Background: There is growing evidence of the impact of post-migration factors on the mental health of refugees. To date, few UK studies have been conducted.

Aims: The study investigated the relationship between trauma, post-migration problems, social support and the mental health of refugees and asylum seekers.

Methods: Refugees and asylum seekers (n = 47) were recruited mainly from clinical settings. Self-report measures of post-migration problems, mental health problems and social support were completed in an interview.

Results: Bivariate associations were identified between increased symptoms and number of traumas, adaptation difficulties, loss of culture and support and confidant support. In multivariate analyses post-migration problems were significantly associated with post-traumatic stress disorder symptoms and emotional distress. There was no significant association of symptoms and number of traumas or social support.

Conclusions: The results suggest that clinical services should provide holistic interventions within a phased approach when working with refugees and asylum seekers. At a policy level, the results suggest the need for asylum policies that reduce post-migration problems and provide support for refugees and asylum seekers.

Background: Political and social developments point at increasing marginalization of Muslim migrants, but little is known about its consequences for the mental health of this particular group.

Aim: To explore the relationship between acculturation and psychological distress among first-generation Muslim migrants from Turkey and Morocco in the Netherlands.

Methods: A cross-sectional study. Respondents were interviewed in their preferred language. Acculturation was measured with the Lowlands Acculturation Scale (LAS) and psychological distress with the Kessler Psychological Distress Scale (K10). Data were complete for 321 subjects and analyzed with multivariate linear regression.

Results: Less skills for living in Dutch society was associated with distress (p = 0.032). Feelings of loss were related to distress among Moroccans (p = 0.037). There was an interaction between traditionalism and ethnic background (p = 0.037); traditionalism was related to less distress among Moroccans (p = 0.020), but not among Turkish. Finally, there was an interaction by gender among Turks (p = 0.029); conservative norms and values seemed to be related to distress among men (p = 0.062), not women.

Conclusion: Successful contact and participation in Dutch society, and maintenance of heritage culture and identity were moderately associated with less psychological distress. Improving mastery of the dominant language in host societies, and allowing migrants to preserve their traditions, might be effective measures in improving the mental well-being of migrants.

Background: The study of the pathways into care as a social process subject to a wide range of influences is needed to build appropriate and effective mental health services for culturally diverse societies.

Material: Grounded theory and situational analysis of 21 in-depth interviews explores the help-seeking behaviour of ultra-Orthodox Jewish parents: which help-seeking pathways parents follow and how they make the decision to consult regular services for their child.

Discussion: Three help-seeking pathways are influenced by glob/calization dynamics and gender: parents draw on diverse parenting discourses and strat-egies, socio-religious frameworks and cultural realities.

Conclusion: Strategies are suggested to enhance the accessibility of services.

Aims: The aims of this study were to determine the characteristics of self-mutilation (SM) and examine the relationship between SM and psychopathy in male subjects with antisocial personality disorder (APD).

Methods: APD diagnosis was established by the Structured Clinical Interview for DSM-III-R Axis II Disorders. Subjects (N = 116) were assessed using the Psychopathy Checklist-Revised and a semi-structured self-mutilation question-naire form.

Results: In males with APD, the percentages of psychopathy and SM were 48.3% (N =56) and 96.6% (N = 112), respectively. There were positive correlations be-tween severity of psychopathy and severity, number, and frequency of SM.

Conclusion: Considerably high rates of SM and psychopathy were found in Turkish males with APD. The features of SM were associated with comorbidity of psychopathy. These results showed the importance of exploring the self-injurious behavior and psychopathy when diagnosed with APD.

Background: Post-partum depression, although heterogeneous, is often con-sidered a medical disease when viewed from the biomedical perspective. How-ever, recent reports from the Indian subcontinent have documented psychosocial causal factors.

Method: This study employed qualitative methodology in a representative sample of women in rural South India. Women in the post-partum period were assessed using the Tamil versions of the Short Explanatory Model Interview, the Edinburgh Postnatal Depression Scale and a semi-structured interview to diagnose ICD 10 depression. Socio-demographic and clinical details were also recorded.

Results: Some 137 women were recruited and assessed, of these, 26.3% were diagnosed to have post-partum depression. The following factors were associated with post-partum depression after adjusting for age and education: age less than 20 or over 30 years, schooling less than five years, thoughts of aborting current pregnancy, unhappy marriage, physical abuse during current pregnancy and after childbirth, husband’s use of alcohol, girl child delivered in the absence of living boys and a preference for a boy, low birth weight, and a family history of depression. Post-partum depression was also associated with an increased number of causal models of illness, a number of non-medical models, treatment models and non-medical treatment models.

Conclusion: Many social and cultural factors have a major impact on post-partum depression. Post-partum depression, when viewed from a biomedical framework, fails to acknowledge the role of context in the production of emotional distress in the post-partum period.

Background: Many studies from India have evaluated the burden of schizophrenia on caregivers. Experience of caregiving, on the contrary, is a broader concept that takes into consideration both negative and positive consequences of the disorder and is influenced by factors like social support and coping of caregivers.

Methodology: Fifty caregivers of patients with diagnosis of schizophrenia were assessed on Experience of Caregiving Inventory (ECI), Coping Checklist (CCL), Social Support Questionnaire (SSQ) and General Health Questionnaire-12 (GHQ-12). Patients were assessed on Positive and Negative Syndrome Scale (PANSS).

Results: Maximum ECI score was seen in negative domains of handling the difficult behaviour followed by negative symptoms, loss and dependency. Significant positive correlation was seen between total positive ECI score and the level of education of patients and caregivers. Regression analysis showed that use of problem-focused coping, seeking social support as a coping strategy and education of caregivers explained 30.6% of the variance of ECI positive score.

Conclusion: The study showed that education of caregivers, coping strategies used by the caregivers and available social support influence the final appraisal of caregiving.

Background: Psychiatric services have established children’s representatives in an effort to support children of mentally ill patients.

Material: Twenty two specially designated children’s representatives and 19 other staff members were asked how they conceived the role of children’s repre-sentatives and if those representatives had the responsibility of identifying children of mentally ill patients.

Discussion: Children’s representatives expressed difficulty in functioning as advocates for children whose parents were being treated for mental illness. Members of the psychiatric staff, although aware their patients had children, seldom met them since they focused on the adults.

Conclusions: More than one third of all patients seeking psychiatric care have children, yet children’s representatives and other staff members seldom meet them.

Background: Results of previous studies suggest that many female offenders have co-morbid psychiatric disorders, which require mental health services. However, few longitudinal studies examined subjects during incarceration or detention. This study compares depressive symptoms, abnormal eating behaviour and impulsivity before release from a detention centre and after incarceration, thereby indicating the effectiveness of psychiatric intervention in a Japanese detention centre.

Method: Of 64 young women, 36 were followed up. Self-report measures were used to assess depression, eating behaviour and impulsivity after incarceration and one month before release.

Results: Of the 36 participants, nine were diagnosed using the MINI-kids as needing mental health services. Those who received psychiatric intervention were diag-nosed as having major depression and/or post-traumatic stress disorder. Significant main effects of intervention and effects of time were shown in the DSD. The EAT-26 score demonstrated the significance of the effects of time and interaction. In the BIS-11 scores, neither intervention nor time showed significant effects.

Conclusions: Results of this study showed that the time course and psychiatric intervention contributed to recovery of depression and therapeutic inter-vention. The time course might reduce eating problems. Psychiatric intervention might be necessary for female juvenile detainees, which presents an important issue for future studies.

