This study confirms the validity of a Spanish version of the General Health Questionnaire in its scaled 28-item version. The screening instrument was tested on a sample of 100 patients attending an internal medicine out-patient clinic, who were examined independently by psychiatrists standardized in the use of the Clinical Interview Schedule (CIS). The questionnaire correctly identified 85% of “cases” with a cutting score of 6/7 (sensitivity 76·9%, specificity 90·2%), and 83% of cases with a cutting score of 5/6 (sensitivity 84·6%, specificity 82%), suggesting a discriminative power almost as good as the Spanish GHQ-60. It has the important advantage of being considerably shorter and, although the 4 subscales are by no means independent, its concurrent validity with CIS ratings suggests that they provide additional information concerning anxiety and depression.

Four measures of mental health – Panic, Depression, Somatization and Well-Being – have been developed for use in a population of Southeast Asian refugees. The scales, a product of work with 1348 refugees, demonstrate conceptual significance, good reliability, concurrent validity and stability of structure across samples. They are culturally sensitive, enabling intra-cultural study as well as screening for clinical purposes. The measures also permit comparisons, for research purposes, with non-Asians.

The abridged census estimator, also known as Weinberg's shorter method, is a device used to estimate lifetime incidence from the observed age distribution of a population at risk coupled with data on the current prevalence of a mental disorder. This method, which still enjoys considerable popularity, should have been replaced many years ago by more accurate techniques for making such estimates using similar information. In particular, the abridged census method uses the assumption that the remaining life expectancy of incident cases equals that of non-cases. This assumption is likely to lead to an underestimate of the lifetime risk. Two examples are presented from published literature which illustrate some problems encountered with the use of the abridged census method. Some alternative estimation methods are presented which can be implemented using only a hand calculator and which lead to more accurate results.

Psychological correlates of gastric and duodenal ulcer disease were assessed in a group of somewhat older patients with ulcer disease identified by endoscopy. Associations between both ulcer types and symptom measures (anxiety and depression) seemed only to reflect severity or chronicity of gastrointestinal symptoms or the impending endoscopy procedure. Associations with ‘trait’ psychological indices may be of causal significance. Duodenal ulcer patients had higher ‘introversion’ and ‘psychoticism’ scores (on the EPQ) than controls, while gastric ulcer patients had higher psychoticism scores and ‘trait anxiety’ scores. These findings could not be attributed to confounding variables.

When the two ulcer groups were compared, the gastric ulcer group had significantly higher neuroticism, psychoticism and hostility scores which were not attributable to confounding variables. The higher depression scores in gastric ulcer patients, however, simply reflected the greater chronicity of their physical symptoms. The groups did not differ significantly on measures of trait anxiety, tension, introversion or Type A behaviour.

The inconclusiveness of the literature on the role of loss of parent in influencing psychiatric disorder in adulthood is well known. A number of reasons involving sampling, location and other methodological features, are given to account for these contradictory findings. A study specially designed to cope with these features is then described and basic results are reported. These indicate that, in a sample of women aged 18–65, loss of mother before the age of 17, either by death or by separation of one year or more, was associated with clinical depression in the year of interview. Loss of father by death was in no way associated with current depression, but separation from father showed a trend which, however, did not reach statistical significance. Control for other possible confounding factors did not change this patterning of results; these were further supported when psychiatric episodes earlier in adulthood were examined. Examination of the caregiving arrangements in childhood suggests that it is ‘lack of care’, defined in terms of neglect rather than simply hostile parental behaviour, which accounts for the raised rate of depression. Such ‘lack of care’ is more frequent after loss of mother than after loss of father.

Results are reported from a large population study (of working people) comparing Holocaust survivors and a control group in regard to emotional distress, satisfaction in life and psychosomatic symptoms. It was found that, even 40 years after the traumatic experience, this group of survivors exhibited a slightly higher degree of emotional disorders than controls who were not under Nazi occupation during WWII. These long-term effects were usually more prominent in women than in men, and the relationship to age was minimal.

Couples in whom the main complaint was of a lack of female sexual response were treated using a practical counselling approach. A number of pre-treatment measures were studied to determine which factors were predictive of treatment outcome. While age and chronicity were not predictive, the quality of the general relationship and measures of sexual attitude did give useful indications of likely outcome.

