Psychiatric status and psychosocial variables were assessed in a group of 80 unemployed men. Symptoms of depression and anxiety were assessed using the Present State Examination and ‘caseness’ rated according to the Bedford College criteria. Among men who were normal at the time of job loss, 14% developed a ‘case’ disorder and a further 17% a ‘borderline case’ disorder over the first 6 months of unemployment. These rates are similar to those found in studies concerned with a wider range of severe life events. An increased risk of onset was associated with three factors: lack of an intimate relationship with a wife or girlfriend, trait shyness, and preexisting economic difficulties.

Studies relying on subjects' retrospective reports have recently been interpreted as indicating that individuals born since World War II are at increased risk for a diagnosis of lifetime major depression. Examining the validity of this ‘cohort effect’ is essential, given the potential importance of such a phenomenon for research and policy. Among a number of artefactual explanations for the cohort effect is the possibility that older individuals are less likely to recognize depression as a mental disorder, and hence are less likely to remember depressive episodes as such, or to report these episodes in interviews on mental health. To test whether age was related to the recognition of major depression as a mental problem, we analysed responses from 152 randomly selected community residents on whether a vignette describing DSM-III major depression represented a psychological or emotional problem. Older respondents were much less likely to characterize major depression this way, even controlling for other factors. Such an age effect may provide a partial explanation for the apparent cohort effect, although the issue is complex and further research is needed.

Results on the age/sex specific prevalence of DSM-III affective disorders from the NIMH Epidemiologic Catchment Area Study (ECA), a probability sample of over 18000 adults from five United States communities, are presented. The cross-site means for bipolar disorder ranged from 0·7/100 (2 weeks) to 1–2/100 (lifetime), with a mean age of onset of 21 years and no sex difference in rates. The cross-site means for major depression ranged from 1·5/100 (2 weeks) to 4·4/ 100 (lifetime), with a mean age of onset of 27 years and higher rates in women. The cross-site means for dysthymia, a chronic condition, was 3·1/100 with a higher rate in women. There was reasonable consistency in prevalence rates among sites. The implications of these findings for understanding psychopathology are discussed.

This is a report of clinical and epidemiological trends in parasuicide in Edinburgh and Oxford over the period 1976 to 1984. Rates of parasuicide declined in both cities, but more markedly among women than men. Male rates tended to be higher in Edinburgh and female rates higher in Oxford. Age-specific rates were similar for the two cities in 1983–84, with peak rates for females among 15–19 year olds and those for males among 20–24 year olds in Edinburgh and 25–34 year olds in Oxford. Parasuicide incidence was higher in lower social class groups and among the unemployed in both cities. During the study period there was a massive decline in barbiturate overdoses, a more modest decline in minor tranquillizer overdoses but, in Oxford, a marked increase in self-poisoning with paracetamol. By the end of the study period the proportion of patients receiving a diagnosis of drug addiction had doubled in Edinburgh, although it had remained fairly constant in Oxford. There were differences in patterns of aftercare offered to patients in the two cities; these almost certainly reflect differing clinical policies.

Data on self-reported symptoms collected in the East Baltimore site of the Epidemiologic Catchment Area Program are analysed in parallel fashion for the two syndromes of anxiety and depression. Patterns of relationships of anxiety and depression to sociodemographic factors, prior psychopathology, and life events fail markedly to distinguish the two syndromes.

Recent research has shown that suicidal patients are not only biased in the speed with which they can remember positive and negative events from their past, but that they also find it more difficult to be specific in their memories. That is, they tend to recall sequences of events, or time periods, rather than single episodes. This tendency has been found to be more evident with positive than with negative events. This paper examines whether the same phenomenon can be observed in patients with a diagnosis of primary Major Depressive Disorder. Twenty depressed patients and twenty matched controls were presented with positive and negative cue words and asked to retrieve specific personal memories. Results showed that depressives (unlike controls) took longer to respond to positive than to negative cues. In addition, the depressed patients were less specific in their memories, especially in response to positive cues. These results are explained within a ‘descriptions’ theory of autobiographical memory, and the remedial implications are discussed.

