International Journal of Social Psychiatry

Published by SAGE Publications
Print ISSN: 0020-7640
A diagnostic system for ICD-11 is proposed which commences with broad reorganization and simplification of the current categories and the use of clinically relevant specifiers. Such changes have implications for the positioning of diagnostic groups and lead to a range of possibilities for improving terminology and the juxtaposition of individual conditions. The development of ICD-11 provides the fi rst opportunity in almost two decades to improve the validity and reliability of the international classification system. Widespread change in broad categories and criteria cannot be justified by research that has emerged since the last revision. It would also be disruptive to clinical practice and might devalue past research work. However, the case for reorganization of the categories is stronger and has recently been made by an eminent international group of researchers (Andrews et al., 2009). A simpler, interlinked diagnostic system is proposed here which is likely to have fewer categories than its predecessor. There are major advantages of such a system for clinical practice and research and it could also produce much needed simplification for primary care (Gask et al., 2008) and the developing world (Wig, 1990; Kohn et al., 2004).
The changes in fiamily burden and participation in care of relatives to both voluntarily and compulsorily admitted patients were investigated as part of a longitudinal study of the quality of the mental health services in a Swedish county perfiorrned between 1986 and 1997. The relationship between the relative's mental health and family burden, participation in care and need of own support was also investigated. The results showed similar and high levels of burden and a non-sufficient participation in care in both periods investigated despite the ongoing changes in the delivery of psychiatric services and a change in the compulsory legislation in Sweden during the period. More relatives experienced an own need of care and support from the psychiatric services in the 1997 investigation. Relatives who experienced mental health problems of their own more often experienced other forms of burden, experienced less participation in the patient's treatment and also more often had own needs of care and support. It is concluded that interventions in families where relatives experience mental health problems will be useful, since a well-functioning network around the mentally ill person has shown to reduce relapse.
Social, demographic and clinical information was collected retrospectively on all 99 people referred to a South London hospital in 1986 under Section 136 of the Mental Health Act (1983), this being the last complete year before local changes in the procedure for assessment of Section 136 cases were initiated. An over-representation of Afro-Caribbeans was confirmed and this seemed to be accounted for largely by young men under the age of 30 who with Africans had very high rates of previous Section 136 referral, were more likely to be perceived as threatening, incoherent and disturbed but less clearly diagnosed with a mental illness, and were more likely than the Caucasian sample to be living in stable accommodation. The implications of these results are discussed.
This paper is a historical review of mental health services in Hong Kong. The development of mental health services in Hong Kong can be roughly divided into several stages: the pre-asylum period (1841-1924), the asylum period (1925-1948), the organization period (1 948-1965), the initial rehabilitation period (1966-1973), the centralized rehabilitation period (1974-1981) and the civic control vs community care period (1982-1995). From the development of mental health services in Hong Kong, it is clearly demonstrated that the aims and the trends of mental health services had gradually progressed from a detention model, to a treatment model and finally to a rehabilitation model. Nevertheless, under a shortage of governmental resources and the severe opposition of public stigmatization, community based rehabilitation existed in the form of institution-like service units. In comparison with the international de-institutionalization and community care movement, mental health services in Hong Kong are not affected by any de-institutionalization movement. Instead, the unique political and social context nurtured a parallel development of both institutional care and community care for mental patients.
Clinical observations and research have found the content of delusions in schizophrenia to be sensitive to sociopolitical and cultural factors. The aim of this retrospective case-note study was to determine changes in the frequencies of various contents of delusions in schizophrenia patients over time. A total of 120 records of first-time admission schizophrenia patient at Ljubljana's psychiatric hospital in the period from 1881 to 2000 were randomly selected. Information was taken from each record to fill out a form specially created for this study. The frequencies of delusions with regard to their content in various time spans were compared. A marked increase in two delusional themes--persecution and self-reference--was found after the change of political regime (1941-2000) in Slovenia. After the spread of radio in the 1920s and television in the 1950s in Slovenia, there was an obvious increase in delusions of outside influence and control as well as delusions with technical themes. A striking increase in the percentage of Schneiderian first-rank symptoms was found after the spread of Schneider's ideas in the 1950s. Sociopolitical changes and scientific and technical developments have a marked influence on the delusional content in schizophrenia.