Variations within and between observer-judges reduce the accuracy of clinical research. Judgement Analysis allows strategies to be developed and applied which reduce variation in judgement. The prediction that the removal of important sources of error variance by this means would reduce the likelihood of committing a Type 2 Error was supported by the application of Judgement Analysis to assessments by 15 psychiatrists of 92 patients in a clinical trial of 2 antidepressive treatments. The statistical significance of differences between the effect of the treatments on the severity of depression was increased, and significant differences appeared earlier. Ten stimulated patient profiles were also converted into narrative case histories, enacted by experienced psychiatrists or psychologists and videotaped. The participants' judgements of the overall severity of the depression were in good agreement with those they had made on the original cases. Videotapes so prepared help training to reduce variation in observation, just as Judgement Analysis can lead to reductions in the variation of judgement.

A comparison was made of the crime rate among 181 suicides and 181 controls, representing an unselected sample of the population matched with the suicides for sex, age, marital status, place of residence and occupational level. Sixteen per cent of the suicides and 11% of the controls had a criminal record, a statistically insignificant difference. In addition, no significant differences were found in the proportion of recidivists and of violent offenders, or in the number of their offences and convictions. A significant difference was found regarding the distribution of the offences by particular laws: more than a half of the offences committed by criminal suicides concerned violations of the road traffic laws, this being in agreement with the hypothesis that risky, accident-prone behaviour is a suicidal behaviour equivalent.

The three experiments described aimed to establish whether the achievements of idiot savant calendrical calculators were based solely on rote memory and arithmetical procedures, or whether these subjects also used rule-based strategies. It was found that, although different structural calendar regularities were tested by using differing experimental paradigms, all subjects could at least use some of the rules under investigation. The more cognitively able subjects could make use of all the three structural regularities of the calendar tested here. It was concluded that idiot savant calendrical calculators can use rule-based strategies to aid them in the calculation of the days on which past and future dates fall.

In a community sample of the elderly (N = 274) in Hobart, Tasmania, cases of dementia and depression were ascertained by the Canberra Geriatric Mental State and the Mini Mental State Examination. Social relationships and support were examined by means of the Interview Schedule for Social Interaction. The elderly had fewer social relationships than younger adults, but were more content with what they did have. Elderly women had more affectional ties than elderly men. The presence of offspring in the same town increased the number of close ties and of social relationships, but was more important for men than for women. Persons with cognitive impairment or an established dementia reported that they had less social interaction than they would like. Depressed subjects reported having markedly less social interaction than the mentally healthy elderly, but did not complain that it was too little. This study provides a systematic description of the social environment of the elderly, both in mental health and in states of depression or impaired cognition.

Developmental psychopathology constitutes a research strategy that is concerned with questions about continuities and discontinuities over time (the developmental perspective) and over the span of behavioural variation (the psychopathological perspective). The utility of this approach is discussed in relation to childhood depression, autism and schizophrenia, and the effects of adverse life experiences.

Latent trait modelling is a recent psychometric technique with great potential for the construction and refinement of psychiatric instruments. It provides a greater insight into the nature of measurement in psychiatry and the statistical machinery for improving it. This expository paper starts with a non-technical outline of the latent trait model, gives a detailed analysis of the 12-item General Health Questionnaire (GHQ) and examines points raised by the empirical analysis through computer simulation. It is shown that the latent trait model can give a good representation of empirical data and uncover new aspects of a familiar instrument. It provides a precise methodology for evaluating the functioning of a questionnaire and for developing better short instruments. It highlights the need, and provides the means, to tailor instruments for different tasks, such as (a) screening, and (b) measuring over the whole range of the population. We examine scoring in the light of the model, and show that simple scoring is often adequate. While points for further methodological development are noted, it is argued that the method is already sufficiently developed for general application.

A population study was undertaken in two health districts of children with severe mental handicap. Prevalence figures for behaviour problems are presented. A stratified random sample of 200 families was drawn from the population. Detailed structured interviews were carried out with the children's parents. The children were divided into two groups comprising those with behaviour problems and those with no problems. There was a significant association between behaviour disorder and incontinence, lack of self-help skills, poor reading, writing and counting skills, and poor communication skills. Environmental correlates were few. There were no differences between groups in family size, birth order, age of parents, marital discord, social class or income. However, behaviour problems were more common in one-parent families. An association was found between maternal stress and problem behaviour. The possible mechanisms underlying this association are discussed

Standard scores on tests of intelligence, memory and academic achievement were obtained from individuals with either schizophrenic spectrum disorders, mania, alcohol abuse, antisocial personality disorders or no mental disorder. The three cognitive measures were highly and positively correlated in three groups (normal controls, alcohol abusers and antisocial personality disorders), while in the schizophrenic spectrum and manic groups a pattern of average reading and spelling achievement was contrasted with lower intelligence and memory quotients. It was suggested that reading and spelling ability are more accurate predictors of premorbid ability in psychotic disorders than other psychometric scales. This parallels previous findings with organic dementias and raises questions about possible shared aetiological bases between dementias and psychoses.

