This study of 111 institutionalised Down's syndrome subjects and 74 controls found a relatively low risk of hypothyroidism in both groups compared with certain other studies of Down's subjects, which found very high rates of thyroid hypofunction. However, the Down's syndrome group had a significantly raised risk of hypothyroidism (9%), hyperthyroidism (1·8%) and the presence of thyroid microsomal antibodies (29%) compared with the controls and with laboratory reference data. It is recommended that thyroid function testing should be routine in older Down's syndrome subjects, with special attention being given to the clinical status of those with microsomal antibodies present.

In an earlier paper (Goldberg et al. 1987) 36 common symptoms of minor psychiatric disorder in general practice were analysed using the technique of latent trait analysis. From this analysis two dimensions of illness emerged, corresponding to anxiety and depression. In the present paper, this symptom-based representation of minor psychiatric illness is used as a framework for comparing four diagnostic systems: General Practitioner (GP) diagnoses, the ID-CATEGO diagnostic system, the DSM-III system and the Bedford College diagnostic system. This analysis clarifies the reasons for disagreement among systems of diagnostic criteria and examines the practical effects of alternative diagnostic algorithms.

Fifteen persons who admitted to chronic worry were asked to complete morning and evening diaries in which they reported the occurrence of headaches, assessed their mood, and observed a visually stressful pattern, noting the illusions it induced. Results showed an association between both trait and state measures of mood and headache occurrence, and between trait and state measures of headache occurrence and illusion susceptibility. However, mood and illusion susceptibility did not appear themselves to be associated either as trait or state variables. The implications of these results for remediation of headaches are discussed.

This paper addresses the critique which maintains that loss of parent in a sample of female adults plays no role in determining current depression over and above that of low social class position with which such loss is associated. It examines a series of variables which combine to determine current social class position and which seem to stem from lack of adequate replacement care following loss of mother. The experience of a premarital pregnancy and the way in which women cope with it emerge as critical in this process. The relationship of low social class to the onset of depression is discussed in the light of better-known vulnerability factors such as low confiding in, and undependability of, marital partner, employment outside the home and number of children. It is concluded that a current low social class position, far from explaining away the association between loss of mother and current depression, may itself be brought about by a chain of circumstances stemming from the loss. Once again, the quality of replacement care is shown to play a critical role.

This paper reports an investigation of the incidence of schizophrenia in Ireland by means of standardized case-finding procedures. Our findings do not support the popular belief, based on first admissions figures, of a raised incidence in Ireland. We show this to have been considerably overestimated.

Psychological factors have long been thought to play a contributing role in either the predisposition, onset or course of various physical illnesses. Recently, rapid advances in immunology have created interest in the interaction between psychosocial factors, behaviour and the immune system. This paper reviews some of the models proposed to explain the relationship between psychological variables and physical illness and presents evidence for a contribution of psychological factors to certain illnesses in which abnormalities in immunologic state are thought to be important. From a somewhat different perspective, animal studies have demonstrated complex effects of stress, on disease susceptibility. Recent human studies have demonstrated consistent immunologic changes in people undergoing acute naturally occurring psychological stress such as bereavement or an important examination. In humans, the effects of chronic stress may be different from acute stress, corresponding to the findings in animals. Abnormalities in immunologic functioning and physical illness are reviewed for different psychiatric disorders — depression, anorexia nervosa and schizophrenia; depression is the only disorder which consistently demonstrated immunologic changes. Possible mechanisms for the stress/immune-change relationship are suggested.

A sample of 60 patients selected at random from an adult population of 419 patients with end-stage renal disease was assessed for major depression. Diagnoses were based on a structured interview using DSM-III criteria. Eighteen patients (30%) met criteria for a major depression on a lifetime basis. In addition, depressive symptoms and treatment for each depressed patient are reported.