Based on experience with the Hopkins Symptom Checklist-25 (HSCL-25) in a Tanzanian population, this study attempted to develop a locally specific screen that employs indigenous expressions. Thirty ethnographically derived local idioms were added and the final 47-item questionnaire administered to 787 randomly selected antenatal clinic attendees. Logistic regression identified 19 items for the Dar-es-Salaam Symptom Questionnaire (DSQ), which demonstrated good internal consistency (Cronbach's alpha = 0.84), interrater reliability (intraclass r = 0.89), and test-retest reliability (intraclass r = 0.82). Positive endorsement overall increased only slightly, but the report of mild symptoms was more frequent with the DSQ (15.0%) than the HSCL-25 (10.8%). Content and discriminant validation of the local scale conformed to expectation, but depressed affect failed to emerge as an important feature. Locally derived expressions may aid in the reporting of illness and illness severity. Further studies are recommended to uncover universal aspects and culturally specific manifestations of illness expression. Declaration of interest: None to report.
Characteristics of the sample and study groups. 
The Chornobyl nuclear power plant explosion in April 1986 was one of the worst ecological disasters of the 20th century. As with most disasters, its long-term mental health consequences have not been examined. This study describes the psychological well-being and risk perceptions of exposed women 19-20 years later and the risk factors associated with mental health. We assessed Chornobyl-related post-traumatic stress disorder (PTSD), major depressive episode (MDE) and overall distress among three groups of women in Kyiv, Ukraine (N = 797): mothers of small children evacuated to Kyiv in 1986 from the contaminated area near the plant (evacuees); mothers of their children's classmates (neighbourhood controls); and population-based controls from Kyiv. Risk perceptions and epidemiologic correlates were also obtained. Evacuees reported poorer well-being and more negative risk perceptions than controls. Group differences in psychological well-being remained after adjustment for epidemiologic risk factors but became non-significant when Chornobyl risk perceptions were added to the models. The relatively poorer psychological well-being among evacuees is largely explained by their continued concerns about the physical health risks stemming from the accident. We suggest that this is due to the long-term, non-resolvable nature of health fears associated with exposure.
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Unstable family environment during childhood is known to predispose to juvenile delinquency. This study explored whether childhood family structure is associated with violent behaviour of adult offspring. We used a large, unselected general population birth cohort (n = 5589 males) linked with the national crime registers (up to the age of 32 years). The Ministry of Justice provided information on registered offences for all subjects. A logistic regression analysis was performed to examine the association between family type and criminality (violent and non-violent crimes). We found that single-parent family "at birth" (adj. OR 3.6, 95% CI 1.8-7.0) and "all time" (up to the age of 14 years) (adj. OR 5.2, 95% CI 2.5-10.6) were risk factors for violent offences of an adult offspring. Also parental death (adj. OR 2.2, 95% CI 1.3-3.6) and divorce (adj. OR 2.5, 95% CI 1.6-3.7) doubled the risk for violence. Non-violent offences were associated only with parental death and, divorce. A single-parent family of origin is strongly associated with later violent criminality of male offspring. Further studies are needed to explore the psychosocial aspects of single-parent family environment which may promote the vulnerability to violent offending in adulthood.
This paper describes some of the social trends of the 1970's that may be affecting patterns of psychiatric needs and presents data showing their impact. It suggests possible psychiatric and sociopolitical responses to meet these needs. Patients were studied in the outpatient and inpatient services of the Shands Teaching Hospital and Student Mental Health Services at the University of Florida. The main findings were that single youth, both females and especially males, were requiring less help since the winding down of American participation in the Vietnam War, perhaps indicating that youth are feeling less alienated from the national effort. Black women are seeking help more than ever before, probably because the black liberation movement has offered them hope that psychiatry can help them. Despite the women's liberation movement, white women still remain the largest group of psychiatric outpatients, as they were in the 1950's and 1960's.
