorder predicts recurrence. Journal of Psychiatric Research, 151, 65–72. https://doi.org/10.1016/j.jpsychires.2022.04.005
Breedvelt, J., Brouwer, M. E., Harrer, M., Semkovska, M., Ebert, D. D., Cuijpers, P., & Bockting, C. L. (2021). Psychological interventions as an alternative and add-on to antidepressant medication to prevent depressive relapse: Systematic review and meta-analysis. The British Journal of Psychiatry :The Journal of Mental Science, 219(4), 538–545. https://doi.org/10.1192/bjp.2020.198
Breedvelt, J., Warren, F. C., Segal, Z., Kuyken, W., & Bockting, C. L. (2021). Continuation of antidepressants vs sequential psychological interventions to prevent relapse in depression: An individual participant data meta-analysis. JAMA Psychiatry, 78(8), 868–875. https://doi.org/10.1001/jamapsychiatry.2021.0823
Breedvelt, J. J. F., Warren, F. C., Brouwer, M. E., Karyotaki, E., Kuyken, W., Cuijpers, P., van Oppen, P., Gilbody., S. & Bockting, C. L. (2020). Individual participant data (IPD) meta-analysis of psychological relapse prevention interventions versus control for patients in remission from depression: A protocol. BMJ Open, 10(2), e034158. https://doi.org/10.1136/bmjopen-2019-034158
Van Tol, M. J., Eike, R., Van Kleef, R., Marsman, J. B., Van Valen, E., Aleman, A., & Bockting, C. L. (2020). P.348 Understanding neurocognitive working mechanisms of relapse prevention – the role of emotion regulation in remitted major depressive disorder. European Neuropsychopharmacology, 40, S202-S203. https://doi.org/10.1016/j.euroneuro.2020.09.264
Brouwer, M. E., Williams, A. D., Forand, N. R., DeRubeis, R. J., & Bockting, C. L. (2019). Dysfunctional attitudes or extreme response style as predictors of depressive relapse and recurrence after mobile cognitive therapy for recurrent depression. Journal of Affective Disorders, 243, 48-54. https://doi.org/10.1016/j.jad.2018.09.002
Brouwer, M. E., Williams, A. D., Kennis, M., Fu, Z., Klein, N. S., Cuijpers, P., & Bockting, C. L. (2019). Psychological theories of depressive relapse and recurrence: A systematic review and meta-analysis of prospective studies. Clinical Psychology Review, 74, 101773. https://doi.org/10.1016/j.cpr.2019.101773
Elgersma, H. J., Koster, E. H. W., Vugteveen, J., Hoekzema, A., Penninx, B., Bockting, C. L., & de Jong, P. J. (2019). Predictive value of attentional bias for the recurrence of depression: A 4-year prospective study in remitted depressed individuals. Behaviour Research and Therapy, 114, 25-34. https://doi.org/10.1016/j.brat.2019.01.001
van Kleef, R. S., Bockting, C. L., van Valen, E., Aleman, A., Marsman, J. C., & van Tol, M. J. (2019). Neurocognitive working mechanisms of the prevention of relapse in remitted recurrent depression (NEWPRIDE): Protocol of a randomized controlled neuroimaging trial of preventive cognitive therapy. BMC Psychiatry, 19(1), 409. https://doi.org/10.1186/s12888-019-2384-0
De Jonge, M., Bockting, C. L., van Oppen, P., Van, H. L., Peen, J., Kikkert, M. J., & Dekker, J. J. M. (2018). The association between the number of previous episodes and modifiable vulnerability factors in remitted patients with recurrent depression. PLOS One, 13(11), e0206495. https://doi.org/10.1371/journal.pone.0206495