Research suggests that Type A behaviour and ‘social insecurity’ (SI) may represent independent additive task factors for coronary disease. Research examining SI and Type A behaviour, however, has not rigorously evaluated the structure of the SI scale. The present study examined the structure of a previously used eight-item SI scale, and its relation to a questionnaire measure of Type A (the student Jenkins Activity Survey), for a sample of 504 undergraduates. Exploratory and confirmatory factor analyses of responses to the SI items revealed a three-factor solution was most appropriate for Type As, and a two-factor solution for Type Bs. For both As and Bs, the first factor reflected insecurity regarding one's own capabilities and worth (self-specific insecurity), and the second factor reflected insecurity specific to a group or social context (group-specific insecurity). A third factor emerging only for Type As reflected insecurity regarding others' capabilities (other-directed insecurity). Semipartial correlations revealed Type A total score was marginally negatively related to group-specific insecurity and marginally positively related to other-directed insecurity, corroborating previous angiographic and prospective medical research. The hard-driving/competitive subscale was significantly negatively related to self-specific insecurity, supporting evidence regarding Type A and interpersonal dominance, competitiveness, and aggression.

School children (N = 2013) completed questionnaires in class on three occasions over a period of 17 months. Life stress data for 12 months were gathered retrospectively in the last questionnaire. Life events and interpersonal problems were associated with psychosomatic symptoms. In terms of change in symptoms, the impact of life events and interpersonal problems was demonstrated in boys but not in girls. Though boys with a history of no events or problems had lower symptom scores than girls, boys with a history of many events or problems caught up with the girls by the end of the follow-up period. On the other hand, symptom differences related to life stress scores were already apparent at the beginning of the study, and these differences were greater in girls than in boys.

A considerable amount of research documents the negative effects of job loss on both physical and mental health. Yet we know comparatively little about the mechanisms through which these effects occur. Unemployment, like other events, is not the same experience for everyone exposed to it. An understanding of this variation might be facilitated by breaking down the analysis of unemployment into a consideration of the various stresses that it creates or exacerbates. This is our purpose in the present paper.

We demonstrate that, for one area of the United States, the effect of job loss on several health outcomes involves two mechanisms: (1) unemployment results in increased financial strain which, in turn, results in negative health effects, and (2) unemployment leaves the individual more vulnerable to the impact of unrelated life events. Controlling for financial strain, unemployed people in our sample who have not experienced an additional life event in the previous year are in no worse health than the stably employed. This provides useful insights into the nature of the unemployment experience in this particular setting. It also provides a basis for future detailed explorations of the various ways people cope with this event.

This longitudinal study examined the psychological impact of a bushfire disaster on a group of 808 children aged from 5 to 12. Contrary to prediction, the prevalence of behaviour and emotional problems 2 months after the fire was less than the prevalence in a carefully selected comparison group. Rather than decrease with time, the prevalence of psychological morbidity increased significantly, being as great 26 months after the disaster as at 8 months.

Forty-two male patients with an anorexic syndrome were assessed. Twenty-nine of them had a primary anorexia nervosa (most of them also had bulimic symptoms). They were compared with a series of 23 female anorexia nervosa patients. The males scored more highly than female patients on a number of symptoms, but generally more similarities than differences in symptomatology were apparent. Male patients with primary anorexia nervosa also showed several signs of a disturbed psychosexual and gender identity development. The data support the hypothesis that males with atypical gender role behaviour have an increased risk for developing anorexia nervosa or bulimia in adolescence.

Affiliation preferences of 150 cancer out-patients were assessed in the waiting-room and day-to-day life. Results indicated the vast majority avoided fellow patients, preferring to be alone or with healthy people. Similarly, patients tended to avoid the topic of illness in their social contacts. Moreover, those desiring to be with the healthy displayed the highest levels of negative emotion. Finally, avoidance of fellow patients was higher among males, the elderly, and the more highly educated. Overall, the findings were inconsistent with the thesis that those under stress seek out others in similar straits, as suggested by Schachter's emotional comparison theory or Will's downward comparison theory. Rather, they support Rofé's utility theory of stress and affiliation.

