Are common mental disorders more persistent over time? Insights from the Netherlands Mental Health Survey and Incident Studies (NEMESIS)

Abstract

Abstract 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.