This paper is part of a series dealing with the role of life events in the onset of depressive disorders. Women who developed depression in a general population sample in Islington in North London are contrasted with a National Health Service-treated series of depressed patients in the same area. Findings among the latter confirm the importance of a severely threatening provoking event for onset among the majority of depressed women patients. The results for the two series are similar except for a small subgroup of patients characterized by a melancholic/psychotic condition with a prior episode.

The severe events of importance have been recognized for some time by the traditional ratings of the Life Events and Difficulty Schedule (LEDS). However, the full descriptive material collected by the LEDS has been used to develop a new refined measure reflecting the likelihood of feelings of humiliation and being trapped following a severely threatening event, in addition to existing measures of loss or danger. The experience of humiliation and entrapment was important in provoking depression in both the patient and non-patient series. It proved to be associated with a far greater risk of depression than the experience of loss or danger without humiliation or entrapment.

Low self-esteem, defined as negative evaluation of self (NES), has been shown to play a significant role in the development of depression at a case level (Brown et al. 1986). This study investigated the stability of this risk factor in 102 women over a 7-year period and examined psychosocial factors that might influence change. At the end of the 7 years about half of those originally identified as having NES no longer had it, but very few moved in the reverse direction to NES. Level of depressive symptomatology also decreased but this was not a sufficient explanation for the substantial improvement in self-esteem. Life changes that involved an improvement in the quality of close relationships or an increase in work status appeared to be the most important factors in positive NES change. Ratings made at the time of first contact of environmental difficulties and positive evaluation of self (measured independently of NES) were related to positive NES change, but only via their link with positive life changes occurring in the 7-year follow-up period.

Comparison between general practice attenders and community subjects with emotional distress (as measured by GHQ–12) showed that women from a general practice sample reported more social problems than those from the community. In both men and women, problems with their spouse or partner were far more likely among general practice attenders than among community probands. Furthermore, women who consulted the general practitioners could count less often on the availability of friend confidants and had more well-defined physical disorder than their community counterparts. Results from a logistic regression analysis showed that in women (but not in men) problems in the relationship with spouse or partner increased the probability of being a general practice attender more than twofold. Physical health status did not exert a significant effect either in men or in women.

The paper explores the reliability, concurrent validity and overlap of some positive/negative symptom rating scales and typological criteria in 100 schizophrenic patients. Rating scales include Andreasen's Scales for the Assessment of Positive and Negative Symptoms, Abrams and Taylor's Scale for Emotional Blunting, and Kay's Positive and Negative Syndrome Scale. Criteria for categorizing individual patients include Andreasen's and Kay's criteria for positive and negative types of schizophrenia as well as Carpenter's criteria for the deficit syndrome. The correlations among positive as well as among negative scales were high. The agreement among criteria tended to be lower. Both positive scales showed low internal consistency. Kay's negative scale had the greatest internal consistency, which suggests that it is measuring a homogeneous syndrome. All negative symptom scales and categorical syndromes identified a group of patients who were single and exhibited schizoid or schizotypal pre-morbid personality disorders, poor premorbid sexual/social adjustment, poor response to neuroleptics and poor prognosis.

Non-response of the autonomic orienting response (OR), as indexed jointly by deficient skin conductance (SCR) and finger pulse amplitude responding (FPAR), has been shown to occur with excessive frequency in the schizophrenic population. The present study is an attempt to replicate earlier evidence that SCR-OR and FPAR-OR, when measured in concert, could distinguish schizophrenic from depressed patients (Bernstein et al. 1988). This issue is critical of the question of diagnostic specificity of OR non-responding, since reduced SCR has been found repeatedly in depression as well as in schizophrenia. We examined SCR and FPAR concurrently in 69 schizophrenic, 45 depressed, and 67 normal subjects. SCR non-responding was more frequent in both schizophrenics and depressives than in normal controls, while only the schizophrenics displayed excessive FPAR non-responding. Moreover, among SCR non-responders, concordant OR non-responding — defined as non-responding indexed simultaneously in both the SCR and FPAR components — was most common in the schizophrenic sample. These findings support our previous conclusion that OR non-responding in depression, may have distinct peripheral origins. Our results also suggest that measuring multiple biochemically distinct components of the OR may be more sound methodologically than obtaining a single channel recording.

Two previous epidemiological studies of autistic twins suggested that autism was predominantly genetically determined, although the findings with regard to a broader phenotype of cognitive, and possibly social, abnormalities were contradictory. Obstetric and perinatal hazards were also invoked as environmentally determined aetiological factors. The first British twin sample has been re-examined and a second total population sample of autistic twins recruited. In the combined sample 60% of monozygotic (MZ) pairs were concordant for autism versus no dizygotic (DZ) pairs; 92% of MZ pairs were concordant for a broader spectrum of related cognitive or social abnormalities versus 10% of DZ pairs. The findings indicate that autism is under a high degree of genetic control and suggest the involvement of multiple genetic loci. Obstetric hazards usually appear to be consequences of genetically influenced abnormal development, rather than independent aetiological factors. Few new cases had possible medical aetiologies, refuting claims that recognized disorders are common aetiological influences.

