Brugha and his colleagues in this issue raise important questions about the validity of standardized diagnostic interviews of mental disorders, such as the Composite International Diagnostic Interview (CIDI) (WHO, 1990). Although their concerns refer predominantly to the use of such instruments in epidemiological research, the authors' conclusions also have significant implications for diagnostic assessments in clinical practice and research. We agree with Brugha et al. that the inflexible approach to questioning used in standardized interviews can lead to an increased risk of invalidity with regard to some diagnoses. We also agree that the use of more semi-structured clinical questions has the potential to address this problem. However, we disagree with Brugha et al. in several other respects.

First, we disagree with the authors' initial exclusive emphasis on diagnosis with regard to need assessment and consequences for the allocation of service resources. It is becoming increasingly clear that knowledge about diagnosis does not, in itself, whether assessed by clinical or non-clinical diagnostic interviews, provide sufficient information we need for policy purposes and the determination of societal costs, or to judge clinical management guidelines and treatment needs (Regier et al. 1998). Additional, preferably dimensional, data on associated disabilities and distress as well as a focused need evaluation for those psychosocial, psychological and drug interventions that characterize modern treatment strategies are also important. It also has become evident that a great many people in the general population carry more than one diagnosis. This ‘co-morbidity’ complicates further such simple equation of diagnosis prevalence with need assessment and policy decisions. Secondly, we disagree with the conclusion of Brugha et al. that the use of a semi-structured clinical interview, like the most current version of the Structured Clinical Assessment for Neuropsychiatry (SCAN), whether in the hands of clinical or non-clinical interviewers, is most closely approximating the ‘clinical gold standard’ and is the most feasible way to correct the problem of disagreement between semi-structured clinical diagnostic interviews and standardized diagnostic interviews. We believe that the practical reliability and validity problems associated with using such a clinical interviewing approach especially in large-scale community surveys as well as in cross-national research more than cancel out any theoretical advantage this approach might have in clarifying meaning. Thirdly, we disagree with the suggestion of Brugha et al. that the problem of validity is inherent in standardized non-clinician interviews. Indeed, as detailed below, there is no evidence that across all diagnoses clinical semi-structured interviews reveal more promising psychometric properties than standardized interviews. Also methodological research shows quite clearly that a substantial number of potential validity problems in standardized interviews can be overcome.

Background. The descriptive validity of the melancholic features specifier of the DSM-IV major depressive disorder (MDD) is uncertain. Little is known about its relationship to psychiatric co-morbidity, stability across episodes, or strength in predicting course of illness.

Method. The Vantaa Depression Study (VDS) is a prospective, naturalistic cohort study of 269 patients with a new episode of DSM-IV MDD who were interviewed with SCAN and SCID-II between 1 February 1997 and 31 May 1998, and again at 6 and 18 months. Ninety-seven (36%) MDD patients met DSM-IV criteria for the melancholic features specifier, and were contrasted with 172 (64%) subjects with a non-melancholic MDD. The duration of the index episode was examined using a life chart.

Results. We found no difference in rates of any current co-morbid Axis I or II disorders between melancholic and non-melancholic depressed patients. Of those who had melancholic features at the index episode and subsequent episodes during the 18-month follow-up, only 22% (5/23) presented melancholic features during the latter. The non-melancholic subtype switched to melancholic in 25% (8/32) of cases. Differences in the course of melancholic and non-melancholic depression were very minor.

Conclusions. The descriptive validity of the DSM-IV melancholic features specifier may be questionable in MDD. There appear to be no major differences in current co-morbidity, or course of depression between melancholic and non-melancholic patients. The consistency of DSM-IV melancholic features across episodes appears weak.

A two-stage case-identification method, using a modified General Health Questionnaire (GHQ) and the Clinical Interview Schedule (CIS), was applied in a pilot study of mental disorders in an urban city in Taiwan. The validity of the modified GHQ was proved to be greater than that of the original, with a very high sensitivity and specificity. The Chinese version of the CIS was found to be feasible for community study in Taiwan. The total prevalence rate of all mental disorders was 26·0%, with a higher morbidity among females.

