International Journal of Social Psychiatry

Background: In 2008, mental health units in England went smoke-free by law. This study explores inpatients’ experience with a smoke-free policy, their smoking behaviour, dependence, withdrawal and related issues.

Material: Semi-structured interviews in a criterion sample of 15 inpatient smokers.

Discussion: Patients generally approved of the smoke-free policy, provided they could smoke outside. Most participants had changed their smoking behaviour following admission. Most had little knowledge of nicotine dependence, reported a lack of structured support for smoking cessation, and a general interest in this being made available. Nicotine dependence was reportedly lower in the ward than in the home setting.

Conclusions: More structured support is needed to ensure that opportunities for health promotion in a vulnerable population are not being missed.

Background: In epidemiological studies, analyses are needed to investigate the consequences of non-response.

Aims: To analyse the consequences of attrition in the second wave of the population-based PART study, which was performed three years after the first wave.

Methods: Potential determinants for non-participation obtained from population registers and the first wave were analyzed. The relationships between potential determinants and reduced well-being or depressive mood in the first wave questionnaire were investigated separately for participants and non-participants in the second wave. Samples of respondents to the second wave questionnaire with reduced or not reduced well-being were summoned for interview regarding determinants of distress and disorder. The occurrence of potential determinants was compared between participants and non-participants in both groups

Results: Low income, low education, non-Nordic origin, not being married and previous psychiatric diagnosis were associated with lower participation rates. These variables were similarly related to depressive mood and low psychological well-being in the first wave among participants and non-participants in the second wave. Potential determinants were not or only weakly related to participation in the interview groups.

Conclusion: Although the true prevalence of distress and disorder is underestimated, the true associations between potential determinants and the outcomes seem reasonably well reproduced.

Background: Community-based estimates of psychopathology prevalence in developing countries such as Vietnam, are needed to reduce presumed significant burden of poor mental health.

Aims: This study derived population-based prevalence estimates of mental distress, as measured by the SRQ-20, in a community sample of 4,981 adults living in Vietnam. This study also examined correlates of mental distress based on SRQ-20 caseness indications. Risk and protective factors were identified in terms of their unique contribution to caseness.

Results: Using a cut-off of 7/8, 19.2% of the sample was considered to be a probable case (n = 954), with females endorsing more items than males. Marital status and employment status were not associated with mental health distress. Higher wealth, endorsing religious affi liation, and self-reports of good health were associated with lower SRQ-20 scores. Age and being female were associated with higher SRQ-20 scores.

Conclusions: A single item was as adequate a measure of wealth as multi-item rating scales. Our estimate of mental distress using the SRQ-20 is much greater than that of other studies, and in contrast to western prevalence studies, age was not a protective factor in this study. The SRQ-20 is a brief, cost-effective and reasonably valid measure of both community and individual mental distress.

Background: At present, China has approximately 20 million migrant school-aged children accompanying their parents in relocating to the cities. However, very little is known about them. Using a resilience framework, the present study attempted to examine the psychosocial factors affecting their life satisfaction in Shanghai, China.

Methods: A total of 625 migrant children were recruited from 10 schools in Shanghai through a cross-sectional survey design using multi-stage cluster sampling method. The questionnaire included measures of life satisfaction, self-esteem, social support, relationships at school and the parent—child and peer relationships.

Results: Hierarchical regression analysis was performed to explore the relative effects of different relationship domains, self-esteem and social support on the life satisfaction of migrant children. The results suggested that parent—child and peer relationships significantly influenced the life satisfaction of children of migrant workers. Relationships in school did not exert such effect. Both social support and self-esteem had significant effects on the life satisfaction of migrant children.

Conclusions: Relationship factors, social support and self-esteem are critical factors affecting the life satisfaction of migrant children. The findings and implications were discussed in relation to developmental and migration-related issues and the social contexts of the lives of children of migrant workers in Shanghai, China.

Background: Although previous research has established a direct impact of natural disasters on child mental health, there is limited knowledge on the underpinning mechanisms, particularly when there has been the loss of a parent.

