General practitioners using DSM-III criteria have studied the incidence and prevalence of anorexia nervosa and bulimia nervosa in a large (N = 151781) representative sample of the Dutch population. The incidence rate for anorexia nervosa is 6·3 and for bulimia nervosa 9·9 per year per 100000 population. The prevalence of bulimia nervosa is three times higher in larger cities than in smaller urbanized or rural areas, while anorexia nervosa is found with almost equal frequency in areas with a different degree of urbanization.

From 1 January 1984 until 30 June 1986 all 517 compulsorily admitted psychiatric patients of a well-defined mixed rural–urban catchment area in Baden-Württemberg, a southern State of the German Federal Republic, were compared with all 10232 voluntarily admitted patients. Because of the very low frequency of compulsory admissions this population can be regarded as a ‘core group’ of committed patients. In a logit analysis the characteristics distinguishing involuntary from voluntary patients can be reduced to three main factors: the diagnosis ‘schizophrenia/ paranoid disorder’, ‘masculine gender’ and the compound indicator ‘not owning a home’, the latter being mainly associated with youth, masculine gender and low occupational status. The strong association of these characteristics with the criteria ‘severity of disease’ and ‘danger to oneself and others’, both pre-requisites for compulsory admission according to the laws of most countries, is discussed.

The aims of this study were, first, to estimate the prevalence of depressive disorders in Australian nursing home residents using international diagnostic criteria, and second, to explore environmental determinants of such disorders. Residents of 24 nursing homes were surveyed using the Canberra Interview for the Elderly (CIE) and a range of environmental measures was also taken. Of 323 residents who were screened for cognitive impairment, 165 (51%) scored 18 or above on the Mini-Mental State Examination (Folstein et al. 1975), and were interviewed with the CIE. According to DSM-III-R criteria and the CIE, the prevalence of major depressive episode was 9·7%. Using ICD-10 criteria, 6·1% of residents suffered from a severe depressive episode, 6·7% from a moderate depressive episode and 6·7% from a mild depressive episode. Some measures of the social environment were significantly related to depressive symptoms.

Three studies explored the causal attributions of common somatic symptoms. The first two studies established the reliability and validity of a measure of attributional style, the Symptom Interpretation Questionnaire (SIQ). Three dimensions of causal attribution were confirmed: psychological, somatic and normalizing. The third study examined the antecedents and consequences of attributional style in a sample of family medicine patients. Medical and psychiatric history differentially influenced attributional style. Past history and attributional style independently influenced clinical presentations over the subsequent 6 months. Symptom attributional style may contribute to the somatization and psychologization of distress in primary care.

From an original sample of 177 patients in community care and suffering from functional psychosis, the psychiatric teams involved in the treatment of these patients interviewed 136 patients and 103 relatives. The interviews aimed at determining the patient's problems in socialrole behaviour, as evaluated both by the patients themselves and by their relatives, and to measure the stress caused to the relatives.

According to the patients themselves, over 60% had considerable difficulties in at least one area of social-role behaviour; the same conclusion was reached by over 50% of the relatives. The patients had a more positive view of their abilities to cope with housework, self-care, and managing money than their relatives. One-third of the relatives said they were dissatisfied with the situation, and more than 40% displayed a resigned attitude to the amount of support required by the patient.

Problems in social-role behaviour were commonest in patients who were dissatisfied with their treatment, in male patients, and in patients who lived together with their spouse, and among the relatives dissatisfaction with the situation as a whole was also highest in these cases. On the basis of these findings it is stressed that the treatment of psychotic patients should be based on a broad approach involving not only the patients themselves but also their relatives.

A two-stage probability sample of community subjects was developed with a full psychiatric examination employing DSM-III criteria in conjunction with the Epidemiological Catchment Area (ECA) survey conducted in Baltimore, MD. This report details the observation on those subjects diagnosed with compulsive personality disorder and compulsive personality traits. The results indicate that this condition has a prevalence of 1·7% in a general population. Male, white, married and employed individuals receive this diagnosis most often. Our data suggest a dimensional rather than categorical character for this disorder. The disorder imparts a vulnerability for the development of anxiety disorders.

It has repeatedly been demonstrated that patients with dementia of the Alzheimer type (DAT) show an absence of the primacy effect when asked to recall a list of items. The results of the present study show that the absence of the primacy effect in DAT patients is related to list length but probably in a way that is qualitatively not specific since it follows the same pattern as in normal ageing. It is also demonstrated that DAT patients differ in learning style. It is suggested that this indicates a reduced capacity to maintain controlled processing.

