Objectives: To determine whether assessments of patients admitted to a general hospital following deliberate self-harm (DSH) were in line with the Royal College of Psychiatrists guidelines. To examine the profile of cases and presentations and to make recommendations for improvements to the service.

Method: Clinical and demographic data recorded on 70 admissions after DSH during 1997-98 were analysed retrospectively. A checklist was also developed, using factors shown by previous research to be associated with future risk of suicide, to determine the quality of assessments.

Results: The majority (70%) of assessments took place within 24 hours of admission thereby meeting College recommendations. Medical personnel performed all adult assessments. Circumstances of the overdose, recent stresses, psychiatric diagnosis, immediate risk and follow-up arrangements were documented in the majority of cases. Family psychiatric history, past suicidal behaviour, alcohol and drug abuse history, and previous violence, were frequently not documented. A copy of a discharge summary to the GP was found in 41% of charts. Overdoses accounted for 93% of cases of DSH. The most frequently recorded problem (37.5%) was adjustment disorder.

Conclusions: Despite evidence showing that non-psychiatric medical staff are competent in assessing DSH and guidelines encouraging multidisciplinary involvement, DSH assessments remain the preserve of the medical psychiatric team. Closer attention should be paid to all the risk factors associated with suicide by assessors; a checklist could prove helpful. There is room for improved communication between psychiatric services and GPs following DSH. The setting up of a self-harm service planning group could improve the co-ordination and efficiency of delivery of general hospital services to this patient group.

Objectives: To determine the frequency of reported suicidal thoughts and acts in (a) a school-based sample of Irish adolescents, (b) adolescents attending a community child and family mental health service.

Method: The study population consisted of: (a) 195 adolescents aged 13-15 years attending ten secondary schools throughout Ireland. The schools were selected to represent a wide social and cultural spread: and (b) 66 adolescents aged 13-15 years attending a community child mental health service. The measures used were the Child Behaviour Checklist completed by the parents of the adolescents and the Youth Self Report completed by the adolescents.

Results: Within the school sample, the parents of 3% of adolescents reported that their child had talked of harming him/herself, but none reported acts of self-harm. Fifteen percent of the adolescents themselves reported that they had thoughts of harming or killing themselves, and 8% reported that they had tried to harm or kill themselves.

Within the mental health clinic attenders sample, the parents of 33% of the adolescents reported that their child had talked of harming him/herself, and the parents of 27% reported that their child had tried to harm or kill themselves. Twenty-one percent of the adolescents themselves reported that they had thoughts of harming or killing themselves, and 21% percent reported that they had tried to do so. In both groups, adolescents with higher total problem, internalising and externalising scores on the questionnaires, indicating greater disturbance, were more likely to report thoughts and acts of self harm.

Conclusions: Thoughts of suicide and acts of self harm are common in Irish adolescents and are not limited to those attending mental health services. Parents are frequently unaware of these thoughts. Further studies involving interviews with adolescents at risk are indicated to determine the significance of these thoughts and how adolescents deal with them.

Objectives: To estimate the prevalence of postnatal depression in a community sample of women in a disadvantaged urban area in West Dublin, and to examine the factors which may be associated with it.

Method: All women who had a live birth in the area over a one year period were identified (944) and the self-rated Edinburgh Postnatal Depression Scale (EPDS) was distributed to those who could be contacted by the public health nurses. Those scoring in the depressed range (> 12) were compared to non-depressed for age, marital status, employment, parity, presence of a confidant, mode of delivery, previous miscarriage and previous psychiatric history.

Results: Contact was made with 596 women and 377 responded. Responders were older and more likely to be first time mothers, but there was no significant difference between responders and eligible population for marital status. One hundred and eight women (28.6%) scored in the depressed range. Ten sociodemographic and clinical variables were entered into a logistic regression. Scores over the threshold (> 12), suggesting clinical depression, were significantly associated with four variables, lower age, absence of a confidant, previous miscarriage and previous treatment for depression by a GP.