Intercorrelation Matrix, Means and Standard Deviations for the Variables inthis study 
This study corroborates the findings by Stack (1980) on the relationship between interstate migration and suicide. The present application is to Canada during the early and later parts of the 1970s decade. Strong support for a migration effect emerges, thus supporting the culture shock hypothesis that because migration involves the concomitant processes of severing important social ties with the origin, and adjusting to a new environment, Provinces characterized by high rates of migration will experience high rates of suicide. It is found that while a province's percentage of the population who have received university education is negatively related to suicide, the main effect of migration acts to raise the odds of suicide, but this effect is lower in magnitude than the education measure. A one percent gain in the education index would have served to lower the suicide rate by 1.3%, while a similar change in migration would increase the rate of suicide by .67%.
This paper is the final summary and report of an eighteen-month project funded by the Research and Demon stration Branch of the Department of Social and Family Services, Province of Ontario. The project extended from October 1, 1970 to March 31, 1972 and was designed to study the feasibility of the community-initiated, Family Life Centre concept. All of us connected with the Family Life Centre are deeply grateful to the Department of Social and Family Services for this research opportunity.
Aims: To explore temporal trends since 1980 in alcohol-related death for people resident in the European Union (EU) and to examine differences between EU members admitted prior to 2004 and new EU members admitted since 2004. Methods: The data were extracted from the World Health Organization's European mortality database and the European Health for All database. Results: New EU members had higher rates of alcohol-related deaths (135.0 ± 18.48 vs 88.9 ± 18.93; t = -8.55 (d.f. = 46), p < .001) and higher death rates from alcohol abuse (whole population: 3.4 ± 1.24 vs 2.6 ± 0.12; t = -2.98 (d.f. = 23.45), p < .01; male population: 6.1 ± 2.17 vs 4.4 ± 0.19; t = -3.87 (d.f. = 23.35), p < .001) than early EU countries. However, a mortality gradient between groups of countries was visible only for female alcohol-related deaths when controlling for mortality rates from all causes. Multivariate regression analyses also indicated that alcohol-related deaths and alcohol consumption were associated negatively with the gross national product (GNP) of EU countries and positively with levels of urbanization. Conclusions: Alcohol-related deaths represent more than 10% of all EU mortality and confirm the importance of national prevention strategies for alcohol problems.
Transposition CHAM > DSM-IV 
Characteristics of the consultations 
Diagnostic categories 
There has been a striking increase in the number of compulsory admission proceedings in the Netherlands since 1992, to such an extent that treatment in Amsterdam's psychiatric clinics is in danger of being dominated by coercive treatment. Our aim was to establish a picture of the changes in emergency psychiatry that have contributed to the increase in the number of acute compulsory admissions. A cohort (N = 460) of psychiatric emergency consultations with the city crisis service in 1983 was compared with a similar cohort (N = 436) in 2004-2005. The study focused on the following variables: patient characteristics, crisis-service procedures and consultation outcomes. Compared with 1983, there are now more services involved in crisis support in the public domain for psychiatric patients. The number of patients referred by the police has risen from 29% to 63%. In 1983, all consultations took place where the patients were located; at present, 60% take place at the crisis service premises. The number of psychotic patients in the cohort has increased from 52.0% and 63.3 %. There has been an increase in the proportion of compulsory admissions and a sharp decrease in the proportion of voluntary admissions from 61% to 28% of all admissions. Overall, the percentage of consultations leading to a psychiatric admission has fallen from 42% to 27%. The front-line outreach service of 1983 has changed into a specialist psychiatric emergency department with a less pronounced outreach component. Voluntary admissions to psychiatric hospitals have almost disappeared as a feature of the crisis service.
This paper represents the first report of an ongoing collaborative project and charts the activities of social workers undertaking their duties within the framework of the 1983 Mental Health Act in five English Local Authorities for one year. Social workers are involved in a range of duties under the Act, but most commonly they are involved in assessments with a view to compulsory detention. The characteristics of people assessed are examined, and a profile emerges of vulnerable subgroups, typically younger men, older women, and people living in socially impoverished situations. Considerable variation between Authorities is found in terms of numbers of assessments, and in numbers of detentions. Low levels of 'diversion' into alternative care are identified. Comparisons are made with a major national study which took place four years earlier. Higher rates of detention are found on average, but lower rates of use of emergency provision (Section 4). An examination of the organisational context within which Approved Social Workers (ASWs) practice reveals a great deal of variation between authorities in terms of the ongoing experience of assessments available to ASWs. Social workers based in Emergency Duty Teams and Hospital Teams are compared, and a distinctive profile of their work emerges, the hospital-based ASVVs being more likely to be assessing 'known' people, often already in hospital, and referred for assessment by consultants. The implications of these findings for the management and deployment of Approved Social Workers are briefly discussed. The emphasis is upon the role of the ASW in terms of balancing the rights and needs of people assessed under the Act.
