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IN THIS ISSUE
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- 04 November 2004, pp. 1373-1374
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This issue features an Invited Review on birth cohort studies in psychiatry, and original articles reporting major follow-up studies of psychiatric disorder, studies of depression, genetic studies, factors associated with disorder in the community, and neuropsychology of schizophrenia.
Invited Review
Birth cohort studies in psychiatry: beginning at the beginning
- IAN COLMAN, PETER B. JONES
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- 04 November 2004, pp. 1375-1383
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Longitudinal formulations of psychiatric illness have long been familiar. In the 19th century, Thomas Clouston wrote about developmental insanity in young men, presaging modern views of schizophrenia as having some of its origins or first manifestations in early life (Clouston, 1891; O'Connell et al. 1997). At the same time, Sigmund Freud was creating his system of psychoanalysis to understand hysterical conversion and other aspects of adult psychology as sequelae of early psychological events. Now, within an epidemiological and neuroscientific framework, we are beginning to understand that a variety of psychiatric disorders, including those of later life, such as cognitive decline and dementia may be the final common pathway of a long chain of mutable events (Richards et al. 2004). Just as in clinical neurology, where one is taught to place the causal lesion as high as possible so, too, in psychiatry we should look for the seeds of causality earlier rather than later in life.
Research Article
The Nottingham Study of Neurotic Disorder: predictors of 12-year outcome of dysthymic, panic and generalized anxiety disorder
- PETER TYRER, HELEN SEIVEWRIGHT, TONY JOHNSON
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- 04 November 2004, pp. 1385-1394
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Background. Controlled prospective studies of the simultaneous long-term outcome of several mental disorders are rare. This study sought to determine if there were important differences between the outcome of anxiety and depressive disorders after 12 years and to examine their main predictors.
Method. A cohort of 210 people seen in general practice psychiatric clinics with a DSM-III diagnosis of generalized anxiety disorder (71), panic disorder (74), or dysthymic disorder (65), including combined anxiety-depressive disorder (cothymia) (67) was followed up after 12 years. Interview assessments of symptoms, social functioning and outcome were made, the latter using a new scale, the Neurotic Disorder Outcome Scale. Seventeen baseline predictors were also examined.
Results. Data were obtained from 201 (96%) patients, 17 of whom had died. Only 73 (36%) had no DSM diagnosis at the time of follow-up. Using univariate and stepwise multiple linear regression those with cothymia, personality disorder, recurrent episodes and greater baseline self-rated anxiety and depression ratings had a worse outcome than others; initial diagnosis did not contribute significantly to outcome and instability of diagnosis over time was much more common than consistency.
Conclusion. Only two out of five people with the common neurotic disorders have a good outcome despite alleged advances in treatment. Those with greater mood symptoms and pre-morbid personality disorder have the least favourable outcome. It is suggested that greater attention be paid to the concurrent treatment of personality disorder and environmental factors rather than symptoms as these may be the real cause of apparent treatment resistance.
Twelve-year course and outcome of bulimia nervosa
- MANFRED M. FICHTER, NORBERT QUADFLIEG
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- 04 November 2004, pp. 1395-1406
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Background. Since little is known about the long-term course and outcome of bulimia nervosa, the authors designed a 12-year prospective longitudinal study with five cross-sectional assessments based on a large sample of consecutively treated females with bulimia nervosa (purging type) (BN-P).
Method. One hundred and ninety-six females with BN-P were assessed (1) at the beginning of treatment, (2) at the end of treatment, (3) at 2-year follow-up, (4) at 6-year follow-up, and (5) at 12-year follow-up. In self-ratings as well as expert ratings based on interviews we assessed specific eating-disorder and general psychopathology.
Results. The general pattern of results over time showed substantial improvement during treatment, slight (in most cases non-significant) decline during the first two years after the end of treatment, and further improvement and stabilization until 12-year follow-up. At that point the majority of patients (70·1%) showed no major DSM-IV eating disorder, 13·2% had eating disorders not otherwise specified, 10·1% had BN-P and 2% had died. Very few had undergone transition to anorexia nervosa or binge-eating disorders. Logistic regression analyses showed that psychiatric co-morbidity was the best and most stable predictor for eating-disorder outcome at 2, 6 and 12 years.