Background: Several studies have suggested the continuity of psychotic symptoms between the general population and clinical samples, and have shown that, in fact, the predisposition to hallucinations is a multidimensional construct. However, there is no agreement concerning the number of factors comprising it or the significance of psychotic-like experiences. An examination of the beliefs associated with these experiences could increase knowledge of the continuity of hallucinations.

Aims: The purpose of this work was to analyze the structure of the Revized Hallucination Scale (RHS), applied to a sample of Spanish university students to find out the meaning for the participants and their associated beliefs on each item.

Methods: The RHS was administered to a total of 265 participants. Along with the frequency of each experience, participants were asked to provide an example of each situation described and to what they attributed it.

Results: The results emphasized the presence of four factors that are variously made up of six types of beliefs: personal difficulties; psychological explanations;dreamlike experiences; vivid thoughts; perceptive distortions; and personal desires.

Conclusions: The relevance of these results with regard to the differences that might exist in hallucinations in clinical and normal populations is discussed.

Background: Healthcare professionals commonly exhibit negative attitudes toward people with mental disorders. Few international studies have sought to investigate the determinants of stigma.

Objective: To conduct an international comparison of pharmacy students’ stigma towards people with schizophrenia, and to determine whether stigma is con-sistently associated with stereotypical attributes of people with schizophrenia.

Method: Students (n = 649) at eight universities in Australia, Belgium, India, Finland, Estonia and Latvia completed a seven-item Social Distance Scale (SDS) and six items related to stereotypical attributes of people with schizophrenia.

Results: Mean SDS scores were 19.65 (± 3.97) in Australia, 19.61 (± 2.92) in Belgium, 18.75 (± 3.57) in India, 18.05 (± 3.12) in Finland, and 20.90 (± 4.04) in Estonia and Latvia. Unpredictability was most strongly associated with having a high social distance in Australia (<β>= –1.285), the perception that people will never recover in India (<β> = –0.881), dangerousness in Finland (<β> = –1.473) and the per-ception of being difficult to talk to in Estonia and Latvia (<β> = –2.076). Unpredictability was associated with lower social distance in Belgium (<β> = 0.839).

Conclusion: The extent to which students held stigmatizing attitudes was similar in each country, however, the determinants of stigma were different. Pharmacy education may need to be tailored to address the determinants of stigma in each country.

Objective: The role of environmental factors in hospitalization of patients with schizophrenia is incompletely understood. This study attempts to relate the pattern of hospital admissions to environmental variables such as season and to social factors such as nationally celebrated holidays.

Methods: Charts of all adults (n = 4,331) with a discharge diagnosis of schizophrenia admitted to the Abarbanel Mental Health Centre (Bat Yam, Israel) between 1 January 2001 and 31 December 2005 were reviewed. Hospitalizations were classified by gender, first or repeat admission, month and season of admission, and whether or not the admission coincided with a major Jewish holiday period.

Results: There was a significant reduction (p < 0.05) in first admissions for men during April, the month corresponding to Passover, the most widely celebrated holiday in Israel. This pattern was not seen for women or for repeat admissions. There was no significant effect of the season upon admission rates, using two dif-ferent methods of defining the season.

Conclusions: This study demonstrated significant monthly variability in admission rates and a possible protective effect of a widely celebrated public religious holiday. A consistent effect of season upon rates of admission was not found. Future studies need to identify which specifi c social factors exert a protective or harmful effect and study how knowledge of these effects can be translated into clinical practice.

Background: University students are prone to stressors due to the transitional nature of university life. High levels of stress are believed to affect students’ health as well as their academic performance.

Aims: The aims of this study were to identify stressors and reactions to stressors among university students, and to examine the correlations between student stressors and study variables.

Methods: A correlational descriptive design was used. Student-life Stress Inventory (SSI) was used to measure the stressors and reactions to stressors. Stratified random sampling was employed to recruit participants. The final sample consisted of 877 participants (students).

Results: Results indicated that the highest group of stressors experienced by stu-dents were ‘self-imposed’ stressors followed by ‘pressures’. Cognitive responses were found to be the highest responses to stressors experienced by students. Negative correlations were found with student’s perception of health, and father’s and mother’s level of education.

Conclusions: This study revealed that stressors among university students come from ‘self-imposed’ stressors and ‘pressures’. Stress management, assertiveness skills, time management and counselling sessions will be effective in reducing stress experienced by students.

Objectives: Few studies in Taiwan have looked into the burden of caregivers for the mentally ill and the influence of the burden on the quality of life among caregivers. The aim of this study is to explore the risk factors that may aggravate care burden and to assess the relationship between the caregivers’ burden and their quality of life.

Method: Ninety caregivers of patients with mental illness, who were attending outpatient clinic services in Taipei City Psychiatric Centre, were assessed using a burden questionnaire and the brief questionnaire of the World Health Organization Quality of Life instrument (WHOQOL-BREF).

Results: Burden scores were significantly correlated with the number of care hours the caregivers spent daily with the patient, irrespective of their age, gender, kinship and educational level. Caregivers of patients with different psychiatric illnesses had similar levels of burden. Higher burden scores were correlated with a lower quality of life and retained unique predictive variance in multiple regressions in all four domains of the WHOQOL-BREF.

Conclusions: These findings indicate that care burden has a significant impact on caregivers’ quality of life. Daily care hours with the patient are the unique deter-minant of caregivers’ burden in Taiwan. Measures to reduce daily care hours should be considered.

Background: Migration may have consequences on the mental health of those who enter a new cultural environment. In Spain, migration has increased tenfold in 20 years. It is important to study how these migrants are interacting within this new context and which variables hinder their personal and social development.

Aims: To analyze acculturation differences in Spain between first-generation immigrants from two different countries; to analyze the self-reported mental health of these participants; and to evaluate which variables best predict mental health disorders.

Method: One hundred and thirty five (135) respondents from Romania and Ecuador responded to a questionnaire analyzing mental health by means of the GHQ-12, coupled with other personal, social and psychosocial acculturation variables.

Results: Both cultural groups differed significantly regarding the impact of personal and social variables on their well-being. Nevertheless, mental health distress was not explained by their cultural differences but by gender, gross income and perceived discrimination. Social support offered by those still living at home acted as a buffer.

Conclusion: It is important to analyze female migration patterns in order to reduce mental health problems, stress the importance of economic income, and examine how social support offered by those living in one’s home culture is an effective buffer against mental distress.

Background: Little empirical research has been done to assess the impact of obsessive-compulsive disorder (OCD) on patients and their caregivers.

Objective: To assess the psychosocial impact of OCD on patients and their caregivers and compare it with depressed controls.

Method: Thirty two patients with OCD and their caregivers and 30 patients of depression and their caregivers were assessed on sociodemographic and clinical variables and the following scales: World Health Organization Quality of Life Questionnaire-BREF version (WHOQOL-BREF); Schedule for Assessment of Psychiatric Disability; Family Burden Interview Schedule; and Family Accommodation Scale. Yale Brown Obsessive-Compulsive Disorder Scale (YBOCS) and Hamilton Depression Rating Scale (HDRS) were applied to rate the severity of obsessive-compulsive and depressive symptoms.

