The clinical value of information on the risk of future psychiatric illness in women who have experienced puerperal (post-partum) psychosis has been limited by inconsistencies in terminology and nosology. Here we report rates of subsequent puerperal and non-puerperal episodes, in a well-characterised sample of women diagnosed with clearly defined bipolar affective puerperal psychosis (n=103). Out of 54 women having further children, 31 (57%; 95% Cl 44–69) experienced an additional puerperal psychotic episode, and 64 of 103 women (62%; 95%Cl 52–71) experienced a non-puerperal affective episode during the follow-up period (mean duration 9 years). A history of bipolar episodes prior to the puerperal psychosis did not predict risk following subsequent pregnancies, but positive family history of mental illness predicted shorter time to non-puerperal relapse.

We explored the role of baseline characteristics of 105 patients who presented with fatigue in primary care in determining outcome following either graded exercise or cognitive–behavioural therapy. Meeting the criteria for chronic fatigue syndrome was the most powerful predictor of poor outcome and this negative effect was enhanced by greater functional impairment or greater perceived negative consequences, but was not further enhanced by both.

Culling 27000 farm animals during an epidemic of foot and mouth disease in The Netherlands in 2001 resulted in substantial psychological distress among Dutch farmers. We investigated the association of exposure to this crisis with symptoms of intrusions and avoidance as found in post-traumatic stress disorder. Survey results from the Impact of Event Scale administered to 661 Dutch dairy farmers showed that about half of those whose animals were culled suffered from severe post-traumatic distress; we conclude that such agricultural crises can have a substantial impact on mental health.

A cross-sectional study of 3426 referred children and adolescents showed that the presence of both migration history and family dysfunction was associated with a fourfold (95% CI 2–9) higher risk of psychotic symptoms compared with the absence of these factors. The relative risk was 2 (95% CI 1–4) for migration history only. Interaction between migration history and family dysfunction accounted for 58% (95% CI 5–91%) of those with psychotic symptoms. These results suggest a relationship between family dysfunction and migration in the development of psychosis.

We studied 162 cases of hanging by suicide occurring in 24 coroners' jurisdictions in England within a 6-month period in 2001. Prison and psychiatric ward suicides accounted for only 6% of these. The most frequently used ligatures (ropes, belts and cable) and ligature points (beams, girders, lofts and trees) are commonly available in community settings, limiting opportunities for prevention. In only half the cases (52%) were victims fully suspended with both feet off the ground. Four per cent had also taken an overdose.

The prevalence and severity of suicidal ideation was established in a patient sample seeking emergency treatment for non-psychiatric reasons. Using a computerised mental health screening panel, data were collected from waiting-room patients during randomised shifts over a 45-day period. Of 1590 screened patients, 185 (11.6%) acknowledged suicidal ideation and 31 (2%) reported planning to kill themselves. Almost all of those with suicidal ideation (97%) acknowledged symptoms consistent with mood, anxiety and/or substance-related disorders. Structured medical record review revealed that 25 of the 31 patients planning suicide were undetected during their index visit, and that 4 attempted suicide within 45 days of the visit. All survived.

We carried out a brief longitudinal mental health screen of 254 members of the UK's Air Assault Brigade before and after deployment to Iraq last year. Analysis of General Health Questionnaire (GHQ–28) scores before and after deployment revealed a lower score after deployment (mean difference=0. 93, 95% CI 0. 35–1. 52). This indicated a highly significant relative improvement in mental health (P < 0. 005). Moreover, only 9 of a larger sample of 421 (2%) exceeded cut-off criteria on the Trauma Screening Questionnaire. These findings suggest that war is not necessarily bad for psychological health.

Studying non-fatal self-harm in older adults may provide insight into suicidal behaviour in this age group. The objectives of the study were to determine clinical factors that might help to differentiate those older adults with depression who are most at risk of self-harm and suicide. We examined social factors, life events, hopelessness and other depression symptoms in a group of 48 older people with depression referred following an episode of self-harm compared with 50 similarly aged people with depression who had no history of self-harm. The groups were similar in many respects, although those in the self-harm group were more likely to have a poorly integrated social network and were more hopeless.