Conclusions. Course and outcome of BN-P was generally more favourable than for anorexia nervosa.
Personality characteristics of women before and after recovery from an eating disorder
- KELLY L. KLUMP, MICHAEL STROBER, CYNTHIA M. BULIK, LAURA THORNTON, CRAIG JOHNSON, BERNIE DEVLIN, MANFRED M. FICHTER, KATHERINE A. HALMI, ALLAN S. KAPLAN, D. BLAKE WOODSIDE, SCOTT CROW, JAMES MITCHELL, ALESSANDRO ROTONDO, PAMELA K. KEEL, WADE H. BERRETTINI, KATHERINE PLOTNICOV, CHRISTINE POLLICE, LISA R. LILENFELD, WALTER H. KAYE
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- 04 November 2004, pp. 1407-1418
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Background. Previous studies of personality characteristics in women with eating disorders primarily have focused on women who are acutely ill. This study compares personality characteristics among women who are ill with eating disorders, recovered from eating disorders, and those without eating or other Axis I disorder pathology.
Method. Female participants were assessed for personality characteristics using the Temperament and Character Inventory (TCI): 122 with anorexia nervosa (AN; 77 ill, 45 recovered), 279 with bulimia nervosa (BN; 194 ill, 85 recovered), 267 with lifetime histories of both anorexia and bulimia nervosa (AN+BN; 194 ill, 73 recovered), 63 with eating disorder not otherwise specified (EDNOS; 31 ill, 32 recovered), and 507 without eating or Axis I disorder pathology.
Results. Women ill with all types of eating disorders exhibited several TCI score differences from control women, particularly in the areas of novelty-seeking, harm avoidance, self-directedness, and cooperativeness. Interestingly, women recovered from eating disorders reported higher levels of harm avoidance and lower self-directedness and cooperativeness scores than did normal control women.
Conclusions. Women with eating disorders in both the ill and recovered state show higher levels of harm avoidance and lower self-directedness and cooperativeness scores than normal control women. Although findings suggest that disturbances may be trait-related and contribute to the disorders' pathogenesis, additional research with more representative community controls, rather than our pre-screened, normal controls, is needed to confirm these impressions.
Psychological health of Australian veterans of the 1991 Gulf War: an assessment using the SF-12, GHQ-12 and PCL-S
- D. P. McKENZIE, J. F. IKIN, A. C. McFARLANE, M. CREAMER, A. B. FORBES, H. L. KELSALL, D. C. GLASS, P. ITTAK, M. R. SIM
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- 04 November 2004, pp. 1419-1430
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Background. Elevated rates of psychological morbidity and symptomatology have been widely reported in 1991 Gulf War veterans. The present study used brief self-report instruments to compare the psychological health of Australian Gulf War veterans with that of a randomly sampled military comparison group.
Method. The 12-item Short Form Health Survey (SF-12), 12-item General Health Questionnaire (GHQ-12), Posttraumatic Stress Disorder Checklist – Specific (PCL-S) and Military Service Experience (MSE) questionnaire were administered to 1424 male Australian Gulf War veterans and 1548 male Australian Defence Force members who were operational at the time of the Gulf War conflict, but were not deployed there.
Results. The Gulf War veterans exhibited poorer psychological health, as measured by the above three instruments, than the comparison group members. For Gulf War veterans, the number of stressful experiences, as measured by the MSE questionnaire, was correlated with scores on the three instruments. SF-12 mental health component summary scores and PCL-S caseness, but not GHQ-12 caseness, differed significantly between Gulf War veterans and comparison group members who had been on at least one active deployment.
Conclusions. More than a decade after the 1991 Gulf War, Australian Gulf War veterans are exhibiting higher levels of current (past month) psychological ill-health, as measured using the GHQ-12 and PCL-S, as well as lower mental health status, as measured by the SF-12, than the comparison group. Although not a replacement for formal psychiatric diagnosis, instruments such as those above may aid in the assessment of veterans' psychological health.
