The experience of having been sexually abused is associated with a wide range of psychiatric symptoms and difficulties, and these problems can persist over years. The psychological treatment of children who have experienced sexual abuse has only recently begun to be systematically investigated. An increasing number of robust studies have been conducted.

To review systematically the available evidence from randomised controlled trials of psychological treatments for children who have been sexually abused, and to consider the place of these treatments in a multi-disciplinary service.

A systematic search of the available research was undertaken. Included trials were critically appraised and the results considered.

Twelve studies were included in the review. The best evidence of efficacy for improving psychological symptoms in these children was found for cognitive–behavioural therapy, particularly for young children.

Efficacious treatments exist to improve psychological symptoms in children who have experienced sexual abuse. Consideration is given to the place of these treatments within the response of a multi-disciplinary service.

It is important not to foster unnecessary public anxiety with regard to the risk of a biochemical terrorist incident, but the authorities need to consider their response strategy, particularly with regard to mental health issues.

To describe the likely effects of a terrorist incident involving biochemical agents and to identify important response issues.

Literature survey.

Observations following conventional terrorist incidents and other major trauma, including biochemical and nuclear accidents, suggest that a biochemical terrorist incident would have widespread public effects. The mental health services should play a major role in designing an effective multi-disciplinary response, particularly with regard to the reduction of public anxiety, identifying at-risk individuals and collaborating with medical and emergency services, as well as providing care for those who develop post-traumatic psychopathology.

We should not feel helpless in the face of a biochemical threat; there is considerable knowledge and experience to be tapped. Awell-designed, well-coordinated and rehearsed strategy based on empirical evidence will do much to reduce public anxiety and increase professional confidence.

Concern is widespread about potential sponsorship influence on research, especially in pharmacoeconomic studies. Quantitative analysis of possible bias in such studies is limited.

To determine whether there is an association between sponsorship and quantitative outcomes in pharmacoeconomic studies of antidepressants.

Using all identifiable articles with original comparative quantitative cost or cost-effectiveness outcomes for antidepressants, we performed contingency table analyses of study sponsorship and design v. study outcome.

Studies sponsored by selective serotonin reuptake inhibitor (SSR1) manufacturers favoured SSRIs over tricyclic antidepressants more than non-industry-sponsored studies. Studies sponsored by manufacturers of newer antidepressants favoured these drugs more than did non-industry-sponsored studies. Among industry-sponsored studies, modelling studies favoured the sponsor's drug more than did administrative studies. Industry-sponsored modelling studies were more favourable to industry than were non-industry-sponsored ones.

Pharmacoeconomic studies of antidepressants reveal clear associations of study sponsorship with quantitative outcome.

Few studies have examined the relationship between antidepressant prescription and receipt of depression-related disability benefits.

To address two questions: first, is prescription of antidepressants in accordance with published clinical guides associated with better disability outcomes, and second, what is the relationship between guideline-concordant antidepressant prescription and length of disability?

An observational study was conducted using administrative data from three major Canadian financial and insurance sector companies. Short-term disability and prescription drug claims records for 1996–1998 were linked for workers receiving depression-related short-term disability benefits during that time.

Recommended first-line agents and recommended doses were significantly associated with return to work (χ2=6.64, P < 0.036). In addition, among those who returned to work, early intervention was significantly associated with a shortened disability episode (β=-24.1; 95% CI-34.4 to −13.8).

Depression-related workplace disability is a problem for which there is no simple solution. These results provide an additional piece to the puzzle of helping workers disabled by depression to return to work.

The cost of depression in the UK was estimated at £33.5 billion almost: adecade ago. The shift to community-based management for depression alongside the availability of more accurate data have allowed these estimates to be revised.

To calculate the total cost of depression in adults in England during 2000.

Recorded data on health service use by patients with depression were analysed and the cost of treating patients was calculated. The cost of working life lost was estimated from sickness benefit claims and the number of registered deaths of patients with depression.

The total cost of adult depression was estimated at over £9 billion, of which £370 million represents direct treatment costs. There were 109.7 million working days lost and 2615 deaths due to depression in 2000.

Despite awareness campaigns and the availability of effective treatments, depression remains a considerable burden on both society and the individual, especially in terms of incapacity to work.

People with psychosis have an elevated risk of violence.

To examine whether violent behaviour in adults with psychosis can be accounted for by psychotic symptoms or physical aggression in childhood.

We used data from a prospective longitudinal study of a complete birth cohort born in New Zealand. When cohort members were 26 years old, information was obtained on past-year psychiatric diagnosis of schizophreniform disorder and on violent behaviour. Childhood psychotic symptoms were measured at age 11 years using a diagnostic interview, and childhood physical aggression was assessed by teachers when cohort members were aged 7, 9 and 11 years.

