BackgroundThe gatekeeper training is designed to help identify suicidal individuals, respond to suicidal ideation and refer to help. The internationally widely used training shows promising results. This is the first study presenting its effectiveness in the Netherlands and the first study investigating the effect in different employment sectors.MethodsIn an observational study, 113 Suicide Prevention – the Dutch suicide prevention expertise centre and lifeline - trained 526 professionals as gatekeepers. Changes in gatekeepers’ identifying and referral behaviour, knowledge of suicide prevention and skills-confidence were studied, using a pre-post (6 weeks after training) self-report questionnaire. Outcomes were analyzed with General Linear Model (GLM) repeated measures with four employment sectors (healthcare-, educational-, socioeconomic and other sectors) as a between-subjects factor.ResultsPre-post self-reports of 174 respondents showed no change in the identification of suicidal people, referrals to the general practitioner (GP) or lifeline 113, but significant improvement in professionals’ knowledge and confidence (p < .001). Results did not differ between employment sectors.ConclusionsThe gatekeeper training significantly increases suicide prevention knowledge and skills confidence in abilities to address suicidality. Healthcare, education, socioeconomic and other professionals (e.g. security, justice, transport, church workers) benefit similarly from the training. Increasing the number of gatekeeper training programs in all sectors is recommended.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5512-8) contains supplementary material, which is available to authorized users.

In today’s world of rapid changes and increasing complexity, understanding and enhancing creativity is of critical importance. Studies investigating EEG correlates of creativity linked power in the alpha frequency band to creativity, and alpha-power has been interpreted as reflecting attention on internal mental representations and inhibition of external sensory input. Thus far, however, there is no direct evidence for the idea that internally directed attention facilitates creativity. The aim of the current study was to experimentally investigate the relationship between eye-closure—a simple and effective means to stimulate internally directed attention—and creativity. Moreover, to test whether the potential beneficial effect of eye-closure is specific for creativity, or whether it improves general cognitive functioning, the current study tested the effect of eye-closure on creativity and on working memory (WM). Participants completed four tasks to measure divergent and convergent creativity (Adapted Alternative Uses (AAU) Test, Remote Associates Test (RAT), Sentence Construction Test, and Word Construction Test), and one task to measure WM (Digit Span Test). For each task, participants had to perform two versions, one version with eyes open and one version with eyes closed. Eye-closure facilitated creative performance on the classical divergent and convergent creativity tasks (AAU Test and RAT). No effect of eye-closure was observed on the WM task. These findings provide a novel and easily applicable means to enhance divergent and convergent creativity through eye-closure.

As a result of the rapid ageing of societies, meeting the demands for long-term care has become increasingly difficult. In the Netherlands, informal care is recognised as a key element to compensate for cut-backs in formal care provision. Formal, informal and privately paid long-term care services, however, are not used equally across socio-economic status (SES) groups and whether these inequalities have been reduced or exacerbated over time has not been researched. This study investigates to what extent educational and income inequalities in the use of formal, informal and privately paid care have changed over time. Data from the Longitudinal Aging Study Amsterdam (LASA) was used from three points in time: 1995 (N = 787), 2005 (N = 550) and 2015 (N = 473). Participants were between 75 and 85 years of age and living independently. The results indicate that lower SES groups are consistently more likely to use formal and informal care, and less likely to use privately paid care compared to higher SES groups. An increase in inequality was only found in the use of informal care; while informal care use is stable among lower SES groups, it decreases steeply among higher SES groups. These findings highlight the importance of education for explaining variation and changes over time in care use. Governmental efforts to mobilise informal care-givers might be outweighed by trends towards less long-term care.

This study aims at investigating to what extent inequalities in the use of formal, informal and privately paid care have changed over time. Data from the Longitudinal Aging Study Amsterdam (LASA) was used from three points in time (1995, 2005 and 2015) that capture distinct periods in the recent development of the Dutch long-term care system. In particular, the reforms of 2007 and 2015 might have impacted care uses. All participants (N = 1810) were living at home and between the age of 75 and 85 at measurement. The results indicate that, adjusted for health and partner status, formal, informal and privately paid care have decreased over time. Socioeconomic differences in informal care use have increased over time, but no change was found for privately paid or formal care use. These findings suggest that changes in the LTC system and long-term care resources in particular benefit lower socioeconomic groups.

In Western societies, the rapid population ageing has led to a drastically increasing demand for long-term care (LTC). In the Netherlands, LTC is not used equally by those with a lower socioeconomic status (SES) and certain socieconomic groups might be disadvantaged. Therefore, the first aim of the present dissertation was to investigate how SES-differences in LTC use have changed over the past decades in the Netherlands, and how these changes can be explained by both individual factors and characteristics of the LTC system. In addition, potential inequalities in LTC use raise the question to what extent they affect the wellbeing of older adults. LTC plays an important role in maintaining the wellbeing of individuals with health impairments, but also leads to an undesirable dependency on caregivers. Therefore, the second aim of this dissertation was to investigate the relationship between LTC use, the subjective evaluation of LTC and psychological wellbeing. The first study investigates how and why SES-inequalities in the use of LTC have changed over time. The findings indicate that they remained similar. However, the SES-gradient in informal care widened over time: Informal care use decreased steeply among higher, but not lower SES-groups. This exacerbation of SES-inequalities persisted even when we accounted for individual factors such as health and partner status. The second study investigates to what extent defamilization as a system-characteristic can explain SES-differences in LTC use in addition to individual factors. The findings indicate that de-familization had a limited direct impact on LTC use: It is associated with less use of privately-paid care, but does not impact informal care use beyond individual characteristics. Formal care, however, was used more by lower compared to higher SES-groups in a de-familized context, but was used less by them when de-familization is limited. Thus, lower levels of de-familization threaten the equitable access to formal care by lower SES-groups. The third study investigates how long-term care trajectories look like in a time of rapid retrenchment of the LTC system for different SES-groups in the Netherlands. Five distinct types of LTC trajectories are identified: No LTC use, privately paid care use, formal care use, informal care use and residential care use. Thus, individuals generally used one main source of LTC throughout their trajectory, yet sometimes mixed with other types of care. Higher SES-groups were more likely to be members of the “privately paid care” group, but otherwise, no SES-differences could be observed. The fourth study investigates how the relationship between LTC use, perceived care sufficiency and psychological wellbeing looks like in 1998, 2008 and 2018. The findings indicate that after taking health and partner status into account, no SES-differences in psychological wellbeing can be observed. There was no negative trend in the association between LTC and wellbeing over the three years of observation. However, perceiving LTC provision as insufficient was consistently associated with worse psychological wellbeing in all time periods. This effect was stronger than that of objective LTC use and highlights the importance of the subjective evaluation of care provision. Conclusion Given the drastic effects of population ageing and increasing LTC demands, the present dissertation highlights that lower SES-groups are less disadvantaged than expected as a high proportion still receives informal or formal care. Furthermore, no SES-group was substantially disadvantaged in their psychological wellbeing, which underlines that they are generally able to adjust to a more limited welfare state. To maintain the wellbeing of older adults from all SES-groups, practitioners and policymakers should take individuals’ subjective evaluation of LTC into account to realize LTC arrangements that are in line with their needs, so that no group of older adults becomes disadvantaged.