Anxiety and depression in parents 4–9 years after the loss of a child owing to a malignancy: a population-based follow-up
- ULRIKA KREICBERGS, UNNUR VALDIMARSDÓTTIR, ERIK ONELÖV, JAN-INGE HENTER, GUNNAR STEINECK
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- 04 November 2004, pp. 1431-1441
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Background. Some consider the loss of a child as the most stressful life event. When the death is caused by a malignancy, the parents are commonly exposed not only to their own loss, but also to the protracted physical and emotional suffering of the child. We investigated parental risk of anxiety and depression 4–9 years after the loss of a child owing to a malignancy.
Method. In 2001, we attempted to contact all parents in Sweden who had lost a child due to a malignancy during 1992–1997. We used an anonymous postal questionnaire and utilized a control group of non-bereaved parents with a living child.
Results. Participation among bereaved parents was 449/561 (80%); among non-bereaved 457/659 (69%). We found an increased risk of anxiety (relative risk 1·5, 95% confidence interval 1·1–1·9) and depression (relative risk 1·4, 95% confidence interval 1·1–1·7) among bereaved parents compared with non-bereaved. The risk of anxiety and depression was higher in the period 4–6 years after bereavement than in the 7–9 years period, during which the average excess risks approached zero. Psychological distress was overall higher among bereaved mothers and loss of a child aged 9 years or older implied an increased risk, particularly for fathers.
Conclusions. Psychological morbidity in bereaved parents decreases to levels similar to those among non-bereaved parents 7–9 years after the loss. Bereaved mothers and parents who lose a child 9 years or older have on average an excess risk for long-term psychological distress.
Co-morbidity and stability of melancholic features in DSM-IV major depressive disorder
- TARJA MELARTIN, ULLA LESKELÄ, HEIKKI RYTSÄLÄ, PETTERI SOKERO, PAULA LESTELÄ-MIELONEN, ERKKI ISOMETSÄ
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- 04 November 2004, pp. 1443-1452
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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.
Impaired divided attention predicts delayed response and risk to relapse in subjects with depressive disorders
- M. MAJER, M. ISING, H. KÜNZEL, E. B. BINDER, F. HOLSBOER, S. MODELL, J. ZIHL
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- 04 November 2004, pp. 1453-1463
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Background. This study addresses the complex relationship between cognitive function and the course of depression.
Method. A sample of patients (n=73) in a depressive episode (major depression or bipolar disorder) was tested with a comprehensive battery of attention and executive tasks at both admission and discharge. In addition, response to pharmacological treatment and remission was assessed with standardized rating scales. Nineteen patients, recovered from depression, were re-investigated 6 months after discharge to determine whether specific cognitive parameters were related to subsequent relapse.
Results. On admission, patients were impaired in almost all cognitive tasks. At discharge, we found a significant reduction in psychopathology, but only marginal cognitive improvements. Non-responders after 4 weeks of antidepressive medication and subjects who did not achieve remission prior to discharge were specifically impaired in divided attention on admission (p<0·05). In addition, a trend was found for the association between impaired divided attention at discharge and an elevated risk to relapse (p<0·10).
Conclusions. We observed generalized cognitive impairment in most cognitive domains in acute depression. Cognitive impairments were still within abnormal ranges at discharge but less distinct. Divided attention performance predicted response to treatment, remission of symptoms, and risk to relapse. Impaired divided attention capacity can be explained either by reduced attentional resources or impaired activation and/or top-down control of attentional resources by the central executive.
Asthma and depressive and anxiety disorders among young persons in the community
- RENEE D. GOODWIN, DAVID M. FERGUSSON, L. JOHN HORWOOD
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- 04 November 2004, pp. 1465-1474
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Background. The objectives of the study were to examine linkages between asthma and depressive and anxiety disorders in a birth cohort of over 1000 young persons studied to the age of 21 years. Specifically, the study aimed to ascertain the extent to which associations between asthma and depressive and anxiety disorders could be explained by non-observed fixed confounding factors.
Method. Asthma and depressive and anxiety disorders were measured prospectively over the course of a 21-year longitudinal study. Fixed effects logistic regression models were used to determine the relationship between asthma and depressive and anxiety disorders, adjusting for potentially confounding factors.
