Occupation and mental health in a national UK survey.

OBJECTIVES: To measure the prevalence of common mental disorder (CMD) by occupation in a representative sample of Great Britain and to identify occupations with increased and decreased risk of CMD. METHODS: A cross-sectional interview-based survey was carried out including 5,497 working male and female respondents, 16-64 years from a stratified random survey of private households in Britain. Occupations were classified by the Standard Occupational Classification (SOC) into four groups: major, sub-major, minor and constituent unit groups. Common Mental Disorder was measured by the Revised Clinical Interview Schedule. RESULTS: Major SOC groups with higher prevalence of common mental disorder included clerical and secretarial, sales, and personal and protective services whereas craft and related, 'other' professional occupations and plant and machine operatives had lower prevalence compared to 13% overall prevalence in all adults. In sub-major SOC groups managers and administrators, teaching professionals, clerical and secretarial, 'other' sales and personal service occupations had higher prevalence whereas many professional and skilled occupations had lower prevalence. Specific SOC unit groups with higher prevalence included primary and secondary teachers, welfare community, youth workers, security staff, waiters, bar staff, nurse auxiliaries and care assistants. General managers in government and large organizations (OR=2.79, 95% CI 1.41-5.54), managers in transport and storing (OR=2.44, 95% CI 1.18-5.03), buyers and mobile sales persons (OR=2.48, 95% CI 1.09-5.60), sales occupations (NES) (OR=2.78, 95% CI 1.25-6.19) and clerks (NES) (OR=2.71, 95% CI 1.59-4.61) had increased risk of common mental disorder relative to specialist managers adjusting for social and financial factors and physical ill-health. CONCLUSIONS: Occupations with higher risk of common mental disorder may be typified by high levels of job demands, especially emotional demands and lack of job security. The reasons why occupations have low rates of common mental disorder are varied and may include high levels of job discretion, good job training and clearly defined job tasks.

Borderline personality disorder: health service use and social functioning among a national household population.

BACKGROUND: It is unclear whether Axis II psychopathology or co-morbid clinical syndromes result in the treatment-seeking behaviour and social impairment of patients with borderline personality disorder (BPD). This study examined the independent associations between social functioning and service use and Axis I and Axis II disorders in persons with BPD in the national household population of Britain. METHOD: The study was a cross-sectional survey of adults aged 16-74 years in households (n=8397). Data included self-reported consultations with health-care professionals and behavioural problems. Diagnosis was determined by computer-assisted interviews. Analyses included logistic regression adjusting for demography, co-morbid Axis I clinical syndromes and other Axis II disorders. RESULTS: Consultation in the past year was reported by 57.5% of persons with BPD but only 13.4% reported lifetime psychiatric admission. BPD was not independently associated with impaired functioning but was associated with co-morbid psychotic, depressive and anxiety disorders. Only general practitioners (GPs) were consulted for problems independently due to BPD. CONCLUSIONS: Functional effects of BPD are mediated through co-morbid clinical syndromes, not Axis II psychopathology. A subgroup do not have co-morbid disorders or seek treatment, and are high functioning.

Drug use and initiation in prison: results from a national prison survey in England and Wales.

AIMS: To investigate heroin and cocaine use in a sample of British prisoners, and to explore the characteristics of inmates who use these drugs for the first time while in prison. DESIGN, PARTICIPANTS: A cross-sectional survey of all prisons in England and Wales conducted as part of a major national study of psychiatric morbidity. A total of 3142 prisoners (88.2% of those selected) completed a structured interviewer-administered questionnaire. MEASUREMENTS: Interview measures of personal demographics, social history, psychiatric morbidity and drug use. Personality disorders were diagnosed via the Structured Clinical Interview for DSM-IV (SCID-II) and neurotic symptoms were assessed using the revised Clinical Interview Schedule (CIS-R). FINDINGS: More than 60% of the heroin users and cannabis users reported that they had used these drugs in prison compared with less than a quarter of the life-time cocaine users. More than a quarter of the heroin users reported that they had initiated use of this drug in prison. The extent of an individual's experience of prison was related more consistently to heroin and/or cocaine use in and out of prison than other personal background, social history or psychiatric variables assessed. CONCLUSIONS: The findings indicate that prisons are a high-risk environment for heroin and other drug initiation and use. Although related to drug use, psychiatric variables were not generally associated with initiation in prison, which was dominated by prison exposure. There is a need to explore ways of reducing heroin initiation in prison as part of a broader risk-prevention strategy.

An assessment of the nutrition education of students in grades 3 to 12.

