One hundred and thirty out-patients with depression were studied by grade of membership multivariate (GOM) analysis. Five depressive types were generated. Pure Type I represented a mild form of melancholia in older, stable males, who showed a modest drug response. Pure Type II included obsessive-anxious symptoms in older patients who responded well to an MAOI drug, but poorly to placebo. Pure Type III was a mildly symptomatic form of depression which responded well to placebo. Pure Type IV included features of agitation, mood worsening later in the day, anorexia and depersonalization; it was commonly precipitated by external stress and MAOI treatment was more effective than placebo. In Pure Type V depression, patients were mostly younger females with high levels of symptomatology, atypical vegetative symptoms, unstable life-styles, disadvantaged backgrounds and a poor response to MAOI and placebo. These results resemble in many ways our earlier GOM study of depression, as well as other multivariate studies of depression in the literature.

This study examines the Likert-style successive integer scoring of Goldberg's (1972, 1978) General Health Questionnaire (GHQ) with a psychometric model in which the thresholds between successive categories within each item can be estimated. The model is particularly appropriate because the scoring of the successive categories, which are not named in the same way across items, by successive integers has received substantial discussion in the literature. Results from 1967 teachers in Western Australia who completed the 30-item form of the GHQ show that the items conform reasonably well to the model at a general or macro-level of analysis. In particular, the original ordering of categories is supported. However, as expected, there are systematic differences between distances among threshold within items and systematic differences among thresholds between items. The differences between positively and negatively orientated items confirm a suggestion in the literature that these two classes of items form sufficiently different scales so that they could be treated as separate, though reasonably correlated, scales.

An appropriate choice of controls in case/control studies of specific psychiatric disorders is crucial for valid risk-factor assessment. One suggested approach to control-group selection, the use of a well control group, is the focus of this paper. While using well controls has intuitive appeal, this paper shows that such a procedure can lead to ambiguous and biased results.

Twenty-two men, who had been forcibly sexually assaulted, participated in a study to determine the circumstances of the attacks and the effects on the victims. The immediate and long-term responses were very similar to those described in female victims of rape.

Caffeine toxicity remains a rarely reported condition, which may mimic anxiety disorders. Anxiety disorder patients do not consume toxic amounts of caffeine. However, increased sensitivity to caffeine in these patients has been suggested as contributing to their symptoms. Six cases of anxiety disorder are presented who improved with only caffeine abstention, and remained well for at least a six-month follow-up period.

In total, 103 cases were randomly selected from the Groningen, Nottingham and South Verona registers. Six raters (two in each of the register areas) were involved in coding these cases according to the ICD–9. In general, interrater agreement was satisfactory when codes were grouped into a limited number of categories. Nevertheless, considerable variation in agreement rates was found. We distinguished three steps in the diagnostic process. The selected logistic model showed that reliability is significantly affected in each step, but only substantial in the first where clinicians formulate a diagnosis.

When general population samples are assessed on two occasions with psychiatric symptom or personality measures, a mean change in scores towards less psychopathology is often observed. This re-test artefact is a potential threat to the validity of longitudinal studies. Data from a longitudinal general population study were analysed to discover under what circumstances the re-test artefact occurs. It was found that the artefact is unrelated to the time lag between occasions, being equally strong at intervals ranging from 4 to 34 weeks. However, the artefact did not occur for all measures, but was confined to those assessing negative self-characteristics and administered orally by an interviewer. These findings are consistent with both the ‘mechanical responding’ and ‘social desirability’ hypotheses of the re-test artefact.

Investigation into the referral histories of a consecutive series of new patients attending two psychiatric out-patient clinics questioned the assumption that only the more severe and problematic cases are selected by general practitioners for specialist referral. In 40% of cases, clinical indications only became decisive in relation to emergent difficulties in managing the case, while 38% of patients or their relatives requested referral. The implications of these observations are considered in relation to alternative models of psychiatric intervention in the management of psychosocial disorders in primary care.

