Objectives - To present the results obtained from a cross-sectional evaluation of a sample of primary care attenders selected in Verona in the framework of the World Health Organization International Multicentre Study on Psychological Problems in Primary Care Settings. Methods - Among consecutive attenders at 16 primary care clinics in Verona during the period April 1991/February 1992, a random sample, stratified on the basis of GHQ-12 scores, was selected for a thorough evaluation of psychological status, physical status and disability in occupational and other daily activities. All patients with psychopathological symptoms at baseline assessment and a 20% random sample of those without psychopathological symptoms were interviewed again after 3 and 12 months (data not presented here). Results - Overall, 1,656 subjects were approached at the primary care clinics and 1,625 met inclusion criteria. The screening procedure was completed by 1,558 subjects and the second-stage evaluation by 250. Psychiatric disorders according to ICD-10 criteria were diagnosed in 12.4% of consecutive primary care attenders; of these, about one-third (4.5% of consecutive primary care attenders) satisfied ICD-10 diagnostic criteria for two or more disorders. Current Depressive Episode (4.7%) and Generalized Anxiety Disorder (3.7%) were the most common diagnoses. In addition, 11.2% of consecutive primary care attenders had ‘sub-threshold’ psychiatric disorders (i.e., they suffered from symptoms in at least two different areas among those listed in ICD-10, but they did not satisfy diagnostic criteria for well-defined disorders). Psychiatric disorders were more common among females and those aged 24-44 years. Only 20.6% of the subjects with psychiatric disorders contacted the general practitioner for their psychological symptoms, 5.7% complained of symptoms which might have had a psychological origin, whereas in about 70% of the cases the psychiatric disorder was concealed behind the presentation of somatic symptoms, pains in various parts of the body or chronic physical illness. Sixty-two percent of the subjects with psychiatric disorders rated their health status as fair or poor, as compared to 52.0% of those with chronic physical illness and 31.3% of those without such disorders. According to the general practitioner, 40.1% of the subjects with psychiatric disorders and 45.3% of those with chronic physical illness had a fair or poor health status, compared to 14.4% of those without such disorders. Disability in occupational and other daily activities was reported by 52.5% of the subjects with psychiatric disorders (in 40.1% of the cases disability was moderate or severe), 44.4% of those with chronic physical illness (in 26.8% of the cases disability was moderate or severe), and 15.0% of the subjects without such disorders (in 9.1% of the cases disability was moderate or severe). According to the interviewer, disability was identified in 48.4% of the subjects with psychiatric disorders, 39.0% of those with chronic physical illness, and 27.6% of the subjects without such disorders. Sixty per cent of the subjects with psychiatric disorders suffered from concurrent chronic physical illness; these subjects had a poorer health status and higher disability levels than those with psychiatric disorders only. Conclusions - Psychiatric disorders among primary care attenders are frequent and represents a major public health problem, since they entail severe functional limitations for the patients and high costs for the society. Thus, appropriate programs for their recognition and treatment are needed.

Objectives - (I) To review the studies which investigated the frequency of psychiatric disorders among primary care attenders, using a standardized psychiatric interview as the case finding instrument; (II) to discuss the factors possibly explaining the different results found; (III) to highlight the central role of international multicenter collaborative studies, carried out in primary care settings. Method - the studies were reviewed, which were published in international journals between 1970 and 1993. The studies were located through a computerized search of the databases MEDLINE and Psychological Abstracts; in addition, the reference lists of the studies located in this way were examined and international journals were manually scanned in order to avoid possible omissions. Finally, the annotated bibliography, edited by Wilkinson (1985), was examined, since it included the studies having psychiatric focus, carried out in primary care and published between 1977 and 1985. Results - Thirty papers were traced, but 9 were excluded since they duplicated results or because of methodological limitations. So far, the overall frequency of psychiatric disorders among primary care attenders has been investigated using standardized procedures in 13 countries only. The frequency of psychiatric disorders ranged between approximately 10% and 50%. The possible reasons accounting for the differe- nces between the studies were discussed in the light of three factors: I) the research design and study characteristics; II) the reliability and comparability of different diagnostic categories and classificatory systems; and III) the different organization of health services across countries. Conclusions - In the light of the difficulties faced when the findings of independent studies, carried out in different countries or even in the same country, are compared, the central role of in- ternational multicenter collaborative studies conducted in this field is suggested.