This report examines the trends in the utilization of psychiatric inpatient care for the period 1984-1996, when the implementation of the psychiatric reform programme was initiated in Greece. Admissions in public mental hospitals declined by 7.2%. However discharges have been increased by 30.6% with a parallel decrease of the length of stay by 53.7% followed by an increase in discharges of patients diagnosed as suffering from schizophrenia and affective psychoses by 61.1 % and 123.8% respectively. In the prirrate sector a remarkable reduction in both admissions and discharges was noticed. Admissions in psychiatric departments of general hospi tals for the same years have been increased by 1054.1 %. It seems that the recent deinstitutionalization process resulted in increasing trends in the discharges of patients suffering from psychoses. Additionaliy, a substantial increase in the number of extramural psychiatric services and rehabilitation places between 1994-1996 was observed. The demand for the mental health care services expressed as the urbanization index was found to be related with mental health professionals and the extramural units ratios. The higher degree of urbanism is, the greater the number of extramural services exist. The models explained variance reached 50.6%.
This is a descriptive paper. It outlines the running of a specialist service aimed to meet the needs of long-term mentally ill patients who live in community settings in an inner urban district of London. The service functions in an outreach model from an office base on a large public housing estate. No patient care premises are available on site, consequently all patient activities are carried out in public rooms and other non-mental-health venues. The staffing of the Team and details of its organisational practice are described: demographic and clinical statistics for two years' working are presented. Advantages and disadvantages of the outreach model are discussed. The need for such a specialist service in contrast to the traditional generic service model is argued. The paper is intended as a basic description to underlie current evaluative studies. No evaluation data are presented here.
The treatment of major mental disorders usually combines medical and psychosocial interventions. The present study reviews research pertaining to the efficacy of group psychosocial interventions for people with psychotic illness. An electronic search was conducted through Medline and PsychINFO to identify articles relevant to group therapy for people with schizophrenia and bipolar affective disorder. Articles published in the English language, between January 1986 and May 2006, were considered. Studies were included if they had a control group and at least 20 participants. The search resulted in 23 articles concerning patients with schizophrenia and five concerning patients with bipolar affective disorder. The therapeutic approach in the majority of the studies was along the lines of cognitive behaviour therapy and psychoeducation. All studies reported improvement in at least one parameter. Most of them report improvement in skills and overall functioning.
This paper presents the results of the latest in a series of surveys of an inner-city public psychiatric inpatient service. Severe pressures on the service had led to the purchase of inpatient beds in the private hospital sector and intensive care facilities in a large psychiatric hospital. On a census day the nominal occupancy for the inpatient unit was 117%. Implications of the survey, trends over time and possible solutions to the difficulties of the inpatient unit are discussed.
Recent legislation in the U.K., particularly the NHS and Community Care Act 1990, has encouraged the direct participation of service users in the planning and management of care services. This paper explores evidence of how the interests of service users experiencing mental distress are represented within community care services in the U.K. and the extent to which this leads to a devolution of power to those service users. The evidence is drawn from a survey of principal officers in social services departments responsible for mental health services and interviews with 135 service users. This reveals considerable confusion about the meaning and purpose of user involvement and about how service users can best be represented; little evidence, despite users' interest in it, of power-sharing; and limited commitment of resources to make further participation possible. The conclusion considers how, in the light of this evidence, Central and Local Government might further develop user involvement.
This article presents a review and assessment of a community Mobile Crisis Intervention Team working on the Lower East Side of Manhattan. Of special importance, a trend is noted involving a changing philosophy and modus operandi. Some reasons are offered to explain the trend and questions are raised about the future of the delivery of mental health services in large urban areas.