Participants with schizophreniform disorder were more likely to be violent than participants without, even after controlling for sociodemographic variables and concurrent substance dependence disorders. Childhood psychotic symptoms were a strong risk factor for violence in adults with schizophreniform disorder, as was childhood physical aggression, allthough to a lesser extent.

Violence by individuals with schizophreniform disorder could be prevented by monitoring early signs of psychotic symptoms and by controlling childhood physical aggression.

The levels and experiences of harassment of people with mental health problems in the community compared with those of the general population have not been explored.

To measure the levels and experience of harassment experienced by people with mental health problems in the community in Scotland and compare them with the general population.

Experiences of harassment were collected by interviewing 165 individuals with mental health problems and a control group of 165 people from the general population.

Harassment in the community was found to be twice as common for individuals with mental health problems (41%) than for those in the general population (15%). The harassment commonly involved verbal abuse referring to the individual's mental health problems and was committed primarily by teenagers and neighbours.

Harassment has a significantly higher prevalence among individuals with mental health problems living in the community and is believed to have a detrimental effect on mental health.

Physical health of people with schizophrenia is poor and they die early from cardiovascular disease.

To describe the lifestyle of people with schizophrenia through diet, smoking habits, weight and exercise, and to report risk of coronary heart disease (CHD).

Dietary habits of 102 community-dwelling people with schizophrenia were assessed by the Scottish Health Survey Questionnaire. Also assessed were smoking habits, physical activity biochemical indices of nutrition and future risk of CHD.

Fewer males, compared with the general population, reached acceptable levels for consumption of fruit, vegetables, milk, potatoes and pulses. Fewer females reached the levels for consumption of milk and potatoes. Mean number of fruit and vegetable portions consumed per week was 16 (s.d.=14); 71 (70%) were smokers; 25 (86%) females and 50 (70%) males were overweight or obese; 59 (59%) considered themselves physically active; 46 (53%) had a raised cholesterol: high-density lipoprotein ratio, and 64 (74%) a low α-tocopherol: cholesterol ratio. Mean 10-year risk of CHD in males was 10.5% (s.d.=8) and in females 7% (s.d.=6).

The lifestyle of people with schizophrenia must give cause for concern in relation to CHD Care from secondary care services must address physical as well as mental health.

In war-affected societies it is assumed that the major mental health problem facing the population will be stress reactions.

To describe the creation of a child and adolescent mental health service (CAMHS) in Kosovo after the military conflict ended in 1999, and to establish the range of problems and diagnoses that presented.

Data were collected on 559 patients over 2 years, including their referring problems and diagnoses.

Stress-related disorders constituted only a fifth of the case-load in year 1. A substantial number of patients were symptom-free but attended because they had been exposed to atraumatic event, and believed it might make them ill. Non-organic enuresis and learning disability were the most common diagnoses in year 2. Many patients had a complex mix of social and psychological difficulties that did not fit conventional diagnostic categories.

Mental health services that only address traumatic stress may fail to meet the needs of war-affected children. A comprehensive, culturally appropriate CAMHS is needed to address a wide range of problems including learning disability. It should be developed through local actors, and build on existing local infrastructure. Services can also have an educational role in ‘depathologising’ normative responses.

Little is known about the current state of provision of child and adolescent mental health service in-patient units in the UK.

To describe the full number, distribution and key characteristics of child and adolescent psychiatric in-patient units in England and Wales.

Following identification of units, data were collected by a postal general survey with telephone follow-up.

Eighty units were identified; these provided 900 beds, of which 244 (27%) were managed by the independent sector. Units are unevenly distributed, with a concentration of beds in London and the south-east of England. The independent sector, which manages a high proportion of specialist services and eating disorder units in particular, accentuates this uneven distribution. Nearly two-thirds of units reported that they would not accept emergency admissions.

A national approach is needed to the planning and commissioning of this specialist service.

Little is known about the mental health of gay men and lesbians living in Europe.

To compare psychological status, quality of life and use of mental health services by lesbians and gay men with heterosexual people.

Cross-sectional study in England and Wales using ‘snowball’ sampling.

Participants: 656 gay men, 505 heterosexual men, 430 lesbians and 588 heterosexual women. Gay men were more likely than heterosexual men to score above threshold on the Clinical Interview Schedule, indicating greater levels of psychological distress (RR 1.24, 95% Cl 1.07–1.43), as were lesbians compared with heterosexual women (RR 1.30, 95% Cl 1.11-1.52). Gay men and lesbians were more likely than heterosexuals to have consulted a mental health professional in the past, deliberately harmed themselves and used recreational drugs. Lesbians were more likely to have experienced verbal and physical intimidation and to consume more alcohol than heterosexual women.

Awareness of mental health issues for gay men and lesbians should become a standard part of training for mental health professionals, who need to be aware of the potential for substance misuse and self-harm in this group and of the discrimination experienced by many lesbians.