Elgersma, H. J., Koster, E. H. W., van Tuijl, L. A., Hoekzema, A., Penninx, B., Bockting, C. L., & de Jong, P. J. (2018). Attentional bias for negative, positive, and threat words in current and remitted depression. PLOS One, 13(10), e0205154. https://doi.org/10.1371/journal.pone.0205154
Figueroa, C. A., Mocking, R. J. T., Mahmoud, G. A., Koeter, M. W., Bockting, C. L., van der Does, W., Ruhé, H., & Schene, A. H. (2018). The measurement of cognitive reactivity to sad mood in patients remitted from major depressive disorder. The British Journal of Clinical Psychology, 57(3), 313-327. https://doi.org/10.1111/bjc.12175
Klein, N. S., Holtman, G. A., Bockting, C. L., Heymans, M. W., & Burger, H. (2018). Development and validation of a clinical prediction tool to estimate the individual risk of depressive relapse or recurrence in individuals with recurrent depression. Journal of Psychiatric Research, 104, 1-7. https://doi.org/10.1016/j.jpsychires.2018.06.006
Klein, N. S., Kok, G. D., Burger, H., van Valen, E., Riper, H., Cuijpers, P., Dekker, J., Smit, F., van der Heiden, C., & Bockting, C. L. (2018). No sustainable effects of an internet-based relapse prevention program over 24 months in recurrent depression: Primary outcomes of a randomized controlled trial. Psychotherapy and Psychosomatics, 87(1), 55-57. https://doi.org/10.1159/000485039
Slofstra, C., Nauta, M. H., Bringmann, L. F., Klein, N. S., Albers, C. J., Batalas, N., Wicher, M., & Bockting, C. L. (2018). Individual negative affective trajectories can be detected during different depressive relapse prevention strategies. Psychotherapy and Psychosomatics, 87(4), 243-245. https://doi.org/10.1159/000489044
van Tuijl, L. A., Glashouwer, K. A., Elgersma, H. J., Bockting, C. L., Penninx, B., & de Jong, P. J. (2018). Depression recurrence after recovery: Prognostic value of implicit and explicit self-depressed associations. Behaviour Research and Therapy, 107, 76-82. https://doi.org/10.1016/j.brat.2018.06.001
De Jonge, M., Dekker, J. J. M., Kikkert, M. J., Peen, J., van Rijsbergen, G. D., & Bockting, C. L. (2017). The role of affect in predicting depressive symptomatology in remitted recurrently depressed patients. Journal of Affective Disorders, 210, 66-71. https://doi.org/10.1016/j.jad.2016.12.015
Ebert, D. D., Hopfinger, L., Bockting, C. L., Berking, M.(2017). Emotion regulation protects against recurrence of depressive symptoms following inpatient care for major depressive disorder. Behavior Therapy 48(6), 739-749, https://doi.org/10.1016/j.beth.2017.03.003
Van Kleef, R. S., Nijmeijer, S., Marsman, J. B. C., Bockting, C. L., Van Valen, E., Aleman, A., & Van Tol, M. J. (2017). Attentional processing of emotional information in remitted recurrent major depressive disorder – preliminary results from the NEWPRIDE study. European Neuropsychopharmacology, 27, S778-S779. https://doi.org/10.1016/S0924-977X(17)31418-9
Mocking, R. J. T., Figueroa, C. A., Rive, M. M., Geugies, H., Servaas, M. N., Assies, J., Koeter, M. W. J., Vaz, F. M., Wichers, M., van Straalen, J. P., de Raedt, R., Bockting, C. L.,Harmer, C. J., Schene, A. H., & Ruhé, H. G. (2016). Vulnerability for new episodes in recurrent major depressive disorder: protocol for the longitudinal DELTA neuroimaging cohort study. BMJ Open, 6, e009510. https://doi.org/10.1136/bmjopen-2015009510
