Introduction. Patients with unipolar depression show impaired performance on the Tower of London planning task. Positron emission tomography, which has previously identified resting state blood flow abnormalities in depression, was used to investigate neural activity associated with performance of this task in depressed patients and normal controls.

Methods. Six patients with unipolar depression and six matched controls were scanned while performing easy and hard Tower of London problems in a one-touch computerized paradigm and while performing a perceptuomotor control task.

Results. The patients in this study showed an expected task-related performance deficit compared with normal subjects. In normal subjects, the task engaged a network of prefrontal cortex, anterior cingulate, posterior cortical areas and subcortical structures including the striatum, thalamus and cerebellum. Depressed patients failed to show significant activation in the cingulate and striatum; activation in the other prefrontal and posterior cortical regions was significantly attenuated relative to controls. Crucially, patients also failed to show the normal augmentation of activation in the caudate nucleus, anterior cingulate and right prefrontal cortex associated with increasing task difficulty.

Conclusions. These findings provide evidence for cingulate, prefrontal and striatal dysfunction associated with impaired task performance in depression. The present results are consistent with a central role of cingulate dysfunction in depression as well as suggesting impaired frontostriatal function.

Background. Several clinical and neuroimaging investigations support the notion that underlying brain changes may relate to depression in older patients, especially those with a later-age initial episode. However uncertainty still exists about diagnostic and pathogenic significance of structural brain abnormalities in aged depressives, in part because many studies lack all-elderly and age-similar normal comparison populations.

Methods. Brain morphology of elderly depressives (N = 30) and normal controls (N = 36) was compared by assessing magnetic resonance imaging (MRI) brain scans with qualitative criteria-based scales. Ratings included lateral and third ventricle enlargement, and cortical, medial temporal, and caudate atrophy.

Results. Significant differences between depressed and control groups were not demonstrated. Later-onset depressives had significantly more left medial temporal and left caudate atrophy than early-onset counterparts of similar age. Medial temporal atrophy significantly correlated with cognitive impairment and was not related to physical illness. Depressives with medial temporal atrophy (N = 7) were older and had later age at onset of depression than those without such changes. Cerebrovascular disease risk factors did not predict MRI abnormalities.

Conclusions. Results indicate non-specificity and lack of homogeneity of qualitatively measured structural brain changes in geriatric depression, but suggest that pathology of specific, lateralized brain regions may be implicated in some later-onset patients. The relationship between medial temporal atrophy and late-onset depression raises the possibility that such patients may suffer from as-yet undeclared Alzheimer's disease. Lack of association between cerebrovascular disease risk factors and brain changes suggests other pathophysiological contributions.

Background. A sample of 1089 Australian adults was selected for the longitudinal component of the Quake Impact Study, a 2-year, four-phase investigation of the psychosocial effects of the 1989 Newcastle earthquake. Of these, 845 (78%) completed a survey 6 months post-disaster as well as one or more of the three follow-up surveys.

Methods. The phase 1 survey was used to construct dimensional indices of self-reported exposure to threat the disruption and also to classify subjects by their membership of five ‘at risk’ groups (the injured; the displaced; owners of damaged small businesses; helpers in threat and non-threat situations). Psychological morbidity was assessed at each phase using the 12-item General Health Questionnaire (GHQ-12) and the Impact of Event Scale (IES).

Results. Psychological morbidity declined over time but tended to stabilize at about 12 months post-disaster for general morbidity (GHQ-12) and at about 18 months for trauma-related (IES) morbidity. Initial exposure to threat and/or disruption were significant predictors of psychological morbidity throughout the study and had superior predictive power to membership of the targeted ‘at risk’ groups. The degree of ongoing disruption and other life events since the earthquake were also significant predictors of morbidity. The injured reported the highest levels of distress, but there was a relative absence of morbidity among the helpers.

Conclusions. Future disaster research should carefully assess the threat and disruption experiences of the survivors at the time of the event and monitor ongoing disruptions in the aftermath in order to target interventions more effectively.