The Stroop Colour-Word Test (SCWT) and the Verbal Fluency Test (VFT), two tests that have been suggested to be particularly sensitive to prefrontal dysfunction, were administered to 23 severely depressed in-patients. Both tests were impaired in patients at inclusion, but only verbal fluency normalized with successful treatment of depression. VFT impairment is consistent with the hypothesis of a left prefrontal cortex dysfunction in depression. Moreover, the persistence of an impaired performance on SCWT in patients at discharge suggests that a selective attention deficit may persist in patients beyond a clear clinical improvement.

A series of depressed probands and their first-degree relatives were categorized as follows: (a) currently depressed; (b) recovered depressed; and (c) never-ill relatives. Their scores on a subscaled version of the Dysfunctional Attitude Scale (the DAS-24) were compared. The DAS total scores mirrored previous findings in that the total scores for recovered individuals returned to normal or near-normal levels. However, the dependency subscale scores remained elevated for the recovered depressed group. It is proposed that these results support the conclusion that self-report measures of cognitive vulnerability should focus on specific rather than global effects, if progress is to be made in the search for true vulnerability factors.

This paper discusses minor psychiatric morbidity in the community and its relation to help-seeking. The research is aimed at identifying the demographic and social characteristics that enhance the likelihood of minor psychiatric morbidity, as measured by the General Health Questionnaire, and to reveal how these determinants relate to health status. In the second stage of the study, the same characteristics are related to their effect on the decision to consult a general practitioner and, more specifically, on presenting psycho-social problems to the GP. At the population level, the likelihood of a high GHQ score was greater for women, divorced persons and the unemployed, other variables remaining equal. However, GHQ score was contaminated by poor subjective health perception, especially for unemployed persons. Chronic physical illness did not have an independent effect on the GHQ score. Chronic physical illness did influence help-seeking. In addition, several socio-demographic characteristics showed an independent effect on consulting behaviour for both GHQ-positive and GHQ-negative patients. Women, unemployed persons and publicly insured patients with a minor psychiatric disturbance were more apt to visit their GP, regardless of their physical health status. However, no socio-demographic characteristics increased the likelihood that a GHQ-positive patient would present unambiguous psycho-social complaints as a reason to see their doctor.

Criteria for the diagnosis of ICD-10 Mild Cognitive Disorder (MCD) were applied to a sample of 897 community dwelling elderly participants. Criterion A (the presence of a physical disorder) was met by 44%, Criterion B (report of a cognitive disorder) by 17%, Criterion C (an abnormality in quantified cognitive assessments) by 60%, and Criterion D (exclusion on basis of dementia and other conditions) by 74%. A total of 36 cases (4%) met all four criteria. Correlations between Criteria A and B, and B and C were weak (r = 0·18), and the correlation between Criteria A and C was almost zero (r = 0·02). This suggests that no syndrome exists. Membership of MCD was predicted by a report that memory or intelligence interfered with daily life but not by performance on cognitive tests or by a report of physical illness. Cases of MCD had higher anxiety, depression and neuroticism scores than normal elderly, but did not differ substantially on tests of cognitive functioning. These findings call into question the validity of the ICD-10 diagnosis of MCD.

We sought studies which have attempted to test whether memories of childhood sexual abuse can be repressed. Despite our broad search criteria, which excluded only unsystematic anecdotal reports, we found only four applicable studies. We then examined these studies to assess whether the investigators: (1) presented confirmatory evidence that abuse had actually occurred; and (2) demonstrated that their subjects had actually developed amnesia for the abuse. None of the four studies provided both clear confirmation of trauma and adequate documentation of amnesia in their subjects. Thus, present clinical evidence is insufficient to permit the conclusion that individuals can repress memories of childhood sexual abuse. This finding is surprising, since many writers have implied that hundreds of thousands, or even millions of persons harbour such repressed memories. In view of the widespread recent public and scientific interest in the areas of trauma and memory, it is important to investigate further whether memories of sexual abuse can be repressed.

The psychological outcome for a random community sample of women who had experienced significant childhood sexual abuse was assessed, using two outcome measures: (i) psychiatric morbidity (measured with the short PSE); (ii) self-esteem. Sexual abused women with a good outcome, i.e. who were not a PSE ‘case’ or who had high self-esteem were compared with abused women with a poor outcome. This paper describes the post-abuse factors that modified the two outcomes.

In general, a range of variables, all correlated with each other in a complex manner, distinguished good outcome subjects from poor outcome subjects. Post-abuse adolescent variables included family factors (poor mother–father and parent–child relationships), high school factors (poor academic, sporting and social performance) and early pregnancy. Women who had a good adolescent relationship with their father did better than expected statistically. Sport emerged as an alternative at secondary school to academic achievement in catalysing a good psychological outcome.

Adult factors included the quality of relationship with partner, which was associated with a good outcome on both measures. Current paid employment was linked to high self-esteem but not to lowered psychiatric morbidity, while the converse applied for high socio-economic status. These findings imply that different processes operate for each outcome measure.