Crude mortality rates and mortality rates standardized against a British reference population have been calculated for a group of 460 consecutive patients with eating disorders seen between 1971 and 1981 in a tertiary referral centre for eating disorders. Crude mortality rates were 3·3% and 3·1% in the anorexia nervosa and bulimia nervosa groups respectively. Standardized rates demonstrated a six-fold increase in mortality in the anorexia nervosa group. The most common cause of death in this group was found to be suicide, with the risk of death remaining high for at least eight years after initial assessment. Specific associations of increased mortality were: being in the lowest weight group at the time of presentation, and having recurrent hospital admissions for eating problems.

Most density-pathology research has assumed that dense living conditions have ‘ pathological’ effects on urban dwellers. This study considers the possibility that both low and high density may be problematic and that in-unit and out-unit density may have interacting effects. The data included all first admissions from Chicago to 44 in-patient psychiatric facilities in Illinois during 1960–61. After controlling for socioeconomic status (SES) and race, living alone, which defines low in-unit density, was associated with high admission rates, but only when the outside density was low. Among those not living alone, the contribution of density to admissions was agelinked, with interactions between in–unit and out-unit density observed in the older ages. The results lead to the general conclusions that the negative model guiding earlier research is inadequate and that in-unit and out-unit density have interacting effects on the risk of psychopathology.

This paper reports the results of a comparison of the rates of psychiatric disorder from three general population surveys in which the PSE-ID-CATEGO system was used for case-definition. These surveys were of an English sample in Camberwell, London, and of two Greek samples, the first in Athens, the second of Greek Cypriot immigrants living in Camberwell. The results show that the rates of psychiatric disorders in both Greek samples were somewhat higher than those of the Camberwell population, the differences being accounted for by higher rates of anxiety disorders, especially in women. Comparisons in terms of syndrome profiles showed that Greeks reported more symptoms of generalized anxiety than their English counterparts who, in their turn, reported higher rates of obsessive symptoms, and symptoms of social anxiety. The higher rates in the Greek samples were possibly due to an increased frequency of non-specific neurotic symptoms like worrying and tension. The results of other European community surveys with the PSE suggest that there might be a genuine and general North-South difference in the expression of psychological distress. Cultural differences in terms of personality traits and culturally sanctioned child rearing practices might account for the findings.

A community study of minor psychiatric morbidity (MPM) was carried out on three population samples aged 15 and above randomly selected from rural (Yenpu), suburban (Chishan), and urban (Kaohsiung) communities (N = 350 for each) in Taiwan. A two-stage case finding strategy was applied with a newly developed and validated screening questionnaire (CHQ), and a modified Chinese version of the Clinical Interview Schedule (CIS-CV). The total response rate was 99·4% and there was no time lag between the CHQ screening and the second stage clinical interview conducted by a psychiatrist. The weighted validity of the CHQ was found to be acceptable (sensitivity 69·6%, specificity 94·8%, misclassification rate 11·4%). The overall weighted prevalence rate was 18·0% for men and 33·3% for women. Both the CIS and the CHQ data are used as the morbidity indices to investigate the sociodemographic risk factors of MPM. A higher risk of MPM, which occupied 92% of the total morbidity, was found to be associated with women aged 35 and above, the unemployed men, and the lower socioeconomic status after linear modelling.

A videotape-assisted simulated consultation model was used in a pilot study comparing a range of assessment and treatment decisions made by trainee general practitioners and trainee psychiatrists in response to two cases representing women with depressive disorders. The doctors were studied individually in their consulting rooms or offices. In relation to the methods of analysis chosen, levels of agreement within and between the two groups of trainees were generally low. The findings are discussed in relation to previous similar work undertaken with experienced clinicians studied in groups.