Current methods of measuring quality of life (QoL) impose an external value system on individuals, rather than allowing them to describe their lives in terms of those factors which they consider important. The Schedule for the Evaluation of Individual Quality of Life (SEIQoL) was developed to overcome such limitations. The QoL of 42 healthy attenders at an international immunization clinic was assessed using SEIQoL. Judgement reliability was high (r = 0·74) and individuals' judgement policies accounted for a large percentage of the variance in overall QoL (R2 = 0·75) demonstrating the construct validity of judgement analysis in this context.

In a second study of QoL of out-patients suffering from irritable bowel syndrome (IBS) (N = 20) or peptic ulcer disease (PUD) (N = 20) was assessed using SEIQoL. Judgement reliability was lower (r = 0·54) although statistically highly significant (P < 0·01), and the variance in overall QoL judgements explained was high (R2 = 0·74).

SEIQoL is an acceptable, reliable and valid technique for measuring individual QoL that takes greater account of individual perspectives than traditional measurement approaches.

This study explores possible determinants of somatization in primary care. Hypotheses were tested on samples of ‘somatizers’, ‘psychologizers’ and controls recruited by epidemiological procedures. Although ‘somatizers’ were found to be similar to ‘psychologizers’ in many respects, they were (i) less depressed; (ii) reported lower levels of social dissatisfaction, social stress and less dependence on their relatives; (iii) more likely to have an unsympathetic attitude towards mental illness and less likely to consult a doctor about psychological symptoms, and (iv) more likely to have received medical in-patient care as an adult before they had consulted their doctor with their current illness. These findings are discussed in the context of previous research.

We have reported previously that poorly educated elderly people and those of low social class were at much increased risk of scoring below the customary cut-point on the Mini-Mental State Examination, a widely-used, brief cognitive screening test. As part of the same study, subjects who scored 23 or less on the MMSE out of a maximum of 30 points, and a sample of those who scored 24 or 25 points, were assessed by psychiatrists using a structured, diagnostic interview. Assuming that persons who scored 26 points or above were cognitively intact (our data suggest that 2% or less were not), neither educational attainment nor social class had any influence on the likelihood that subjects would be diagnosed as demented. Our data suggest that social and psychological factors contribute substantially to cognitive test scores and serve to emphasize the importance of detailed assessment procedures in epidemiological surveys of dementia.

In the summer following graduation a sample of 125 female college graduates (mean age = 28) completed Cohen & Wills' ISEL (1985) which includes scales measuring four social support functions: belonging (social companionship), appraisal (availability of confidants), tangible (instrumental), and self-esteem support. In the summer and fall subject status on two outcome scales was ascertained: the Psychophysiologic Symptom Scale and the Center for Epidemiologic Studies Depression Scale (CES-D). Reliability of the difference scores suggested that the ISEL scales do not measure entirely different constructs and the ISEL Self-esteem Scale is operationally redundant with the Rosenberg Self-esteem scale and the CES-D. Cross-sectional analyses indicated that the ISEL scales were related to symptoms. By contrast, standard longitudinal and prospective MLR analyses indicated that only the Belonging Scale was significantly related to future symptoms. The issues of confounding support with symptoms and the dimensionality of the subscales were discussed. The study suggests that specific functions of support take on greater importance during major life transitions and that any one supportive behaviour often serves multiple functions.

This paper describes the referral pathways taken by 1554 patients newly referred to the mental health services in 11 countries, and documents factors associated with delays in referral. The pathways in centres relatively well provided with psychiatric staff were dominated by general practitioners and to a lesser extent hospital doctors: the relatively less well resourced centres showed a variety of pathways with native healers often playing an important part. Delays were remarkably short in all centres regardless of psychiatric resources, but in some centres we found longer delays on pathways involving native healers. Somatic problems were a common presentation in all centres, and in some centres there was a tendency for patients presenting with somatic problems to have longer delays than those with symptoms of depression or anxiety. The implications of these findings are discussed in the context of an ongoing programme of WHO research activities aimed at improving the quality of mental illness care available in community settings.

Specialist psychiatric services run by the Italian National Health Service are mainly hospital-based in North-Verona and community-based in South-Verona. Ninety-two GPs from both areas participated in a one-day survey of their provision of psychiatric care, and this paper focuses on socio-demographic and clinical variables associated with specialist psychiatric referral. The one-day prevalence figure for GP referral to specialist psychiatric services was 7·3% (17·6/10000): the figures did not differ between the sexes or between the two areas. Whereas in North-Verona 49% of the patients referred were sent to the two local hospital-based public services and 51% to other agencies (mainly to private psychiatrists), in South-Verona 71% of referrals were to the community-based public service.

