To explore the modern psychometric properties of the Patient Health Questionnaire (PHQ-9), we used the Rasch analysis in a sample of 767 primary care patients with depression.

The analysis highlighted dependency issues between items 1 and 2 (‘Little interest or pleasure in doing things’ and ‘Feeling down, depressed, or hopeless’), and items 3 and 4 (‘Trouble falling or staying asleep, or sleeping too much’ and ‘Feeling tired or having little energy’). Items 1 and 2 displayed an over-discrimination, suggesting their potential redundancy within the complete item set.

In its current format the PHQ-9 displays some problems with regard to its measurement structure among a sample of primary care patients. These problems can be addressed by removing potentially redundant items to deliver a stable screening tool. The results also lend support for the PHQ-2 to be used as a screening tool in a primary care setting.

To determine the annual rates of assaults and threats to psychiatrists, describing the situations and staff involved, using a retrospective postal questionnaire of 139 doctors working in South Wales.

Over the year, 17% of respondents reported one or more assaults (of these, 42% were assaulted more than once) and 32% reported one or more threats. The most junior senior house officers (SHOs) were significantly more likely to have experienced an incident, regardless of the individual's gender or attendance at a course in managing aggression. Most assaults (61%) were committed by patients from general adult psychiatry, and half occurred during urgent assessments. Eighteen (58%) of the assailants were known to have previously assaulted amember of staff, and this information was known to the doctor before the assault for 16 (88%). Five (16%) of the assailants had been drinking alcohol prior to the assault. Twenty-nine (78%) of the assaults were documented in the case notes and 6 (19%) were reported to management.

Some staff (in particular, inexperienced SHOs) are at greater risk, and efforts should be made to identify and help these individuals and/or grades to deal with aggression. All psychiatric staff should be trained to manage violence. Staff should be encouraged to report incidents to management, so that employers can identify and address problem areas.

To assess the preferences of people attending a substance misuse facility towards the treatment options available for opiate dependency. Interviews were conducted using a card sorting technique.

The majority (60%) of the 101 participants believed that detoxification was superior to maintenance in preventing illicit heroin use. The preferred treatment options were oral methadone, buprenorphine, drug-free rehabilitation, in-patient detoxification and prescription of injectable drugs.

Both pharmacological and psychosocial options, including in-patient detoxification and rehabilitation, are among the treatments preferred by clients of substance misuse services. There is also a significant demand for both injectable drugs and dihydrocodeine.

To examine the quality of information concerning depression available on the internet, identify factors associated with ‘good’ quality, and develop a simple-to-use instrument for assessing websites on depression. The Depression-Website Content Checklist was developed and compared with a previously validated, yet too complex, scale. Websites were assessed using both instruments.

Good quality information is more likely to be found on websites provided by governmental, professional and charitable organisations. The differences we observed in the median scores for these websites using the Depression-Website Content Checklist are significant at the 0.05 level (Ctot; Mann–Whitney, U=24.00; P=0.013). The Depression-Website Content Checklist is a valid and reliable user-friendly tool.

Patients can be directed towards better quality information by diverting them to public and non-sponsored websites. Clinicians can use the Depression-Website Content Checklist to determine website quality.

The Individual Recovery Outcomes Counter (I.ROC) is to date the only recovery outcomes instrument developed in Scotland. This paper describes the steps taken to initially assess its validity and reliability, including factorial analysis, internal consistency and a correlation benchmarking analysis.

The I.ROC tool showed high internal consistency. Exploratory factor analysis indicated a two-factor structure comprising intrapersonal recovery (factor 1) and interpersonal recovery (factor 2), explaining between them over 50% of the variance in I.ROC scores. There were no redundant items and all loaded on at least one of the factors. The I.ROC significantly correlated with widely used existing instruments assessing both personal recovery and clinical outcomes.

I.ROC is a valid and reliable measure of recovery in mental health, preferred by service users when compared with well-established instruments. It could be used in clinical settings to map individual recovery, providing feedback for service users and helping to assess service outcomes.

The study aimed to identify the correlates of aggressive behaviour in an adult acute psychiatric ward. Over a period of 9 months, all incidents of verbal and physical aggressive behaviour exhibited by in-patients were routinely assessed using the Overt Aggression Scale.

Of the 535 patients admitted during the study period, 80 (15%) were involved in a total of 124 aggressive incidents. Of these 80, 44 (55%) had a history of previous violence and 54 (68%) had a history of substance misuse. The majority of events occurred early in the hospital stay and in most cases aggression was against staff. There were significant differences between aggressive and non-aggressive patients in terms of gender and ethnicity, with the lowest rate occurring in European females.