Twenty-five male alcoholic Korsakoff patients were compared with age and sex-matched non-Korsakoff chronic alcoholics and healthy volunteers on clinical and CT brain scan parameters. The scans were assessed by planimetry, visual grading procedures and computerized analysis. Reliable measures of third ventricular size were developed.

The Korsakoff patients had wider third ventricles, larger lateral ventricles and wider interhemispheric fissures than the comparison groups; but sulcal and Sylvian fissure widths were equivalent in Korsakoff and non-Korsakoff alcoholics.

The results suggest that, in addition to their well-established diencephalic lesions, many Korsakoff patients have sustained widespread cerebral damage. Shrinkage in the frontal brain regions appears to be especially pronounced. The implications for a dual aetiology of alcoholic Korsakoff's syndrome involving thiamine deficiency and features associated with alcoholism, probably direct alcohol neurotoxicity, are discussed.

The validity of the Japanese version of the 30-item General Health Questionnaire (GHQ) was examined against the semi-structured interview-based Research Diagnostic Criteria (RDC) as external criteria. The GHQ total score discriminated ‘cases’ and ‘non-cases’ satisfactorily but its recommended cut-off point was higher (7/8) than that of the original English version (4/5). Discriminant function analysis revealed that only 13 items contributed to the discriminatory power and that their discriminant function score was better than a simple summation of the 30 GHQ item scores in terms of validity.

A sample of 1150 unemployed 17 year-olds, containing blacks and whites, males and females, was obtained from 11 urban regions in England. Social support was measured in respect of five different forms of help from others. Measures were also obtained of psychological distress, perceived pressure from others to obtain a job, employment commitment, contact with other young people, and contact with other unemployed young people. Two forms of social support (having someone to turn to for help with money, and having someone to suggest interesting things to do) were significantly associated with measures of distress, as were perceived pressure to obtain a job and employment commitment, but not contact with other unemployed young people. The association between distress and having someone to turn to for help with money was greater for those perceiving pressure from others to obtain a job than those not perceiving pressure. Also, the association between distress and having someone to turn to when feeling low was greater for those with a high employment commitment than for those with a low one. Other associations between support and distress were found to be affected by sex and ethnic differences in the sample. The results are discussed in the light of a stress-buffering model of social support; and the need to disaggregate social support into its component parts is emphasized.

The upsurge in the number of people affected by the COVID-19 is likely to lead to increased rates of emotional trauma and mental illnesses. This article systematically reviewed the available data on the benefits of interventions to reduce adverse mental health sequelae of infectious disease outbreaks, and to offer guidance for mental health service responses to infectious disease pandemic. PubMed, Web of Science, Embase, PsycINFO, WHO Global Research Database on infectious disease, and the preprint server medRxiv were searched. Of 4278 reports identified, 32 were included in this review. Most articles of psychological interventions were implemented to address the impact of COVID-19 pandemic, followed by Ebola, SARS, and MERS for multiple vulnerable populations. Increasing mental health literacy of the public is vital to prevent the mental health crisis under the COVID-19 pandemic. Group-based cognitive behavioral therapy, psychological first aid, community-based psychosocial arts program, and other culturally adapted interventions were reported as being effective against the mental health impacts of COVID-19, Ebola, and SARS. Culturally-adapted, cost-effective, and accessible strategies integrated into the public health emergency response and established medical systems at the local and national levels are likely to be an effective option to enhance mental health response capacity for the current and for future infectious disease outbreaks. Tele-mental healthcare services were key central components of stepped care for both infectious disease outbreak management and routine support; however, the usefulness and limitations of remote health delivery should also be recognized.

Data on serious psychiatric illness (900 cases), suicide (150 cases), indictable crime (1,300 cases), and child welfare problems (800 cases) in individuals living in Brighton have been collected. Rates of these behavioural pathologies have been calculated for 19 wards in the city, and correlated with data collected in the 1966 Census. Results show that the behavioural pathologies are strongly intercorrelated and are associated with in-migrant areas containing rooming houses of poor quality. These areas tend to be in the city centre. Rates of psychiatric illness, including diagnostic groups in different age and sex groups, have been calculated for 110 enumeration districts in the city, and these rates correlated with factor scores from the principal components analysis of 53 census variables. Complex patterning of the data has been demonstrated. The identification of small areas in the city with high rates of behavioural pathology in particular social settings is an important precursor of the establishment of special measures for prevention and treatment. An important area for future research is the establishment of causal patterns, and the investigation of the primary or secondary role of social conditions in the emergence of mental illness and other behavioural pathology.

