The first issue of 1997 brings two changes.

First, we are pleased to announce a further increase in size. Pressure of excellent quality manuscript submissions continues to grow, and this year sees a modest increase in size with each issue around 256 pages. With an earlier increase from four to six issues per year, this represents 40% growth in the total size of each volume in the last 3 years. We recognize the importance of keeping publication delays short, and also the importance of maintaining high quality. The new increase in pages will allow only a modest increase in our current acceptance rate, without loss of these ideals, and the annual volume size is now substantial.

Secondly, we adopt structured abstracts with this issue. This format has become widespread in the last few years. It is better suited to the electronic databases, which are essential for the modern scientist and scholar, and to the various forms of electronic publishing, which are supplementing, but not supplanting, the printed page. We are proud of the literary style of our authors and we hope that the structured format can still accommodate it.

Conclusions about medical interventions or the causes of disease are based upon reviews of the scientific literature. Single studies usually have limited statistical power or may be difficult to interpret or generalize and so the findings from a single study can rarely justify a change in clinical practice or in an aetiological theory. Even when planning larger studies or mega-trials (Yusuf et al. 1984), a thorough review of existing literature is needed and the results of the study need to be placed in that context, though single studies can exert an important and powerful influence.

Background. Gender differences in clinically relevant depression are well established, appear to be greatest in childbearing years and may be the result of gender differences in social roles.

Methods. A community sample of 100 couples who had recently experienced at least one threatening life event that was potentially depressogenic for both of them was studied using a semi-structured interviewer-rated interview. Onset of depression was assessed using the Present State Examination, and, rather than assuming that a gender difference in roles existed uniformly across the couples, they were characterized according to their actual role activity and commitment.

Results. Women were found to have a greater risk of a depressive episode following the life event than men, and this difference was of a similar magnitude to other reports of gender differences in depression. Consistent with a role hypothesis, this greater risk was entirely restricted to episodes that followed events involving children, housing or reproductive problems. In addition, it was found that women's greater risk of a depressive episode following such events was only present among those couples where there were clear gender differences in associated roles. There was some suggestion that differences in roles on the one hand resulted in women being more likely to hold themselves responsible for such events and, on the other hand, enabled men to distance themselves from them.

Conclusions. These results support the hypothesis that gender differences in rates of depression in the general population are, to a considerable extent, a consequence of role differences.

The present study set out to examine the relationship between marital status, poverty and depression in a sample of inner-city women. Single and married mothers were followed up over a 2-year period during which time rates of psychosocial risk factors, onset of depression and experience of chronic episodes were measured. Risk of onset was double among single mothers. Single mothers were twice as likely as their married counterparts to be in financial hardship, despite being twice as likely to be in full-time employment. Both of these factors were independently associated with onset in single mothers. The link between them and onset was via their association with humiliating or entrapping severe life events. Single parents were at a much raised risk of experiencing these events. Onset was also more likely to follow such an event when women had poor self-esteem and lack of support, both of which were more common among single mothers. These risk factors were more frequently found among those in financial hardship. Financial hardship was also related to risk of having a chronic episode (lasting at least a year), of which single parents were also at greater risk. The majority of chronic episodes among single mothers had their origins in prior marital difficulties or widowhood and rates of chronicity reduced with length of time spent in single parenthood. Results are discussed in terms of an aetiological model of onset in which financial hardship probably influences outcome at a wide variety of points.

Background. Studies on the direct and buffering effects of social support have not examined psychiatric sickness absence and few studies have considered support both at home and at work. This study addresses prospectively the effects of chronic stressors and social supports, at home and at work, on psychiatric sickness absence rates.

Methods. Sociodemographic factors, health and social support were measured at baseline, and short and long spells of sickness absence were measured prospectively over a 5-year period. The participants were a subsample of 4202 male and female civil servants, aged 35–55 years at baseline, from an occupational cohort, the Whitehall II Study, who completed detailed social support questions.