Results: Patients with OCD had the lowest scores in the psychological health domain of the WHOQOL-BREF. They were also disabled due to their illness with maximum disability being experienced in the overall behaviour domain. Caregivers of OCD patients experienced burden in several areas and had to accommodate to the patient’s behaviour. Patients with OCD had a better quality of life (QOL) and were less disabled compared with depressed patients, but their caregivers were more burdened and had to accommodate to a greater degree in comparison to caregivers of depressed patients. The OCD patients’ QOL and disability scores and their caregivers’ burden and accommodation scores correlated significantly with several sociodemographic, clinical and psychological variables.

Conclusion: OCD patients, when compared with depressed subjects, have a better QOL and are less disabled, but their caregivers are more burdened and have to accommodate more.

Background: Recent literature on recovery describes the process as deeply personal and unique to each individual. While there are aspects of recovery that are unique to each individual, this article argues that focusing solely on these overlooks the fact that recovery unfolds within a social and interpersonal context.

Materials: Drawing from qualitative data, this article describes aspects of recovery that involve the contributions of others, the social environment and society.

Discussion: These aspects of recovery include relationships, adequate material conditions and responsive services and supports.

Conclusion: The authors consider the implications of these social factors for transforming psychiatric research and theory as well as for recovery-orientated practice.

This descriptive study presented an overview of culturally sensitive mental health services and potential barriers for immigrant Canadians. A semi-structured question-naire was developed and administered to 173 patients who attended a large cross-cultural psychiatry outpatient clinic in Vancouver, British Columbia, Canada. Results indicated that only 21% of patients were able to state their diagnosis or were able to describe the symptoms of their diagnosis that met the DSM-IV criteria given by a psychiatrist. Examination of patient ethnicity showed that more South Asian (25%) or Southeast Asian (24%) patients had more diagnoses of anxiety disorder in comparison to other ethnic groups. Refugees characterized mental illness in terms of stress or stress-related factors (30%) in comparison to non-refugees (13%). There was a greater preference in women, when compared to men, to prefer the term ‘client’ versus ‘patient’. These results elucidate the importance of cultural and systemic barriers for immigrant Canadians. The need for appropriate service delivery is discussed.

Background: Psychiatry along with other medical disciplines has been under siege in the UK and the USA for a number of years and for a number of reasons. These have varied from various medical scandals and funding changes to political imperatives and public expectations. Changes in the knowledge base have added yet another dimension to this debate.

Material: The subject is explored using historical figures and their writings and an overview of historic views on the psychiatry profession.

Discussion: The demise of the psychiatrist as an expert and the profession of psychiatry as an expertise can be related to both real and perceived factors. Unlike, for instance, the language used by cardio-thoracic surgeons, the language used in and for professional communications in pyschiatry has become very similar to that used in lay discourses on psychological and relationship matters in the general population – partly as a result of the Freudian project successfully insinuating itself into ‘common knowledge’ and partly as the influence of media grows across the globe. This language has been misappropriated by a wide variety of non-experts, who then speak and interpret it as if they are specialists and any challenge from professionals is seen as self-protection and heresy. As psychiatrists, we do not use technology in a persuasive way as other branches of medicine tend to and this takes away a powerful symbolic conveying ‘expertise’. Increased consumerism adds yet another dimension to this discourse.

Conclusions: The patient is definitely the expert on how their illness affects their life, but it is the psychiatrist who is the expert on the illness rather than simply focusing on disease. It is time for the profession loudly to proclaim itself for what it is and what it can and cannot do.

Farmers’ suicide in India is a cause of concern and government figures, though conservative, predict an impending epidemic. Various measures to curb this calamity are being made in a piecemeal manner. Considering it as an issue of social and mental health concern, this article attempts to evaluate the situation based on the tenet that health and illness are the result of a complex interplay between bio-logical, psychological, social, environmental, economic and political factors. Thus in India the agrarian crisis, among other causes, has been largely debated as the major reason for the current state of farmers. It is important that (psychiatric) epidemiology and public mental health try to evolve mechanisms to understand and implement measures, and take this into consideration when attempting health promotion and prevention.

Background: The prevalence – and type – of dissociative disorders is considered to vary across cultures and over time.

Aims: The aim of the study was to examine patterns of dissociative disorders among subjects attending psychiatric services over a period of 10 years.

Methods: The sample consisted of both inpatients and outpatients attending a psychiatric hospital between 1999 and 2008. Information of those subjects diagnosed to have dissociative disorders was reviewed. A semi-structured proforma was used to collect information about demographic details and diagnosis.

Results: A total of 893 patients had been diagnosed with dissociative disorder over the past decade: 591 (66%) were outpatients and 302 (34%) were inpatients. The proportion of patients diagnosed with dissociative disorders ranged between 1.5 and 15.0 per 1,000 for outpatients and between 1.5 and 11.6 per 1,000 for inpatients. The majority of patients were diagnosed with dissociative motor dis-order (43.3% outpatients, 37.7% inpatients), followed by dissociative convulsions (23% outpatients, 27.8% inpatients). Female preponderance was seen across all sub-types of dissociative disorder except dissociative fugue.

Conclusions: Dissociative disorders are still commonly diagnosed in both inpatient and outpatient settings. Dissociative motor disorders and dissociative convulsions are the most common disorders. Unlike in the West, dissociative identity disorders were rarely diagnosed; instead, possession states were commonly seen in the Indian population, indicating cross-cultural disparity.

Background: Culture is important to how populations understand the cause of mental disorder, a variable that has implications for treatment-seeking behaviour. Asian populations underutilize professional mental health treatment partly because of their endorsement of supernatural causation models to explain mental disorders, beliefs that stem from their religious backgrounds.

Aims: This study sought to understand the dimensions of explanatory models used by three groups of Singaporean Chinese youth (n = 842) – Christian, Chinese religionist, no religion – and examined their responses to an instrument that combined explanations from psychological and organic perspectives on mental disorder with approaches from Asian and Western religious traditions.

Results: Factor analysis revealed five factors. Two were psychological cor-responding to the humanistic and cognitive-behavioural perspectives respectively. Another two, which were supernatural in nature, dealt with karmaic beliefs popular among Asian religionists and more classical religious explanations common in monotheistic religions. The remaining factor was deemed a physiological model although it incorporated an item that made it consistent with an Asian organic model.

Conclusion: While groups differed in their endorsement of supernatural explan-ations, psychological perspectives had the strongest endorsement among this population. Regression analysis showed that individuals who endorsed supernatural explanations more strongly tended to have no exposure to psychology courses and heightened religiosity.

Background: Explanations for mental disorders in India can be influenced by biomedicine, systems of traditional medicine and supernatural beliefs. Community beliefs about causes of mental distress influence help-seeking behaviours. This study aimed to assess local knowledge and understanding of causes and risks for mental disorders in a rural area of Maharashtra, and to assess the prevalence of possible common mental disorders.

Methods: A cross-sectional mental health literacy survey was undertaken in late 2007. A questionnaire was administered to 240 systematically sampled community members and 60 village health workers (VHWs). Participants were presented with two vignettes describing people experiencing symptoms of mental disorders (depression, psychosis); they were asked about the causes of the problems and the vulnerabilities of community sub-groups. Additionally, the General Health Questionnaire (GHQ12) was administered to assess prevalence of possible com-mon mental disorders.

Results: The most commonly acknowledged causes of the problems were a range of socioeconomic factors. Supernatural and biological explanations were not widely endorsed. Women, the unemployed and the poor were judged as more likely to develop mental disorders, while both young and older people were perceived to be less vulnerable. Results of the GHQ12 indicated that 27% had a possible common mental disorder and that the elderly were at increased risk, contrary to community perceptions.

