Worldwide, 340 million people are affected by depression, with high comorbid, social and economic costs.

To identify potential predictors of effect in prevention programmes.

A meta-analysis was made of 69 programmes to reduce depression or depressive symptoms.

The weighted mean effect size of 0.22 was effective for different age groups and different levels of risk, and in reducing risk factors and depressive or psychiatric symptoms. Programmes with larger effect sizes were multi-component, included competence techniques, had more than eight sessions, had sessions 60–90 min long, had a high quality of research design and were delivered by a health care provider in targeted programmes. Older people benefited from social support, whereas behavioural methods were detrimental.

An 11% improvement in depressive symptoms can be achieved through prevention programmes. Single trial evaluations should ensure high quality of the research design and detailed reporting of results and potential predictors.

Analysis of the patterns of variation in health care costs and the determinants of these costs (including treatment differences) is an increasingly important aspect of research into the performance of mental health services.

To encourage both investigators of the variation in health care costs and the consumers of their investigations to think more critically about the precise aims of these investigations and the choice of statistical methods appropriate to achieve them.

We briefly describe examples of regression models that might be of use in the prediction of mental health costs and how one might choose which one to use for a particular research project.

If the investigators are primarily interested in explanatory mechanisms then they should seriously consider generalised linear models (but with careful attention being paid to the appropriate error distribution). Further insight is likely to be gained through the use of two-part models. For prediction we recommend regression on raw costs using ordinary least-square methods. Whatever method is used, investigators should consider how robust their methods might be to incorrect distributional assumptions (particularly in small samples) and they should not automatically assume that methods such as bootstrapping will allow them to ignore these problems.

Previously reported associations between advancing paternal age and schizophrenia could be due to an increase in paternal germ cell mutations or be confounded by heritable personality traits associated with schizophrenia that result in delayed parenthood.

To investigate this association while adjusting for personality traits related to poor social integration in the subjects.

A cohort of 50 087 adolescent males was followed up by record linkage to determine hospital admissions for schizophrenia between 1970 and 1996.

Advancing paternal age was associated with an increased risk of developing schizophrenia in a ‘dose-dependent’ manner. The adjusted odds ratio for each 10-year increase in paternal age was 1.3 (95% Cl 1.0–1.5; P=0.015).

Advancing paternal age is an independent risk factor for schizophrenia. Adjusting for social integration in subjects made little difference to this association, consistent with the hypothesis that advancing paternal age may increase liability to schizophrenia owing to accumulating germ cell mutations.

Velo-cardio-facial syndrome (VCFS) is associated with interstitial deletions of chromosome 22q11. About 30% of patients with VCFS have psychosis, and the rate of these deletions in schizophrenia has been reported to be about 1%. Even higher rates of VCFS deletions have been reported for childhood-onset schizophrenia.

To test the hypothesis that there is an increased rate of VCFS among patients with early-onset psychosis (age at onset < 18 years). We screened 192 early-onset patients and 329 patients with adult-onset schizophrenia.

We genotyped the patients and 444 healthy controls for hemizygosity of five microsatellite markers and one single nucleotide polymorphism that map to the 22q11-deleted region.

One patient had a VCFS deletion, confirmed with semi-quantitative polymerase chain reaction. None of the controls showed a pattern of genotypes consistent with hemizygosity.

VCFS may be less frequent among patients with psychosis than previously suggested; this rate is not increased among early-onset patients.

Meta-analyses of hippocampal size have indicated that this structure is smaller in schizophrenia. This could reflect a reduction in the size of constituent neurons or a reduced number of neurons.

To measure the size of hippocampal pyramidal neurons in the brains of people with and without schizophrenia.

Pyramidal neuron size in hippocampal subfields was estimated stereologically from sections taken at 5 mm intervals throughout the whole length of right and left hippocampi from the brains of 13 people with schizophrenia and 16 controls. Results were assessed using repeated-measures analysis of covariance looking for a main effect of diagnosis and gender, and interactions of these with side.

We were unable to detect significant differences related to diagnosis, gender or side for any hippocampal subfield for this series of cases.

For this series of brains, hippocampal cell size is unchanged in schizophrenia.