Results. Support from colleagues and supervisors at work is related to lower risk of short spells of psychiatric sickness absence, particularly for those also receiving high levels of negative aspects of close relationships from their closest person outside work. Negative aspects of close relationships from the closest person increase the risk of taking long spells of psychiatric sickness absence in men. High levels of material problems increase the risk of short spells of sickness absence.

Conclusions. Negative aspects of close relationships may have an aetiological role in non-psychotic psychiatric disorder. Social support at work appears to protect against short spells of psychiatric sickness absence. This potentially implies that levels of short spells of absence might be reduced by increasing support at work. Conversely, emotional support at home may influence absence-related behaviour and encourage a person to take absence at a time of illness.

As part of a longitudinal study of bereavement phenomena in three groups, bereaved spouses, bereaved adult children and bereaved parents, scale development was carried out using a pool of bereavement phenomenology questions administered prospectively. The items were derived from the literature, in particular studies dealing with the measurement of grief/bereavement, as well as from clinical experience. Factor analysis of theoretically grouped items produced seven subscales, three of which tapped frequently experienced phenomena in the bereaved. These three subscales formed the basis of a single measure, labelled the Core Bereavement Items (CBI), which demonstrated high reliability and sound face and discriminant validity. Preliminary analysis suggested that the CBI will prove to be a reliable and valid instrument with respect to the measure of core bereavement phenomena in commonly bereaved groups in Western society.

One hundred and seventy-two women randomly selected from a Zimbabwean township were interviewed with a Shona screen for mental disorders and a semi-structured interview to assess symptoms suggestive of emotional distress, followed by the Present State Examination. Using criteria slightly stricter than threshold level 5 of the PSE-CATEGO-ID system, 30·8% of women had a depressive or anxiety disorder during the previous year. Nearly all disorders met Bedford College criteria for depression; 65% of these also had anxiety features. Only 0·6% of women had a ‘pure’ anxiety disorder not preceded by or associated with depression in the study year. Compared with London, the higher annual prevalence of disorders in Harare could mostly be accounted for by an excess of onset cases in the study year, 70% of which made a full or partial recovery within 12 months. The women's own words for these episodes included ‘thinking too much’, ‘deep sadness’ and a variety of terms describing heart discomfort, interpretation showing many of the latter to be expressions for grief, fear, or the possession of an insoluble problem, and 73% explained their symptoms as caused by a specific social stressor.

In a prospective cohort study of consecutive primary care attenders in south London, the estimated prevalence of non-psychotic psychiatric disorder was 45·6%, using the Revised Clinical Interview Schedule (CIS-R). The estimated 12-month incidence rate was 15·7%. Extremely high stability was found in CIS-R scores over 12 months (r = 0·65) and 68·8% of cases at baseline were also cases 12 months later. A clear difference emerged in the types of risk factor which were associated with the incidence and maintenance of disorder in the study population: while socio-economic variables, especially low household income and not having a partner were associated with a worse outcome among prevalent cases at baseline, such variables were only weakly associated with the incidence of psychiatric disorder after adjusting for potential confounders. The latter, notably family psychiatric history and the severity of psychiatric symptoms at baseline were independently associated with the incidence of psychiatric disorder after adjusting for other risk factors, including measures of previous psychiatric disorder.

Patients with chronic fatigue syndrome (CFS) complain that they have difficulties with concentration and memory but studies to date have not found consistent objective evidence of performance deficits. Two groups of CFS patients, depressed and non-depressed, and healthy controls, were asked about concentration problems in general and specifically when reading. CFS subjects were more likely than controls to report that they had concentration problems when reading, that they needed to re-read text and that they failed to take in what they were reading. Subjects then performed a task in which their reading behaviour and text recall was measured. While all CFS subjects complained of general cognitive failures and of difficulties with reading, only depressed CFS subjects recalled significantly less of the text than controls. Severity of complaints about reading problems was not related to amount of text recalled, but was related to severity of depressed mood. However, subjects were able to evaluate accurately their ability to remember the text immediately after reading it and before being tested for recall. Additionally, subjects performed a paired-associate learning task on which no significant differences between the subject groups was found. It is concluded that deficits in cognitive functioning in CFS patients are more likely to be found on naturalistic than on laboratory tasks.