Results. Asthma in adolescence and young adulthood was associated with increased likelihood of major depression (OR 1·7, 95% CI 1·3–2·3), panic attacks (OR 1·9, 95% CI 1·3–2·8), and any anxiety disorder (OR 1·6, 95% CI 1·2–2·2). Associations between asthma and depressive and anxiety disorders were adjusted for confounding factors using a fixed effects regression model which showed that, after control for fixed confounding factors, asthma was no longer significantly related to major depression (OR 1·1), panic attacks (OR 1·1), or any anxiety disorder (OR 1·2). Additional post hoc analyses suggested that exposure to childhood adversity or unexamined familial factors may account for some of the co-morbidity of asthma and depressive and anxiety disorders.
Conclusions. These results confirm and extend previous findings by documenting elevated rates of depressive and anxiety disorders among young adults with asthma, compared with their counterparts without asthma, in the community. The weight of the evidence from this study suggests that associations between asthma and depressive and anxiety symptoms may reflect effects of common factors associated with both asthma and depressive and anxiety disorders, rather than a direct causal link. Future research is needed to identify the specific factors underlying these associations.
Childhood sexual abuse, stressful life events and risk for major depression in women
- KENNETH S. KENDLER, JONATHAN W. KUHN, CAROL A. PRESCOTT
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- 04 November 2004, pp. 1475-1482
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Background. In animals, early trauma can produce long-lasting changes in sensitivity to the pathogenic effects of stress. To explore whether similar processes occur in humans, we examine whether childhood sexual abuse (CSA) in women alters sensitivity in adulthood to the depressogenic effects of stressful life events (SLEs).
Method. A history of CSA was obtained from a population-based sample of 1404 female adult twins. Cox Proportional hazard models were used to predict onsets of episodes of DSM-III-R major depression (MD) in the past year from previously assessed levels of neuroticism (N), CSA and past-year SLEs scored on long-term contextual threat.
Results. In the best-fit model, onset of MD was predicted by CSA, SLEs and N. Individuals with CSA (and especially with severe CSA) had both an overall increased risk for MD and a substantially increased sensitivity to the depressogenic effects of SLEs. A ‘dose–response’ relationship between severity of CSA and sensitivity to SLEs was clearer in those with low to average levels of N than in those with high levels of N.
Conclusion. As documented with physiological responses to a standardized laboratory stressor, CSA increases stress sensitivity in women in a more naturalistic setting. Both genetic and early environmental risk factors can produce long-term increase in the sensitivity of individuals to depressogenic life experiences.
Juvenile- versus adult-onset depression: multiple differences imply different pathways
- JONATHAN HILL, ANDREW PICKLES, LYNN ROLLINSON, RACHEL DAVIES, MARIE BYATT
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- 04 November 2004, pp. 1483-1493
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Background. Several sources of heterogeneity in major depression have been identified. These include age of onset, presence of co-morbid disorders, and history of childhood sexual abuse. This study examined these factors in the context of the contrast between onset of depression in young women before and after age 16.
Method. Sampling was carried out in two phases. In the first, questionnaires were sent to women aged 25–36 in five primary care practices. Second-phase subjects for interview (n=197) were drawn from three strata defined on the basis of childhood adversities. Interviews conducted and rated independently assessed (1) recalled childhood experiences, psychopathology and parental psychiatric disorder, and (2) adult personality functioning and adult lifetime psychopathology. Frequencies of predictor and response variables, effect estimates and their confidence intervals were weighted back to the general population questionnaire sample.
Results. Compared with adult-onset depression, juvenile-onset adult depression was associated with co-morbid childhood psychopathology and peer problems, poor parental care, and childhood sexual abuse involving actual or attempted intercourse; in adult life there were higher levels of co-morbid psychiatric disorders, and personality dysfunction. The adult-onset depression group was characterized by a history of contact childhood sexual abuse without actual or attempted intercourse, and to a lesser extent, poor parental care.
Conclusions. The juvenile- versus adult-onset distinction appears to be important to heterogeneity in adult depression, implicating different individual and environmental factors during childhood, and different mechanisms in adult life.
