Social networks and psychiatric morbidity in New Zealand women.

A random community survey of urban and rural New Zealand women revealed higher rates of psychiatric morbidity in subjects who reported poorer social support. Substantial differences in social networks were found between demographic subgroups. Rural women described better than expected social relationships, giving some support to the pastoral ideal of well integrated rural communities. Women in part-time employment also described better social networks. Elderly, low socio-economic, and widowed, separated and divorced women had poorer social relationships. It is suggested that normative values for social network measures for each demographic subgroup will need to be established before the clinical significance of deviations from the norm can be meaningfully evaluated. Also, the mechanisms linking social networks to health may vary in different subgroups.     

Antenatal psychiatric morbidity in Maltese women

OBJECTIVE: There has been no empirical research on the occurrence of antenatal psychiatric morbidity in Maltese women. Epidemiological studies have shown that depressive episodes occur in 10-20% of pregnant women. Furthermore, studies have shown that antenatal psychiatric morbidity can adversely affect maternal and foetal well being. METHOD: A random sample of 239 pregnant women were interviewed at booking using a detailed sociodemographic history and the Revised Version of the Clinical Interview Schedule (CIS-R). The CIS-R was again administered at 36 weeks and at 8 weeks postpartum to 95.8% of the women. RESULTS: Among the 229 women interviewed the point prevalence of all psychiatric diagnosis was 19.2% and the point prevalence of antenatal depression and anxiety disorders was 14.8% and 4.4%, respectively, at 18.6 weeks of gestation. At 36 weeks of gestation, the point prevalence of depressive disorder was 10%. Two thirds of the antenatal depression remitted postpartum. CONCLUSION: A significant proportion of Maltese women suffer from psychiatric morbidity during pregnancy. Depressive disorders are the commonest morbidity in this study population. Given the scope of the morbidity and potential impact on obstetric and neonatal outcomes, early detection and treatment are recommended.     

Hidden severe psychiatric morbidity in sentenced prisoners: an Australian study

OBJECTIVE: The aim of this survey was to estimate the prevalence of severe mental disorders in a representative sample of sentenced prisoners. METHOD: The subjects were selected as a random sample of sentenced prisoners in Melbourne's three metropolitan prisons. Interviews were conducted with 158 men and 31 women. Clinicians used the Structured Clinical Interview for DSM-III-R (SCID) to diagnose psychotic, affective, and substance use disorders. RESULTS: Six prisoners (3%) received current diagnoses of psychotic disorders, and 23 (12%) were diagnosed as having current mood disorders, mainly major depression. A lifetime diagnosis of at least one mental disorder each was made for 82% of the respondents, and in 26% more than one lifetime disorder was diagnosed. Sixty-nine percent received lifetime diagnoses of dependence on or abuse of alcohol, other psychoactive substances, or a combination of these. CONCLUSIONS: These findings do not indicate a large-scale shift of deinstitutionalized psychotically ill people from mental hospitals to prisons. They do, however, highlight the diversion into the corrections system of substance-dependent people and the apparent pool of prisoners with largely untreated major depression.     

Australian prisoners of war of the Japanese: post-war psychiatric hospitalisation and psychological morbidity

Evidence of chronic psychiatric and psychosomatic morbidity was found in a randomly selected sample of Australian prisoners of war (POWs) of the Japanese over the 40-year period following the Second World War. A clinical interview revealed more contemporary depressive and anxiety disorders and more post-war psychiatric illness overall than in a comparison group of randomly selected combatant veterans of the Pacific and South East Asian campaign. The POWs were no more likely to have had psychiatric admissions than non-POWs and fewer of them had had multiple psychiatric admissions. POWs had more duodenal ulcers than controls but otherwise their physical health was similar, as was their age-adjusted mortality in the post-war years. Finally, POWs were more likely to have Totally and Permanently Incapacitated Service Pensions than controls.     

Psychological functioning and psychiatric morbidity in an elderly urban population in Greece

Summary As part of a systematic epidemiological survey of mental disorders in two Athenian boroughs, a probability sample of 251 elderly community residents was examined by a psychiatrist. For the assessment of their mental health, symptom screening scales were used (Langner and CES-D). Cognitive functioning was also evaluated. An overall psychological functioning profile was composed from previously derived mental health levels. Clinical diagnostic examination was based on a semi-structured schedule (PEF) supplemented by DSM-III criteria.A higher proportion of females than males were characterised as psychologically impaired, reporting nonspecific symtoms of distress. Older respondents of lower socioeconomic status experiencing stressful life events, such as living alone or having been exposed to migration in the past, exhibited a significant degree of psychopathology. Of the sample, 20.3% was diagnosed as suffering from a specific psychiatric illness. The prevalence of organic mental disorders was 5.6% and affective disorders of any type constituted nearly half of the diagnosed psychiatric cases. The implications of this survey are of great importance for the design and the development of preventive strategies and community-based interventions.     

Prospective evaluation of psychological distress and psychiatric morbidity in recurrent vasovagal and unexplained syncope

Syncope is experienced by a third of the population, and in the absence of cardiac pathology is most commonly of vasovagal (VVS) or unexplained origin (US). Psychiatric morbidity has been observed in up to 81% of patients with US but findings with VVS are contradictory. Little is known regarding the chronicity of their psychiatric morbidity.

Objective

To determine the psychological profile of patients with recurrent syncope prior to and following diagnostic head-up tilt testing (HUT), and whether it predicts syncope recurrence.