Conclusion: Enhancing mental health literacy of both VHWs and community members using approaches that are sensitive to local conceptualizations of mental health and illness will contribute to improved treatment and care for people with mental disorders. Further investigation of mental health among the elderly in this community is indicated.

Family intervention in schizophrenia is known to reduce high expressed emotion (EE) burden in relatives, reduce patients’ relapse and improve patient functioning; but these issues have not been studied in Iran.

Aims: To examine the effects of behavioural family management (based on Falloon’s model) for Iranian mothers of patients with schizophrenia, compared with psychoeducation and standard care.

Method: Randomized controlled trial in Iran with 55 mothers of outpatients with schizophrenia, of whom 18 received behavioural family management, 19 psycho-education and 18 standard care. All groups included mothers in all sessions and excluded the patients. Intervention was provided for three months and outcomes were compared at the end of intervention (T1) and over a follow-up period: after three months (T2) and after six months (T3).

Results: Psychoeducation consistently produced greater reduced burden in mothers and reduced positive symptoms in patients over the intervention and follow-up periods, compared with the other two treatments. On the other hand, behavioural family management significantly reduced EE in mothers compared to the other groups. However, the results indicated that family interventions have benefits for mothers and patients.

Conclusions: Family interventions for Iranian mothers of schizophrenia patients can substantially benefit from family functioning.

Background: Migrant groups in the UK are at an increased risk of experiencing psychosis. In particular, South East Asian women are substantially more at risk of mental illness than men. Perceived social support and access to social capital are two important psychosocial factors, which may explain this differential risk.

Aims: This study aimed to explore if migrant status was associated with the perception of social support and access to social capital of Punjabi women suffering from enduring mental illness.

Method: We conducted a cross-sectional survey of a homogeneous group of Punjabi women (n = 54). Outcome measures included the Multidimensional Scale of Perceived Social Support (MSPSS) and Resource Generator-UK (RG-UK).

Results: No significant differences were found between the two generations on our outcome measures. However, univariate analysis revealed an association of socio-economic and demographic variables with the MSPSS and RG-UK. Linear regression confirmed that being employed, living with others and human capital predicted increased access to social capital.

Conclusions: Intervening to help this vulnerable group to enhance their social skills and to develop their social networks may improve their access to social capital and promote their recovery from mental illness.

Background and aim: The incidence of mental ill health in Sweden has increased over the past few years. Thus, the aim of this study is to estimate the burden of psychiatric disorders for both the direct and indirect costs in Sweden for 2001 by making comparisons with data from 1998.

Method: The cost-of-illness approach, which is based on human-capital theory, was applied. We have chosen a prevalence approach and a top-down method based on aggregate healthcare expenditures from national databases.

Results: The total annual economic burden of psychiatric disorders in Sweden is estimated to be 9.4 billion (1 = SEK9.1). The direct costs are estimated to be 1.9 billion comprising 20% of the total costs. The indirect costs are estimated to be 7.5 billion and account for the remaining 80%. A comparison with previous studies indicates that the indirect costs were 60% and 53% in 1975 and 1991, respectively.

Conclusion: The number of beds in specialized psychiatric care decreased by 11% between 1998 and 2001 but the indirect costs increased dramatically (e.g. the number of days of sick leave almost doubled during the same period).

Background: The concept of patient-centredness is increasingly being incorporated into modern healthcare practice, yet little attention has been given to the development of patient-centred principles in research.

Aims: This study aimed to establish convergent validity for a definition of patient-centredness using abstracts from schizophrenia research and to explore the experiences of psychiatrists and service users taking part in research that was designed to be patient-centred.

Methods: Mixed methods were used in this community study.

Results: Thirteen service users and three psychiatrists took part. Service users rated eight of 60 research abstracts as patient-centred, even though 30 of these had been previously rated as such by psychiatrists. There was some accord between psychiatrist and service user ratings as seven out of eight abstracts were identified by both groups as patient-centred. Process aspects of research were valued by service users, for example, being respected as collaborators. Both groups reported benefits to participation in patient-centred research, such as feeling valued and breaking down barriers between doctor and patient.

Conclusions: While there is some agreement between professionals and service users as to what constitutes patient-centred research, other process-related factors are important. Patient-centred research is valued by both service users and doctors and should be incorporated into future studies.

Background: The body of evidence verifies the predictive value of certain work characteristics for mental health problems and that various levels of adaptation mechanisms are employed when dealing with adversity. Data on the relationships between employees’ mental health status, their perceptions of work, and their psychological defences are scarce.

Aims: To examine the role that personal defences play in the relationship between psychiatric symptoms among working people and their working environment.

Methods: Nine hundred and seventy six employees (mean age = 42.4 years, SD = 11.3) participated in a questionnaire study that included the Defence Style Questionnaire, the Symptom Checklist 90 revised, and the Copenhagen Psychosocial Questionnaire.

Results: Data showed that greater maturity of psychological defences was associated with higher level of psychological functioning and there were strong associations between presence of psychopathology and the three defence clusters. Results indicated a strong positive correlation between the mature defence style and the perception of a satisfactory workplace. There was no interaction between psychopathology and defences in relation to work environment.

Conclusion: Psychopathology and defences were significantly associated with work conditions, which could suggest that adaptation mechanisms and psychopathology are two independent forms of adjustment to the rapidly changing world of work.

Background: Patients’ relatives are considered crucial for treatment and recovery in psychosis but family intervention studies have shown contradictory results in first-episode psychosis. The aims of this study were to survey caregivers’ satisfaction with the multi-family intervention delivered by our programme and to verify if knowledge acquisition about illness and treatment provided by the family intervention was considered enough and understandable.

Methods: Sixty five family members of 46 first-episode patients were invited to answer a satisfaction questionnaire about the intervention.

Results: Forty individuals returned the questionnaire: 31 women (77.5%) and nine men (22.5%). Most (82.5%) had daily contact with the patient and 19 (47.5%) were mothers. Regarding knowledge acquisition, approximately one third did not improve their understanding of the illness. Nonetheless, 90% of the participants believed the meetings helped them to cope with their ill relative and 95% approved the multi-family format.

Conclusions: Non-specific aspects of the intervention were seen as the most useful part of the programme. An important target of treatment would be to improve the way in which the specific psychoeducational components are delivered to individuals with low formal education.

Background: Adverse mental health effects in response to a variety of distressing events in specific populations are well documented. However, comparatively little research has been conducted within large community samples outside North America.

Aims: To assess the prevalence and psychological impact of specific traumatic events in a New Zealand community sample.

Methods: Prevalence and psychological impact of 12 traumatic events was examined in a community sample of 1,500 New Zealand adults using a three-stage cluster sampling method. Traumatic events, psychological distress, psychological well-being, and post-traumatic stress disorder symptoms were assessed using modified versions of the Traumatic Stress Schedule, Mental Health Inventory, and Civilian Mississippi Scale. The effects of age, gender and ethnicity were controlled for while assessing impact of traumatic events.

Results: Sixty-one per cent of the sample experienced trauma events in their lifetime, with 9% experiencing events in the past year. Accident-related events were most common in the present sample. Violent crime produced the greatest impact. Tests of interactions involving age, gender, and ethnicity were not significant.

Conclusions: New Zealand community-residing individuals experience post-traumatic stress symptoms, reduced psychological well-being, and increased psychological distress following the experience of violent crime and accidents specifically. Study limitations and suggestions for future research are discussed.