Background. Two recent surveys of depression among Chinese elderly people sampled different populations, used different case ascertainment methods and resulted in a seven-fold difference in prevalence rates. The present study was conducted to compare prevalence rates obtained with two commonly used methods in the same population, and to examine the risk factors for depression.

Methods. The target population included all residents aged 65 years and over in a rural Chinese community. Participants were interviewed for demographic and medical information, examined by a neurologist and administered Chinese versions of the Geriatric Depression Scale-Short Form (GDS-S), the Cognitive Abilities Screening Instrument (CASI) and an Activities of Daily Living (ADL) form. Individuals who screened positive on the GDS-S were also interviewed by a psychiatrist for diagnosis according to the DSM-III-R criteria.

Results. Among the 1313 participants, 26% screened positive on the GDS-S and 13% were diagnosed as having a depressive disorder, including 6·1% with major depression. Individuals with depressive disorders were more likely to have poor ADL scores, lower CASI scores, and chronic physical illnesses. They were also more likely to be female, older, illiterate and without a spouse, but adding these variables did not increase the overall association with the GDS-S score.

Conclusions. Depression was quite common in this Chinese rural geriatric population. The prevalence rate was twice as high when judged by depression symptomatology rather than clinical diagnosis. The critical risk factors were functional impairments, poor cognitive abilities and the presence of chronic physical illnesses.

Background. In order to elucidate further the cognitive processes underlying auditory hallucinations, an experiment investigating delayed and immediate source monitoring for positive, negative and neutral verbal material was conducted with schizophrenic patients.

Methods. Patients experiencing auditory hallucinations, patients not experiencing auditory hallucinations and normal subjects participated in a word association task, rating their responses for how much a self-generated thought was their own, how controllable and involuntary it was and their confidence in these ratings. A delayed source monitoring test in which subjects had to recall the source (self or experimenter) of the words from the association task was also administered.

Results. Hallucinators showed a greater bias towards external attribution of their thoughts compared with both control groups for immediate attributions of source, but not for delayed attributions. Hallucinators showed a bias towards external attribution of emotional material for immediate source monitoring and all subjects showed a bias towards misattribution of positive material to an external source and negative material to an internal source for the delayed source monitoring task.

Conclusions. These findings appear to be most consistent with theories proposing that hallucinations result from an external attributional bias for internal events. The implications of these results for research and practice are also discussed.

Background. Smooth pursuit eye movement (SPEM) dysfunction is considered to be a promising candidate for a biological marker for genetic vulnerability to schizophrenia. There are conflicting findings regarding the question of what is exactly dysfunctional in SPEM dysfunction and what component of eye movements is really specific to schizophrenia. The purpose of the current study was to help to clarify the nature of (SPEM) dysfunction and its specificity to schizophrenia.

Methods. Smooth pursuit eye movements of 43 schizophrenic patients, 34 patients with major depression and 42 normal controls were examined using high resolution infrared oculography. These groups were compared on several indices of oculomotor functioning (gain, different saccadic categories).

Results. Schizophrenics had a significantly higher catch-up saccade rate than depressed patients and normals. The percentage of subjects with an abnormally high catch-up saccade rate defined as beyond the mean plus 2 s.d. of the normal control group was significantly higher in schizophrenics (27·9%) than in depressed patients (8·8%) and normal controls (0%). Low gain and higher numbers of intrusive saccades tended to be more prevalent in both patient groups but did not distinguish schizophrenics from depressed patients.

Conclusions. Low gain and high rates of intrusive saccades contribute to SPEM dysfunction in major depression. Abnormally high rates of catch-up saccades seem to be the oculomotor component in smooth pursuit, that is specific to schizophrenia.

Background. Gender and cross-cultural differences in the association between somatic symptoms and emotional distress were investigated, using data from the World Health Organization Collaborative Project on Psychological Problems in General Health Care.

Methods. Data were collected at 15 centres in 14 countries around the world. At each centre, a stratified random sample of primary care attenders aged 15–65 years was assessed using, among other instruments, the 28-item General Health Questionnaire and the Composite International Diagnostic Interview-Primary Health Care Version.