Biesheuvel-Leliefeld, K. E. M., Kok, G. D., Bockting, C. L.,Cuijpers, P., Hollon, S. D., van Marwijk, H. W. J., & Smit, F. (2015). Effectiveness of psychological interventions in preventing recurrence of depressive disorder: Meta-analysis and meta-regression. Journal of Affective Disorders, 174, 400-410. https://doi.org/10.1016/j.jad.2014.12.016
Bockting, C. L., Hollon, S. D., Kuyken, W., Jarrett. R., & Dobson, K. S. (2015). A lifetime approach to Major Depressive Disorder: The contributions of psychological interventions in preventing relapse and recurrence. Clinical Psychology Review, 41, 16-26. https://doi.org/10.1016/j.cpr.2015.02.003
Elgersma, H. J., de Jong, P. J., van Rijsbergen, G. D., Kok, G. D., Burger, H., van der Does, W., Penninx, B. W., & Bockting, C. L. (2015). Cognitive reactivity, self-depressed associations, and the recurrence of depression. Journal of Affective Disorders, 183, 300-309. https://doi.org/10.1016/j.jad.2015.05.018
Figueroa, C. A., Ruhé, H. G., Koeter, M., Spinhoven, P., van der Does, W., Bockting, C. L.,& Schene, A. H. (2015). Cognitive reactivity versus dysfunctional cognitions and the prediction of relapse in recurrent major depressive disorder. Journal of Clinical Psychiatry, 76, e1306– e1312. https://doi.org/10.4088/JCP.14m09268
Mocking, R. J., Pellikaan, C. M., Lok, A., Assies, J., Ruhé, H. G., Koeter, M. W., Visser, I., Bockting, C. L.,Olff, M., & Schene, A. H. (2015). DHEAS and cortisol/DHEAS-ratio in recurrent depression: State, or trait predicting 10-year recurrence? Psychoneuroendocrinology, 59, 91- 101. https://doi.org/10.1016/j.psyneuen.2015.05.006
Van Rijsbergen, G. D., Hollon, S. D., Elgersma, H. J., Kok, G. D., Dekker, J., Schene, A. H., & Bockting, C. L. (2015). Understanding emotion and emotional scarring in recurrent depression. Comprehensive Psychiatry, 59, 54-61. https://doi.org/10.1016/j.comppsych.2015.02.010
Van Rijsbergen, G. D., Kok, G. D., Elgersma, H. J., Hollon, S. D., & Bockting, C. L. (2015). Personality and cognitive vulnerability in remitted recurrently depressed patients. Journal of Affective Disorders, 173, 97-104. https://doi.org/10.1016/j.jad.2014.10.042
Kok, G., van Rijsbergen, G., Burger, H., Elgersma, H., Riper, H., Cuijpers, P., Dekker, J., Smit, F., & Bockting, C. L. (2014). The scars of childhood adversity: Minor stress sensitivity and depressive symptoms in remitted recurrently depressed adult patients. PLoS ONE, 9, e111711. https://doi.org/10.1371/journal.pone.0111711
Van Rijsbergen, G. D., Bockting, C. L.,Burger, H., Spinhoven, P., Koeter, M. W. J., Ruhé, H. G., Hollon, S. D., & Schene, A. H. (2013). Mood reactivity rather than cognitive reactivity is predictive of depressive relapse: A randomized study with 5.5-year follow-up. Journal of Consulting and Clinical Psychology, 81, 508-17. https://doi.org/10.1037/a0032223
Bockting, C. L.,Lok, A., Visser, I., Assies, J., Koeter, M. W., Schene, A. H., & The DELTA study group (2012). Lower cortisol levels predict recurrence in remitted patients with recurrent depression: A 5.5 year prospective study. Psychiatry research, 200, 281-287. https://doi.org/10.1016/j.psychres.2012.03.044
Lok, A., Assies, J., Koeter, M. W. J., Bockting, C. L.,Wouters, L. F., Mocking, R. J. T., & Schene, A. H. (2012). Sustained medically unexplained physical symptoms in euthymic patients with recurrent depression: Predictive value for recurrence and associations with omega 3- and 6 fatty acids and 5-HTTLPR? Journal of Affective Disorders, 136, 604-611. https://doi.org/10.1016/j.jad.2011.10.024