Method

Seventy-three women and 43 men (mean age=48±16.6) were recruited from all consenting patients referred for HUT. Psychological status (Psychiatric Symptom Index, Anxiety Sensitivity Index (ASI), Fear of Blood Injury Subscale) and presence of mood/anxiety disorders (Primary Care Evaluation of Mental Disorders) were evaluated 1 month prior to and 6 months following HUT. Follow-up data were collected for 83 patients (mean age=48±17.34).

Results

At baseline, clinically significant levels of distress were observed in 60% of patients. Those with US (negative HUT) had a fivefold greater risk of suffering from a depressive or anxiety disorder compared to VVS (positive HUT) after controlling for significant covariates. There was no significant change in distress level over follow-up, although psychiatric morbidity dropped from 33% to 22% (P=.049). Syncope recurrence was predicted by elevations in baseline psychological distress (OR=1.544, P=.013) independently of lifetime number of syncopes.

Conclusions

Patients exhibited high levels of psychological distress and psychiatric morbidity despite reassurance and education received after HUT. Improved screening for and treatment of psychological distress in these patients is critical.     

Influence of traumatizing factors during captivity on somatic and psychiatric morbidity in former prisoners of war]

This study tries to evidence the effect of past traumatic experiences of the present somatic and psychiatric morbidity of the former POW. One hundred POWs hospitalized at the Ste-Ode Center for former prisonners of war and political prisonners having spent five years in the German and Austrian camps were submitted to a semi-structured interview. The number of traumatic experiences spontaneously reported has been compared with the present score on the Cornell Index form N2. The results show a relation between both data: a former POW who had undergone a minimum number of traumas significantly appears to be anxious, asthenic, nervous, with a predisposition to depression and psychosomatic disorders.     

Prospective study of psychiatric morbidity in HIV-seropositive women without AIDS

Prospective studies of psychiatric morbidity in HIV-seropositive women without AIDS have not been previously reported. As part of a 5-year longitudinal study, psychiatric diagnoses are described in 20 employed, educated women who are not intravenous drug abusers. This population is markedly different from the urban, minority, intravenous drug dependent groups previously studied and may be more representative of women who acquire the virus through heterosexual contact. Heterosexual transmission was the rule; 20% had HIV-seropositive spouses. All women were largely asymptomatic and in the early stages of infection. Mean length of knowledge of seropositivity was 14.4 months. Fifty percent were found to have an Axis I diagnosis (35% if minor diagnoses are excluded). None developed major depression or became dependent on drugs; 5% abused alcohol. Fifteen percent exhibited subtle signs of cognitive decline. Suicidal behavior and psychiatric hospitalization were absent. Sexual functioning was disrupted in a majority, with 20% meeting criteria for new onset hypoactive sexual desire disorder. Consistently "safe sex" practices were adhered to in 40%; in spite of intensive and repeated HIV education, 60% engaged in unprotected intercourse after knowledge of seropositivity. Progression of HIV infection was found to be three times faster than in a comparable male sample.     

Psychological wellbeing,distress and coping in Australian Indigenous and multicultural prisoners: a mixed methods analysis

The Australian prison population is growing and becoming increasingly diverse. Yet very little research has investigated mental health concerns for multi-cultural prisoners. This mixed methods study aimed to identify the prevalence of mental health factors (wellbeing, distress and coping) in a cohort of 530 prisoners from Indigenous, culturally and linguistically diverse (CALD) and English-speaking backgrounds (ESB) at a maximum-security prison in Victoria, Australia. Focus group interviews were also conducted with an additional 40 prisoners. It was found that Indigenous prisoners had significantly higher levels of distress and more symptoms of anxiety and depression than CALD and ESB prisoners. CALD prisoners had a greater sense of ‘feeling in control’ in prison than ESB prisoners. The focus group interviews also identified several factors that contributed to mental health differences between the groups. Findings reinforce the need for a more individualised approach in addressing mental health issues for prisoners cross-culturally.     

Psychological distress symptoms in women undergoing medical vs. surgical termination of pregnancy

OBJECTIVES: The purpose of this study is to compare the baseline psychological distress and symptom profile of women undergoing either medical (with mifepristone) or surgical pregnancy termination and the psychological outcome 2 weeks after the procedure. METHODS: Women (n = 200) given free choice of pregnancy termination method, either medical or surgical, were assessed before pregnancy termination by a demographic questionnaire including questions regarding the choice of the method of pregnancy termination, the Brief Symptom Inventory (BSI), the Spielberger State Anxiety questionnaire and the Rotter Locus of Control Scale. Two weeks after the procedure, the BSI and Spielberger questionnaires were repeated. RESULTS: Women with a smaller number of past pregnancies tended to choose the medical procedure. Reasons for choosing the medical procedure were fear of surgery, anesthesia and of future fertility difficulties. Prior to the procedure, the "medical group" had significantly higher levels of obsessive-compulsive symptoms, guilt and BSI general symptom index score, and a trend for higher interpersonal sensitivity and paranoid ideation. Postprocedure, both groups showed significant decline in anxiety levels and did not differ on most symptom parameters. CONCLUSIONS: Women who chose to have a medical termination are marginally more symptomatic before the procedure than women choosing surgical termination. However, both methods of pregnancy termination resulted in significant reduction in preabortion psychological distress level.