Results. Females reported higher levels of somatic symptoms and emotional distress than males. A strong correlation between somatic symptoms and emotional distress was found in both sexes, with females reporting more somatic symptoms at each level of emotional distress. However, linear regression analysis showed that gender had no significant effect on level of somatic symptoms, when the effects of centre and emotional distress were controlled for. In both sexes, no specific pattern of association emerged between somatic symptom clusters and either anxiety or depression. Primary care attenders from less developed centres reported more somatic symptoms and showed greater gender differences than individuals from more developed centres, but inter-centre differences were small. Finally, gender was not a significant predictor of reason for consultation (somatic versus mental/behavioural symptoms), after controlling for levels of somatic symptoms and emotional distress as well as for centre effect.

Conclusions. These data do not support the common belief that females somatize more than males or the traditional view that somatization is a basic orientation prevailing in developing countries. Instead, somatic symptoms and emotional distress are strongly associated in primary care attenders, with few differences between the two sexes and across cultures.

Background. This paper seeks to explain an excess of psychological distress previously found among groups of British South Asians (with ancestry from the Indian subcontinent) living in Glasgow, compared with the general population. The excess was found on a psychosomatic measure and a measure of self-assessed distress but not on a clinically validated measure (the General Health Questionnaire or GHQ). The paper investigates whether South Asians are subject to stressful situations to which the GHQ is less sensitive than the other two measures.

Methods. Random samples of 159 South Asians aged 30–40, mean age 35, and 319 from the general population, all aged 35, were interviewed in Glasgow, using the 12-item General Health Questionnaire (GHQ-12), a psychosomatic symptom scale (PSS) and a self-assessment of distress. Subcultural groupings were differentiated by South Asian origin, English fluency, religion, and gender. Stressful situations assessed were experience of assault, stress/dissatisfaction with work, overcrowding, low standard of living, absence of family and absence of confidants.

Results. The GHQ-12 was less sensitive to certain stressful situations than the other two measures. The PSS and/or self-assessed distress were more sensitive to low standard of living, self-rated stress in work around the house and possibly experience of assault. In a combined analysis, the relation between distress on the PSS or self-assessed measure and subcultural groupings became non-significant, while the relation between distress and key stressful situations remained significant.

Conclusions. The greater distress of women, Muslims and limited English speakers is largely explained by the stressful situations they experience. The GHQ-12 under-estimates distress related to situations experienced particularly by ethnic minorities and by women.

Background. Although much research has focused on mechanisms of traumatization and factors related to post-trauma psychological functioning in survivors of trauma, there have been few studies of survivors of torture despite the widespread practice of torture in the world. The aim of this study was to examine the role of ‘psychological preparedness’ for trauma in post-traumatic stress responses in survivors of torture.

Method. Thirty-four torture survivors who had no history of political activity, commitment to a political cause or group, or expectations of arrest and torture were compared with 55 tortured political activists, using structured interviews and measures of anxiety, depression, and post-traumatic stress disorder.

Results. Compared with tortured political activists, tortured non-activists were subject to relatively less severe torture but showed higher levels of psychopathology. Less psychological preparedness related to greater perceived distress during torture and more severe psychological problems, explaining 4% of the variance in general psychopathology and 9% of the variance in post-traumatic stress disorder symptoms.

Conclusions. The study findings lend support to the role of prior immunization to traumatic stress and to unpredictability and uncontrollability of stressors in the effects of traumatization. Further research aimed at identifying the behavioural and cognitive components of psychological preparedness that play a role in traumatization may provide useful insights into effective treatment strategies for survivors of torture.

Background. Several prior studies have found reduced hippocampal volume in victims of psychological trauma with post-traumatic stress disorder (PTSD). We were interested to determine if this finding was evident in women who were victimized by severe sexual abuse in childhood.

Methods. In this study, hippocampal volume was measured using quantitative magnetic resonance imaging (MRI) in 21 women who reported being severely sexually abused in childhood and 21 socio-demographically similar women without abuse histories.

