Objective - To set out the author's views of the role of epidemiology in social psychiatry and to illustrate this role with reference to affective disorders. Method - Review of work carried out in two areas; the bearing of gender and of age on rates of affective disorder. Results - The use of sociodemographic categories to define high risk groups suggests that affective disorder may be related strongly to role satisfaction and that age may have a pathoplastic effect on the form of disorder that overrides all but the strongest social influences. Conclusions - Epidemiology is an essential tool of the social psychiatrist, but its main strength is in clarifying the nature of the questions to be asked and suggesting new lines of investigation.

Objective - The present study was conducted to determine the excess of mortality in long-term psychiatric inpatients. Setting - Psychiatric hospital, Bologna, Italy. Design – Retrospective study on a cohort of 264 chronic psychiatric inpatients, followed up for ten years since January 1981. Mortality measures were computed by psychiatric diagnosis, length of stay and «still resident at follow-up/discharged» condition. Main measures – Standardized mortality ratios were computed with reference to the mortality by age of the population resident in Bologna in the years 1981- 1991. Presence in the cohort was expressed in person/years. Results – The excess of deaths in the cohort was 2.89 (CI 95%: 2.12-3.86) for males and 2.38 (CI: 1.66-3.31) for females. A remarkable excess of deaths for both sexes was observed in the class of age 15/44 (18.33 for males, CI 9.14-32.81; 60 for females, CI: 21.91-130.6 ) and in association with a diagnosis of personality disorder/alcohol abuse (11.25 for males, CI: 5.13-21.36; 5 for females, CI: 1.35-12.8). Length of stay and age of patients were inversely associated with SMRs. Conclusion – The present study confirms that the excess of mortality is high in psychiatric long-term inpatients and that it may be concentrated in younger classes of age, first years after admission and in subjects with diagnoses of personality disorder/alcohol abuse.

The characteristics of the area utilizying the service, the tipology and the organization of the psychiatric services in the Liguria region of Italy are described with the same methodology employed for four other locations in Italy where a psychiatric case register is operative. This information gathering system officially began in March 1987, when the Regional Council decided to entrust the organization of this project to the Institute of Applied Medical Services of the University of Pavia. The source of the data collected is represented by the psychiatric services facilities operating in the Liguria Region. These include 20 territorial Mental Health Services (SSM), 9 Psychiatric Units in General Hospitals (SPDC) and 2 ex-psychiatric hospitals (PSS). The psychiatric case register is compiled in all Psychiatric Services of the Region by collecting data on charts; futhermore, in 12 of the Mental Health Services, in 2 of the Psychiatric Units in General Hospitals and in the ex-psychiatric hospitals this information has also been computerized. Data collection began in 1988, and in the first regional verification of the functionality of this system took place the following year. Results regarding the utilization of territorial services reveal annual prevalence rates that range from 200-500 per 100.000 inhabitants. As far as interventions involving hospitalization are concerned, SPDC and PSS data were analyzed separately. This analysis confirmed the situation described in the literature, namely that there is an excess of diagnoses of psychosis, most of all among males admitted to Psychiatric Units in General Hospitals and females admitted to ex-psychiatric hospital. Age-specific grouping of these results further revealed that most of these patients are elderly, especially the women.

Objective – The aim of this paper is to analyse long-term care in an area (Portogruaro) monitorized with a Psychiatric Case Register. Design – A cohort composed by patients included in 1987 prevalence was followed in 1992. Three hypothesis have been tested: a) long-term patients (LT) have a better prognosis than long-stay patients; b) clinical and socio-demographical characteristics of LT are significantly different from those of non-LT patients included in the cohort; c) clinical and socio-demographical characteristics of LT that are also high-users are different from those LT that are not high-users. Main outcome measures – Analysis was performed using generalised linear models; principal clinical and socio-demographical characteristics were considered. Results – The results confirm the first hypothesis, and show that two variables (previous psychiatric contact and employment) were associated with patterns of care in 1992. Highly significant is the correlation between patterns of contacts in 1987 and 1992, showing that particularly long-term and high-user patients tend to confirm their pattern over the years. Conclusions – These results underline the necessity for psychiatric services to commit themselves to the care of this group of patients, that constitute the «new chronicity».