A comparison of traditional and symptom-checklist-based histories.

The authors compared the results of independent evaluations of 96 patients, each of whom was given a traditional psychiatric interview, resulting in a narrative report, and a structured interview based on a self-report questionnaire, resulting in a standardized report. Although the latter method produced a higher frequency of report of all symptoms, the overall accuracy of diagnoses was similar for the two methods. The authors enumerate the potential benefits of the use of standardized histories.

The WHO collaborative study on strategies for extending mental health care, II: The development of new research methods.

Teams in seven developing countries under sponsorship of the World Health Organization have been carrying out collaborative operational research on providing mental health care through primary health care services. New techniques of identifying mental disorders in children and adults have been developed and tested. Methods of assessing the skills and attitudes of health workers toward mental health work and of gauging community attitudes toward mental illness have also been developed. Results have been directly applied in planning better mental health care. The authors conclude that cross-cultural collaborative research is effective in improving mental health care for those in greatest need.

The WHO collaborative study on strategies for extending mental health care, III: Evaluative design and illustrative results.

Teams in seven developing countries have adopted a common research design to evaluate new community mental health care services. The nature of the intervention programs varied considerably according to the characteristics of each area. Observations made before the intervention and 18 to 24 months after showed significant changes in the attitudes, knowledge, and diagnostic accuracy of health staff and in community attitudes and reactions. A considerable number of individuals with serious mental disorders received effective care for the first time.

Childhood mental disorders in primary health care: results of observations in four developing countries. A report from the WHO collaborative Study on Strategies for Extending Mental Health Care.

To ascertain the frequency of mental disorders in Sudan, Philippines, India, and Columbia, 925 children attending primary health care facilities were studied. Rates of between 12% and 29% were found in the four study areas. The range of mental disorders diagnosed was similar to the encountered in industrialized countries. The research procedure involved a two-stage screening in which a ten-item "reporting questionnaire" constituted the first stage. The study has shown that mental disorders are common among children attending primary health care facilities in four developing countries and that accompanying adults (usually the mothers) readily recognize and report common psychologic and behavioral symptoms when these are solicited by means of a simple set of questions. Despite this, the primary health workers themselves recognized only between 10% and 22% of the cases of mental disorder. The result have been used to design appropriate brief training courses in childhood mental disorders for primary health workers in the countries participating in the study.

Knowledge and attitudes of primary health care personnel concerning mental health problems in developing countries: a follow-up study.

Within the context of a World Health Organization coordinated collaborative study health workers in six developing countries were assessed 18 months after their training for improvement in their knowledge and attitude towards mental health problems and their management. The approaches to training varied between study areas, but the degree of improvement following the training, was of equal magnitude in all countries. The training process has formalized the recognition by the health workers that treatment of mental health problems is an integral part of their work.

Prediction of risk for drug use in high school students.

On the basis of questionnaires administered to almost 2,000 high school students in Cali, Colombia, a subset of items was selected that deal primarily with parent-child relationships. This 53 item set, referred to as the Drug Risk Scale (DRS), was administered to two new cross-validation samples, one consisting of high school students and the other consisting of drug addicts attending drug rehabilitation centers. Significant differences in parent-child relations were found between these new groups. The DRS was also found to have reasonably high sensitivity and specificity. Its potential value as a risk-prediction instrument is discussed.

[Strategies for extending mental health services to developing countries. I. Description of the project]. / Estrategias para la extensión de los servicios salud mental en países en desarrollo. I. Descripción del proyecto.

Mental Disorders constitute a severe Public Health problem in developing countries due to inadequate resources specially in terms of trained personnel; furthermore, Mental Health care is given out only in specialized Institutions where it has not been possible to provide coverage for more than a small part of the population. In this context the Collaborative Study on Strategies for the Extension of Mental Health Care has been planned, using as its guiding principle the recommendations of the WHO Expert Committee on Organization of Mental Health Services in Developing Countries (W.H.O. 1975). The objectives of the study are to determine the feasibility of introducing Mental Health Care directed toward defined priority conditions into general health services, to develop methods of selection for interventions in Mental Health Care as well as methods for task oriented training for health workers, to evaluate effectiveness of alternative low cost methods and to develop and evaluate ways of simulating community response to problems related to mental disorders. The areas selected are representative of the range of environments in developing countries in terms of overall socioeconomic and health status. In each area, actions will be directed towards making baseline observations and towards provision of care (planning, training, supervision and provision of referral channels). Specific interventions in the Cali area are described in regard to the training of the Health Center personnel in Mental Health, the provision of psychotropic drugs at the peri-urban level and provision of Mental Health Care by Primary Health Workers under the supervision of Health Center physicians and nurses.

[Primary mental health care in Latin America. The Cali program]. / Atención primaria de salud mental en América latina. El programa de Cali.

The paper describes the experience acquired during more than 8 years in carrying out primary mental health care in Cali, Colombia. It had already been shown that the use of trained paramedical personnel achieved some advantages to that of traditional approaches. The present programme is carried out in two different geographical areas (rural and urban) which provide care to about 10 per cent of their population. Although final clinical results are still not available, the basic approach entails the use of primary mental health agents (auxiliary nurses and health promotors) as the first step of assistance, ending in the top of the hierarchy, where a doctor and/or a trained nurse are responsible for the diagnoses. A trained psychiatrist acts only as a periodic consultant and as the main source for training. There is evidence to suggest that these primary mental health care agents have more time to talk to the patients and are more able to understand their local psycho-social circumstances. This system enables cheaper and more effective care services. Its advantages, risks and related problems are discussed, and mention is made for the need to maintain regular clinical assessment. The various training techniques are also discussed.