Aims: To establish: (a) the rates of behavioural and emotional problems of school-aged children who had lost their parents in the 2003 earthquake in Iran, compared with children from intact families who attended the same schools; (b) the relationship between the psychopathology of the surviving parents’ and children’s behavioural and emotional problems; and (c) whether this relationship was compounded by socioeconomic factors.

Methods: Eighty six children of 7—13 years who had lost a parent in the earthquake four years earlier were compared with 80 matched children from intact families. The teacher and parent versions of the Strengths and Difficulties Questionnaire (SDQ) were used as measures of behavioural and emotional problems. Parents’ psychopathology was established by the Self Report Questionnaire (SRQ).

Results: Behavioural and emotional problems were significantly higher in children who had suffered parental loss than in the control group. There was a significant association between parent-rated SDQ and SRQ scores. Parental death was found to interact with socioeconomic variables in predicting children’s behavioural and emotional problems and surviving parents’ mental health problems.

Conclusions: After natural disasters, bereaved children and their surviving parents are at risk of developing mental health problems, and social adversities increase this risk.

Background: Recovery is emerging as a worldwide paradigm in mental health. There is increasing recognition that the transformation of mental health systems to a recovery perspective requires collaboration among all stakeholders. Research to date has focused on the perspectives of service users and providers. The role and influence of organizational decision makers in the transformation process has been less studied.

Materials: This study reports findings from semi-structured interviews with decision makers on the implementation of recovery in Canada.

Discussion: Decision makers view community-based services as most open to recovery-based approaches, and front-line providers as pivotal in implementing system change. Decision makers described their own role as limited to providing overall orientation and funding.

Conclusions: The shift to recovery must include active leadership from decision makers as a catalyst to change.

The purpose of this article is to provide a clinical review of a unique, emerging form of severe social withdrawal that has been described in Japan. This paper begins with a case vignette, then reviews the case defi nition, epidemiology, psychopathology, differential diagnosis, and treatment and management of the condition. Called hikikomori, it is well known to both the psychiatric community and general public in Japan but it has never been reviewed in the English medical literature. Patients are mostly adolescent and young adult men who become recluses in their parents’ homes for months or years. They withdraw from contact with family, rarely have friends, and do not attend school or hold a job. Never described before the late 1970s, hikikomori has become a silent epidemic with tens, perhaps hundreds, of thousands of cases now estimated in Japan. The differential diagnosis includes anxiety and personality disorders, but current nosology in the Diagnostic and Statistic Manual of Mental Disorders may not adequately capture the concept of hikikomori. Treatment strategies are varied and lack a solid evidence base, but often include milieu, family, and exposure therapy. Much further research, including population-based and prospective studies, needs to be conducted to characterize and provide an evidence base for treatment of this condition.

Background: Little is known about effective treatment for personality-disordered (PD) offenders. We aimed to obtain the perspective of service users and staff on: (a) the experience of receiving treatment; and (b) the experience of delivering treatment, within new forensic services for PD offenders.

Material: Thematic analysis was applied to qualitative interviews with 30 service users and 22 staff.

Discussion: Service users perceived that they were making positive changes in the areas of anger management, communication, self-harm, self-esteem and insight into their difficulties. Undertaking the clinical work was extremely stressful for staff.

Conclusions: Forensic PD services may be having an important impact on the quality of service users’ lives. Whether treatment is successful in reducing long-term risk to others remains to be seen, and the cost-effectiveness of these services needs to be examined.

Aims: To examine levels of burnout among staff working in community-based services for people with personality disorder (PD) and to explore factors which add to or lower the risk of burnout among people working in such services.

Methods: In-depth interviews with staff working at 11 dedicated community-based personality disorder services in England together with a cross-sectional staff survey using the Maslach Burnout Inventory.

Results: Levels of burnout were generally lower than those reported in previous studies among mental health workers and levels of personal accomplishment were higher. Staff reported positive as well as negative experiences of working with people with PD. Strong team-work, clear leadership and opportunities for reflective practice were thought to protect staff from burnout.

Conclusions: The low levels of burnout we found may reflect the early stage of the development of these services. However, it is also possible that working with people with PD does not in itself lead to burnout, especially when services are organized to share and contain work-related anxiety.