Objectives - a) To investigate the factor structure of the 12-item General Health Questionnaire (GHQ-12) in a sample of 18-year-old males; b) to test the ability of the standardized factor scores in discriminating between subjects who were suffering from emotional disturbance according to the psychiatrist's ratings and those who were not. Design - A sample of 363 subjects was selected during the medical examination for military service and invited to fill in the GHQ-12 and to be independently interviewed by a psychiatrist. Completed data were available for 320 subjects (88% of the selected sample). Results - The unrotated factor matrix allowed for the identification of two principal components with eigenvalues greater than 1, jointly accounting for 46.7% of the variance in the data. The first component, on which each item of the questionnaire showed a positive coefficient, was interpreted as measuring the overall severity of psychiatric disorder among respondents. The second component was bipolar with «positive» items having positive coefficients and «negative» items having negative coefficients. These findings suggest that the GHQ can assess both the negative (symptoms) and positive (subjective well-being) aspects of mental health. After Vari- max rotation each item of the questionnaire loaded significantly on one factor only, except for item 12 whose loading was lower than 0.500 on both factors. Factor A contained the «negative» items of the GHQ-12 and was termed as «general dysphoria»; factor B included 5 of the 6 «positive» items and was termed as «well-being/social functioning». The best discrimination between «cases» and «non-cases» was offered by the standardized factor scores on the «general Epidemiologia e Psichiatria Sociale, 2, 3, 1993 dysphoria» factor; no advantage was gained by the combination of the scores on the two factors. Conclusions - A better understanding of the GHQ-12 factor structure might provide useful information along with that offered by a single severity score resulting from the simple adding of positive responses and improve the description of emotional disorders beyond the traditional distinction between «cases» and «non-cases».

The garnet Ca3Sc2Si3O12 (CSSO) and the silico-carnotite Ca3Y2Si3O12 (CYSO) and Ca3Lu2Si3O12 (CLSO) materials, both undoped and doped with Pr3+, have been synthesized by solid state reaction at high temperature. The luminescence spectroscopy and the excited state dynamics of the materials have been studied upon VUV and X-ray excitation using synchrotron radiation. All doped samples have shown efficient 5d-4f emission upon direct VUV excitation of 5d levels, but only CSSO:Pr3+ shows luminescence upon interband VUV or X-ray excitation. The VUV excited emission spectra of CYSO:Pr3+ and CLSO:Pr3+ show features attributed to emission from two distinct sites accommodating the Pr3+ dopant. The decay kinetics of the Pr3+ 5d-4f emission in CSSO:Pr3+ upon VUV excitation across the conduction band are characterized by decay times in the range 25-28 ns with no significant rise after the excitation pulse. They appear to be faster upon X-ray irradiation than for VUV excitation. Weak afterglow components are attributed to defect luminescence.

Italy has experienced a significant change in its mental health sector, with a radical shift from old mental institutions to new community-based psychiatric services. The Italian experience attracted international attention and, in some instances, led to similar changes occurring abroad. Recently, economic considerations are imposing additional challenges on the health care system in general, with psychiatry facing distinct and peculiar problems due to its unique organisation and objectives. This paper aims:

(a) to provide a historical overview of the changes in mental health provision in Italy over the past century;

(b) to describe the present organisation of mental health services;

(c) to show the impact of financing on the mental health sector;

(d) to acknowledge the education and training programmes in mental health;

(e) to outline research directions and activities.

Background. Gender and cross-cultural differences in the association between somatic symptoms and emotional distress were investigated, using data from the World Health Organization Collaborative Project on Psychological Problems in General Health Care.

Methods. Data were collected at 15 centres in 14 countries around the world. At each centre, a stratified random sample of primary care attenders aged 15–65 years was assessed using, among other instruments, the 28-item General Health Questionnaire and the Composite International Diagnostic Interview-Primary Health Care Version.

Results. Females reported higher levels of somatic symptoms and emotional distress than males. A strong correlation between somatic symptoms and emotional distress was found in both sexes, with females reporting more somatic symptoms at each level of emotional distress. However, linear regression analysis showed that gender had no significant effect on level of somatic symptoms, when the effects of centre and emotional distress were controlled for. In both sexes, no specific pattern of association emerged between somatic symptom clusters and either anxiety or depression. Primary care attenders from less developed centres reported more somatic symptoms and showed greater gender differences than individuals from more developed centres, but inter-centre differences were small. Finally, gender was not a significant predictor of reason for consultation (somatic versus mental/behavioural symptoms), after controlling for levels of somatic symptoms and emotional distress as well as for centre effect.

Conclusions. These data do not support the common belief that females somatize more than males or the traditional view that somatization is a basic orientation prevailing in developing countries. Instead, somatic symptoms and emotional distress are strongly associated in primary care attenders, with few differences between the two sexes and across cultures.

We reviewed follow-up studies of adults with depressive disorders seen in psychiatric settings, and noted outcomes in terms of recovery, recurrence, and persistent depression, at six months, one year, two to five years, and ten or more years after an index episode of depression. Recovery increased with time: about half recovered at least briefly by six months, and a large majority did so in the long term. Only about a quarter recovered from an index episode and remained well more than ten years thereafter. A quarter of patients suffered recurrence of depression within a year of an index episode, and three-quarters did so at least once during follow-up periods lasting more than ten years. For more than one in ten patients, the depression proved persistent, the proportion affected remaining relatively stable over time. The review highlighted a relative paucity of conclusive investigations on the outcome of the commonest psychiatric disorder in clinical settings.

In 1881 J. M. Machado de Assis published a short novel entitled The Psychiatrist. The main character, Simao Bacamarte, “a physician of noble birth”, devoted himself to “the health of the soul” (as he defined psychopathology) and conceived a new, revolutionary (for the times) hypothesis: “The number of persons suffering from insanity, he believed, was far greater than commonly supposed”. Dr Bacamarte explains: “Till now, madness has been thought a small island in an ocean of sanity. I am beginning to suspect that it is not an island at all but a continent”.