The epidemiology of mental illness in an English city

Abstract

A register of adult patients from Salford, England (population 150,000) who came into any form of special psychiatric care was maintained from 1959 to 1963. — Those seeking psychiatric care for the first time in their lives were classed as inceptions (1,945 cases). — Inception rates were calculated for the population at risk. The effects of sex, age, marital state and social class were considered for all cases and for those in specific diagnostic categories. — Considering all categories of mental illness, women had higher rates than men, but only up to the 60's. Both sexes showed an early peak in the 30's then a decline, followed by a rise beginning in the 60's and climbing steeply at older ages. The married had lower rates of inceptions than did the single, widowed or divorced. Persons in the unskilled manual labourer class had higher rates than other occupational categories. — Schizophrenia, as expected, had higher rates among the young, among men, among the single, and among the unskilled. — Depressive psychosis was nearly twice as common in women as in men. Although the married had the lowest rates of depressive psychosis among marital categories, the differences were not as marked as for schizophrenia, nor were the differences in rates for the social classes remarkable. Nothing to suggest the existence of involutional melancholia was found in the inception rates. Attention is drawn to the bimodal age curve for depressive psychosis, and its possible implications for the definition of the syndrome and its causes. — Psychoneurosis was the largest diagnostic category up to 40 years in both sexes, and then declined in numbers. Women, and especially single women, had higher rates than men. No social class variation in psychoneurosis was discovered. — Epidemiological features of psychopathy, addictive disorders, senile psychosis, organic disorders and epilepsy are also presented. — Comparisons are made with Lundby, Sweden and New Haven, Connecticut. The Salford rates fall between these two. — The age distributions of inceptions of schizophrenia and psychoneurosis are compared with that of Huntington's chorea. The resemblance is great, and these data therefore provoke serious consideration of the existence of genetic susceptibility to schizophrenia and psychoneurosis, although there are good reasons for seeking multiple causes including social causes.