Psychiatric hospitals in Italy had to be closed under a law dated 1994. To investigate the discharge of patients from public psychiatric hospitals. A total of 4492 patients from 22 psychiatric hospitals were described at recruitment and followed during the period 1994-2000. Their characteristics were investigated as determinants of discharge to community residential facilities for psychiatric patients versus other settings. All 22 psychiatric hospitals closed between 1994 and 2000; 678 patients had died, and the remainder were discharged. Of these, 39% went to nursing homes, 29% to community residential facilities for psychiatric patients, 2% joined their family, less than 1% were settled in private independent accommodation, and 29% remained in the psychiatric hospital, although defined as discharged. Ten patients were recorded as missing when still in the psychiatric hospitals, none after discharge. Younger, more educated patients and patients from two of the four regions studied were more likely to be discharged to community residential facilities. The majority of patients were discharged to highly supervised settings. The potential risk of abandonment due to deinstitutionalization was not observed in this population. The wide use of highly supervised settings can be explained by the patients' old age, but different local policies may have affected the discharge process.
The prescribing of psychoactive drugs is increasing progressively in western countries. The new psychiatric care modalities, in contact with the primary care centres and closer to the population, might be determining this increase in a major way. Official data of prescription were collected from the Public Primary Care Department of Pharmacy, to monitor the use of antidepressants during a five year period in a rural health area (140,359 inhabitants). Daily defined dosage (DDD) was used as the measuring unit. The total use of antidepressants increased progressively during the period studied from 10.47 DDD/1000 inhabitants/day in 1995 to 18.50 in 1999 (an increase of 77.08%). The majority of this increase is explained by the greater use of SSRIs for which prescribing multiplied by 2.5. It is significant that the figure for the use of tricyclics has not fallen parallel to the increase of SSRIs. General practitioners might be losing their fear of diagnosing and treating mood disorders. Probably a pool of patients is included who were not receiving the correct treatment a few years ago, but to what level are we going to lower the symptomatic threshold for prescribing antidepressants?
Youth Suicide Statistics 1995 to 2003: Recent Life Stressors by Gender Frequency Counts (%) 
This study explored gender differences in life stressors of children and adolescents who died by suicide. Three main classes of life stressors have been identified by previous research to be significant risk factors for suicide in children and adolescents: interpersonal/relationship problems, family problems, and academic/school problems. The sample consisted of 156 (89 males and 67 females) completed child and adolescent suicides in Singapore from 1995 to 2003. The age of these individuals ranged from 10 to 19 years with a mean age of 16.49 (SD = 2.59). Significantly more females were found to have had interpersonal/ relationship problems as recent life stressors compared with males. No gender differences were found for the other two life stressors, family problems and academic/school problems. In addition, among the three life stressors studied, only interpersonal/relationship problems emerged as a significant predictor of female child and adolescent suicide. Consistent with previous research literature, these findings contribute to a growing literature documenting the relatively larger impact of relational life stressors on child and adolescent female suicidality. Implications for suicide intervention and prevention, especially among young females, were discussed.
Few controlled studies have examined social class as a risk factor for suicide in Korea. The objective of the present study was to investigate the effects of social class on suicide risk in Korea. A case-control design was constructed from cause-of-death statistics for the period 1999 to 2001, in Korea, as published by the Korean National Statistical Office. The cases were defined as people aged between 20 and 64 who died by suicide, while the controls were defined as those who died of natural causes in the same age groups. The proportions and odds ratios for suicide were higher in young people than in elderly people, and higher for divorced subjects than for cohabitants. They were also higher for residents of rural areas, as opposed to residents of Seoul and other metropolitan areas, and for people in social classes III and IV, than they were for those in social class I. To control the variables that influence risk of suicide, such as age, marital status and area of residence, we used multiple logistic regression. Compared with class I, risk of suicide was higher in social classes III and IV, in both sexes. The principal conclusion of this study is that, regardless of sex, lower social class constitutes a high risk for suicide in Korea, even after controlling for variables such as age, marital status and area of residence. We conclude that a well-controlled and balanced social welfare system could reduce suicide risk, especially among people in lower social class.