A study of the validity of the 30- and 12-item versions of the Chinese Health Questionnaire (CHQ) was carried out with a consecutive sample of 386 patients admitted during one year to a medical centre in Taiwan for a 3-day comprehensive general health screening. The Chinese version of the Clinical Interview Schedule was used to derive a criterion measure of minor psychiatric morbidity.

The areas under the Relative Operating Charcteristic curves of both short versions of the CHQ were equivalent (area = 0·85, S.D. = 0·02). The sensitivities of the CHQ-30 and CHQ-12 were found to be 76 and 78% respectively, while the specificity of both was 77%. The estimated prevalence of minor psychiatric morbidity in the sample was 37% (95% confidence intervals 32–41%). In contrast, physicians diagnosed 11% of these patients as having psychiatric disorders, and their sensitivity was 29%.

Taken altogether, the above findings suggest that the CHQ-12 is as effective as and is more efficient than the CHQ-30 in this context, and could be used by physicians in similar settings to improve their identification of minor psychiatric disorders in Chinese patients.

Substantial cross-sectional correlations have been reported between the GHQ and PSE (and CIS) total scores. Although necessary, this is not a sufficient condition for assuming good validity of the GHQ as a severity measure in longitudinal and health care evaluation studies. For this purpose the GHQ should also accurately reflect changes in severity over time. To examine their concurrent validity, GHQ and PSE scores were compared, in a three-wave longitudinal study, among 175 new psychiatric out-patients. Using a longitudinal structural equation model that takes measurement error into account, the strength of both the cross-sectional and longitudinal relationship between GHQ and PSE were estimated. The GHQ performed remarkably well; changes in severity as defined by PSE-ID and PSE total score were clearly reflected by changes in GHQ scores. The revised scoring method of the GHQ proposed by Goodchild and Duncan-Jones did not yield superior results.

First, two examples of dichotomous logistic regression analysis are presented. The probability of being a psychiatric case according to the Present State Examination is predicted from the total score on the General Health Questionnaire and from the general practitioner's judgement on the presence of a mental health problem. Subjects were 292 primary care attenders. Results are compared with those from prior studies.

Next, the extension to the polytomous case is demonstrated. The probability of being at any given level of the Index of Definition (computed from PSE data) is estimated from the General Health Questionnaire total score by an ordered polytomous logistic regression model. Several applications of the polytomous logistic regression model are discussed. These range from estimating the proportion of psychiatric cases among individuals who refuse to be interviewed to the formulation of sampling schemes which can be expected to reduce costs while at the same time yielding optimal information for testing specific hypotheses.

A structured enquiry for assessing autobiographical memory is proposed. It is made up of three standardized time-cued sets of questions focusing on three life periods: adolescence, early and late adulthood, with five questions for each life period. Standardized testing procedure, checking for veracity and scoring methods are described. Normative data from 157 healthy individuals aged over 55 are converted into ‘equivalent scores’ for use with the enquiry and for diagnostic purposes. Education and ageing, but not sex, appear to be significant factors in the efficiency of retrieval from the autobiographic repertoire.

The concept of ‘the pathway to psychiatric care’ as described by Goldberg & Huxley (1980) using a scheme of five ‘levels’ and four ‘filters’, has provided a useful framework in investigating referral processes in places where health services are organized in a way similar to the British National Health Service. Previous estimates of psychiatric morbidity at each of the levels of this model have been calculated, based upon data obtained from diverse geographical areas and over different time frames. The value of these estimates for service planning is therefore limited by the heterogeneity of the data sources. This paper provides data related to all five levels based upon the same geographical area (South-Verona, Italy) and within the same time frame (one week in 1987).

The importance of studying the full spectrum of psychiatric morbidity at all levels in the same area is discussed. In particular, it is shown that the assessment of morbidity in the primary medical care setting (levels 2 and 3) and data about filters 2 and 3 can provide useful information for the evaluation of specialist services (levels 4 and 5) as well as for understanding changes in the provision of specialist care.

