Prevalence, characteristics and comorbidities of anxiety disorders in France: results from the "Mental Health in General Population" survey (MHGP).

PURPOSE: Only a few European countries have carried out large, community-based, national surveys about psychiatric morbidity. Here is presented the first national French survey, aiming to estimate the prevalence of anxiety disorders and associated comorbidities according to sociodemographic characteristics. MATERIALS AND METHODS: The Mental Health in General Population (MHGP) database is derived from a representative national survey of the French adult population (n=36,105), conducted between 1999 and 2003. Data collection was done using an anonymous face-to-face interview. The presence of anxiety disorders (generalized anxiety disorder, panic disorder, agoraphobia, social phobia and post-traumatic stress disorder) was assessed using the Mini International Neuropsychiatric Interview. RESULTS: The overall prevalence of anxiety disorders was estimated to be 21.6%, generalized anxiety disorder being the most prevalent one (12.8%). Women, young people, and people earning low income were identified as the more at risk. Major depressive episode, alcohol abuse and drug addiction frequently co-occur with anxiety disorders (28.3, 4.4 and 2.8% respectively). CONCLUSION: The MHGP study showed that anxiety disorders are highly prevalent in France with a high frequency of comorbidities. Our results highlight the need for considering anxiety disorders as a public health priority in France as well as in other European countries.

Comparing clinical risk assessments using operationalized criteria.

OBJECTIVE: To compare the clinical risk assessment of patients by psychiatrists working in different mental health service settings (low, medium and high security). METHOD: Operationalized criteria of clinical factors recognized as indicating risk of harm to others were developed into a simple checklist with explicit item descriptions and definitions (OP-RISK). This was used to compare risk assessments in a prospective cohort of 161 consecutive referrals to a high secure psychiatric hospital. RESULTS: Agreement on the risk posed by a patient between psychiatrists working outside and inside high secure services using unstructured clinical risk assessment was poor (kappa=-0.006). When OP-RISK was applied to the clinical risk assessments, agreement improved (kappa=0.742). CONCLUSION: Applying operationalized criteria to clinical risk assessment is useful in integrating different mental health service settings. The use of OP-RISK may facilitate the referral process to tertiary care.

A national survey of violence experienced by community mental health researchers.

BACKGROUND: In recent years there has been a vigorous debate concerning the relationship between violence and mental illness. Psychiatric hospital staff are especially likely to experience violence. 'Detached staff' working in the community appear to be at greatest risk. The present study examines reported aggression towards field-based community mental health researchers (CMHRs). It aimed to investigate the nature and extent of violence experienced by CMHRs, to establish which CMHR characteristics act as precipitators of violent incidents and to identify training needs. METHODS: This national survey, conducted between December 1997 and March 1998 at the Department of Mental Health, University of Exeter, used a postal questionnaire circulated among CMHRs working in England, Scotland and Wales. RESULTS: Whilst this study did not achieve comprehensive coverage of all eligible CMHRs, it indicates that, even allowing for response bias, occupational violence is not uncommon among CMHRs: 51% (n = 33) ever experienced at least one verbally violent incident, 9% (n = 6) a mildly violent incident and 2% (n = 1) a severely violent incident. In the 12 months preceding the study, 45% of CMHRs (n = 29) had experienced at least one verbally violent incident and 8% (n = 5) a mildly violent incident. Male CMHRs are more likely (P < 0.05) to experience violence than their female counterparts. CONCLUSIONS: The findings indicate a need to improve existing safety training, procedures and awareness among this occupational group. Additional comparative research among other community-based groups is, however, required.

Trends in admissions to a regional secure unit (1983-1997).

Admissions and discharges from a 30-bed regional secure unit (RSU) were surveyed over a 15-year period. In the last five years there has been a significant increase in the average length of stay of patients and a marked decrease in the number of admissions and discharges. The reasons for this 'silting up' of the RSU by longer-term patients and the consequences for an effective forensic psychiatric service are discussed.

The development of the Short Explanatory Model Interview (SEMI) and its use among primary-care attenders with common mental disorders.