Inefficient civil registration systems, non-report of deaths, variable standards in certifying death and the legal and social consequences of suicide are major obstacles to investigating suicide in the developing world. The aim of this study was to prospectively determine the suicide rate in Kaniyambadi Block, Tamil Nadu, South India, for the years 2000-2002 using verbal autopsies. The setting for the study was a comprehensive community health programme in a development block in rural South India. The main outcome measure was death by suicide, diagnosed by a detailed verbal autopsy and census, and birth and death data to identify the population base. The average suicide rate was 92.1 per 100,000. The ratio of male to female suicides was 1:0.66. The age-specific suicide rate for men increased with age while that for women showed two peaks: 15-24 years and over 65 years of age. Hanging (49%) and poisoning with organo-phosphorus compounds (40.5%) were the commonest methods of committing suicide. Acute and/or chronic stress was elicited for nearly all subjects. More men suffered from chronic stress while more women had acute precipitating events (chi2 = 4.58; p < 0.04). People less than 44 years of age had more acute precipitating events before death while older subjects reported more chronic stress (chi2 = 17.38; p < 0.001). The study replicates findings of an earlier study from the area. The suicide rate documented in this study is very high and is a major public health concern. There is a need for sentinel centres in India and in developing countries to monitor trends and to develop innovative strategies to reduce deaths by suicide.
Earlier comparisons of adult Samis and Norwegians living within the same area are--thus far--unknown concerning mental well being/health and possible background factors. To compare patients from the two communities in search of differences which may be useful in planning health services. Retrospective and anonymised data collected from journals. Comprises 48 'Samis' and 70 'Norwegians' in 108 'demographic cells' according to ethnicity, sex, municipality, education and age. 'Samis' rated higher in schizophrenia/psychosis (0.05 < p < 0.1) and crises (0.1 < p < 0.25), 'Norwegians' rated higher in anxiety disorders (0.001 < p < 0.005), low self-esteem (0.005 < p < 0.01), illegal drugs (0.01 < p < 0.025) and in identity/existential problems (0.1 < p < 0.25). 'Samis' appeared to have suffered more at provincial boarding schools (0.005 < p < 0.01), while 'Norwegians' presented more mental illnesses in their families (0.025 < p < 0.05), more family break-ups (0.05 < p < 0.1) and earlier alcohol/drug abuse (0.05 < p < 0.1). Significant differences were found. 'In the black box' results will raise interesting questions for further research, but will also be useful for planning health services.
Prolonged grief disorder (PGD), previously called complicated grief, is associated with significant distress and long-term disability, and it may complicate assessments for post-traumatic stress disorder (PTSD) after traumatic events. In order to distinguish PGD from PTSD, we conducted a cross-sectional survey among tsunami survivors in five tsunami-affected coastal villages in India, 9 months after the Asian tsunami. Prevalence of PGD among 643 tsunami survivors was 14.2% (95% confidence interval (CI): 11.5%-16.9%) and among the 351 bereaved survivors was 25.9% (95% CI: 21.3%-30.5%). Spousal bereavement, extensive damage to homes, fewer years of education, and absence of tsunami-related physical injury differentiated those with PGD, after adjusting for potential confounders (p < .05). These factors were distinct from the factors associated with post-traumatic stress symptoms (PTSS) among these survivors. Scores on the avoidance, hyper-arousal and intrusion subscales of the Impact of Events Scale-Revised were significantly lower in those with PGD alone than in those with PTSS or with both disorders. Our findings support the validity of PGD in a non-Western post-disaster community and its distinctness from PTSD. They have important public health implications in planning responses to natural disasters and for future revisions of diagnostic classifications. © The Author(s) 2015.
Background: The nosological validity of post-traumatic stress disorder (PTSD) remains controversial in non-Western communities. After natural disasters, epidemiological studies often overlook these conceptual debates and assess post-traumatic stress symptoms (PTSS) by short screening instruments. Such PTSS estimates are reported as inflated prevalence rates of PTSD in post-disaster settings. Aims: To discuss the prevalence and determinants of PTSS within the context of pertinent epidemiological and nosological debates. Methods: We assessed PTSS and grief symptoms of 643 survivors from five Indian villages struck by the Asian tsunami using the Impact of Events Scale - Revised and Complicated Grief Assessment Scale. We adopted a case control design and employed complex sample multiple logistic regression statistics to study the determinants of PTSS. Results: The prevalence of PTSS was 15.1% (95% CI 12.3%-17.9%). PTSS was significantly associated with traumatic grief, female gender, physical injury, death of children and financial losses, but not with functional disability (p = .91). Conclusions: Although PTSS were common in this population, elevating them to a psychiatric construct of PTSD is questionable, when functional impairment and avoidance behaviours were absent. Grief reactions, socio-economic burden, and poor support systems contribute towards PTSS. We highlight the important issues regarding the nosological validity and epidemiology of PTSD in non-Western communities.