The validity of the Japanese version of the 30-item General Health Questionnaire (GHQ) was examined against the semi-structured interview-based Research Diagnostic Criteria (RDC) as external criteria. The GHQ total score discriminated ‘cases’ and ‘non-cases’ satisfactorily but its recommended cut-off point was higher (7/8) than that of the original English version (4/5). Discriminant function analysis revealed that only 13 items contributed to the discriminatory power and that their discriminant function score was better than a simple summation of the 30 GHQ item scores in terms of validity.

The IQCODE is a questionnaire which asks an informant about changes in an elderly person's everyday cognitive function. The questionnaire aims to assess cognitive decline independent of pre-morbid ability. In the present study, the IQCODE was administered to a sample of 613 informants from the general population. In addition, the questionnaire was administered to informants of 309 dementing subjects who had filled it out one year previously. A principal components analysis, using the general population sample, confirmed that the IQCODE measures a general factor of cognitive decline. The questionnaire was found to have high internal reliability in the general population sample (alpha = 0·95) and reasonably high test-retest reliability over one year in the dementing sample (r = 0·75). The total IQCODE score, as well as each of the 26-items, was found to discriminate well between the general population and dementing samples. The correlation with education was quite small (r = – 0·13), indicating that contamination by premorbid ability is not a problem.

This is a study of the criterion validity of a newly developed computerized assessment (PROQSY) of minor psychological morbidity based on the Clinical Interview Schedule, employing a single GP's assessments as criterion measures of such morbidity and Relative Operating Characteristic (ROC) analysis. Two-stage screening was carried out with a consecutive sample of 256 patients aged 15 69 consulting an experienced GP in a semi-rural setting over a six-week period. The GP made a standardized assessment of the reason for consultation and the degree of psychological disorder present. A 40% random sub-sample was then assessed using PROQSY. The area under the ROC curve using a GP criterion of minor psychological disorder (‘degree of psychological problem - mild or greater’) was 081 (s.D. = 006). However, the kappa coefficient obtained between this criterion assessment and the PROQSY assessment of minor psychological problem at the observed optimal cut-off score was only 0·28 (S.E. = 0–1; z = 2.83). It is concluded that PROQSY may be recommended for further development as a research tool providing a valid measure of minor psychological morbidity as assessed by GPs in primary care settings.

The Mini-Mental State Examination was administered to 1865 general-practice patients aged 75 years and over. Even when demented cases were removed from analysis, respondents with relatively little education, together with those in social classes Ill-manual and below, were significantly more likely to score below the cut-off point used in North American community surveys to denote ‘cognitive impairment’. Education and social class influenced scores on all sections within the MMSE with the exception of registration. Sex influenced scores on tests of calculation and spelling backwards but had no effect on total scores. These findings emphasize the importance of investigating low scorers in more detail before making a diagnosis of dementia.

The mental health programme of WHO has been formulated through a process of consultation within WHO, with other United Nations bodies, with Governments, with the scientific community and with various non-governmental organizations (Sartorius, 1978; WHO, 1983 a; Lambo & Sartorius, in the press).

The Parental Bonding Instrument (PBI) was used in a 2-wave community survey of 386 persons. The two factor structure of the instrument was confirmed, as well as the high stability of its scales over time. Respondents who had had children differed significantly from others. No association was found between social desirability, neuroticism or extraversion and either of the scales. No association was observed between the scales and psychiatric disorder, despite using covariance structure analysis to remove the effects of age and attenuation due to measurement error. Estimates of relative risk for affectionless control were low in contrast to estimates calculated from samples with psychiatric disorders. These findings may be characteristic of symptomatic persons in a general population. Because of the importance of the affectionless control construct, the findings invite further investigation in other community and treated samples.

In constructing a new self-report questionnaire for measuring self esteem, the aim has been to satisfy psychometric requirements without sacrificing the intuitive meaning of the concept. Self esteem is seen as a composite, and examination of its components may have more analytic or predictive value than ‘ global’ scores. Preliminary reliability and validity data are encouraging.