A proportionally stratified sample of Louisiana students was surveyed to determine their nutrition knowledge as influenced by selected variables. The 3,309 students in grades 3 to 12 were interviewed individually. A pretested questionnaire was used. Nutrition knowledge was assessed by a test of 15 selected nutrition concepts and the identification of the basic food groups needed daily. A majority of students judged the study of nutrition in school to be important. However, only 40.5% of the sample reported currently studying this science, with 15% studying it as a separate subject. Home and television were most frequently named as informal sources of nutrition information. The mean score on the test of nutrition concepts was 10.3. The number of subjects studied in which nutrition was included did not affect scores. A positive relationship existed between scores and grade division (3 to 6, 7 to 8, 9 to 12), correct identification of food groups needed daily, and number of sources and activities used to learn about nutrition. Thus, nutrition instruction which is varied, innovative, and includes student participation does improve knowledge of this science.

Developing sexual health software incorporating user feedback: a British experience.

This article describes an interactive prototyping model for development of four computer software modules for British youth on sexual issues. An iterative cycle of development, user review and feedback, and subsequent modification and retesting was used with approximately 150 young adults, with particular attention to presentation style, screen design, usability, relevance of material, enjoyment, and learning. The software was designed to be realistically accommodated in school settings, to be used as a reference tool by students working alone or in a group teaching situation. Feedback from youth and adults attests to the feasibility of development, implementation, and instructional usefulness. Interactive prototyping proved essential in the face of skepticism from teachers concerning young people's information needs and acceptance of a computerized educational approach.

Meal and snacking patterns of students.

A 1981 survey of 3,309 students in grades 3-12 enrolled in 135 Louisiana schools was used to determine their meal and snacking patterns. The data were analyzed according to three grade divisions: elementary, 3-6; junior high, 7-8; and senior high, 9-12. An analysis of variance was computed with grade division as the independent variable. Students' responses to questions concerning the consumption of meals, snacks and vitamin supplements, and tasting new, unfamiliar or disliked food were the dependent variables. A majority of students consumed three meals daily; however, breakfast was frequently skipped. Breakfast was usually eaten at home; 15% ate the school breakfast. Most students consumed the school lunch; many reported tasting new, unfamiliar or disliked food as part of these meals. Students snacked, most doing so in the afternoon. Students in grades 9-12 consumed significantly more snacks than their counterparts. Many snacks were purchased at school, primarily from a concession stand. Almost 50% took a vitamin supplement.

Is Friday the 13th bad for your health?

OBJECTIVE: To examine the relation between health, behaviour, and superstition surrounding Friday 13th in the United Kingdom. DESIGN: Retrospective study of paired data comparing driving and shopping patterns and accidents. SUBJECTS: Drivers, shoppers, and residents. SETTING: South West Thames region. MAIN OUTCOME MEASURES: Numbers of vehicles on motorways; numbers of shoppers in supermarkets; and hospital admissions due to accidents. RESULTS: There were consistently and significantly fewer vehicles on the southern section of the M25 on Friday the 13th compared with Friday the 6th. The numbers of shoppers were not significantly different on the two days. Admissions due to transport accidents were significantly increased on Friday 13th (total 65 v 45; p < 0.05). CONCLUSIONS: Friday 13th is unlucky for some. The risk of hospital admission as a result of a transport accident may be increased by as much as 52%. Staying at home is recommended.

Panic disorder and subthreshold panic in the UK general population: epidemiology, comorbidity and functional limitation.

OBJECTIVE: The epidemiology of panic disorder has not been investigated in the past in the UK using a nationally representative sample of the population. The aim of the present paper was to examine the epidemiology, comorbidity and functional impairment of subthreshold panic and panic disorder with or without agoraphobia. METHOD: We used data from the 2000 Office for National Statistics Psychiatric Morbidity survey (N=8580). Panic disorder and agoraphobia were assessed with the Revised Clinical Interview Schedule (CIS-R). RESULT: The prevalence of panic disorder with or without agoraphobia was 1.70% (95% confidence interval: 1.41-2.03%). Subthreshold panic was more common. Economic inactivity was consistently associated with all syndromes. The comorbidity pattern of the panic syndromes and the associated functional impairment show that panic-related conditions are important public health problems, even in subthreshold status. CONCLUSION: The findings show that efforts to reduce the disability associated with psychiatric disorders should include detection and management of panic disorder.

Alcohol consumption as a risk factor for non-recovery from common mental disorder: results from the longitudinal follow-up of the National Psychiatric Morbidity Survey.

BACKGROUND: Alcohol is commonly considered to be associated with persistence of common mental disorder (CMD; anxiety/depression). However no community-based longitudinal studies have investigated the direction of causality. METHOD: We examined the association between alcohol consumption and recovery from CMD using data on 706 community-based subjects with CMD who were followed for 18 months. Alcohol consumption at baseline was defined as hazardous drinking [Alcohol Use Disorders Identification Test (AUDIT) 8], binge drinking (defined as six or more units of alcohol on one occasion, approximately two to three pints of commercially sold beer) and dependence. RESULTS: When compared with a non-binge-drinking group, non-recovery at follow-up was associated with binge drinking on at least a monthly basis at baseline, although the confidence interval (CI) included unity [adjusted odds ratio (OR) 1.47, 95% CI 0.89-2.45]. There was also weak evidence that alcohol dependence was associated with non-recovery (adjusted OR 1.37, 95% CI 0.67-2.81). There was little evidence to support hazardous drinking as a risk factor for non-recovery (adjusted OR 1.12, 95% CI 0.67-1.88). CONCLUSIONS: Binge drinking may be a potential risk factor for non-recovery from CMD, although the possibility of no effect cannot be excluded. Larger studies are required to refute or confirm this finding.

