International Journal of Social Psychiatry

Social anthropology has proposed that social institutions and psychological reactions may at times be alternative ways of dealing with similar situations; and that at a high level of generality, they may be conceived of as variants of similar (psycho-social) phenomena. Response to sudden bereavement in Albanian Kosova may follow two routes: the customary law arguing stoicism but retribution, and the psychological idiom of `trauma' recently introduced by Western European aid agencies. Similarities and differences between what at first appear two quite distinct responses are outlined.

Background: Some countries, mainly in North America and Europe, have adopted psychiatric wards in the general hospital as an alternative to the classic psychiatric hospital. In Brazil there are 6, 169 general hospitals, 1.3% of which with a psychiatric unit. This service strategy is scarcely developed in the country and comprises only 4% of all psychiatric admissions. There was no information on the facilities and functioning of the psychiatric units in general hospitals.

Objective: To determine the main characteristics of psychiatric units in Brazilian general hospitals and to assess the current trends in the services provided.

Method: A mailing survey assessed all 94 Brazilian general hospitals which made psychiatric admissions. A two-page questionnaire was designed to determine the main characteristics of each institution and of the psychiatric unit.

Results: Seventy-nine (84%) questionnaires were returned. In contrast to the 1970s and 1980s, in the last decade the installation of psychiatric units has spread to smaller philanthropic institutions that are not linked to medical schools. A fifth of hospitals admit psychiatric patients to medical wards because there is no specialist psychiatric ward. They try to meet all the local emergency demands, usually alcohol-dependent patients who need short term admission. This could signal the beginning of a program through which mental health professionals may become an integral part of general health services.

Conclusion: The inauguration of psychiatric wards in philanthropic hospitals, as well as the admission of psychiatric patients in their medical wards, is a phenomenon peculiar to this decade. The installation of psychiatric services in these and other general hospitals would overcome two of major difficulties encountered: prejudice and a lack of financial resources.

Background: Research from across the world has shown that rates of seasonal mood disturbances may vary according to such factors as geographical location, age and gender. Little is known of the nature of these problems within representative community samples in UK and Ireland.

Aims: In two studies we examined the extent to which winter disrupts mood and behaviour among random samples of British and Irish adults.

Methods: In the first study, 533 adults randomly chosen from electoral data from four towns spread across 50-58°N completed the Seasonal Pattern Assessment Questionnaire (SPAQ). In the second study, 498 adults from two towns in Northern Ireland (54°N) completed the SPAQ.

Results: Although the combined response rate across the two studies was low (20.5%), the prevalence rates were similar to several other western European sites. The rate of SAD and S-SAD averaged across the six centres as determined from strict SPAQ criteria, was 6.7% and 10.5% respectively. There was some variability in rates from town to town, with one Northern Irish town presenting rates more associated with areas at much lower latitudes, although most differences between towns were not significant. As in most other studies, females of reproductive age tended to supply the higher number of incidences.

Conclusion: This report from community samples across six sites confirms earlier suggestions that rates of seasonal disturbance in mood and behaviour deserve serious consideration by mental health practitioners throughout the region.

Background: Unstable family environment during childhood is known to predispose to juvenile delinquency.

Aims: This study explored whether childhood family structure is associated with violent behaviour of adult offspring.

Methods: We used a large, unselected general population birth cohort (n = 5589 males) linked with the national crime registers (up to the age of 32 years). The Ministry of Justice provided information on registered offences for all subjects. A logistic regression analysis was performed to examine the association between family type and criminality (violent and non-violent crimes).

Results: We found that single-parent family “at birth” (adj. OR 3.6, 95% CI 1.8-7.0) and “all time” (up to the age of 14 years) (adj. OR 5.2, 95% CI 2.5-10.6) were risk factors for violent offences of an adult offspring. Also parental death (adj. OR 2.2, 95% CI 1.3-3.6) and divorce (adj. OR 2.5, 95% CI 1.6-3.7) doubled the risk for violence. Non-violent offences were associated only with parental death and divorce.

Conclusions: A single-parent family of origin is strongly associated with later violent criminality of male offspring. Further studies are needed to explore the psychosocial aspects of single-parent family environment which may promote the vulnerability to violent offending in adulthood.

Background: The millennium posed an unknown challenge to mental health services worldwide. In anticipation, contingencies were implemented in preparation for the unexpected impact on psychiatric morbidity.

Results: This study evaluates the impact of the millennium on psychiatric emergency service utilization in the Northern and Southern hemispheres the UK, Nigeria and Australia. Findings did not demonstrate a notable “millennium effect” on mental health services. A number of patients presented psychopathology incorporating millennium themes. A post-Christmas and post-New Year increase in presentation was observed.