Memory complaints in a community sample aged 60–64 years: associations with cognitive functioning, psychiatric symptoms, medical conditions, APOE genotype, hippocampus and amygdala volumes, and white-matter hyperintensities
- A. F. JORM, P. BUTTERWORTH, K. J. ANSTEY, H. CHRISTENSEN, S. EASTEAL, J. MALLER, K. A. MATHER, R. I. TURAKULOV, W. WEN, P. SACHDEV
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- 04 November 2004, pp. 1495-1506
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Background. Previous research has found that depression is a major cause of memory complaints. However, there is evidence that memory complaints also weakly predict cognitive decline and dementia. The present study examined a range of possible determinants of memory complaints, covering psychiatric and personality factors, medical history, cognitive test performance, and biological risk factors for dementia (APOE genotype, hippocampus and amygdala volumes, and white-matter hyperintensities).
Method. A community survey was carried out with 2546 persons aged 60–64 years living in Canberra and Queanbeyan, Australia. Participants were asked about memory problems which interfered with daily life and whether medical help had been sought. A randomly selected subsample of 476 persons was given a brain MRI scan.
Results. Participants with memory complaints were found to have poorer memory test performance, more depression and anxiety symptoms, have higher scores on personality traits involving negative affect, and to have worse physical health. Multivariate analyses showed that measures of cognitive performance did not make a unique contribution to the prediction of memory complaints above that of the other categories of predictors. Those with memory complaints did not differ on any of the biological risk factors for dementia.
Conclusion. In a community sample aged 60–64 years, memory complaints were most closely related to psychiatric symptoms, personality characteristics and poor physical health. There was no evidence of brain changes indicating early dementia.
Depression in elderly homecare patients: patient versus informant reports
- GAIL J. McAVAY, MARTHA L. BRUCE, PATRICK J. RAUE, ELLEN L. BROWN
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- 04 November 2004, pp. 1507-1517
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Background. This study compares patient and informant reports of depressive disorders in a community sample of elderly medical homecare patients. The associations between specific patterns of agreement/disagreement and other patient and informant characteristics are examined.
Method. A random sample of 355 elderly medical homecare patients and their informants were interviewed using the current mood section of the Structured Clinical Interview for DSM-IV (SCID).
Results. Thirty-seven patients (10·4%) reported a depressive disorder (major or subsyndromal) that was also identified by their informant while 27 (7·6%) patients self-reported depression that the informant did not identify. There were 250 patients (70·4%) who were not depressed according to both patient and informant report and 41 patients (11·5%) were identified as depressed by informant report alone. Patients identified as depressed by informant report alone were similar to patients who self-reported depression on a number of the sociodemographic and clinical correlates of depression, but had significantly poorer performance on items assessing orientation and short-term recall. These patients also had poorer functioning in a number of domains (social, cognitive, and functional) when compared with patients who were not depressed according to both the patient and informant. Finally, patients with younger informants were more likely to be identified as depressed by their informant.
Conclusions. Obtaining informant reports of depression may be a useful method for detecting clinically significant cases of late-life depression that would otherwise be missed when relying only on patient report.
Genetic effects on alcohol dependence risk: re-evaluating the importance of psychiatric and other heritable risk factors
- VALERIE S. KNOPIK, ANDREW C. HEATH, PAMELA A. F. MADDEN, KATHLEEN K. BUCHOLZ, WENDY S. SLUTSKE, ELLIOT C. NELSON, DIXIE STATHAM, JOHN B. WHITFIELD, NICHOLAS G. MARTIN
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- 04 November 2004, pp. 1519-1530
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Background. Genetic influences have been shown to play a major role in determining the risk of alcohol dependence (AD) in both women and men; however, little attention has been directed to identifying the major sources of genetic variation in AD risk.
Method. Diagnostic telephone interview data from young adult Australian twin pairs born between 1964 and 1971 were analyzed. Cox regression models were fitted to interview data from a total of 2708 complete twin pairs (690 MZ female, 485 MZ male, 500 DZ female, 384 DZ male, and 649 DZ female/male pairs). Structural equation models were fitted to determine the extent of residual genetic and environmental influences on AD risk while controlling for effects of sociodemographic and psychiatric predictors on risk.
