International Journal of Social Psychiatry

Background: Recent studies show that self-reported psychotic-like experiences in general population samples are quite common and on a continuum with psychotic symptoms in clinical samples. However, most evidence comes from western settings and there is a dearth of research in developing countries. Examination of these experiences across different cultures adds to their validity.

Aims: To assess psychotic-like ideations and its association with poor mental health in a group of young normal individuals in Iran.

Methods: A total of 150 medical students with no history of a psychiatric disorder completed the Peters et al. Delusions Inventory (PDI-40) and the General Health Questionnaire (GHQ-28). Psychotic-like ideations were rated on the basis of their presence, as well as their levels of distress, preoccupation and conviction (PDI sub-scores).

Results: On average, 9.4 psychotic-like ideations were reported by the subjects (range 0—28). More frequent psychotic-like ideations and higher distress and preoccupation associated with these ideations were correlated with poor mental health as assessed by the GHQ.

Conclusion: Frequency of psychotic-like ideation and its dimensions, as well as its association with poor mental health, were comparable to the studies on healthy subjects conducted in Europe.

Background: Somatoform disorders can be understood to mimic supposedly more `legitimate' physical disorders. To the extent that mental disorders are now also often considered legitimate, might clinicians expect to encounter the psychiatric equivalent of somatoform disorders, `psychiatriform disorders'?

Method: The relevant literature on somatoform disorders is reviewed in light of the tendency for mental and physical symptoms to co-occur.

Discussion: Illness attribution and behaviour may explain some of the recent rise in the prevalence of mental disorder. Hypotheses regarding the cause and nature of somatoform disorders are applied to their proposed psychiatric equivalent. Despite lack of current recognition, there is a strong theoretical basis for the existence of psychiatriform disorders. Psychiatriform disorders can be expected to have similar causes, comorbidity, and response to treatment, as somatoform disorders. A variety of cultural forces may be contributing to a rise in prevalence.

Conclusion: As with somatoform disorders, psychiatriform disorders present problems in their distinction from conscious fabrication and from the `legitimate' disorders they mimic. Given their likely prevalence and associated impairments, psychiatriform disorders warrant further examination, despite the methodological difficulties this presents.

Background: Health professionals frequently exhibit negative attitudes toward people with mental disorders. It is not known whether stigmatising attitudes among pharmacy students predict less positive attitudes toward consumer participation in decision-making about medications.

Aims: (1) To assess the attitudes of pharmacy students toward people with schizophrenia, and (2) to determine whether stigma predicts less positive attitudes toward concordant medication counselling.

Method: All pharmacy students enrolled in a five-year degree program were invited to participate. Students completed the seven-item Social Distance Scale, six items related to stereotypical attributes of people with schizophrenia and the 14-item Leeds Attitudes Toward Concordance Scale.

Results: Completed survey instruments were received from 157 students (94% response rate). Previous employment in a pharmacy and personal experience of a mental disorder were associated with low social distance. Later year of study, believing that people with schizophrenia are difficult to talk to, and believing people with schizophrenia have themselves to blame were predictive of high social distance. Low social distance and later year of study were associated with positive attitudes toward providing concordant medication counselling.

Conclusion: Mental health stigma was common and predictive of less positive attitudes toward consumer participation in decision-making about medications.

Background: The 34-year-long, Guatemalan war left at least 1,841 persons disabled in the country. The aim of this study was to describe the prevalence of mental disorders in individuals who acquired their disability as a result of the war, and to identify probable risk factors.

Method: A cross-sectional study was conducted of a group of 99 civilians with a disability in Guatemala. Participants were selected from four civilian organizations serving disabled persons in the municipality of Nebaj, Quiche. The diagnostic instrument was the computerized version of the Composite International Diagnostic Instrument 2.1 (CIDI 2.1). Data were collected from 2002 to 2004.

Results: Of the 99 disabled persons who completed the interview, 44 had some type of lifetime psychiatric disorder. Post-traumatic stress disorder (PTSD) was the most prevalent, with 34.34% (34 cases), followed by dysthymia, with 10.10% (10 cases), and depression, with 6.06% (6 cases).

Conclusion: The traumatic events experienced during the conflict caused long-term psychological sequelae in people who were disabled as a result of the war. Increased exposure to traumatic events, being married, physical disability, illiteracy and advanced age were identified as probable risk factors for mental disorders .

Aims: The impact of war trauma on civilians may include, but also extend beyond, post-traumatic stress disorder (PTSD) to include complex sequelae such as those described by the syndrome of Disorders of Extreme Stress Not Otherwise Specified (DESNOS).

Methods: In the present study, 102 civilian war victims were interviewed in Kosovo, assessing traumatic life events, PTSD, DESNOS, and depression.