Four groups of families were investigated using an interview designed to assess expressed emotion (EE) in relatives of psychiatric patients and a family interaction questionnaire (FIQ) based upon the Leary and Benjamin schemes for coding interpersonal behaviour. The families included 25 containing a psychiatric patient aged between 18 and 46, and three groups of 12 families each, all containing a patient over 60 (patients with dementia, a functional psychiatric disorder, or a chronic physical disorder respectively). In all cases data were obtained from key relatives.

The FIQ clearly separated out the group of dementia relatives who reported the most dominant and protective behaviours and the highest levels of hostile-dominance and the lowest levels of affection. EE was not found to be so sensitive to interactions occurring in families with a member with dementia, and the possible reasons for this are discussed.

Women report more symptoms than men in mental health surveys. The evidence shows that psychometric biases cannot explain this significant difference. This study attempts to explore other factors that could bias the results – for example, that women are likely to report less serious symptoms than men or are less apprehensive in reporting symptoms because they have a higher tendency to report symptoms than men. A random sample of 213 women and 222 men, all married and between the age of 25 and 40, were interviewed at home in two districts of Montreal (Canada) and given the Health Opinion Survey (HOS). As has been usually found, women scored higher than men on the HOS. A variety of scales assessed the seriousness of the symptoms and the results did not indicate any sex difference in this regard. Moreover, there was no correlation between the mental health and the Jourard Self-Confidence Scale. Finally, women did not confide more about their symptoms than men, contrary to the prevalent opinion according to which they are more likely to do so. Sex differences on mental health scales do not, therefore, appear to be related to the type of bias assessed in this survey.

A theoretical model designed to assess the contribution of systematic factors contributing to vulnerability to life-events exposure is described. This model is applied to six-year longitudinal data on life events exposure for a sample of New Zealand women with school-aged children. The fitted model suggests that in the region of 30% of the variance in life-event reports over the six-year period was attributable to a common vulnerability factor. Modelling of this vulnerability factor suggested that two major determinants of vulnerability to life events were the level of social disadvantage of the woman and her level of neuroticism: women of socially disadvantaged backgrounds and women with high neuroticism scores showed a consistent tendency to report high life-event exposure during the six-year period. The implications of these findings are discussed.

In a randomized prospective treatment study, 80 overdose patients (not requiring intensive psychiatric intervention) received either brief out-patient counselling or were returned to the care of their general practitioners with advice on management. There was little difference in outcome between the two groups. However, two sub-groups of patients benefited more from out-patient counselling than from general practitioner care, these were: (a) women, and (b) patients with dyadic problems. Counselling following overdoses should be focused on groups of patients such as these who are most likely to benefit from it. Further work is needed to identify treatment approaches that will help other groups who take overdoses, especially men.

We report the development of a new procedure for assessing the needs for treatment and care of the long-term mentally ill. This procedure covers 21 areas of clinical and social functioning, and in each of these specifies appropriate interventions. Decision rules are described which permit problems in functioning to be primarily classified as a met need, an unmet need, or as involving no need, and which allow the identification of various secondary needs. We report preliminary data on the reliability and validity of this procedure and discuss its potential applications in the care of the long-term mentally ill.

This study of 519 coronary angiography patients failed to replicate our earlier findings in 90 angiography patients (Tennant & Langeluddecke, 1985) which showed that trait tension, trait anxiety and suppression of anger were correlates of atherosclerosis. In the present studya variety of psychological measures, including state and trait anxiety, tension, anger, locus of control and suppression of anger, depression and anxiety, showed no significant association with coronary atherosclerosis as assessed by coronary angiography.

This paper outlines and evaluates a newly developed measure of neuroticism, the Scale of Emotional Arousability (SEA). The 15-item scale is economical to use, avoids the consistent pattern of negatively worded items that plagues the neuroticism (N) Scale of the Eysenck Personality Inventory (EPI) and comprises of items that focus specifically on emotional arousability, thereby bringing the measurement of neuroticism in line with Eysenck&s (1967) original conceptualization. The SEA shows every indication of being psychometrically sound and correlates with related constructs in much the same way as the N Scale of the EPI. The SEA is recommended as an alternative to the EPI for research purposes, particularly where there is a need to measure independently such related constructs as neurosis, self-esteem and private self-consciousness.