Results. Risk of AD was increased in males, in Roman Catholics, in those reporting a history of major depression, social anxiety problems, and conduct disorder, or (in females only) a history of suicide attempt and childhood sexual abuse; but was decreased in those reporting Baptist, Methodist, or Orthodox religion, in those who reported weekly church attendance, and in university-educated males. After allowing for the effects of sociodemographic and psychiatric predictors, 47% (95% CI 28–55) of the residual variance in alcoholism risk was attributable to additive genetic effects, 0% (95% CI 0–14) to shared environmental factors, and 53% (95% CI 45–63) to non-shared environmental influences.
Conclusions. Controlling for other risk factors, substantial residual heritability of AD was observed, suggesting that psychiatric and other risk factors play a minor role in the inheritance of AD.
Interaction of genetic risk and adoptive parent communication deviance: longitudinal prediction of adoptee psychiatric disorders
- KARL-ERIK WAHLBERG, LYMAN C. WYNNE, HELINÄ HAKKO, KRISTIAN LÄKSY, JUHA MORING, JOUKO MIETTUNEN, PEKKA TIENARI
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- 04 November 2004, pp. 1531-1541
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Background. In the Finnish Adoptive Family Study of Schizophrenia, adoptee thinking disorders have been shown to be a joint effect of genetic liability for schizophrenia spectrum disorders and adoptive rearing-parent communication patterns. However, longitudinal predictions of clinical psychiatric disorders of the adoptees have not been reported.
Method. Adoptees (n=109) who had no DSM-III-R disorder at initial assessment (median age 18 years) were selected from the total sample of the Finnish Adoption Study of Schizophrenia. They were defined as at high versus low genetic risk based upon the lifetime diagnoses of their biological, adopting-away mothers – schizophrenia spectrum disorder versus no spectrum disorder. At initial assessment, adoptive rearing parents were independently evaluated from tape-recorded Rorschach protocols scored as manifesting either high or low Communication Deviance (CD), a composite index of communication patterns that distract and befuddle listeners. Adoptees were independently re-diagnosed after a median interval of 14 years and followed-up from national registers for an additional 7 years.
Results. The main effects of genetic liability (G) and CD of the adoptive parents (E), each taken separately, predicted significantly for psychiatric disorders of the adoptees as adults. However, when G, E, and their joint interaction effect were entered into the same logistic model, only the interaction effect was significant. The sample included seven adoptees with schizophrenia spectrum disorders, but a separate analysis to predict them was non-significant.
Conclusion. Genetic liability for schizophrenia spectrum disorder and an adoptive family rearing variable interact, predicting longitudinally and significantly to broadly defined adoptee psychiatric disorder.
Common mental disorders and ethnicity in England: the EMPIRIC Study
- SCOTT WEICH, JAMES NAZROO, KERRY SPROSTON, SALLY McMANUS, MARTIN BLANCHARD, BOB ERENS, SAFFRON KARLSEN, MICHAEL KING, KEITH LLOYD, STEPHEN STANSFELD, PETER TYRER
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- 04 November 2004, pp. 1543-1551
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Background. There is little population-based evidence on ethnic variation in the most common mental disorders (CMD), anxiety and depression. We compared the prevalence of CMD among representative samples of White, Irish, Black Caribbean, Bangladeshi, Indian and Pakistani individuals living in England using a standardized clinical interview.
Method. Cross-sectional survey of 4281 adults aged 16–74 years living in private households in England. CMD were assessed using the Revised Clinical Interview Schedule (CIS-R), a standardized clinical interview.
Results. Ethnic differences in the prevalence of CMD were modest, and some variation with age and sex was noted. Compared to White counterparts, the prevalence of CMD was higher to a statistically significant degree among Irish [adjusted rate ratios (RR) 2·09, 95% CI 1·16–2·95, p=0·02] and Pakistani (adjusted RR 2·38, 95% CI 1·25–3·53, p=0·02) men aged 35–54 years, even after adjusting for differences in socio-economic status. Higher rates of CMD were also observed among Indian and Pakistani women aged 55–74 years, compared to White women of similar age. The prevalence of CMD among Bangladeshi women was lower than among White women, although this was restricted to those not interviewed in English. There were no differences in rates between Black Caribbean and White samples.