Results. Women who reported sexual victimization in childhood had significantly reduced (5% smaller) left-sided hippocampal volume compared to the non-victimized women. Hippocampal volume was also smaller on the right side, but this failed to reach statistical significance. Left-sided hippocampal volume correlated highly (rs=−0·73) with dissociative symptom severity, but not with indices of explicit memory functioning.

Conclusions. These findings, which are generally consistent with prior reports of reduced hippocampal volume in combat veterans with PTSD, suggest that diminished hippocampal size may be either a consequence of trauma exposure or a risk factor for the development of psychiatric complications following trauma exposure. The observed relationship between symptom severity and hippocampal volume suggests that mesial temporal lobe dysfunction may directly mediate certain aspects of PTSD and dissociative disorder symptomatology.

Background. This paper examines the contributions of dispositional and non-dispositional factors to post-disaster psychological morbidity. Data reported are from the 845 participants in the longitudinal component of the Quake Impact Study.

Methods. The phase 1 survey was used to construct dimensional indices of threat and disruption exposure. Subsequently, a range of dispositional characteristics were measured, including neuroticism, personal hopefulness and defence style. The main morbidity measures were the General Health Questionnaire (GHQ-12) and Impact of Event Scale (IES).

Results. Dispositional characteristics were the best predictors of psychological morbidity throughout the 2 years post-disaster, contributing substantially more to the variance in morbidity (12–39%) than did initial exposure (5–12%), but the extent of their contribution was greater for general (GHQ-12) than for post-traumatic (IES) morbidity. Among the non-dispositional factors, avoidance coping contributed equally to general and post-traumatic morbidity (pr = 0·24). Life events since the earthquake (pr = 0·18), poor social relationships (pr =−0·25) and ongoing earthquake-related disruptions (pr = 0·22) also contributed to general morbidity, while only the latter contributed significantly to post-traumatic morbidity (pr = 0·15).

Conclusions. Medium-term post-earthquake morbidity appears to be a function of multiple factors whose contributions vary depending on the type of morbidity experienced and include trait vulnerability, the nature and degree of initial exposure, avoidance coping and the nature and severity of subsequent events.

Background. Most studies of social support appear to assume that it is something that the external environment provides to an individual. However, longitudinal and genetic studies are beginning to question this assumption. The purpose of the present study is to differentiate quantitatively the intra-individual determinants of social support from its extra-individual components.

Methods. The subjects were 103 high school exchange students who were enrolled in a 1-year placement with a host family in various countries of the world. The People In Your Life scale, a reliable and validated self-report measure of perceived social support, was administered before their departure from home, after 6 months of stay in a completely unfamiliar foreign community and 6 months after their return home. Structural equation models were examined that partitioned the intra-individual and extra-individual components of social support, and the best fitting models were selected.

Results. Between 24% and 69%, or up to 86% depending on the situation, of the variances of social support measures were stable across situations and considered intra-individual; 31% to 76% of what is measured as social support was of extra-individual origin. Moderately strong correlations were noted between the intra-individual components and the trait extraversion.

Conclusions. Measures of social support, which is usually tacitly understood as something extrinsic to an individual, in fact may not be measures of the external environment only.

Background. Altering the balance of provision between hospital and community care is a key and often contentious component of mental health care policy in many countries. Implementation of this policy in the UK has been slowed by the apparent shortage of suitable community accommodation for people with long-term needs for care and support. Among the consequences could be the silting up of hospital beds by people who could be supported more appropriately elsewhere, in turn denying in-patient treatment to people with acute psychiatric problems and unnecessarily pushing up health service expenditure.

Methods. Using data collected in a survey of hospital and residential accommodation services and their residents in eight areas of England and Wales, the cost components of today's balance of care were explored. Comprehensive costs were calculated and their associations with resident characteristics examined using multiple regression analyses.

Results. On a like-with-like basis, the costs of hospital in-patient treatment for inappropriately placed patients greatly exceeded the costs of community-based care.

Conclusion. Further reduction of hospital beds, however, is not the panacea for an appropriate balance of mental health care, given the unknown but potentially considerable extent of unmet demand, as well as the impact of previous in-patient bed reductions apparent in the services surveyed. Rather, service providers and purchasers should focus on developing community-based care (including increased provision of 24-hour nursed beds) by ensuring that resources released through earlier closure programmes have been redeployed for their intended use and by accessing additional pump-priming or bridging resources.