Conclusion: There was no change in service needs.

Background: The present study was conducted to compare the influence of culture and immediate environment on the phenomenology of schizophrenic symptoms by examining the actual content of delusions and hallucinations in three groups of schizophrenic patients.

Method: Pakistanis living in Britain (BP; N = 53), Pakistanis in Pakistan (PP; N = 98) and British White (BW; N = 50). The content of the patients' delusions and hallucinations was obtained from medical records and key-workers' reports from All-Saints Hospital, Birmingham and two psychiatric units in Lahore. All references to delusions and hallucinations were coded in accordance with the classification scheme developed for the Present State Examination (Wing et al., 1974).

Results: Comparisons indicated greater differences in phenomenology of delusions and hallucinations between the Pakistani pair (BP vs. PP) than between the British groups (BP vs. BW). The findings suggested a stronger influence of the immediate environment on the pathogenesis of delusions and hallucinations.

Conclusions: The results are discussed with reference to the cultural and religious values of the ethnic groups.

Objective: To determine the effect of patient education on patient perspectives and outcome of depression in a sample of Asian women in primary care.

Design: A randomised, clinical trial of “patient education” versus “usual care”.

Setting: A general practice in London, which has a high proportion of Asians.

Subjects: Seventy patients with psychiatric morbidity (a score of 3 or more on the General Health Questionnaire 12) were recruited for the trial.

Outcome measures: Patient's explanatory models of illness (the patient's perspective on depression; recognition of depression as illness and recommend a medical intervention for this condition) and psychiatric morbidity at follow-up after two months were the primary outcome measures.

Results: One hundred and fifty-five women of Asian decent were contacted. One hundred and forty-eight (95.5%) agreed to take part in the study. Seventy (47.3%) were classed as cases of common mental disorder using the General Health Questionnaire 12. Thirty-five were randomly allocated to receive education about the nature, causes, prevalence and treatment of depression, 35 did not receive such information. There were no statistical differences between the two groups on baseline characteristics. Sixty-six (94.3%) subjects were followed up at two months. An intention to treat analysis showed that there was no difference in explanatory model measures between the two groups at the end of the study. However, more patients who received education were no longer cases (a score of 2 or less on the GHQ) (15/35; 42.9%) compared to controls (7/35; 20%) (p < 0.05) as did those with lower GHQ scores at entry (p < 0.03). Receipt of educational intervention (OR 3.4; 95% CI 1.01, 11.5) and lower GHQ scores at entry (OR 7.1; 95% CI 1.05, 30.2) remained significantly associated with recovery after adjusting for baseline variables using logistic regression.

Conclusions: Patients with common mental disorders, especially those with milder forms of the condition, who received the educational material had a higher recovery rate than patients who do not receive such education. The mechanism for this improvement was unclear, not being reflected in patient's apparent understanding of depression nor explained by change in general practitioner's response. The results of this study need to be replicated.

Background: Relatives often experience considerable problems looking after a family member with severe mental illness. The problems arising from verbal and physical abuse are not well researched or acknowledged.

Aims: To examine the frequency with which family carers experienced verbal and physical abuse from relatives who were being looked after by a community mental health service and to identify the correlates and consequences of that abuse.

Method: Interviews with all the clients of a community mental health service in suburban Melbourne who had regular contact with a family carer together with interviews with the carers.

Results: One hundred and one clients and their family carers were interviewed. Supporting a previous study of patients on an acute admission ward, the experiences of verbal and physical abuse were positively correlated. Higher rates of abuse were associated with poor relationships between patients and their families and a history of poly-drug misuse and previous criminal offences on the part of the patient. Relatives experiencing higher levels of abuse were more likely to have symptoms of emotional distress and were rated as experiencing more burden.

Conclusions: Verbal and physical abuse are not infrequent problems facing family members caring for a relative with severe mental illness. Some of the risk factors for such abuse can be identified. Care plans for family carers could usefully target risk reduction strategies to minimise the occurrence of abuse.

Background: Rehabilitation can be carried out at various sites.

Method: Two groups of patients with severe mental disorders were compared: those included in community rehabilitation service and those only attending an outpatient clinic regarding their clinical status, social functioning, standard of living and quality of life.

Results: We found no significant global differences in group characteristics, social functioning and clinical status, but we did prove the lower social status of the group included in the rehabilitation service and their satisfaction with the services they use.

Conclusions: The community rehabilitation services in Slovenia are coping with existential social needs of their users but this study failed to demonstrate their success in improving health or social functioning.