Results: Full DESNOS rarely occurred (2% prevalence), however, clinically significant DESNOS symptoms of somatization, altered relationships, and altered systems of meaning were reported by between 24—42% of respondents. Although DESNOS symptoms were correlated with PTSD symptoms, DESNOS symptoms were associated with poorer overall psychological functioning, self-evaluations, satisfaction with life, and social support independent of the effects of PTSD.

Conclusion: The findings suggest that DESNOS warrants attention in addition to PTSD in the assessment and treatment of civilians who have been exposed to war and genocide.

Background: The psychosocial climate of inpatient units has proved to be related to both patient satisfaction and outcome.

Aims: The aims of the study were twofold: to study the relationship between patient and staff satisfaction, and to study the relationship between the patients' perception of the treatment environment and the perceived working conditions of the staff.

Method: A total of 129 different patients completed the Ward Atmosphere Scale (WAS) and a General Satisfaction Index (GSI) at 11 time points between 1981 and 2000. Staff members completed the Working Environment Scale-10 (WES-10) and the GSI. Z-scores were calculated to describe the fluctuations in the WAS, WES-10 and the GSI subscale scores.

Results: The study revealed a strong correlation between patient satisfaction and staff satisfaction. Staff satisfaction correlated significantly with the WAS subscales of Practical orientation and Staff control. Furthermore, the study revealed a significant correlation between patient satisfaction and staff members' perception on the WES-10 subscale of Self-realization.

Conclusion: This exploratory study revealed that the working conditions of staff are related to both patient satisfaction and the patients' perceptions of the treatment environment. A satisfactory working environment for psychiatric staff members seems important for the quality of care perceived by patients.

Background: The influence of socio-economic conditions on covariates of depression has received little attention.

Aims: Examine whether prevalence and covariates of depressive symptoms are affected by socio-economic circumstances.

Methods: Participants were 1,499 (86%) residents in Bambuí city, Brazil, aged ->- 60 years. Depressive symptoms were assessed by the GHQ-12 questionnaire and exploratory variables included demographic characteristics, life events, social support, health conditions and health service use. The analysis was stratified by family income (< US$240.00 [lowest tertile] vs. ->- US$240.00).

Results: The prevalence of depressive symptoms was higher in those with lower income (43.9%) in comparison with the better off (27.7%). Dissatisfaction with relationships, worse self-rated health and insomnia were independently associated with depressive symptoms in both income groups (OR from 2.00 to 4.74; p < 0.05). Depressive symptoms were associated with number of chronic diseases, functional disability and hospitalizations among the poorer (OR from 1.73 to 2.37; p < 0.05), while old age (OR 2.08) and female gender (OR 2.03) were associated with depressive symptoms among the better off.

Conclusion: This study provides evidence that the prevalence of depressive symptoms and their covariates are influenced by socio-economic conditions in a population with slight income differences.

Aim: To investigate (1) general mental health, (2) quality of life and (3) suicide-related attitudes in Kurds living in Iranian Kurdistan.

Methods: Cross-sectional investigation; cluster random sampling procedure; 1,000 Kurds were randomly selected from 1,000 of 68,000 households in Sannandaj City, Iran; General Health Questionnaire (GHQ-12); Questionnaire on Attitudes Towards Suicide (ATTS).

Results: About 27% of the subjects had to be regarded as probably suffering from a psychological disturbance. There was no gender difference regarding the number of `cases'. These possible `cases' were younger than `non-cases'. The most `cases' occurred among the unemployed. An increasing number of experiences related to suicide and the increasing emotional closeness of those experiences was found to be related to an increased probability that the individual would be classified as a `case' according to the GHQ-12 total score. Unmarried individuals more often evaluated their overall quality of life as `moderate' or `bad' compared to married individuals. Unemployed people, self-employed people and housewives formed the groups who most often reported a `very bad' or `bad' quality of life.

Conclusions: Kurdish people in Iran are in need of facilities and interventional programmes aiming to improve general mental health.

Background: In India few studies exist that explore attitudes of mental health professionals, especially psychiatric ward attendants, towards psychiatric illnesses. This study aimed to explore attitudes of psychiatric ward attendants since they work closely with psychiatric patients in the hospital ward, and which may differ given their cultural and social background.

Methods: Five hundred psychiatric ward attendants were targeted and a 100 sample size chosen based on systematic random sampling. A control group from guardians attending the outpatient department of Central Institute of Psychiatry was selected using the same methods. Attitudes of both groups were assessed using Community Attitudes towards Mental Illness (CAMI) after written informed consent.

Results: There were no significant differences noted in Authoritarianism and Benevolence domains of CAMI. However, there were significant differences in the domains of Social Restrictiveness and Community Mental Health Ideology with psychiatric ward attendants scoring higher than the general attendants. Among the socio-demographic variables, there was significant correlation between age, duration of contact and educational background and various domains of CAMI.

Conclusions: Psychiatric ward attendants had more positive attitudes than general attendants towards psychiatric illnesses. Socio-demographic variables like older age, higher education and longer duration of contact with the psychiatrically ill predicted more favourable attitudes.