Background. The DSM-IV criteria for melancholia include the clinical feature ‘distinct quality’, defined as a mood state differing from that experienced in bereavement. Both propositions – its specificity to melancholia and its definition – remain problematical.

Methods. We examine both propositions by analysing an adjective checklist completed by melancholic and non-melancholic depressed subjects, as well as by a bereaved sample. The checklist was refined by a principal components analysis to four scales – one assessing a general ‘mood’ severity or dysphoric dimension, and the other three assessing dimensions of ‘fatigue’, ‘numbness’ and ‘guilt’.

Results. If the concept of ‘distinct quality’ has validity, we would require specificity of the refined qualitative constructs to melancholic depression. The ‘numbness’ component met that requirement, but only to a degree. While bereaved subjects did differ from those with melancholic depression on a number of our refined qualitative mood domains, such differences appeared more related to lower levels of depression in the bereaved sample.

Conclusions. We argue for deleting the ‘distinct quality’ criterion from diagnostic checklists of melancholia until its definition has been improved, its utility demonstrated and its specificity to any depressive subtype established as having clinical significance.

Background. Prior evidence on the relationship between hostility and minor health problems is limited to cross-sectional self-report studies. In the present study, this relationship was examined prospectively.

Methods. Hostility of 1077 municipal employees was measured by a questionnaire survey and minor health problems by using 4-year register-based absence data including medically certificated diagnoses.

Results. High hostility predicted a high total number of long-term sickness absence spells among men, but not among women. In separate diagnostic categories (musculo-skeletal, traumas and injuries, respiratory), hostility related positively and linearly to absences due to traumatic causes and curvilinearly (U-shape) to absences due to musculo-skeletal causes. Controlling the effects of health risk behaviour and demographic background did not significantly change these figures. However, health risk behaviour moderated the relations of hostility to overall long-term sickness absences, and to traumatic and musculo-skeletal absences, being significantly stronger in high-risk groups. No association was found between hostility and non-certificated short-term absence spells.

Conclusions. The results suggest that hostility plays a role in the aetiology of minor health problems.

Background. The Parental Bonding Instrument (PBI) measures fundamental parenting dimensions (care and over-protection), but does not directly assess abusive parenting.

Methods. We describe the development of the Measure of Parenting Style (the MOPS), comprising refined PBI scales assessing parental indifference and over-control, as well as a scale assessing parental abuse.

Results. We examine psychometric properties of the MOPS, while several analyses build to the concurrent validity of the abuse scale as an experiential measure. We examine the extent to which both the PBI and the MOPS scales showed specificity of dysfunctional parenting to the non-melancholic depressive subtype, and across a range of anxiety disorders. Non-melancholic depressed patients returned anomalous parenting scale scores (compared to melancholic subjects), but only when such subtyping decisions were clinician-generated. Those receiving DSM-III-R lifetime anxiety diagnoses of panic disorder and of social phobia returned higher PBI protection and MOPS over-control scores than non-anxious subjects, while differences were not established for those with generalized anxiety disorder or obsessive compulsive disorder.

Conclusions. We consider the likely utility of the MOPS scale and note the module capacity of separate MOPS and PBI scales, which allow a set of options for assessing perceived parenting characteristics.

Background. Diagnostic Related Groups (DRGs) and Healthcare Resource Groups (HRGs) do not predict accurately length of stay or resources needed for treatment in psychiatry. This preliminary study assessed the relative contribution of severity of illness, in combination with other variables, in predicting length of stay.

Method. Data were analysed on 115 consecutive admissions to a district psychiatric in-patient unit to assess the variables which most accurately predict length of stay. The variables included demographic data, diagnosis, clinical, social and behavioural measures.