Log-linear analysis showed that past psychiatric history, psychological presenting complaint, social problems and GPs' psychiatric diagnosis exerted positive joint main effects on GP referral to specialist psychiatric services, and that diagnosed organic illness had a negative effect in this regard. In the presence of a psychological complaint, a psychiatric diagnosis proved to be quite unimportant, so that those without a psychiatric diagnosis were just as likely to be referred as those with one. However, in the absence of a psychological complaint a GP diagnosis of depression greatly increased the risk of referral.

Though the type of psychiatric service proved not to be an important determinant of GP referral to specialist psychiatric services it influenced the GPs' choice of referral agency.

Using standardized interviews 374 subjects randomly selected among people living in two villages in a mining district in Sardinia (Italy), were studied. Of these, 57 subjects (15·2%) were identified as ‘cases’. Ten per cent of the sample was affected by a depressive syndrome and 4% by an anxiety disorder. Females were significantly more at risk for anxiety disorders, while a trend towards a major risk for depression emerged among middle-aged and elderly people. Of the sample 9·8% were taking benzodiazepines, with a significant over representation of females. Depressed subjects took benzodiazepines more frequently than anxious subjects, while the use of antidepressants was negligible.

A measure has been developed which assesses a broad range of attitudes which women hold towards their bodies. The Ben-Tovim Walker Body Attitudes Questionnaire (BAQ) is a 44-item self-report questionnaire whose subscales encompass six distinct aspects of body experience (feelings of overall fatness, self-disparagement, strength, salience of weight, feelings of attractiveness and consciousness of lower body fat). The development of the BAQ involved administering increasingly refined versions to a wide range of female respondents. The final version appears to have satisfactory psychometric properties. When the BAQ scores of 29 patients with anorexia nervosa were compared with those of a large community sample, a more complex pattern of deviant attitudes appeared than would previously have been suspected. The BAQ appears to have potential as a research instrument in this and other fields in which the measurement of attitudes towards the body is important.

The SIDAM – a new instrument for the symptomatic diagnosis and measurement of dementia according to DSM-III-R and ICD-10 – is described. It comprises a brief structured clinical interview, a range of cognitive tests (e.g. including the Mini-Mental State (Folstein et al. 1975)) which constitute a short neuropsychological battery and a section for clinical judgement and third party information. All items rely on DSM-III-R and ICD-10 algorithms. The SIDAM has a high overall test–retest reliability which equally holds true on the diagnostic, criterion and item level. It is a brief (average of 28 min), practical and easily scored diagnostic instrument, which reliably separates subjects with DSM-III-R and ICD-10 dementia from those without such a disorder. Good congruence was found between SIDAM diagnoses and corresponding ICD-9 expert diagnoses. Furthermore, the SIDAM-Score (SISCO) allows a detailed measurement of even low levels of cognitive impairment and provides quantification of severity grading of cognitive dysfunction.

Follow-up by examination of medical and psychiatric records was carried out on 357 patients with conspicuous psychiatric morbidity in two general practices three years after clinical and personality assessment using structured interview schedules. One practice was an inner-city urban one and the other was rural. Full follow-up data over the 3-year period was available for 301 patients (84 3%). After three years patients with personality disorder and those in the urban practice had greater morbidity, more contacts with all levels of the psychiatric service and more psychotropic drugs, particularly benzodiazepines. Despite this increased morbidity, the number of consultations with the general practitioner for psychiatric illness was no higher in the urban group and those for medical illness were significantly higher in the rural one. The implications of the findings are discussed with particular reference to developments in community psychiatric care.

Measures of disease severity are required as experimental, control and outcome variables in studies of the psychosocial aspects of physical illness. The Endstage Renal Disease Severity Index (ESRD-SI) was developed for these purposes during a prospective study of patient adjustment to dialysis and endstage renal disease (ESRD). It was found to have adequate inter-rater reliability, test–retest reliability, and construct and predictive validity in two subsamples (total N = 233) of dialysis patients. The ESRD-SI is suitable as a sensitive indicator of disease severity in these patients.

A 26-item informant questionnaire (IQCODE) and the Mini-Mental State Examination (MMSE) were compared as screening tests for dementia in a sample of 69 patients. Dementia diagnoses were made by both a clinician and a research interview using a computer algorithm to meet DSM-III-R and ICD-10 (Draft) criteria. The IQCODE was found to perform at least as well as the MMSE against all diagnoses and significantly better when judged against the algorithmic ICD-10 diagnoses. Also, the IQCODE was found to be uncontaminated by pre-morbid ability as estimated from the National Adult Reading Test and to have very high test–retest reliability after a delay of a day or more.