Of 49 compulsive ritualizers one-third perceived their obsessive thoughts as rational and felt that their rituals warded off some unwanted or feared event (the content of their obsessions). The more bizarre the obsessive belief the more strongly it was defended and 12% of cases made no attempt to resist the urge to ritualize. Neither fixity of belief nor resistance to compulsive urges were related to duration of illness. Patients with bizarre and fixed obsessive beliefs responded as well to treatment (all but three received exposure), as did patients whose obsessions were less bizarre and recognized as senseless. There was no difference in outcome between patients who initially found it hard to control their obsessions or never resisted the urge to ritualize and those who initially could control obsessions or resist rituals. One year after starting treatment, patients whose obsessions and compulsions had improved with treatment recognized their irrationality more readily and controlled their compulsive urges more easily. Beliefs appeared to normalize as a function of habituation.

The aims of the Camberwell High Contract Survey (CHCS) were to develop and test a systematic needs assessment procedure and use it to evaluate the services provided to long-term users of day centres and sheltered residential accommodation (excluding hospital wards). This paper describes the background to the study, the sample of 145 attenders and their characteristics, their clinical and social problems and the care provided for them.

Grade of Membership (GOM) analysis, a multivariate technique for studying disease, was used to explore depressive typology and relationships between depression and anxiety. One hundred and ninety patients with RDC diagnoses of major or minor depression were assessed by the Hamilton and SCL-90 symptom rating scales, the Newcastle diagnostic indices for endogenous depression and for anxiety and depression. Demographic, family and treatment response information were used as external validators.

Five pure types provided the most satisfactory solution to these data. One group corresponded to classical melancholia, occurring in older, stable, in-patients, who lacked panic-phobic symptoms. All patients with agoraphobia fell into two distinct in-patient and out-patient groups, which differed from each other in several ways. In one group, a link was found between panic attacks, agitated melancholia and familial pure depression. The second group was less symptomatic and had more atypical vegetative symptoms.

Two more groups comprised mildly symptomatic, hypochondriacal, depression, and a highly neurotic, obsessive, anxious, non-phobic depression, which was commonly related to a physical stressor.

On the background of the recent discussion about the appropriateness of linear difference and ratio models for testing interaction effects of social support and stress, it is argued that interaction effects are basically unstable when dichotomized continuous variables are analysed. A data set with known interrelationships of the continuous variables ‘stress’, ‘social support’, and ‘depression’ was simulated and analysed in tabular format. It is shown that the choice of cut-points for the independent variables crucially determines the size and presence of interaction effects in ratio analysis models.

This paper summarizes the information gathered from healer and hospital patients consulting for mental illness in the Kathmandu Valley. While the tantrik healer appeared to be emulating the hospital in the speed and impersonality with which patients were processed, healer patients appeared to enjoy a greater degree of family support than did hospital patients.

The prevalence of psychiatric disorder, as assessed by both the GHQ-28 and the short PSE, is described for a random community sample of New Zealand women. In contrast to previous studies, married and widowed women and mothers showed lower rates than the never married and childless women. A plausible explanation is provided by available analysis of New Zealand gender roles. Such an explanation would reconfirm the importance of socio-cultural factors in community psychiatric disorder.

We report the results of a survey of the needs for items of care of 145 long-term users of psychiatric day-hospitals and day-centres in Camberwell. The overall ratio of met to unmet need was almost exactly 5:1. Need was shown to vary according to chronicity, degree of participation, and placement in day-hospital or day-centre. Specific areas of functioning and specific types of care were identified in which there was significant overprovision or underprovision. The utility of our measures, and their ability to identify clinically significant unmet need, are discussed.

Two hundred and twenty-eight cases of children with final clinical diagnoses of childhood psychosis were reviewed using a standard coding scheme; cases were grouped in three broad categories on the basis of clinical diagnosis (autistic, atypical and schizophreniform). These three groups differed significantly in many respects, although the ‘atypical’ group more closely resembled the autistic group. While it was possible meaningfully to differentiate diagnostic groups using DSM-III criteria, some cases were difficult to classify. Childhood schizophrenia, as strictly defined, was far less common than childhood autism. The development of diagnostic schemes for those children whose disorders are difficult to classify is an important topic for future research.

A meta-analysis of studies was carried out to compare treatment by specialist mental health professionals in the general practice setting and ‘usual GP treatment ’. Overall, treatment by specialist mental health professionals had a 10% greater success rate.