Results. For initial admission, diagnosis of neurosis predicted shortest stay, but diagnosis alone accounted for only 14·6% of the variation in length of stay. Addition of Social Behaviour Scale score, living alone and specific psychiatric symptoms significantly increased the predictive value (adjusted R2=36·6%). Addition of variables available at discharge (use of ECT, major tranquillizers and antidepressants) significantly increased the adjusted R2 to 49·0%. Prediction of total length of hospitalization over a 12-month period, from the date of initial admission, indicated that mania predicted the longest stay and addition of other variables meant that only 18·9% of length of stay was predicted.

Conclusion. If these results are borne out in a larger study, they indicate that diagnostic or health related groups (DRGs) are only likely to be useful in psychiatry if they include more detailed social, clinical and behavioural variables.

Background. In recent years the 12-item General Health Questionnaire (GHQ-12) has been extensively used as a short screening instrument, producing results that are comparable to longer versions of the GHQ.

Methods. The validity of the GHQ-12 was compared with the GHQ-28 in a World Health Organization study of psychological disorders in general health care. Results are presented for 5438 patients interviewed in 15 centres using the primary care version of the Composite International Diagnostic Instrument, or CIDI-PC.

Results. Results were uniformly good, with the average area under the ROC curve 88, range from 83 to 95. Minor variations in the criteria used for defining a case made little difference to the validity of the GHQ, and complex scoring methods offered no advantages over simpler ones. The GHQ was translated into 10 other languages for the purposes of this study, and validity coefficients were almost as high as in the original language. There was no tendency for the GHQ to work less efficiently in developing countries. Finally gender, age and educational level are shown to have no significant effect on the validity of the GHQ.

Conclusions. If investigators wish to use a screening instrument as a case detector, the shorter GHQ is remarkably robust and works as well as the longer instrument. The latter should only be preferred if there is an interest in the scaled scores provided in addition to the total score.

Background. It has been suggested that a failure to control for point in the menstrual cycle can lead to biased results in assessing psychiatric symptoms among women since state affects associated with premenstrual symptoms may lead to unreliability of symptom reporting as well as an artificial elevation of symptom ratings. We examine these hypotheses and the extent to which they can account for gender differences in symptom scale scores of demoralization and enervation.

Methods. The data are derived from an epidemiological study of Jews born in Israel between 1949 and 1958. The symptom scale scores of 2265 men and 1769 women (368 premenstrual, 458 menstruation and 943 postmenstrual) were compared regarding reliability, homogeneity and mean score.

Results. There were no differences among the menstrual groups, or between the men and women, in reliability of their responses as measured by the alpha coefficient and the coefficient of variation. There were no significant differences among the female groups on mean symptom scale score. The mean scale scores for each female group were significantly higher than the mean scores for men.

Conclusions. Our results suggest that menstrual cycle stage does not influence the reliability of reporting, the variability of response or mean symptom levels. However, our conclusions may not apply to studies of drug effects or clinical studies of premenstrual dysphoria.

Background. Research indicates that deluded patients ‘jump to conclusions’ on probabilistic reasoning tasks. Two experiments were carried out with patients suffering from persecutory delusions and depressed and normal controls in order to determine whether this response bias is affected by task difficulty and the meaningfulness of the materials.

Methods. Tasks were variants of those employed by Huq et al. (1988) and Garety et al. (1991). In Experiment 1, subjects judged which of two bags a sequence of coloured beads had been taken from. Difficulty was manipulated by varying the ratios of coloured beads in the bags. In Experiment 2, a neutral condition required judgements about coloured beads drawn whereas, in meaningful conditions, subjects had to judge whether personality characteristics described one of two individuals.

Results. In Experiment 1, estimates of certainty varied with task difficulty, and there was no evidence of ‘jumping to conclusions’ in the deluded group. In Experiment 2, all groups reached an initial level of certainty and reduced their estimates of certainty following disconfirmatory evidence more quickly in the meaningful conditions. Both clinical groups expressed higher certainty levels in early trials, and a greater magnitude of reduction in certainty following disconfirmatory information. These group differences were more evident in the meaningful conditions than in the neutral conditions.

Conclusions. Probabilistic reasoning is affected by task difficulty and meaningfulness of materials in both deluded and depressed subjects. Observed reasoning abnormalities were not specific to the deluded group.