Background. Borderline personality disorder (BPD) is often co-morbid with major depression and may complicate its treatment. We were interested in differences in genetic and developmental risk factors between depressed patients with or without a co-morbid BPD.

Method. Out-patients with major depressive disorder were recruited for two treatment trials. Assessment of depressed patients included the assessment of personality disorders, developmental risk factors and DNA samples for genetic analyses.

Results. In each study there was a significant association between the 9-repeat allele of the dopamine transporter (DAT1) and BPD, with odds ratios (OR) >3 and p[les ]0·02. This association remained significant when developmental risk factors for BPD (childhood abuse and neglect and borderline temperament) were also included in the analyses. The OR was even larger in the depressed patients aged [ges ]35 years (OR 9·31, p=0·005).

Conclusion. This replicated association in depressed patients between the 9-repeat allele of DAT1 and BPD may provide clues to understanding the neurobiology of BPD. The finding that the association is larger in the older depressed patients, suggests that the 9-repeat allele may be associated with a poorer prognosis BPD, rather than a young adult limited variant of BPD.

Background. The General Health Questionnaire (GHQ) is the most popular screening instrument for detecting psychiatric disorders in community samples. Using longitudinal data of a large sample of UK twin pairs, we explored (i) heritabilities of the four scales and the total score; (ii) the genetic stability over time; and (iii) the existence of differential heritable influences at the high (ill) and low (healthy) tail of the distribution.

Method. At baseline we assessed the GHQ in 627 MZ and 1323 DZ female pairs and at a second occasion (3·5 years later) for a small subsample (90 MZ and 270 DZ pairs). Liability threshold models and raw ordinal maximum likelihood were used to estimate twin correlations and to fit longitudinal genetic models. We estimated extreme group heritabilities of the GHQ distribution by using a model-fitting implementation of the DeFries–Fulker regression method for selected twin data.

Results. Heritabilities for Somatic Symptoms, Anxiety, Social Dysfunction, Depression and total score were 0·37, 0·40, 0·20, 0·42 and 0·44, respectively. The contribution of shared genetic factors to the correlations between time points is substantial for the total score (73%). Group heritabilities of 0·48 and 0·43 were estimated for the top and bottom 10% of the total GHQ score distribution, respectively.

Conclusion. The overall heritability of the GHQ as a measure of psychosocial distress was substantial (44%), with all scales having significant additive genetic influences that persisted across time periods. Extreme group analyses suggest that the genetic control of resilience is as important as the genetic control of vulnerability.

Groups of elderly people, matched by level of dependency and probability of dementia, were identified in day centres, day hospitals, wards, and local authority homes, and followed up over 9 months to determine the impact of type of care upon outcome. No difference in mortality or changes in dementia scores were found, but the survivors' levels of dependency improved most in day centres and local authority homes. This finding, and the problems of matching, are discussed.

Background. We investigated the impact of widowhood on depression and how resources and contextual factors that define the meaning of loss modified this effect.

Method. In a prospective, nationally representative sample of women in the US aged 54 or older we compared 64 women who were widowed in the 3 years between data collection waves with 431 women who were stably married over the time interval.

Results. Those who became widowed reported more depression than controls for 2 years following the loss. However, this effect was confined to respondents whose husbands were not ill at baseline. Widowed women whose husbands were ill at baseline already had elevated depression in the baseline interview and did not become significantly more depressed after the death. Consistent with this result, women who were not depressed pre-bereavement were most vulnerable to depression following the loss of an ill spouse during the first year of widowhood.

Conclusions. Results suggest that spouses' illness may forewarn wives of their impending loss and these women may begin to grieve before his death. Those forewarned women who are not depressed pre-bereavement may experience the most post-bereavement depression. Findings are discussed in light of previous, more methodologically limited studies.