BACKGROUND: Recent anthropological studies have documented the importance of understanding the relation of culture to the experience of mental illness. The use of interviews that elicit explanatory models has facilitated such research, but currently available interviews are lengthy and impractical for epidemiological studies. This paper is a preliminary report on the development of a brief instrument to elicit explanatory models for use in field work. METHOD: The development of the SEMI, a short interview to elicit explanatory models is described. The interview explores the subject's cultural background, nature of presenting problem, help-seeking behaviour, interaction with physician/healer and beliefs related to mental illness. RESULTS: The SEMI was employed to study the explanatory models of subjects with common mental disorders among Whites, African-Caribbean and Asians living in London and was also used in Harare, Zimbabwe. Data from its use in four different ethnic groups is presented with the aim of demonstrating its capacity to show up differences in these varied settings. CONCLUSIONS: The simplicity and brevity of the SEMI allow for its use in field studies in different cultures, data can be used to provide variables for use in quantitative analysis and provide qualitative descriptions.

Common mental disorders, explanatory models and consultation behaviour among Indian women living in the UK.

Women of Indian origin are said to have a lower rate of recognized common mental disorders and a higher frequency of consultation in primary care than white British. The aim of this study was to evaluate factors, including explanatory models (patient perspectives) of illness, associated with common mental disorders and with frequency of consultation among women of Indian origin in primary care. The investigation was conducted in a general practice in West London with a large Indian population. Consecutive woman attenders of Indian descent were screened with the General Health Questionnaire-12 to identify probable cases of psychiatric morbidity. 100 patients were interviewed with the Revised Clinical Interview Schedule (CIS-R), a specific tool for the diagnosis of common mental disorders, and the Short Explanatory Model Interview, which elicits the individual's conceptualization of his or her illness. Those patients who satisfied CIS-R criteria were classified as 'cases', the others as 'controls'. Common mental disorders were documented in 30% of patients. The general practitioner's diagnosis of common mental disorders had a sensitivity of 17% and a specificity of 91%. Individuals with common mental disorders had a higher frequency of consultation (P = 0.017), were less likely to see depression as an indication for medical intervention and were more likely to withhold some of their concerns from the general practitioner. Incorrect diagnosis by the GP was most likely to occur when patients did not disclose all their complaints. These associations were all statistically significant after adjustment for possible confounders by multiple linear and logistic regression. Women of Indian origin in this sample had rates of common mental disorders similar to those in other UK populations. Differing conceptualizations of common mental disorders may contribute to their underrecognition in women of Indian origin.

Long-term outcome of patients with neurotic illness in general practice.

OBJECTIVE: To determine the 11 year outcome of neurotic disorder in general practice. DESIGN: Cohort study over 11 years. SETTING: Two general practices in Warwickshire England. SUBJECTS: 100 patients selected to be representative of those identified nationally by general practitioners as having neurotic disorders. MAIN OUTCOME MEASURES: Mortality, morbidity, and use of health services. RESULTS: At 11 years 87 subjects were traced. The 11 year standardised mortality ratio was 173 (95% confidence interval 164 to 200). 47 were cases on the general health questionnaire, 32 had a relapsing or chronic psychiatric course, and 49 a relapsing or chronic physical course. Treatment for psychiatric illness was mainly drugs. The mean number of consultations per year was 10.8 (median 8.7). A persistent psychiatric diagnosis at one year follow up was associated with high attendance ( > 12 visits a year for 11 years) at follow up after age, sex, and physical illness were adjusted for. Severity of psychiatric illness (general health questionnaire score) at outset predicted general health questionnaire score at 11 year follow up, course of psychiatric illness, and high consultation rate. CONCLUSION: These data support the view that a neurotic illness can become chronic and is associated with raised mortality from all causes and high use of services. Such patients need effective intervention, particularly those with a more severe illness who do not recover within one year.

Focus groups in mental health research: enhancing the validity of user and provider questionnaires.

Most mental health researchers rely upon quantitative methods of data collection. Whilst such methods are commonly seen as reliable, qualitative methods are often seen as more valid. Despite the value of qualitative methods of data collection, however, many researchers denigrate their use. Qualitative research is often viewed as lacking in scientific rigour. This paper explores the use of the focus group as a qualitative instrument to enhance the validity of existing questionnaires for mental health service users and providers. Between July and August 1995 four focus groups were conducted in Exeter and Taunton among service users (with severe or long-term mental health problems) and providers (community psychiatric nurses, social workers and occupational therapists). It is demonstrated that focus groups enhance the validity of existing questionnaires by highlighting those concerns held by users and providers that would otherwise have been neglected.