Background: It has often been shown that immigrants are particularly at risk for mental ill health. The aim of the study was to investigate the association of immigrant- and non-immigrant-specific factors with mental ill health within a diverse immigrant population.

Method: An extensive questionnaire was sent out to a stratified random sample of three immigrant populations from Finland, Iraq and Iran. The 720 respondents completed a Swedish, Arabic or Farsi (Persian) version of the questionnaire including the WHO (10) Well-Being Index and the HSCL-25.

Results: The results indicate that mental ill health among immigrants is independently associated with non-immigrant-specific factors (i.e. high number of types of traumatic episodes, divorced/widowed, poor social network, economic insecurity and being female) and immigrant-specific factors (i.e. low level of socio-cultural adaptation). These results were obtained regardless of whether mental ill health was operationalized as low subjective well-being or a high symptom level of anxiety/depression.

Conclusions: These findings support the notion that mental ill health among immigrants is a multi-faceted phenomenon that needs to be tackled within a wide range of sectors – e.g. the healthcare system, the social service sector and, of course, the political arena.

Objective: The main aims were to examine the relationship between general population suicide rates and the presence of national policies on mental health, funding for mental health, and measures of mental health service provision.

Methods: Data on general population suicide rates for both genders were obtained from the World Health Organization (WHO) databank available on the WHO web-site. Data on the presence of national policies on mental health, funding for mental health and measures of mental health service provision were obtained from the Mental Health Atlas 2005, also available on the WHO website.

Findings: The main findings were: (i) there was no relationship between suicide rates in both genders and different measures of mental health policy, except they were increased in countries with mental health legislation; (ii) there was a significant positive correlation between suicide rates in both genders and the percentage of the total health budget spent on mental health; and (iii) suicide rates in both genders were higher in countries with greater provision of mental health services, including the number of psychiatric beds, psychiatrists and psychiatric nurses, and the availability of training in mental health for primary care professionals.

Conclusions: Cross-national ecological studies using national-level aggregate data are not helpful in establishing a causal relationship (and the direction of this relationship) between suicide rates and mental health funding, service provision and national policies. The impact of introducing national policies on mental health, increasing funding for mental health services and increasing mental health service provision on suicide rates requires further examination in longitudinal within-country studies.

Background: Despite the fact that about 10% of children experience mental health problems, they tend to hold negative views about mental illness. The objective of this study was to investigate the views of Nigerian schoolchildren towards individuals with mental illness or mental health problems.

Methods: A cross-sectional design was used. Junior and senior secondary schoolchildren from rural and urban southwest Nigeria were asked: ‘What sorts of words or phrases might you use to describe someone who experiences mental health problems?’ The responses were tabulated, grouped and interpreted by qualitative thematic analysis.

Results: Of 164 students, 132 (80.5%) responded to the question. Six major themes emerged from the answers. The most popular descriptions were ‘derogatory terms’ (33%). This was followed by ‘abnormal appearance and behaviour’ (29.6%); ‘don’t know’ answers (13.6%); ‘physical illness and disability’ (13.6%); ‘negative emotional states’ (6.8%); and ‘language and communication difficulties’ (3.4%).

Conclusion: The results suggest that, similar to findings elsewhere, stigmatization of mental illness is highly prevalent among Nigerian children. This may be underpinned by lack of knowledge regarding mental health problems and/or fuelled by the media. Educational interventions and encouraging contact with mentally ill persons could play a role in reducing stigma among schoolchildren.

Aim: The study aimed to examine the perceptions of illness in self and among others in patients with bipolar disorder in remission. The effect of a structured edu-cational programme on the perceptions of illness was also tested.

Method: We examined the perceptions of illness in self and in others (using a vignette) among patients with bipolar disorder in remission attending the Depart-ment of Psychiatry, Christian Medical College, Vellore, India. We also examined the effect of a structured educational programme on explanatory models in a randomized controlled trial. Explanatory models were assessed using the Tamil version of the Short Explanatory Model Interview.

Results: Eighty two subjects were recruited for the trial; half of them received structured education while the other half received treatment as usual. There was agreement between perceptions related to the individual’s own illness and their opinion of illness in others as assessed using a vignette at baseline and at follow-up. There were no significant differences in explanatory models between patients who received education and those who did not.

Conclusions: The results of this study show that during periods of remission, patients can clearly see the relationship between their own illness and that de-scribed in others, suggesting that insight is state dependent and may be related to psychopathology with good recovery of insight during periods of remission. These findings also argue for the fact that the current multi-dimensional models of insight which focus on biomedical explanations and treatments are not culturally sensitive. The assessment of insight demands universal conventions with comparison to the local cultural standards rather than universal definitions and yardsticks which employ Western and biomedical perspectives.

Background: Body ornamentation is becoming more and more popular, especially among young people.

Aims: To establish the sociodemographic characteristics of people with tattoos or body piercing and to analyze the motivations for body ornamentation.

Methods: The questionnaire studies were undertaken in Lodz – one of the largest cities in Poland. The data was collected from a group of 968 people, 476 of whom had a piercing and 492 a permanent tattoo.

Results: Statistical analysis revealed that in the group of people with a tattoo, 36.8% were female and 63.2% were male. Contrary proportions were noted among people with a piercing: 78.8% female and 21.2% male.

Conclusions: Body piercing is significantly more popular among women while tattooing is more popular in men. Among adolescents, body piercing is performed considerably earlier than tattooing. The main reasons for body ornamenting in the Polish population are the desire to enhance one’s individuality and the need to increase sexual attractiveness.

Introduction: This paper uses findings from a larger study to present a nuanced depiction of the interplay of informal and formal help-seeking processes of a sample of Chinese immigrants in their mental healthcare in New York City.

Method: Thirty one participants who were receiving mental health treatment were interviewed with regard to their experiences preceding their suicide attempt. Their narratives were coded for thematic analysis.

Findings: Acculturation difficulties, inaccessibility to services and stigma associated with mental illness were major obstacles in the participants’ help-seeking process, which was consistent with other studies of immigrants of ethnic minority groups in the USA. In addition, the findings showed how changes in this sample of Chinese immigrants’ socio-cultural reality disrupted familiar help-seeking pathways, and perpetuated and amplified the aforementioned stressors. Issues of human con-nection, immigrants’ resiliency and missed opportunities were also identified as potential resources to modify cultural stigmas and help-seeking behaviour.

Conclusion: There are varied socio-cultural factors that need to be considered in mental health outreach services in immigrant communities.

Objective: The low level of psychiatric research in low- and middle-income (LAMI) countries has been identified as a cause for concern, particularly because the extent of the unmet need for psychiatric treatment in many LAMI countries is not known. The aim of this study was to establish if the worldwide increase in research publication during the last decade included an increase in publication about mental disorders from LAMI countries.

Method: We searched PubMed for articles about mental disorder, depression and schizophrenia using the names of LAMI and high-income (HI) countries in the institutional affiliation address (AD) field published during two five-year periods: 1998–2002 and 2003–2007. We then examined the relationship between per capita publications about mental disorder and the independent variables of per capita gross domestic product purchasing power parity (GDP ppp), per capita psychiatric beds, per capita psychiatrists, total population and whether the country had a designated mental health budget.

Results: The number of medical research publications per capita, and the number of publications about mental disorder from LAMI countries is low when compared to the rate from HI countries. However, the absolute number of publications from LAMI regions and the proportion of research publications about mental disorder, schizophrenia and depression increased significantly during the decade of the study. There were independent associations between GDP ppp and population size and the rate of publications about mental disorder in LAMI countries.