Data from a two-wave longitudinal study of an elderly community sample were used to assess whether cognitive complaints either predict subsequent cognitive decline or reflect past cognitive decline. Cognitive complaints and cognitive functioning were assessed on two occasions three and a half years apart. Cognitive complaints at Wave 1 were found not to predict future cognitive change on the Mini-Mental State Examination, an episodic memory test or a test of mental speed. Similarly, cognitive complaints at Wave 2 were unrelated to past cognitive changes on these tests after statistically controlling for the effects of anxiety and depression. Furthermore, cognitive complaints did not predict either mortality (after controlling for anxiety and depression) or future dementia. These results are evidence against the inclusion of cognitive complaints in diagnostic criteria for proposed disorders such as age-associated memory impairment, mild cognitive disorder and ageing-associated cognitive decline.

This paper attempts to construct a simplified system for the classification of personality disorders, and relates this system to normally distributed human personality characteristics. One hundred and forty-eight subjects with a variety of psychiatric diagnoses were evaluated using the SCID-II structured clinical interview for personality disorders. A four-factor solution of personality disorder symptoms was obtained and we labelled these factors ‘the four As’ : antisocial, asocial, asthenic and anankastic. The factors related to the four temperament dimensions of the Tridimensional Personality Questionnaire (TPQ), but less closely to Eysenck Personality Questionnaire (EPQ) dimensions. The four factors were similar to those identified in a number of studies using a variety of assessment methods and this lends some credibility to our findings. It suggests that a more parsimonious set of trait descriptors could be used to provide simpler, less overlapping categories that retain links with current clinical practice. In addition, these factors can be seen as extremes of normally distributed behaviours obtained using the TPQ questionnaire.

In order to examine factors that influence the time to recovery (TTR) from depressive episodes in women, we examined members of 1030 female–female twin pairs of known zygosity, ascertained from a population-based twin registry. We predicted, in a Cox model, TTR in 235 women with an onset of an episode of major depression (MD) in the last year meeting DSM-III-R criteria. The median and mean TTR for episodes of MD was 42 and 82 days, respectively ; only 2·2% of women had not recovered by 1 year. Four variables predicted TTR: financial difficulties, obsessive–compulsive symptoms, severe life events (SLEs), and genetic risk. Dividing all depressive episodes meeting symptomatic DSM-III-R criteria into early (5–28 days) and late (>28 days) phases, significant predictors of TTR early in the course of illness (income, parental protectiveness and separation, personality, lifetime traumas and SLEs) differed from those that predicted TTR later in the depressive episode (health, social support, obsessive–compulsive symptoms, SLEs and genetic risk). Including cases with chronic MD increased the strength of personality, financial problems and genetic risk as predictors of slow TTR. These exploratory analyses suggest that TTR from MD in women is influenced by multiple environmental, temperamental and genetic factors. Predictors of TTR early and later in the course of MD may differ qualitatively, suggesting different processes in recovery from brief versus prolonged depressions.

Background. We report the outcome of depressive states after 3-4 years in a community sample of the elderly.

Methods. A sample of 1045 persons aged 70+ years in 1990–1 was re-interviewed after 3·6 years.

Results. Mortality (21·7%) and refusal or non-availability (10·4%) were higher in those who initially had had a diagnosis or symptoms of depression. Of those with an ICD-10 depressive episode in 1990–1, 13% retained that diagnosis. Of those who were not depressed initially only 2·5% had become cases. Depression was unrelated to age or apolipoprotein E genotype. The best predictors of the number of depressive symptoms at follow-up was the number at Wave 1, followed by deterioration in health and in activities of daily living, high neuroticism, poor current health, poor social support, low current activity levels and high service use. Depressive symptoms at Wave 1 did not predict subsequent cognitive decline or dementia.

Conclusions. Non-random sample attrition is unavoidable. ICD-10 criteria yield more cases than other systems, while continuous measures of symptoms confer analytical advantages. Risk factors for depressive states in the elderly have been further identified. The prognosis for these states is favourable. At the community level, depressive symptoms do not seem to predict cognitive decline, as they do in referred series.