Conclusions: A high prevalence of postnatal depression of 28.6% was reported, which may be associated with overall high levels of social disadvantage in this sample. There were implications for the targeting of resources into such areas. The associated factors are discussed.

Objectives: To determine the prevalence of psychiatric disorders in adults with learning disabilities, and the relationship with severity of learning disabilities.

Method: The study is population-based. Detailed psychiatric assessments on 207 adults with learning disabilities living in Leicestershire, UK. were conducted by a learning disabilities psychiatrist, using the Present Psychiatric State - Learning Disabilities; and Disability Assessment Schedule. Diagnostic criteria are clearly defined. Developmental assessments were undertaken using the Vineland Scale (survey form).

Results: Psychiatric disorders were found in 49.2%, and rates for most individual disorders were higher than those found in the general population. Comparison with the two previous population-based studies shows the ascertained rates were broadly similar to those reported by Corbett but higher than those reported by Lund. Adults with more severe learning disabilities had higher rates of additional psychiatric disorders.

Conclusions: The results may be explained by a combination of the genetic, physical, psychological and social factors associated with learning disabilities also being aetiological to psychiatric disorders. The high prevalence rates of psychiatric disorders demonstrate the importance of health service provision for adults with learning disabilities.

Objectives: To assess the current attitudes of Irish psychiatric trainees to their training and to determine whether problems identified five years ago have improved.

Method: A postal questionnaire was circulated to all identified psychiatric trainees in the eastern region of Ireland over a six-month period in 2000.

Results: 153 (62%) trainees responded to the study, and 81% described their training as ‘adequate’ or better. Significant demographic changes over the last five years are recorded. Satisfactory induction, regular supervision and access to tutors are all associated with higher overall satisfaction with training. Sixty-seven per cent report receiving an induction course, but just 40% describe this as satisfactory, and only 49% of trainees receive regular supervision. Specific difficulties in training are reported less frequently than in 1995, but 35% of non-EU doctors report racial discrimination in training and only 59% of trainees received a practical demonstration prior to administering electroconvulsive therapy (ECT).

Conclusions: Trainees continue to express high levels of satisfaction with their training. Improvements have been made in a number of key areas, although difficulties remain. For example, regular supervision, which was associated with a positive outlook on training, are unavailable to a majority of trainees.

Objectives: To examine the mental health status of homeless children and their families living in a supported temporary housing project.

Method: The assessment measures used: (i) the 28-item General Health Questionnaire (GHQ); (ii) the Child Behaviour Checklist (CBCL); and (iii) the Parenting Stress Index (PSI). The population studied consisted of 14 families and 31 children. Children aged two to 16 years were eligible for the study. Most of the families (12/14) assessed were single parent (mother only) family units.

Results: The General Health Questionnaire was completed by the 14 mothers and two fathers. Of the mothers 28% (4/14) indicated the presence of psychiatric ‘caseness’. The Child Behaviour Checklist (CBCL) was completed on 31 children by the mothers. More than a third of the children (12/31) had a Total Problem Score above the ‘clinical’ threshold, indicating the presence of mental health problems of sufficient severity to merit referral for treatment. Of the children 45% (14/31) manifested externalising problems in the ‘deviant’ range, while 29% of the children (9/31) manifested internalising problems in the ‘clinical’ range. In all, when the CBCL scores were examined within each family, 78% (11/14) had at least one child with a CBCL dimension of clinical significance. The Parenting Stress Index was completed by each mother. Of the mothers 70% (10/14) obtained scores in the critical range. They reported feeling incompetent in their parenting role, being dominated by their children's needs and feeling social isolated from their relatives and peers. Their scores also indicated poor self-esteem and significant depressive symptoms. Of note the peak score was the lack of emotional and active support from the other parent.

Conclusion: This study revealed a high level of stress and clinical morbidity in this group of homeless mothers and their children and the need to provide appropriate mental health supports and services for them.

Objectives: To evaluate factors that predict HIV testing using the model of health care utilisation as its conceptual framework and to analyse some of the factors that encourage or inhibit seeking an HIV test in this population.