Lok A., Mocking, R. J. T., Ruhé, H. G., Visser, I., Koeter, M. W., Assies, J., Bockting, C. L.,Olff, M., & Schene, A. H. (2012). Longitudinal hypothalamic-pituitary-adrenal axis trait and state effects in recurrent depression. Psychoneuroendocrinology, 37, 892-902. https://doi.org/10.1016/j.psyneuen.2011.10.005
Mocking, R. J. T., Assies, J., Lok, A., Ruhé, H. G., Koeter, M. W. J., Visser, I., Bockting, C. L.,& Schene, A. H. (2012). Statistical methodological issues in handling data of fatty acid data: Percentages or concentration, imputation and indices. Lipids, 47, 541-547. https://doi.org/10.1007/s11745-012-3665-2
Van Rijsbergen, G. D., Bockting, C. L.,Berking, M., Koeter, M. W. J., & Schene, A. H. (2012). Can a one-item mood scale do the trick? Predicting relapse over 5.5-years in recurrent depression. PLoS ONE, 7, e46796. https://doi.org/10.1371/journal.pone.0046796
Wekking, E. M., Bockting, C. L.,Koeter, M. W. J., & Schene, A. H. (2012). Cognitive functioning in euthymic recurrently depressed patients: Relationship with future relapses and prior course of disease. Journal of Affective Disorders, 141, 300-307. https://doi.org/10.1016/j.jad.2012.03.034
Beshai, S., Dobson, K. S., Bockting, C. L.,& Quigley, L. (2011). Relapse and recurrence prevention in depression: Current research and future prospects. Clinical Psychology Review, 31, 1349-1360. https://doi.org/10.1016/j.cpr.2011.09.003
Assies, J., Pouwer, F., Lok, A., Mocking, R. J. T., Bockting, C. L.,Visser, I., Abeling, N. G. G. M., Duran, M., & Schene, A. H. (2010). Plasma and erythrocyte fatty acid patterns in patients with recurrent depression: A matched case-control study. PLoS ONE, 5, e10635. https://doi.org/10.1371/journal.pone.0010635
prevention for depression. Psychological Topics, 19, 273-287.
De Jonge, P., Conradi, H. J., Kaptein, K. I., Bockting, C. L.,Korf, J., & Ormel, J. (2010). Duration of subsequent episodes and periods of recovery in recurrent major depression. Journal of Affective Disorders, 125, 141-145. https://doi.org/10.1016/j.jad.2009.12.013
ten Doesschate, M. C, Bockting, C. L.,Koeter, M. W. J., & Schene, A. H. (2010). Prediction of recurrence in recurrent depression: A 5.5-year prospective study. Journal of Clinical Psychiatry, 71, 984-91. https://doi.org/10.4088/JCP.08m04858blu
ten Doesschate, M. C., Koeter, M. W. J., Bockting, C. L.,& Schene, A. H. (2010). Health related quality of life in recurrent depression: A comparison with a general population sample. Journal of Affective Disorders, 120, 126-132. https://doi.org/10.1016/j.jad.2009.04.026
Bockting C. L., Spinhoven, P. H., Koeter, M.W.J., Wouters, L. F., Schene, A. H. (2008). Prediction of recurrence and the influence of consecutive episodes on vulnerability: A 2-year prospective study in recurrent depression, Journal of Affective Disorders,107(1), 89. https://doi.org/10.1016/j.jad.2007.12.078
Bockting, C. L., Spinhoven, Ph., Koeter, M. W. J., Wouters, L. F., Schene, A. H., & the DELTA study group. (2006). Prediction of recurrence in recurrent depression and the influence of consecutive episodes on vulnerability: A 2-year prospective study. Journal of Clinical Psychiatry, 67, 747-755. https://doi.org/10.4088/JCP.v67n0508