BEGIN:VCALENDAR VERSION:2.0 PRODID:-//Vrije Universiteit Amsterdam//NONSGML v1.0//EN NAME:PhD defence W.G. ter Meulen METHOD:PUBLISH BEGIN:VEVENT DTSTART:20260112T114500 DTEND:20260112T131500 DTSTAMP:20260112T114500 UID:phd-defence-w-g-ter-meulen@8F96275E-9F55-4B3F-A143-836282E12573 CREATED:20260826T004113 LOCATION: SUMMARY:PhD defence W.G. ter Meulen X-ALT-DESC;FMTTYPE=text/html:

Comorbidity of mood disorders and substance use disorders: in concert and co-travelling

Depression and smoking prove a persistent combination: res earch shows why integrated care is urgently needed

Psychiatric disorders often occur together. This phenomenon - comorbidity - is n ot only common but also remarkably persistent: people who develop mul tiple problems at the same time tend to keep them for long periods. R esearch by psychiatrist Wendela ter Meulen sheds light on why this ha ppens and what the societal consequences are.

More symp toms, more risks
A synthesis of existing studies on the m ost common combination - depression and anxiety - shows that people w ho experience both conditions suffer from more severe psychological s ymptoms and face a higher risk of physical health problems, social li mitations, and reduced quality of life. Psychosocial factors, such as childhood trauma, play a significant role in the development of this double burden.

People with depression smoke the most
In a follow-up study, Ter Meulen compared risk factors for smoking among people with and without depression. The differences we re striking: people with depression not only smoke far more often, bu t they also encounter circumstances - such as financial hardship or s tressful living conditions - that reinforce smoking behaviour. This m akes quitting substantially more difficult.

Disease pro gression as the silent driver of comorbidity
Ter Meulen a lso examined the long-term course of mood disorders. Some people reco ver less well from depression or experience more episodes of bipolar mood instability. This so-called disease progression appears to be th e main driver behind the persistent pairing of mood disorders and sub stance-use problems. In addition, a clinical assessment tool that mea sures comorbidity seems reasonably able to predict which people with depression later develop bipolar disorder.

Impact and o pportunities for healthcare
The findings make clear that comorbidity leads to a stacking of risks and adverse outcomes - psych ological, physical, and social. This underscores the need for integra ted care, in which conditions are not treated separately but addresse d together within a single care pathway. A lesser-known but socially relevant insight is that early in the course of bipolar disorder, a v ulnerable period may exist in which substance use is especially desta bilising. According to the researchers, education and prevention coul d yield significant benefits here.

Smokers with depression also deserve special attention: they often succeed in reducing their smok ing only after their depressive symptoms improve - sometimes even par tially is enough. This calls for treatment approaches that tackle dep ression and addiction simultaneously, such as combined psychotherapy. Ter Meulen’s work shows that better, integrated care not only help s individual patients but may also reduce health problems, lower drop out from work or education, and ultimately decrease societal costs.

More information on the thesis

DESCRIPTION: Comorbidity of mood disorders and substance use disorders : in concert and co-travelling

Depression and smoking prove a per sistent combination: research shows why integrated care is urgently n eeded

Psychiatric disorders often occur together. This phenomenon - comorbidity - is not only common but also remarkably persistent: p eople who develop multiple problems at the same time tend to keep the m for long periods. Research by psychiatrist Wendela ter Meulen sheds light on why this happens and what the societal consequences are.More symptoms, more risks
A synthesis of existing st udies on the most common combination - depression and anxiety - shows that people who experience both conditions suffer from more severe p sychological symptoms and face a higher risk of physical health probl ems, social limitations, and reduced quality of life. Psychosocial fa ctors, such as childhood trauma, play a significant role in the devel opment of this double burden.People with depression smoke the most
In a follow-up study, Ter Meulen compared risk fact ors for smoking among people with and without depression. The differe nces were striking: people with depression not only smoke far more of ten, but they also encounter circumstances - such as financial hardsh ip or stressful living conditions - that reinforce smoking behaviour. This makes quitting substantially more difficult.Disease pro gression as the silent driver of comorbidity
Ter Meulen a lso examined the long-term course of mood disorders. Some people reco ver less well from depression or experience more episodes of bipolar mood instability. This so-called disease progression appears to be th e main driver behind the persistent pairing of mood disorders and sub stance-use problems. In addition, a clinical assessment tool that mea sures comorbidity seems reasonably able to predict which people with depression later develop bipolar disorder.Impact and opportun ities for healthcare
The findings make clear that comorbi dity leads to a stacking of risks and adverse outcomes - psychologica l, physical, and social. This underscores the need for integrated car e, in which conditions are not treated separately but addressed toget her within a single care pathway. A lesser-known but socially relevan t insight is that early in the course of bipolar disorder, a vulnerab le period may exist in which substance use is especially destabilisin g. According to the researchers, education and prevention could yield significant benefits here.Smokers with depression also deserve speci al attention: they often succeed in reducing their smoking only after their depressive symptoms improve - sometimes even partially is enou gh. This calls for treatment approaches that tackle depression and ad diction simultaneously, such as combined psychotherapy. Ter Meulen’ s work shows that better, integrated care not only helps individual p atients but may also reduce health problems, lower dropout from work or education, and ultimately decrease societal costs.More information on the thesis END:VEVENT END:VCALENDAR