Debt, income and mental disorder in the general population.

BACKGROUND: The association between poor mental health and poverty is well known but its mechanism is not fully understood. This study tests the hypothesis that the association between low income and mental disorder is mediated by debt and its attendant financial hardship. METHOD: The study is a cross-sectional nationally representative survey of private households in England, Scotland and Wales, which assessed 8580 participants aged 16-74 years living in general households. Psychosis, neurosis, alcohol abuse and drug abuse were identified by the Clinical Interview Schedule--Revised, the Schedule for Assessment in Neuropsychiatry (SCAN), the Alcohol Use Disorder Identification Test (AUDIT) and other measures. Detailed questions were asked about income, debt and financial hardship. RESULTS: Those with low income were more likely to have mental disorder [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.68-2.59] but this relationship was attenuated after adjustment for debt (OR 1.58, 95% CI 1.25-1.97) and vanished when other sociodemographic variables were also controlled (OR 1.07, 95% CI 0.77-1.48). Of those with mental disorder, 23% were in debt (compared with 8% of those without disorder), and 10% had had a utility disconnected (compared with 3%). The more debts people had, the more likely they were to have some form of mental disorder, even after adjustment for income and other sociodemographic variables. People with six or more separate debts had a six-fold increase in mental disorder after adjustment for income (OR 6.0, 95% CI 3.5-10.3). CONCLUSIONS: Both low income and debt are associated with mental illness, but the effect of income appears to be mediated largely by debt.

Vitamin D status of Asian infants.

Vitamin D intakes of infants aged 6 and 18 months from the Asian community in Southhall, Middlesex, were studied to assess the effectiveness of food fortification as a means of preventing vitamin D deficiency. Infants aged 6 months generally had similar diets to white children of the same age and had reasonable vitamin D intakes owing to consumption of fortified dried milks and cereals, reinforced by health visitors and baby clinics. Children aged 18 months, however, ate largely Asian diets and had much lower vitamin D intakes than the 6-month-old group with a corresponding increase in symptoms of vitamin D deficiency. Hence new measures for preventing vitamin D deficiency should probably be aimed at children aged over 1 year. The results of this survey suggest that fortifying chapati flour would be the most effective method of doing this.

Factors influencing the development and amelioration of suicidal thoughts in the general population. Cohort study.

BACKGROUND: The incidence of suicidal thoughts in the British population is unknown. AIMS: To determine the factors associated with the development of, and recovery from, suicidal thoughts. METHOD: An 18-month follow-up survey investigated 2404 of the adults who took part in the second National Psychiatric Morbidity Survey. RESULTS: The annual incidence of suicidal thoughts was 2.3%. Incidence was highest in women and among 16- to 24-year-olds. Increased incidence was associated with not being in a stable relationship, low levels of social support and being unemployed. Fifty-seven per cent of those with suicidal thoughts at baseline had recovered by the 18-month follow-up interview. CONCLUSIONS: Risk factors for suicidal thoughts are similar to those for completed suicide, although the age and gender patterning is different. Fewer than 1 in 200 people who experience suicidal thoughts go on to complete suicide. Further study into explanations for the differences in the epidemiology of suicidal thoughts and suicide is crucial to understanding the pathways (protective and precipitating) linking suicidal thoughts to completed suicide and should help inform effective prevention of suicide.

Psychosis and drug dependence: results from a national survey of prisoners.

BACKGROUND: The links between drug use and psychosis are of major aetiological and prognostic significance. Psychosis and drug dependence frequently co-occur within the prison population, providing the opportunity to study this link more closely. AIMS: To explore the relationship between psychosis and drug dependence in a sample of prisoners. METHOD: A total of 3142 prisoners were surveyed nationally, and structured clinical data were obtained from a subsample of 503 respondents. Psychiatric assessment was based on the Schedules for Clinical Assessment in Neuropsychiatry (version 1.0). Measures of amphetamine, cannabis, cocaine and heroin use and dependence were obtained through self-report. RESULTS: Logistic regression analyses indicated that first use of amphetamines or cocaine before the age of 16 years and severe cannabis or cocaine dependence were related to an increased risk of psychosis. In contrast, severe dependence on heroin was associated with a reduced risk of this classification. CONCLUSIONS: Severe dependence on cannabis and psychostimulants is associated with a higher risk of psychosis and is in contrast to severe dependence on heroin, which has a negative relationship with psychosis.