Conclusions: The overall increase in the number of publications about mental disorder in the last decade probably reflects an increase in psychiatric research in LAMI countries. The increase in rates of publication was greatest in middle-income countries with the largest populations.

Background: This study examined knowledge and beliefs about depression among Malaysian Malays varying in socioeconomic status.

Methods: A total of 153 urban and 189 rural participants completed a questionnaire in which they had to identify two cases of depression and rate a series of items about the causes and best treatments for depression.

Results: Results showed that urban participants were more likely to use psych-iatric labels (‘depression’) for the two vignettes, whereas rural participants tended to use more generic terms (‘emotional stress’).

Conclusion: Principal components analysis (PCA) showed that beliefs about the causes of depression factored into five components, of which stressful life events was most strongly endorsed by both groups. PCA of treatment items revealed four stable components, of which religious factors were most strongly endorsed. There were also a number of significant between-group differences in the endorsement of these factors (_p² = .03–.11), with rural participants generally rating supernatural and religious factors more strongly than urban Malays. These results are discussed in relation to mental health literacy programmes in Malaysia.

Background: Coercive physical measures are commonly used in psychiatric units throughout the world for the management of severe behaviourally disturbed patients.

Aim: The aim of this study was to assess the rates of coercive physical measures (seclusion and restraint) used in psychiatric inpatients in the psychiatric unit of a general hospital in Greece.

Methods: A retrospective chart review of all admissions to the psychiatric unit of the University General Hospital of Ioannina during a six-month period was conducted. Differences between patients who were subjected to coercion and patients who did not receive any coercive treatment were statistically analyzed and compared.

Results: Of the total of 282 admissions during the study period, 31 (11.0%) cases had been subjected to some form of coercive physical measures: 9.55% and 1.76% were affected by seclusion and mechanical restraint, respectively (one patient had been subjected to both). The mean duration of any one seclusion and mechanical restraint was 64.9 hours and the mean number of seclusion and restraint per affected case was 3.58. Statistical analysis between the group subjected to coercive measures and the group who was not did not reveal any association with demographic data or diagnosis. Coercive measures were found to be associated only with the type of admission at intake.

Conclusions: Involuntary admissions were associated with statistically significant higher levels of restraint and seclusion in this patient sample. Strategies that will enhance patients’ follow-up are expected to prevent involuntary admissions and reduce the use of coercive measures.

Background: A great amount of research has been done in the area of gender and severe mental illness. However, there is an apparent lack of studies on gender differences concerning needs and care.

Aim: To analyze differences in needs and care between men and women con-sidered to be severely mentally ill (SMI) after the 1995 Swedish mental health care reform.

Method: In one area of Sweden, surveys were made in 1995/96 and 2006 of persons considered to be SMI. These persons were interviewed and their needs assessed. In a cross-sectional study in 2006, the needs and care of men and women were compared. In a longitudinal study, men and women interviewed in both 1995/96 and 2006 were compared concerning the development of needs and care.

Results: The structure of needs differed between men and women. Men had more needs concerning functional disability and those needs seemed possible to meet in the existing service structure. Women’s needs concerning physical health, information about health and own security, seemed to be more difficult to meet. Only a few gender differences were found in satisfaction with services and service utilization.

Conclusion: It seems urgent to have a gender perspective in a needs-led mental healthcare service.

Background: User involvement in health services has been a priority for govern-ment since 1990. In mental health, concern has been expressed that involved service users (activists) are not representative of ‘ordinary’ patients.

Aims: (i) To investigate service users’ perceptions of the outcomes of user involve-ment in two London boroughs. (ii) To determine whether the perceptions of outcomes differ between activists and non-activists.

Method: The study was user-led. The user-researchers compiled a semi-structured interview schedule which they then administered to a sample of 40 people; 20 were defined as activists and 20 as non-activists. There were also 20 participants in each borough.

Results: Activists were aware of more user groups and forms of user involve-ment than non-activists. However, in terms of perceptions of the outcomes of user involvement, there was little difference between the activists and non-activists.

Discussion: There is very little extant work on the outcomes of user involvement in mental health services. This study examined this and, contrary to reservations often expressed, there was little difference between activists and non-activists.

Conclusion: This is a pilot study. Further work should examine perceptions of the outcomes of user involvement by other stakeholders, for example, front-line workers, managers, carers and commissioners.

Introduction: In recent times, much attention has been focused on the reduction of seclusion and restraint in psychiatric settings. This paper analyzes evidence available from evaluations of single seclusion and/or restraint reduction pro-grammes. A total of 29 papers were included in the review.

Results: Seven key strategy types emerged from the analysis: (i) policy change/leadership; (ii) external review/debriefi ng; (iii) data use; (iv) training; (v) consumer/family involvement; (vi) increase in staff ratio/crisis response teams; and (vii) programme elements/changes. Outcomes indicate that a range of reduction pro-grammes are successful in reducing the frequency and duration of seclusion and restraint use, while at the same time maintaining a safe environment.

Conclusion: The development of new seclusion and restraint reduction pro-grammes should include strong leadership from local management; external seclusion and restraint review committees or post-incident debriefing and analysis; broad-based staff training and programme changes at a local level. Behavioural and cognitive-behavioural programmes appear to be very useful in child and adolescent services. Further systematic research should be conducted to more fully understand which elements of successful programmes are the most powerful in reducing incidents of seclusion and restraint.

Background: Among Filipino youth in Hawai‘i, low Filipino cultural identification and low family support may be important risk factors for delinquency.

Aims: To examine, in a sample of Filipino youth in Hawai‘i, correlations between delinquent behaviour and the aforementioned – as well as other, potentially mediating – variables.

Methods: A youth risk survey and Filipino Culture Scale were administered to Filipino students (N = 150) in Hawai‘i. A parent risk survey was administered to available and consenting parents.

Results: Delinquent behaviour correlated positively with acculturative stress, low cultural identification and adverse peer influences; and negatively with total Filipino Culture Scale score. Structural equation modelling suggested that absent/ineffective adults and adverse peer influences might be more important variables compared to low self-esteem and less religiosity, linking low cultural identifi cation to delinquent behaviour.

Conclusions: Although further studies are warranted, to be effective, efforts to prevent delinquency by enhancing Filipino youths’ cultural connectedness may also need to enhance family connectedness and address adverse peer influences.

Background: It is increasingly acknowledged that satisfaction with sexual relations forms an important aspect of people’s lives, but little is known of factors associated with this phenomenon among people with mental illness.

Aim: This study aimed to investigate how demographic, social, clinical, and health-related factors were related to satisfaction with sexual relations.

Methods: Patients with persistent mental illness (N = 103), recruited from an out-patient unit, were assessed regarding the target variables.

Results: No clinical variable, and only one demographic factor, namely being a cohabitant, was found to be important to satisfaction with sexual relations. Several social factors, pertaining to how everyday occupations were valued and how the social network was perceived, were shown to be of importance. General quality of life, but not self-rated health or interviewer-assessed psychopathology, was also important for satisfaction with sexual relations. A multivariate analysis showed that the most significant factor for satisfaction with sexual relations was how everyday activities were valued, and being a cohabitant explained some additional variation.

Conclusion: Previous research indicates that the mental health care services largely neglect sexual problems among people with mental illness, and the findings may provide additional knowledge that may be used in the support of this target group.