Empirical evidence has linked social contacts with mental stability. The aim is to assess how social contacts are associated with depression among the general population. We analysed the data of 5,681 adults aged 40 or older, who completed a depression screening as a part of the National Health and Nutrition Examination Survey, 2005-2008. Depression was ascertained using the Patient Health Questionnaire (PHQ), a nine-item screening instrument asking about the frequency of depression symptoms over the past two weeks. A PHQ score of 10 or higher was defined as depression. The prevalence of depression was 5.54% (SE = 0.64) and 8.49% (SE = 0.71), respectively, among men and women. The association between social contacts and depression were more salient among men than women. The odds ratios (ORs) of depression were 2.43 (95% CI = 1.44-4.10), 2.42 (95% CI = 1.37-4.28), 1.00 (reference) and 1.94 (95% CI = 0.80-4.71), respectively, among men who never attended church, attended occasionally, weekly and more than weekly. The corresponding ORs were 1.79 (95% CI = 1.10-2.91), 1.72 (95% CI = 1.06-2.80), 1.00(reference) and 0.98 (95% CI = 0.52-1.84) for women. Compared with the respondents who had 10 or more friends, the ORs of depression were 4.01 (95% CI = 1.89-8.50) and 1.86 (95% CI = 0.92-3.79), respectively, for men and women who had no close friends. The current study concluded that traditional social contacts remain strongly associated with depression in the digital era. Digital social networking is one of the biggest growing industries, creating a new platform to make social contacts. There is an urgent need to explore how to maximize the potential of digital social networking to strengthen social bonds while minimizing its negative effects.
Differences in delusion content have been studied across time periods and in various international samples, with variations reflecting sociocultural influences. A similar analysis of delusion content in an American sample has yet to be reported. : The current study seeks to contribute to this growing database by reporting delusion content from a sample in the US across a 100-year period. Archival medical records of 102 patients hospitalized for psychosis across the 20th century were examined for types of delusion content. Random samples were selected from each decade. All patients were hospitalized at the same state psychiatric facility in the US. Persecutory was the most common delusion category, followed by religious, somatic and grandiose. Greater frequency of persecutory delusions occurred after 1950. Delusion content also reflected sociocultural factors during the associated time period. As in most samples internationally, persecutory was the most common delusion type. Delusion content paralleled sociocultural changes, as has been reported in non-American samples.
Sensitivity and specifi city for different GHQ-28 threshold scores 
ROC for the Setswana GHQ-28 
To develop a Setswana version of the 28-item General Health Questionnaire (GHQ-28) for use in Botswana. A sample of 126 subjects attending primary healthcare clinics completed the GHQ-28, which contains four subscales of seven questions each for the following domains: somatic concerns, anxiety, social function and depression. All subjects were also interviewed with the Clinical Interview Schedule (CIS). Psychiatric casesness was ascertained by CIS scores greater than 20 and an overall severity of symptoms rating (OSR) of > or =2 on a 0-4 point scale. A receiver operating characteristic (ROC) analysis was undertaken to assess which GHQ cut-off score gave the best casesness yield as defined by the combined CIS and OSR assessments. Of the 126 subjects enrolled, 122 completed the study, with 18 (14.5%) meeting criteria for caseness. There were no gender differences with respect to GHQ or CIS scores. The ROC analysis revealed that the GHQ threshold of 7/8 gave the best sensitivity (88%) and specificity (67%) results. The internal consistency of the translated GHQ was maintained with Cronbach alpha scores ranging from 0.76 to 0.91 for the subscales. The Setswana GHQ-28 represents a valid instrument of screening for psychological distress in a primary healthcare setting in Botswana.