Method: A cross sectional questionnaire study in two Genito-Urinary Medicine (GUM) clinics in central Scotland. A final sample of 195 represented a 91% response rate. Participants were categorised by their HIV testing status (already tested, planning to be tested, no intention to seek testing).

Results: The ‘already tested’ and ‘planning to be tested’ groups were combined as there were no significant differences on reported risk behaviours. Analysis therefore compared two groups those ‘testing’ (n = 66) and ‘not testing’ (n = 129). 67% of those not tested for HIV reported at least one HIV risk factor. Perceived risk was the strongest predictor of HIV testing using our model. Perception of risk and actual risk were not correlated. Those not seeking testing endorsed less benefits of testing and more denial of the need to be tested. Same day testing and testing without an appointment were endorsed as factors to promote testing.

Conclusion: To encourage people who have high risk factors to access HIV testing, programmes should: (1) highlight the benefits of testing which would be lost if people do not test, eg. effective drug treatments (2) increase the range of HIV testing services available (eg. same day testing). Furthermore, studies to determine the main predictors of perceived risk are needed if we are to increase testing in relevant populations.

Objectives: To establish the prevalence of psychological problems in early school leavers, who attend training schemes.

Method: The Youth self report inventory was completed by teenagers as part of a group setting. Percentages of those scoring above clinical threshold were calculated and gender differences examined.

Results: 78 teenagers participated in the study, 40 males and 38 females. 24% were classified as being in the clinical range of total problem score. Girls reported more total, internalising and externalising problems than boys. 13% of girls frequently thought of suicide and 7% had frequent thoughts of self harm, this contrasts with none of the boys admitting suicidal ideation and 2.5% reporting thoughts of self harm.

Conclusions: 24% of this group experienced problems which placed them within the clinical range. Girls experienced greater problems than boys and appear to be at greater risk of self harm. This group appear to be representative of those who attend training programmes, however it is not possible to determine whether they are representative of all early school leavers. This highlights the vulnerability of older adolescents, and in particular those who leave school early. More detailed examination of issues facing this group are needed and should be a priority along with greater service provision from the educational and health sectors.

Objectives: This exploratory study was designed to explore the social correlates of suicides rates of Irish counties.

Method: Suicide rates were calculated for Irish counties and subdivisions for the period 1988-1994 and correlated with social data for these regions obtained from the 1991 Census.

Results: The suicide rates showed a low level of reliability for the periods 1978-1984 and 1988-1994, and the social correlates of suicide rates changed between the two periods. Whereas age structure was associated with suicide rates in 1978-1984, urbanisation was associated with suicide rates in 1988-1994.

Conclusions: It is important to check the reliability of results of ecological studies of Irish suicide rates. Furthermore, the impact on suicide rates of the changing role of women in Ireland needs to be explored in time-series studies of the Irish suicide rate.

Objectives: Up to one third of patients presenting to neurology outpatients clinics have medically unexplained symptoms, but the aetiology of such symptoms is not well understood. In the current study we sought to investigate the role of anxiety, depression, cognitive factors and early experience in the development of medically unexplained symptoms.

Method: Fifty-seven new patients presenting to a neurology outpatients clinic were studied. Demographic details were recorded and a Hospital Anxiety and Depression Scale, an Illness Perception Questionnaire, and a Childhood Development Questionnaire were administered. An assessment was made by trained medical investigators as to whether the patients symptoms were medically unexplained or accounted for by organic pathology.

Results: We found that 17 out of 56 patients (30%) had medically unexplained symptoms. Such patients complained of a greater number of symptoms, were more anxious, were more likely to have a past history of depression, and were more likely to attribute their illness to stress than patients with a presumed organic basis for their disease. They were also more likely to have been in foster care as children. High levels of depression and anxiety were strongly associated with the number of physical symptoms and the perceived negative consequences of the illness.

Conclusions: The recognition and treatment of anxiety and depressive disorders may contribute to the management of patients with medically unexplained symptoms. Open discussion of beliefs regarding aetiology are also likely to be of benefit regardless of the presence or absence of organic pathology.