Background: Research consistently suggests nurses working in mental health settings are more likely to be assaulted than nurses in other settings.

Aims: Belated recognition of the issue in terms of social policy (Elston et al. 2006) has been accompanied by an as yet unexamined contest between conflicting ‘frames’ of the problem, which this paper seeks to make transparent.

Method: Frame analysis.

Results: Two distinct ‘master’ frames are discussed: the ‘individualizing’ and the ‘co-creationist’.

Conclusions: The influence of these frames has influenced the nature of responses to the problem but the recent dominance of the individualizing frame is being challenged by the emergence, or perhaps re-emergence, of co-creationism.

Background: Doctors are poor at help-seeking, particularly for mental ill health; attitudes of colleagues reflecting stigmatisation may be important factors influencing decisions to seek support.

Aims: This article focuses on doctors’ attitudes to depression rather than mental illness in general. It seeks to determine the extent to which doctors perceive de-pression is stigmatised within the medical profession and whether the level of perceived stigma affects patterns of help-seeking behaviour.

Method: A postal survey was sent to 1488 General Practitioners and 152 psy-chiatrists in Devon and Cornwall. Questions assessed stigmatising attitudes to depression; help-seeking behaviour and barriers to help-seeking. Prevalence of self-reported depression and time off work was measured.

Results: The response rate was 76.6%. Doctors perceived that many of their pro-fession hold stigmatising views of depression. Some 46.2% of respondents reported that they had suffered an episode of depression. Help-seeking was significantly reduced in those with a history of depression. Barriers to help-seeking were reported as letting colleagues down (73.1%), confi dentiality (53.4%), letting patients down (51.9%) and career progression (15.7%). Gender and a history of depression significantly affected help-seeking behaviour and perceived stigmatisation. Higher levels of perceived stigma increased concerns about help-seeking and reduced help-seeking from own GP or colleagues.

Conclusion: Stigma associated with depression in doctors is endemic in the medical profession and the level of perceived stigma is related to reduced help-seeking behaviour. Efforts need to be made by the profession to reduce the stigma anticipated by those who become depressed, to enable appropriate help-seeking and support.

Aim: There has been a striking increase in the number of compulsory admission proceedings in the Netherlands since 1992, to such an extent that treatment in Amsterdam’s psychiatric clinics is in danger of being dominated by coercive treatment. Our aim was to establish a picture of the changes in emergency psychiatry that have contributed to the increase in the number of acute compulsory admissions.

Methods: A cohort (N = 460) of psychiatric emergency consultations with the city crisis service in 1983 was compared with a similar cohort (N = 436) in 2004–2005. The study focused on the following variables: patient characteristics, crisis-service procedures and consultation outcomes.

Results: Compared with 1983, there are now more services involved in crisis support in the public domain for psychiatric patients. The number of patients referred by the police has risen from 29% to 63%. In 1983, all consultations took place where the patients were located; at present, 60% take place at the crisis service premises. The number of psychotic patients in the cohort has increased from 52.0% and 63.3 %. There has been an increase in the proportion of compulsory admissions and a sharp decrease in the proportion of voluntary admissions from 61% to 28% of all admissions. Overall, the percentage of consultations leading to a psychiatric admission has fallen from 42% to 27%.

Conclusion: The front-line outreach service of 1983 has changed into a specialist psychiatric emergency department with a less pronounced outreach component. Voluntary admissions to psychiatric hospitals have almost disappeared as a feature of the crisis service.

Background: This study aimed to determine whether subjective dimensions of recovery such as empowerment are associated with self-report of more objective indicators such as level of participation in the community and income from employment. A secondary aim was to investigate the extent to which diagnosis or other consumer characteristics mediated any relationship between these variables.

Methods: The Community Integration Measure, the Empowerment Scale, the Recovery Assessment Scale, and the Camberwell Assessment of Needs Short Appraisal Schedule were administered to a convenience sample of 161 consumers with severe mental illness.

Results: The majority of participants had a primary diagnosis of schizophreniform, anxiety/depression or bipolar affective disorder. The Empowerment Scale was quite strongly correlated with the Recovery Assessment Scale and the Community Integration Measure. Participants with a diagnosis of bipolar affective disorder had significantly higher recovery and empowerment scores than participants with schizophrenia or depression. Both empowerment and recovery scores were significantly higher for people engaged in paid employment than for those receiving social security benefits.

Conclusions: The measurement of subjective dimensions of recovery such as empowerment has validity in evaluation of global recovery for people with severe mental illness. A diagnosis of bipolar disorder is associated with higher scores on subjective and objective indicators of recovery.

Aims: To examine levels of burnout among staff working in community-based services for people with personality disorder (PD) and to explore factors which add to or lower the risk of burnout among people working in such services.

Methods: In-depth interviews with staff working at 11 dedicated community-based personality disorder services in England together with a cross-sectional staff survey using the Maslach Burnout Inventory.

Results: Levels of burnout were generally lower than those reported in previous studies among mental health workers and levels of personal accomplishment were higher. Staff reported positive as well as negative experiences of working with people with PD. Strong team-work, clear leadership and opportunities for reflective practice were thought to protect staff from burnout.

Conclusions: The low levels of burnout we found may reflect the early stage of the development of these services. However, it is also possible that working with people with PD does not in itself lead to burnout, especially when services are organized to share and contain work-related anxiety.

Background: Suicide rates generally increase with age. Internet websites and chat rooms have been reported both to promote suicides and to have a positive beneficial effect on suicidal individuals. The role of the internet in elderly suicides has not been studied.

Methods: The relationship between elderly suicide rates and the prevalence of internet users was examined in a cross-national study using data from the World Health Organization and the United Nations website.

Results: The prevalence of internet users was significantly and positively correlated with suicide rates in both genders in the age bands 65–74 years and 75+ years. On multiple regression analysis the prevalence of internet users was independently associated with suicide rates in both genders in both age bands.

Conclusion: Caution should be exercised in the attribution of a causal relationship and the direction of this relationship because of the cross-sectional and ecological study design whereby the findings are subject to ecological fallacy. However, the findings identify and support a need for further research.

Background: The purpose of this study is to report on the cultural appro-priateness of the 60-item Armenian version of the Family Assessment Device (FAD) among ethnic Armenian adolescents in the ethnically and religiously pluralist Lebanon.

Method: A total of 558 Armenian adolescents in Grades 10, 11 and 12 completed the Armenian FAD scale and the Self-Family Closeness (SFC) scale in a randomized order. The internal consistencies and intercorrelations of the Armenian FAD domains were examined, as were their correlations with the SFC ratings.

Results: The Armenian FAD and its General Functioning subscale showed excellent internal consistencies (= 0.89 and = 0.80, respectively), whereas the reliabilities were satisfactory for the family domains of Communication and Role functioning but less than satisfactory for the Affective Responsiveness, Problem Solving, Affective Involvement and Behaviour Control domains. The Armenian FAD scale and its subscales correlated with each other and with SFC ratings (r = –0.55 for Armenian FAD scale; r = –0.57 forGeneral Functioning), and showed sensitivity to gender differences, females reporting better family functioning than males.

Conclusions: Overall, the findings support the cultural appropriateness of the 12-item Armenian FAD General Functioning subscale and its advantage over the 60-item scale. The findings also suggest the need to rethink the items of the four Armenian FAD domains with low internal consistencies for their increased cultural relevance in the case of Armenian adolescents in Lebanon.