Background. In 1975, a special commission appointed by the German Parliament submitted its report on the desolate state of psychiatric care in the old Federal Republic of Germany including suggestions for much-needed reforms. Among them was a call for the reduction of existing prejudices against mentally ill people. This study addresses the question as to what attitude is commonly found among the general public towards the mentally ill nowadays, two decades after the first step towards reform in psychiatric care and focuses on social distance.

Methods. Between spring 1990 and the end of 1993, a total of 11 representative surveys were carried out in Germany, eight of them in the former Federal Republic, or the old Länder.

Results. Even today, mentally ill people are met with a great deal of rejection by the German public. Alcohol dependants are rejected most, even more so than those suffering from schizophrenia. Personal experience with mental illness is associated with a lower level of derived social distance, which may be attributed to an increase in positive emotional reactions and reduced feelings of anxiety. There is an association between a person's attitude towards the mentally ill and his/her overall value orientation.

Conclusions. Although, for methodological reasons, we are not able to show a significant change in attitude in the wake of the reform in psychiatric care, our results lend support to one of the basic assumptions of community psychiatry, namely the premise that personal contact with the mentally ill can help to reduce feelings of resentment towards the latter.

Background. In this study, we tested the hypothesis that low smooth pursuit gain in schizophrenia is related to an abnormality in motion perception.

Methods. The subjects were 19 schizophrenics treated with clozapine and 19 controls. In addition to smooth pursuit and motion perception paradigms, sustained attention was also assessed using a continuous performance task (CPT).

Results. In the patient group, there was a statistically significant negative correlation between smooth pursuit gain and motion perception threshold (r =−0·60, P<0·01). This relationship was not secondary to attention deficits as assessed by the CPT.

Conclusions. Our results are consistent with the notion that the smooth pursuit gain deficit is related to a deficit in motion perception rather than in attention. Brain area V5 (also referred to as ‘MT’ in macaque), located in the parieto-occipital region, is known to be critically important both for motion perception and gain. Thus, our results point to an abnormality in this area in schizophrenia.

Background. In post-traumatic stress disorder (PTSD) there is a need for self-rating scales that are sensitive to treatment effects and have been tested in a broad range of trauma survivors. Separate measures of frequency and severity may also provide an advantage.

Methods. Three hundred and fifty-three men and women completed the Davidson Trauma Scale (DTS), a 17-item scale measuring each DSM-IV symptom of PTSD on 5-point frequency and severity scales. These subjects comprised war veterans, survivors of rape or hurricane and a mixed trauma group participating in a clinical trial. Other scales were included as validity checks as follows: Global ratings, SCL-90-R, Eysenck Scale, Impact of Event Scale and Structured Clinical Interview for DSM-III-R.

Results. The scale demonstrated good test–retest reliability (r = 0·86), internal consistency (r = 0·99). One main factor emerged for severity and a smaller one for intrusion. In PTSD diagnosed subjects, and the factor structure more closely resembled the traditional grouping of symptoms. Concurrent validity was obtained against the SCID, with a diagnostic accuracy of 83% at a DTS score of 40. Good convergent and divergent validity was obtained. The DTS showed predictive validity against response to treatment, as well as being sensitive to treatment effects.

Conclusions. The DTS showed good reliability and validity, and offers promised as a scale which is particularly suited to assessing symptom severity, treatment outcome and in screening for the likely diagnosis of PTSD.

The Brief Social Phobia Scale (BSPS) is an observer-rated scale designed to assess the characteristic symptoms of social phobia, using three subscales – fear, avoidance, and physiological arousal – which may be combined into a total score. Each of 18 BSPS items is anchored to a 5-point rating scale. Psychometric evaluation of the BSPS in a sample of 275 social-phobia patients yielded a high level of reliability and validity. Test–retest reliability was excellent, as was internal consistency. The fear and avoidance subscales demonstrated highly significant correlations with remaining item totals; however, the physiological subscale did not. The BSPS also demonstrated significant relationships with other established scales that assess anxiety and disability, and it proved sensitive to treatment effects in a trial of a 5-HT3 antagonist and placebo. Factor analysis yielded six meaningful factors. We conclude that the BSPS provides a reliable, valid, and sensitive measure for the evaluation of social phobia.