Objective: This retrospective study describes the follow-up of a birth cohort of alcohol dependent patients as they enter old age. The aim is to define the global outcome of survivors by combining a measure of current drinking behaviour with ratings for depression and dementia.

Methods: A series of 100 referrals to a regional unit for alcohol misuse in Bristol, England, were followed up at a mean of 13 years after first referral for treatment. Survivors were traced when they were aged between 67 and 77 years. At follow-up interview, subjects were screened for current alcohol problems, depression and dementia.

Results: The mortality rate in the cohort was raised significantly. Almost one third of survivors had depressive symptoms at follow-up and rates of global dementia were higher than expected in an aged-matched sample of the general population. However, the majority of survivors were classified as having an intermediate global outcome with less than 10% having a poor outcome.

Conclusions: The high rates of mortality and psychiatric morbidity observed in this cohort illustrate the importance of detecting alcohol problems in the elderly. Further prospective studies are necessary to validate these findings in a community sample of older people.

Objectives: To establish if the relocation of the acute adult psychiatric services of the Dartford area from a district general hospital (DGH) to a new unit in the grounds of Stone House Hospital, the large institution where they were formerly based, increased the stigma of receiving inpatient treatment.

Method: A brief survey of service users asked if this move near to, but not within, the old institution potentially increased the stigma of receiving inpatient treatment.

Results: Inpatients initially welcomed the move but expressed greater concern about stigma and on balance were substantially less enthused than outpatients about the move to a separate psychiatric hospital.

Conclusions: Moving an inpatient unit back to the vicinity of a large institution from a DGH setting is rare, however concerns about consequent stigma, particularly felt by inpatients merits early consideration at planning stages.

Objectives: This report describes an epidemic outbreak of mass hysteria in secondary school girls in a North Indian village following tetanus toxoid injection. It also attempts to identify the aetiological roles of the immunisation programme and the adverse media reports.

Method: The socio-demographic, clinical, and school environment variables of the 58 symptomatic students were evaluated. Interviews with health staff, parents and school teachers were conducted.

Results: Fifty-eight out of 200 immunised students reported giddiness, headache, vomiting and restlessness. This initiated an exaggerated socio-political response. The majority of the students responded to counselling and reassurance.

Conclusions: This outbreak fulfils the criteria of epidemic or communicable hysteria with mass presentations of unusual behaviour and spread of somatic symptoms without any organic basis. The episode exposed flaws in the immunisation programme and suggests the need to formulate clear guidelines for vaccination, including pre-vaccination counselling.

Objectives: To measure the level of psychological distress caused to supporters of a football team by relegation from the English Premier League. The relationship between age, sex and psychological distress are examined.

Method: Opportunity sample cross-sectional survey. Participants were approached through networks of fans and through e-mail networks. Participants were supporters (n = 65) of two relegated premiership football teams. Participants completed the Impact of Event Scale.

Results: Mean total Impact of Event Scale scores indicated a clinically significant degree of psychological distress for the majority of respondents. Age or sex of the participants did not predict Impact of Event Scale scores.

Conclusions: The results are discussed in terms of the magnitude of Impact of Event Scale scores in relation to other stressors. It is concluded that the impact of such sporting events is psychologically significant. The psychological literature has considered traumatic stress responses to a number of stressors such as threats to life, threats to psychological well-being, threats to physical/ psychological well-being of others, witnessing traumatic events and involvement in a human or natural disaster.

Objectives: Prompted by the current debate in Ireland regarding involuntary detention, we undertook a survey of psychiatric trainees to examine their level of knowledge of the legislation governing such admissions.

Method: Eighty psychiatric trainees working in centres affiliated to a particular training scheme were invited to complete a purpose-designed instrument.

Results: Response rate was 52/80. Trainees were well informed concerning the procedures necessary to initiate detention. Their knowledge of the legal indications for involuntary detention and restrictions on its duration was patchy.

Conclusions: We suggest that training in the area of mental health legislation needs to be increased and to focus on satisfying legal requirements in real-life scenarios.