Background: Previous studies have reported that many suicide victims have had contact with their physicians a week or month prior to their suicide.

Aims: To assess the date of the last appointment (and complaint) of suicide victims in the Skofja Loka region within Slovenia.

Method: We included all suicide victims in the region in the period 1993–2003. Each of the cases was assigned the closest control in terms of age and gender. Medical death certificates served as a source of demographic data information and information about suicide method. From personal medical records we obtained the date of the last appointment (and the complaint) with the primary care physician. The same was done for the control group. The groups were compared for their last appointment with their physician (date and complaint).

Results: Thirty out of 77 suicide victims visited their physician in the last month before suicide (14/77 in the last week); only 16/77 controls did so before the index day (3/77 in the last week). In 30% of suicide victims, the reason for the last visit was mental health problems (only 3% in the control group).

Conclusion: The results emphasize the important role of primary care physicians in suicide prevention.

Background: Little is known about effective treatment for personality-disordered (PD) offenders. We aimed to obtain the perspective of service users and staff on: (a) the experience of receiving treatment; and (b) the experience of delivering treatment, within new forensic services for PD offenders.

Material: Thematic analysis was applied to qualitative interviews with 30 service users and 22 staff.

Discussion: Service users perceived that they were making positive changes in the areas of anger management, communication, self-harm, self-esteem and insight into their difficulties. Undertaking the clinical work was extremely stressful for staff.

Conclusions: Forensic PD services may be having an important impact on the quality of service users’ lives. Whether treatment is successful in reducing long-term risk to others remains to be seen, and the cost-effectiveness of these services needs to be examined.

Background: This study aimed at examining diagnostic concordance between Prolonged Grief Disorder (PGD), Major Depressive Disorder (MDD), and Posttraumatic Stress Disorder (PTSD) among bereaved war survivors who had lost relatives due to war-related violence.

Method: We investigated the rates of PGD and its association with PTSD and MDD among 60 bereaved people who had lost first-degree relatives due to war-related violence seven years ago and had also experienced other war-related events.

Results: The results indicated that 38.3% of the sample fulfilled the criteria for PGD, 55.0% for PTSD, and 38.3% for MDD. Thirty per cent of the participants without PTSD and 21.6% of those without MDD met criteria for PGD. Women were more likely to have PGD than men. The immediate threat to life was significantly associated with an elevated risk for PTSD and MDD, but not PGD.

Conclusion: The findings suggest that many cases of PGD would be missed by an exclusive focus on PTSD among bereaved war survivors.

Background: This article presents the first epidemiological portrait of ataques de nervios among Latinos in the mainland United States. Much of the previous literature has focused on Puerto Ricans in Puerto Rico and New York City.

Aims: This study examines the social and psychiatric correlates of ataque de nervios in a nationally representative sample of Latinos in the United States.

Methods: This study employs data from the Latino sample (N = 2554) of the National Latino and Asian American Study (NLAAS). Analyses examined the associations between ataques de nervios and a range of social and migration variables, as well as psychiatric diagnoses and measures of mental health need.

Results:Ataques de nervios were reported by 7–15% of the different Latino groups, with Puerto Ricans reporting the highest frequency. Ataques de nervios were more frequent in women, those with disrupted marital status, and those more acculturated to the US. The frequency of those who met criteria for affective, anxiety and substance abuse disorders was higher among those reporting an ataque de nervios.

Conclusion:Ataque de nervioscan serve as an important indicator of social and psychiatric vulnerability in future epidemiological and clinical studies with Latino populations.

Background: Family (whanau) and other carers can play a central part in the natural history of psychiatric service users. Diagnoses or the classification of mental disorders play a significant role in communications between clinicians, psychiatric service users, and family. Despite that centrality, the views and experiences of family on the utility of the present classification systems have been little studied.

Aims: This study aimed to document the understanding and opinions of families/whanau on the utility of diagnostic labels as they observed them being applied to their family members.

Method: This is a qualitative study. The families of two cultural groups (New Zealand Maori and non-Maori) of psychiatric service users were interviewed using a structured approach.

Results: A number of themes on the utility of the diagnostic systems emerged. The single most powerful message being that how the diagnostic labels were communicated, and how they were utilized in the patient management planning, were of paramount importance. There were some cross-cultural differences. From Maori, there was a particular plea for a greater incorporation of culturally syntonic concepts.

Conclusion: Family/whanau had positive views of the contributions current diagnostic practices make to patient care. The study elicited the view that more contextual issues, and not just phenomenology, should be taken into account in the development of diagnostic systems.

Background: Nidotherapy is a new treatment aimed at the systematic alteration of the environment in order to make a better fit for a person with chronic mental health difficulties. Preliminary work has suggested that it might have particular value in those with antisocial personality disorder.

Aims: To examine the views of patients with mental illness combined with antisocial personality features about the acceptability and value of nidotherapy when given over a six-month period as an adjunct to conventional care.

Method: A two-phase study was used. First, a set of key informant interviews was carried out to determine how nidotherapy was perceived in order to identify potentially important themes. Specific topic guides derived from these themes were drawn up for use in the second stage of the study, involving semi-structured interviews with a sample of patients, members of their care teams and their nidotherapists. Nine patients were purposively selected to ensure that a range of demographic and clinical factors was covered.

Results: Analysis of the results showed that the common threads of the per-ception of nidotherapy were that it was both feasible and acceptable to those with antisocial personality disturbance and that the nidotherapists were felt to be valuable allies in what was otherwise seen as a hostile world. It was also seen to improve adherence to other therapies. It was much less valuable when the staff on the clinical teams were not able to embrace the collaborative approach necessary with this therapy.

Conclusion: Nidotherapy is an acceptable form of management and was per-ceived in this study to have largely positive results for both patients and clinical teams as it offered intervention beyond that provided by conventional teams. It was felt to require more than six months of treatment and was less successful when there was inadequate communication between the nidotherapist and clinical teams and when the philosophy of care was not congruent.

Background: Research on gambling behaviours among the Chinese, especially compared to Caucasians, is lacking.

Aims and Methods: Gambling behaviours and motivations between community-based Chinese (n = 199) and Caucasians (n = 306) living in Australia were compared.

Results: There were significant differences between Caucasians and Australian Chinese in relation to gambling behaviours and types of motivations that could predict problem gambling between the two groups.

Conclusions: The findings provide relevant information in understanding gambling behaviours and motivations among the Chinese, as well as a step towards the development of tailored preventive and treatment interventions for problem gambling in this population.

The purpose of this article is to provide a clinical review of a unique, emerging form of severe social withdrawal that has been described in Japan. This paper begins with a case vignette, then reviews the case definition, epidemiology, psycho-pathology, differential diagnosis, and treatment and management of the condition. Called hikikomori, it is well known to both the psychiatric community and general public in Japan but it has never been reviewed in the English medical literature. Patients are mostly adolescent and young adult men who become recluses in their parents’ homes for months or years. They withdraw from contact with family, rarely have friends, and do not attend school or hold a job. Never described before the late 1970s, hikikomori has become a silent epidemic with tens, perhaps hundreds, of thousands of cases now estimated in Japan. The differential diagnosis includes anxiety and personality disorders, but current nosology in the Diagnostic and Statistic Manual of Mental Disorders may not adequately capture the concept of hikikomori. Treatment strategies are varied and lack a solid evidence base, but often include milieu, family, and exposure therapy. Much further research, including population-based and prospective studies, needs to be conducted to characterize and provide an evidence base for treatment of this condition.