A clear recognition by the school of childhood sexual abuse may help to provide the opportunity for the girl to experience success in some arena; this in turn may protect her against the likely adult consequences of low self-esteem and increased psychiatric morbidity.

The clinical course and outcome of anorexia nervosa are presented in a 10-year followup study of 76 severely ill females with anorexia nervosa who met specific diagnostic criteria and had participated in a well-documented hospital treatment study. Information was obtained on 100% of the subjects. A comprehensive assessment was made in 93% of the living subjects in specific categories of weight, eating and weight control behaviours, menstrual function, anorexic attitudes, and psychological, sexual, social and vocational adjustment. Five subjects had died, which gives a crude mortality rate of 6·6%. Standardized mortality rates demonstrated an almost 13-fold increase in mortality in the anorexia nervosa subjects. Only eighteen (23·7%) were fully recovered. Sixty-four per cent developed binge-eating at some time during their illness, 57% at least weekly. Twenty-nine (41%) were still bulimic at follow-up. The high frequency and chronicity of the bulimic symptoms plus the high rate of weight relapse (42% during the first year after hospital treatment) suggest that intensive intervention is needed to help anorexics restore and maintain their weight within a normal range and to decrease abnormal eating and weight control behaviours.

One hundred and eighteen subjects with an admission diagnosis of schizophrenia were reassessed after 12 months to establish whether hospital readmission had occurred. All subjects were rated at baseline and after 12 months on the Life Skills Profile (LSP), a 39-item measure of disability, with scores demonstrating moderate stability. The baseline LSP score was a significant predictor of readmission, both in univariate and multivariate analyses. By contrast, several univariate variables (e.g. unemployment and non-compliance with medication over the review period) did not maintain their predictive capacity in multivariate analyses, suggesting that they were manifestations or consequences of significant disability, rather than independent contributors to poor outcome.

In this study we assessed the accuracy of the General Health Questionnaire in detecting psychiatric disorders in general medical out-patients. A total of 290 newly referred patients were interviewed with the Present State Examination. Prior to the interview, 112 patients completed the full GHQ-60, 100 completed the GHQ-30 and 78 completed the GHQ-12. Data from the first group were used to study the full GHQ-60, together with the GHQ-30 and and GHQ-12, when disembedded from the full questionnaire. In a comparison between the disembedded and the separate versions of the GHQ-30 and GHQ-12 we observed considerable variation in the cut-off scores where a certain sensitivity and specificity was attained. In ROC-analysis, the versions were not materially different in their discriminatory capacity (area under the curve). The use of different criteria to define a ‘case’ demonstrated that case severity was another source of increasing cut-off scores. Our data demonstrate that the use of disembedded or separate versions of the questionnaire, together with variation in the case criteria can be a major explanation for variation in cut-off scores that was observed in previous studies.

Factors associated with reduced survival were investigated in elderly people diagnosed as having Alzheimer's disease (AD) and in those free of dementia at diagnosis. The study population comprised 155 people free of dementia and 222 with AD; all were aged 75 years and over and were part of a two-stage prevalence study of dementia during 1988 in Melton Mowbray, Leicestershire. An increased risk of death was found for those with a history of heavy alcohol use, lower cognitive function, a history of heart failure and those in institutional care, these factors acting in the same manner for persons free of dementia and those with AD. For the non-demented group a greater risk of death was found with increasing age and for those with a history of cancer. A greater risk of death was found for males with AD compared to females with the risk increasing over time. The longer survival of women over men may explain the sex differences found in the prevalence of AD without accompanying differences in incidence.

During the 14 years between the beginning of academic year 1976–7 and the end of academic year 1989–90, 216 Oxford University students (119 females and 97 males) were referred to the general hospital in Oxford because of suicide attempts (254 in all). The rate of attempted suicide during university term-time (106/100000) was lower than in other young people of similar age in Oxford City (164/100000). The difference was particularly marked in females (178/100000 v. 269/100000). The lower rate in the students may in part reflect their generally higher socio-economic status. Very few of the attempts by the students appeared to be failed suicides. The most frequent problems faced by the students at the time of their attempts were interpersonal, especially difficulties regarding partners, followed by academic problems. The latter were usually problems with ongoing course work rather than with the Finals examinations. Approximately a quarter of the students had psychiatric problems, with personality disorders and depression being most common. At least 30% had a history of previous attempts. Suggestions are made concerning measures for improving the management and prevention of attempted suicide by students.

The validity of a recently developed measure of disease severity, the End-stage Renal Disease Severity Index (Craven et al. 1991) was examined in haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients (total N = 82). Scores on the ESRD Severity Index were compared with three commonly identified components of disease severity: physiological indices of severity, functional status, and psychological burden of illness. For the entire group of subjects, scores on the ESRD Severity Index were negatively associated with functional ability and positively related to physiological severity. ESRD Severity Index scores showed a weaker relationship with psychological burden of illness which depended in part on treatment mode. Disease severity scores were positively related to depression in CAPD patients but not in HD patients. These findings suggest that the ESRD Severity Index is a valuable research tool with construct validity.