A Fijian community affected by a cyclone was compared with an unaffected but similar community. Two months after the cyclone both psychological and physical morbidity was 2–3 times greater in the affected community than in controls. By the third month morbidity had resolved to levels similar to those in the unaffected population. Brief, catastrophic stress without loss of life appears to provoke psychological and physical morbidity of relatively brief duration.

Groups of highly anxious, moderately anxious and minimally anxious primiparous mothers (N= 147) were obtained on the basis of Spielberger trait anxiety scores in the postpartum period, and subjects were compared. Allocation to those groups appeared to be more likely to reflect constitutional levels of anxiety, rather than recent or current social stressors. Highly anxious mothers were distinguished on a number of presumed correlates of anxiety measured by clinical questions (e.g. terminating of anxious situations), hospital notes (e.g. mood problems noted by nursing staff) and blind rater assessments (e.g. unassertiveness). While highly anxious mothers were more likely to report more recent life events, less social support, and negative interpretations of the pregnancy, the hospital experience and the hospital staff, such variables were less discriminating when neuroticism levels were effectively controlled. This suggests an intrinsic perceptual bias, rather than that the factors were determinants. Highly anxious mothers had more delivery complications, while their babies were more likely to be dysmature and slow to suckle, features we interpret as consequences of the anxiety levels. In the postpartum period these mothers were more depressed, had more concerns about their baby, themselves and their marriage, and were less confident about coping and their parenting capacities. Such variables may be correlates or consequences of anxiety.

A retrospective case note analysis for 30 boys diagnosed as having a ‘schizoid’ personality disorder (Asperger's syndrome) in childhood, and for 30 matched clinic attenders (with systematic follow-up data for 19 matched pairs), showed the incidence of antisocial conduct to be the same in the two groups. However, the ‘schizoid’ boys stole less often and had fewer alcohol problems. In this group antisocial conduct was less related to family disruption and social disadvantage, and more to an unusual fantasy life. Clinical descriptions of a series of ‘schizoid’ boys and girls with conspicuous antisocial conduct follow. They suggest that characteristic patterns of antisocial conduct in such children are persistent expressions of hostility and, especially in girls, pathological lying, for which environmental circumstances provide no explanation.

Case register data are used to describe the age and diagnostic distribution of people using the community psychiatric nursing (CPN) service in Salford. Data are related to those in hospital-based psychiatric services. Annual prevalence rates grew dramatically, and increasing numbers of people were found to have received continuous CPN care for 2 years and over. Following the establishment of the CPN service in a primary care setting, the proportion of patients suffering from depression in receipt of CPN care increased, and the resulting overall diagnostic distribution of CPN patients became similar to that of the specialist psychiatric services as a whole. Patients under the sole care of community psychiatric nurses (about 19 % of the total CPN prevalence each calendar year) contributed to an overall increase in treated prevalence. The data indicate that CPN services in Salford are treating the morbidity found at primary care level, rather than reducing the demands made on the traditional services.

In a context of a WHO collaborative study, 12 research centres in 10 countries monitored geographically defined populations over 2 years to identify individuals making a first-in-lifetime contact with any type of ‘helping agency’ because of symptoms of psychotic illness. A total of 1379 persons who met specified inclusion criteria for schizophrenia and other related non-affective disorders were examined extensively, using standardized instruments, on entry into the study and on two consecutive follow-ups at annual intervals. Patients in different cultures, meeting the ICD and CATEGO criteria for schizophrenia, were remarkably similar in their symptom profiles and 49% of them presented the central schizophrenic conditions as defined by CATEGO class S+. However, the 2-year pattern of course was considerably more favourable in patients in developing countries compared with patients in developed countries, and the difference could not be fully explained by the higher frequency of acute onsets among the former. Age- and sex-specific incidence rates and estimates of disease expectancy were determined for a ‘broad’ diagnostic group of schizophrenic illness and for CATEGO S+ cases. While the former showed significant differences among the centres, the differences in the rates for S+ cases were non-significant or marginal. The results provide strong support for the notion that schizophrenic illnesses occur with comparable frequency in different populations and support earlier findings that the prognosis is better in less industrialized societies.