Comorbid substance misuse in people with schizophrenia is associated with poor clinical and social outcomes. There are few studies of psychological treatments for this population and little long-term follow-up of their benefits.

To investigate symptom, substance use, functioning and health economy outcomes for patients with schizophrenia and their carers 18 months after a cognitive–behavioural treatment (CBT) programme.

Patients with dual diagnosis from a randomised controlled trial of motivational intervention, individual CBT and family intervention were assessed on multiple outcomes at 18-month follow-up. Carers were assessed on symptom, functioning and needs over 12 months. Health economy data were collected over 18 months.

There were significant improvements in patient functioning compared with routine care over 18 months. No significant differences between treatment groups were found in carer or cost outcomes.

The treatment programme was superior to routine care on outcomes relating to illness and service use, and the cost was comparable to the control treatment.

This paper is part of a project to identify the proportion of the burden of each mental disorder averted by current and optimal interventions, and the cost-effectiveness of both.

To use epidemiological data on schizophrenia to model the cost-effectiveness of current and optimal treatment.

Calculate the burden of schizophrenia in the years lived with disability (YLD) component of disability-adjusted life-years lost, the proportion averted by current interventions, the proportion that could be averted by optimal treatment and the cost-effectiveness of both.

Current interventions avert some 13% of the burden, whereas 22% could be averted by optimal treatment. Current interventions cost about AUS$200 000 per YLD averted, whereas optimal treatment at a similar cost could increase the number of YLDs averted by two-thirds. Even so, the majority of the burden of schizophrenia remains unavertable.

Optimal treatment is affordable within the present budget and should be implemented.

It is unclear why intensive case management (ICM) failed to reduce hospitalisation in the UK700 trial.

To investigate outcome generation in the UK700 trial.

A qualitative investigation was undertaken in one UK700 centre.

Both intensive and standard case management practised individual casework, employed assertive outreach with comparable frequency, and performed similarly in the out-patient management of emergencies and inpatient discharge. However, ICM was advantaged in managing some noncompliance and undertaking casework that prevented psychiatric emergencies. Absence of team-based management and bureaucratised access to social care limited the impact of these differences on outcomes and the effective practice of assertive outreach, although this was relevant to only a sub-population of patients.

The impact of ICM was undermined by organisational factors. Sensitive anticipatory casework, which prevents psychiatric emergencies, may make ICM more effective than an exclusive focus on assertive outreach. Our findings demonstrate the value of qualitative research in evaluating complex interventions.

An increased risk of choking associated with antipsychotic medication has been repeatedly postulated.

To examine this association in a large number of cases of choking deaths.

Cases of individuals who had died because of choking were linked with a case register recording contacts with public mental health services. The actual and expected rates of psychiatric disorder and the presence of psychotropic medication in post-mortem blood samples were compared.

The 70 people who had choked to death were over 20 times more likely to have been treated previously for schizophrenia. They were also more likely to have had a prior organic psychiatric syndrome. The risk for those receiving thioridazine or lithium was, respectively, 92 times and 30 times greater than expected. Other antipsychotic and psychotropic drugs were not over-represented.

The increased risk of death in people with schizophrenia may be a combination of inherent predispositions and the use of specific antipsychotic drugs. The increased risk of choking in those with organic psychiatric syndromes is consistent with the consequences of compromised neurological competence.

The association between sexual abuse, mental health and behavioural problems in people with learning disabilities has not previously been examined in a controlled study.

To identify symptoms of psychological disturbance in adults with and without a confirmed history of sexual abuse.

The study used a matched (1:1) case–control design comparing 54 adults who had experienced sexual abuse with 54 adults with no reported history of abuse. The two groups were selected from a community population of adults with learning disabilities living in residential care, and compared for selected psychiatric diagnoses and for scores on measures of disturbed behaviour.

Sexual abuse was associated with increased rates of mental illness and behavioural problems, and with symptoms of post-traumatic stress. Psychological reactions to abuse were similar to those observed in the general population, but with the addition of stereotypical behaviour. The more serious the abuse, the more severe the symptoms that were reported.

The study provides the first evidence from a controlled study that sexual abuse is associated with a higher incidence of psychiatric and behavioural disorder in people with learning disabilities.