Described are ten residential facilities, which represent examples of different residential arrangements available for mentally-ill people in a north London region. Administrative issues, daily routine, physical layout, and other aspects regarding residents and staff are addressed. The environmental features of the facilities were rated by using structured assessments. The facilities, though run by various agencies and providing different levels of care, demonstrate a common set of principles and practices, which formulates a framework for successful care Generally, there has been no indication of any shortcomings in providing a reliable and good standard of care.
Two shorter versions of the General Health Questionnaire (GHQ) viz. GHQ-36 physical illness items removed (GHQ-36-P) and GHQ-12 were validated in the psychiatric OPD of a teaching hospital in Calcutta among known patients and controls. It was found that a higher cut-off point than that originally recommended yielded satisfactory validation indices for both the versions.
Distorted ethnic identity is a difficult concept to define, but relates to individuals from one ethnic group thinking that they want to belong to another ethnic group or that they do so already, but have been "misattributed" to the wrong category. The aim of the present study is to study descriptions of these behaviours. Patients admitted to three hospitals in London were screened by the respective teams looking after them and case notes studied. No direct interviews were carried out. A total of 43 cases were identified. A large proportion were African-Caribbean males who fulfilled the criteria for DSM-IV diagnosis of paranoid schizophrenia. Female patients were more likely to use extreme measures to alter their appearance. Majority white culture may influence vulnerable patients who have psychoses to incorporate a range of ideas of distorted ethnic identity in their psychopathology.
Aims: To examine if divorce is associated with an increased risk of psychiatric disorder. Methods: A register-based cohort study of all married or divorced individuals aged 45-54 in Sweden in 2006. After exclusion of 129,669 individuals with a history of psychiatric care in 1987-2005, we followed 703,960 persons for psychiatric disorder during 2007, measured as psychiatric inpatient care, outpatient care and use of psychotropic medication. Marital trajectories were taken into consideration. Data were analysed using Poisson regression. Results: Divorced women and men had a higher risk for psychiatric inpatient care compared to married (ORwomen = 3.2, 95%CI = 1.6-6.3, ORmen = 3.3, 95%CI = 2.0-5.4). The longer the marriage, the lower the risk for psychiatric disorders. Lower educational level increased the risk for psychiatric inpatient care. Conclusions: In conclusion, our study supports both the selection hypothesis, linking healthy individuals to long and stable marriages, and the social causation hypothesis, linking the stress of recent divorce to increased psychiatric disorder for both women and men.
Data on the prevalence of social disablement in long-stay psychiatric patients, and the assessment of the psychometric properties of the instruments that evaluate social behaviour in this population are scarce in Brazil. Therefore, this cross-sectional study aimed to estimate the prevalence rates of social disablement in a population of long-stay psychiatric patients from the Rio de Janeiro metropolitan area, and assessed the psychometric properties of the Social Behaviour Schedule (SBS). Data were collected from a population of 881 psychiatric patients housed in the Municipal Mental Health Institute using the 21-item SBS. Most of the patients were women (59%), the mean age was 65.8 years (SD = 11) and the mean length of stay was 37.3 years (SD = 11.5). Of the population, 50.6% were scored as having poor self-care, 46% with little spontaneous communication, 41.1% with poor attention span, and 37.1% with underactivity. Comparing our data with international studies that used the same instrument, we found that our population was more disabled than the others, especially on the social withdrawal factor. Regarding psychometric properties, the inter-rater kappa was 0.709, the inter-informant kappa was 0.500, and the Cronbach's alpha coefficient was 0.766. The groups of patients in the six settings of the institute presented significant statistical differences in the total score (F = 11.447, p < 0.001). This study demonstrates the high rates of social disablement in this population. The precarious conditions of the institution where the patients have been living for decades and unmet individual care may have exacerbated their social disablement. Furthermore, the SBS-BR had satisfactory psychometric properties, particularly reliability, showing it to be an adequate instrument for measuring social disablement in Brazil.
Top-cited authors
Antonio Ventriglio
  • Università degli studi di Foggia
Julio Torales
  • Universidad Nacional de Asunción
João Mauricio Castaldelli-Maia
  • University of São Paulo
Marcelo O'Higgins
  • Universidad Nacional de Asunción
Stefan Priebe
  • Queen Mary, University of London