Prediction of risk for drug use in high school students.

On the basis of questionnaires administered to almost 2,000 high school students in Cali, Colombia, a subset of items was selected that deal primarily with parent--child relationships. This 53-item set, referred to as the Drug Risk Scale (DRS), was administered to two new cross-validation samples, one consisting of high school students and the other consisting of drug addicts attending drug rehabilitation centers. Significant differences in parent--child relations were found between these new groups. The DRS was also found to have reasonably high sensitivity and specificity. Its potential value as a risk-prediction instrument is discussed.

[The symptoms questionnaire for problem detection in adults]. / El cuestionario de síntomas para la detección de problemas en adultos.

This questionnaire has been designed considering transcultural differences. Its validation includes an approximately 400-patient sample, with their relatives as control sample population. Such populations come from General Health Centers located in Colombia, India, the Philippines, and Sudan. In each area, different cut-off points were used on the calculation of sensitivity and specificity. This instrument is currently used in different parts of the world: It is demonstrating to be valuable and sensitive a tool for identifying mental disorders among individuals seeking treatment at General Health Services. At the same time, it is being used in a training manual for Psychiatry primary care workers. Even though the instrument does not diagnosticate, it nonetheless identifies individuals suffering from psychological disrupting symptoms. Both its simplicity and high sensitivity help in a practical approach to Psychiatry primary care strategies.

Research screening instruments as tools in training health workers for mental health care.

Two simple screening instruments for mental disorders in adults and children respectively were developed in the course of an evaluative study on mental health care in developing countries. Two research teams have attempted to use these same instruments as training tools for primary health care workers. Their experience has shown that the design of the instruments with short, easily understandable questions to which an answer "yes" or "no" can be given is also highly appropriate in the training situation and in daily work. The adaptation and use of these new training tools for primary health care workers in Manila (Philippines) and Cali (Colombia) is described.

[Training in psychiatry for health teams in Colombia]. / Capacitación en psiquiatría de grupos de salud en Colombia.

About 90% of the 40 million victims of mental disorders in the developing countries receive no treatment, and little progress is being made in this respect. This article examines the use of new strategies for solving the problem. It is obvious that the traditional methods of mental health care have been ineffective and that new programs should now be undertaken that can ensure proper service within the coming decades for those being neglected. Based on the results of a practical experiment carried out in Colombia, the authors, without making any definitive recommendations, point to the usefulness of training auxiliary staff of urban and rural health centers to work as a team (under the supervision of a physician or a graduate nurse) in the care and management of psychiatric patients. They enumerate the advantages offered by training programs on various aspects of mental health for general practitioners (who usually have little interest in psychiatry), psychiatry residents, nurses, and auxiliaries.

Epidemiological studies of female prisoners. IV. Homosexual behavior.

The existence of homosexual behavior in female offenders is investigated not only as an adaptive process but as an established behavior existing prior to detention. Ninety-five prisoners from the Framingham Institution for Women were included: 26 were self-reported homosexuals, 42 were considered homosexuals by prision staff, and 27 were nonhomosexuals. Suicidal thoughts, suicidal attempts, psychiatric problems during menstruation, and a history of violent crimes against persons were characteristic of the homosexual group, whereas a history of crimes against self and property as well as history of alcoholism were common in the nonhomosexual group. Violet behavior together with suicidal attempts in homosexual female prisoners support the hypothesis that aggressive impulses may be expressed either externally or toward the self, the problem being one of impairment in control mechanisms. The findings also suppor the idea that violent behavior, as shown by this group of incarcerated homosexual females, is multidetermined. The factors that influence its appearance and expression could include a history of family violence, impulse control as children, neurological abnormality, sex role identification problems, biochemical abnormalities (manifested as menstrual irregularities), and impulse control problems as adults. A better understanding of human violence must be based on the recognition of the multidimensional nature of the problem using the tools and insights from many disciplines.

Parental loss, depression and violence. III. Epidemiological studies of female prisoners.

Information was obtained from 95 incarcerated female prisoners on their history of violence, on their feelings of depression, their suicide attempts, and on their history of loss of parents. The data revealed that the loss of father before the age of 10 years was more highly correlated with signs of depression in these women prisoners than was loss of mother. Women who reported at least one suicide attempt in the past were significantly more depressed on the self-report measure of depression than the other women, and were more likely to be judged as violent on the basis of several independent indices. The results support the hypothesis that violence toward others and suicidal behavior are part of the same phenomenon of impairment in control mechanisms.

The classification of psychiatric disorder. A reliability study in the WHO collaborative study on strategies for extending mental health care.

Altogether 26 psychiatrists and other mental health workers, from Colombia, Brazil, Sudan, Egypt, India and the Philippines tried to reach agreement on the classification of 10 case histories, using the International Classification of Diseases (8th revision). The exercise was part of the WHO Collaborative Study on Strategies for Extending Mental Health Care. Conventions, mistakes, differences of opinion and a lack of rules are discussed as causes for disagreement.

Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries.

1624 patients who were attending primary health facilities in 4 developing countries were examined to determine how many were suffering from mental disorder. Using stringent criteria to establish the presence of psychiatric morbidity, 225 cases were found, indicating an overall frequency of 13.9%. The great majority of cases were suffering from neurotic illnesses and for most the presenting complaint was of a physical symptom, such as headache, abdominal pain, cough or weakness. The health workers following their normal procedure correctly detected one third of the psychiatric cases.