Background. A sample of 1089 Australian adults was selected for the longitudinal component of the Quake Impact Study, a 2-year, four-phase investigation of the psychosocial effects of the 1989 Newcastle earthquake. Of these, 845 (78%) completed a survey 6 months post-disaster as well as one or more of the three follow-up surveys.

Methods. The phase 1 survey was used to construct dimensional indices of self-reported exposure to threat the disruption and also to classify subjects by their membership of five ‘at risk’ groups (the injured; the displaced; owners of damaged small businesses; helpers in threat and non-threat situations). Psychological morbidity was assessed at each phase using the 12-item General Health Questionnaire (GHQ-12) and the Impact of Event Scale (IES).

Results. Psychological morbidity declined over time but tended to stabilize at about 12 months post-disaster for general morbidity (GHQ-12) and at about 18 months for trauma-related (IES) morbidity. Initial exposure to threat and/or disruption were significant predictors of psychological morbidity throughout the study and had superior predictive power to membership of the targeted ‘at risk’ groups. The degree of ongoing disruption and other life events since the earthquake were also significant predictors of morbidity. The injured reported the highest levels of distress, but there was a relative absence of morbidity among the helpers.

Conclusions. Future disaster research should carefully assess the threat and disruption experiences of the survivors at the time of the event and monitor ongoing disruptions in the aftermath in order to target interventions more effectively.

Background. This paper examines the contributions of dispositional and non-dispositional factors to post-disaster psychological morbidity. Data reported are from the 845 participants in the longitudinal component of the Quake Impact Study.

Methods. The phase 1 survey was used to construct dimensional indices of threat and disruption exposure. Subsequently, a range of dispositional characteristics were measured, including neuroticism, personal hopefulness and defence style. The main morbidity measures were the General Health Questionnaire (GHQ-12) and Impact of Event Scale (IES).

Results. Dispositional characteristics were the best predictors of psychological morbidity throughout the 2 years post-disaster, contributing substantially more to the variance in morbidity (12–39%) than did initial exposure (5–12%), but the extent of their contribution was greater for general (GHQ-12) than for post-traumatic (IES) morbidity. Among the non-dispositional factors, avoidance coping contributed equally to general and post-traumatic morbidity (pr = 0·24). Life events since the earthquake (pr = 0·18), poor social relationships (pr =−0·25) and ongoing earthquake-related disruptions (pr = 0·22) also contributed to general morbidity, while only the latter contributed significantly to post-traumatic morbidity (pr = 0·15).

Conclusions. Medium-term post-earthquake morbidity appears to be a function of multiple factors whose contributions vary depending on the type of morbidity experienced and include trait vulnerability, the nature and degree of initial exposure, avoidance coping and the nature and severity of subsequent events.

Background. In recent years the 12-item General Health Questionnaire (GHQ-12) has been extensively used as a short screening instrument, producing results that are comparable to longer versions of the GHQ.

Methods. The validity of the GHQ-12 was compared with the GHQ-28 in a World Health Organization study of psychological disorders in general health care. Results are presented for 5438 patients interviewed in 15 centres using the primary care version of the Composite International Diagnostic Instrument, or CIDI-PC.

Results. Results were uniformly good, with the average area under the ROC curve 88, range from 83 to 95. Minor variations in the criteria used for defining a case made little difference to the validity of the GHQ, and complex scoring methods offered no advantages over simpler ones. The GHQ was translated into 10 other languages for the purposes of this study, and validity coefficients were almost as high as in the original language. There was no tendency for the GHQ to work less efficiently in developing countries. Finally gender, age and educational level are shown to have no significant effect on the validity of the GHQ.

Conclusions. If investigators wish to use a screening instrument as a case detector, the shorter GHQ is remarkably robust and works as well as the longer instrument. The latter should only be preferred if there is an interest in the scaled scores provided in addition to the total score.