Conclusions. Middle-aged Irish and Pakistani men, and older Indian and Pakistani women, had significantly higher rates of CMD than their White counterparts. The very low prevalence of CMD among Bangladeshi women contrasted with high levels of socio-economic deprivation among this group. Further study is needed to explore reasons for this variation.
Cohabiting unions, repartnering and mental health
- DAVID J. PEVALIN, JOHN ERMISCH
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- 04 November 2004, pp. 1553-1559
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Background. A considerable body of research has established that transitions out of marriage are generally deleterious for mental health and some have examined transitions out of cohabitation. In this study we depart from these established areas to investigate the effects of poor mental health on the duration and outcome of cohabitations and on the time to, and likelihood of, repartnering after both cohabitation and marriage.
Method. Samples came from the British Household Panel Survey, 1991–2001. These were: (1) 447 cohabiting spells; (2) 5571 paired person-years during cohabitation; (3) 508 spells after cohabitation; (4) 1197 person-year observations within those spells; (5) 869 spells after marriage; and (6) 2736 person-year observations within those spells. Life tables, log-rank tests, multinomial logit and proportional hazard models were used. Mental health was measured by the 12-item General Health Questionnaire.
Results. Poor mental health increased the risk of dissolving a cohabiting union for both men and women. Poor mental health reduced the risk of repartnering after a cohabiting union but had no effect on the risk of repartnering after a marriage. Other factors such as past marital status, age and parental status also had significant effects.
Conclusions. This study provides evidence that poor mental health during a cohabiting union increases the chances of that union dissolving instead of turning into marriage and poorer mental health immediately after a transition out of a cohabiting union is associated with reduced chances of repartnering.
Self-monitoring in patients with schizophrenia
- GÜNTHER KNOBLICH, FRANK STOTTMEISTER, TILO KIRCHER
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- 04 November 2004, pp. 1561-1569
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Background. The present study investigated whether a failure of self-monitoring contributes to core syndromes of schizophrenia.
Method. Three groups of patients with a DSM-IV diagnosis of schizophrenia (n=27), with either prominent paranoid hallucinatory or disorganization syndrome, or without these symptoms, and a matched healthy control group (n=23) drew circles on a writing pad connected to a PC monitor. Subjects were instructed to continuously monitor the relationship between their hand movements and their visual consequences. They were asked to detect gain changes in the mapping. Self-monitoring ability and the ability to automatically correct movements were assessed.
Results. Patients with either paranoid-hallucinatory syndrome or formal thought disorder were selectively impaired in their ability to detect a mismatch between a self-generated movement and its consequences, but not impaired in their ability to automatically compensate for the gain change.
Conclusions. These results support the claim that a failure of self-monitoring may underlie the core symptoms of schizophrenia.
Interpersonal and role-related schema influence the relationship with the dominant ‘voice’ in schizophrenia: a comparison of three models
- MAX BIRCHWOOD, PAUL GILBERT, JEAN GILBERT, PETER TROWER, ALAN MEADEN, JUSTIN HAY, ELEANOR MURRAY, JEREMY N. V. MILES
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- 04 November 2004, pp. 1571-1580
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Background. Auditory hallucinations in psychosis often contain critical evaluations of the voice-hearer (for example, attacks on self-worth). A voice-hearer's experience with their dominant voice is a mirror of their social relationships in general, with experiences of feeling low in rank to both voices and others being associated with depression. However, the direction of the relationship between psychosis, depression and feeling subordinate is unclear.
Method. Covariance structural equation modelling was used with data from 125 participants diagnosed with schizophrenia to compare three ‘causal’ models: (1) that depression leads to the appraisal of low social rank, voice power and distress; (2) that psychotic illness leads to voice activity (frequency, audibility), which in turn leads to depression and the appraisal of voices' power; (3) our hypothesized model, that perceptions of social rank and social power lead to the appraisal of voice power, distress and depression.
Results. Findings supported model 3, suggesting that the appraisal of social power and rank are primary organizing schema underlying the appraisal of voice power, and the distress of voices.
Conclusions. Voices can be seen to operate like external social relationships. Voice content and experience can mirror a person's social sense of being powerless and controlled by others. These findings suggest important new targets for intervention with cognitive and social therapy.