These results reinforce clinical impressions, and empirical evidence, and allow risk assessment to be performed with greater confidence. The relevance of ethnicity (or more likely culture) highlights the difficulties of a ‘one size fits all’ approach to risk assessment.

To assess the compliance of contemporary online media output with guidelines for the responsible reporting of suicidal acts. A search engine was used to identify online media reports of suicide from UK sources over the course of 1 month. Each article was assessed against guidelines for the responsible reporting of suicide produced by the Samaritans, a UK mental health charity.

We identified 229 articles, of which 199 failed to comply with at least one of the Samaritans' guidelines. Failure to mention support sources, excessive detail about the method used and undue speculation about the trigger for suicide were the most commonly breached guidelines. Significant differences were found between the quality of local and national media sources, with local media sources being broadly more compliant with guidelines.

This study highlights the urgent need for the implementation of responsible reporting guidelines in online media articles as a component of suicide prevention efforts.

To develop a service development plan supporting recovery-based practice through collaborative service user-led methodology, and contribute to the National Institute for Mental Health in England (NIMHE) pilot evaluation of recovery sensitive measures. Staff, residents and service user group representatives collaborated in implementing the Developing Recovery Enhancing Environments Measure (DREEM) in a residential rehabilitation service.

Staff and residents demonstrated a shared vision of recovery. Many areas were being addressed to a high level but others showed areas of deficiency, and illustrated discrepant views between staff and residents, which provided a focus for the development of a clinical service action plan.

As an experimental measure DREEM provides a user-led structure, which enables services to measure their commitment to, and effectiveness in, providing recovery-based care. It focuses service development and enhances collaborative work with service users, thus mirroring the principles of recovery it measures. It merits further evaluation and consolidation.

We examined the impact of a crisis resolution and home treatment teams (CRHTT) on hospital admission rates, bed days and treatment satisfaction among older people with mental illness and their carers. We compared these factors in the 6 months before the service started and 6 months after its introduction.

The CRHTT significantly reduced admissions (P<0.001), but there was no significant difference in the length of hospital stay as compared before and after the introduction of this service. There was a trend towards carers, but not patients, being more satisfied with treatment after the introduction of the CRHTT.

The CRHTT reduced hospital admissions for older people by 31% and carers preferred the service. Further research on crisis teams in older people with mental illness is needed using randomised controlled methodology.

Information concerning team staffing, keyworker case-loads, and keyworker diagnostic case-mix was collected from six community mental health teams caring for 1651 patients to establish the clinical burden across teams and professions.

Team case-loads varied from 427 to 121, an average of 275 patients. Over half the patients were female, and psychotic disorders constituted 44% of the sample. The most common diagnoses were schizophrenia (28.6%) and depression (23.6%). Keyworker case-loads varied across both teams and professions, averaging 30 patients per full-time equivalent. Psychiatrists' case-loads were the largest. Diagnostic case-mix varied with profession. Community psychiatric nurses had the largest proportion of patients with psychosis (73.8%).

Multi-disciplinary community mental health teams have a shared view of appropriate work distribution. Consultant psychiatrists may underestimate the resources required by patients with non-psychotic disorders even in inner city areas.

Recent policy guidelines published by the Department of Health highlight the need to develop gender-sensitive psychiatric services. However, very little is currently known about the specific characteristics and needs of female patients entering acute psychiatric wards, particularly psychiatric intensive care units. This article aims to review the current literature on what is known about this group of patients. PubMed, Embase and PsycINFO were systematically searched using a number of key terms.

A total of 27 articles were obtained. The findings were divided into four categories: admission characteristics, treatment needs, risk management and outcomes after discharge. Gender differences were found in diagnosis and presentation.

The differences observed in the reviewed studies suggest that women may have different assessment and treatment needs, and ultimately, different philosophies of care. A dearth of studies in this area indicates that if services are to develop in line with government policies, more research is needed.

To describe Drayton Park, the first women-only residential mental health crisis facility in the UK and to investigate whether it is succeeding in its remit of providing a viable alternative to hospital admission. We randomly selected case files from 100 women admitted to Drayton Park since its opening and examined variables including demographic details, the reasons for referral, diagnosis and the source of referral.

Our findings show that the service is able to respond quickly to referrals and appears to be functioning safely. The women admitted have a relatively short length of stay, half suffer from depressive episodes and one-third have a relapse of schizophrenia or bipolar disorder.

This project appears to be succeeding in providing a safe alternative to hospital admission for women with severe and enduring mental health problems.