British National Survey Research Articles

Psychosis in the Community and in Prisons: A Report From the British National Survey of Psychiatric Morbidity

Reports of increased rates of psychosis in prisons could be due to sampling and ascertainment differences. The authors compared two samples of subjects 16-64 years of age: those from the general population of residents in Great Britain and prisoners in England and Wales. A random sample of remanded and sentenced male and female prisoners (N=3,142) and a two-phase, cross-sectional random sample of household residents (N=10,108) were assessed with structured questionnaires and the semistructured Schedules for Clinical Assessment in Neuropsychiatry. The weighted prevalence of probable functional psychosis in the past year was 4.5 per thousand (95% CI=3.1 to 5.8) in the household survey. In the prison survey, the weighted prevalence was over 10 times greater: 52 per thousand (95% CI=45 to 60). One in four prisoners with a psychotic disorder had psychotic symptoms attributed to toxic or withdrawal effects of psychoactive substances. The proportion of subjects with specific types of hallucinations or delusions did not differ between prison and household psychosis cases. This large study using standardized comparisons showed that the prevalence of psychosis in prisons is substantially higher than in the community and is deserving of greater attention to treatment and prevention. Apart from a minority of prisoners with symptoms attributable to psychoactive substances, the clinical symptom profile of psychosis is the same in both settings. Longitudinal research is needed to better understand these prevalence differences.

Ethnic variations in sexual behaviour in Great Britain and risk of sexually transmitted infections: a probability survey

Ethnic variations in the rate of diagnosed sexually transmitted infections (STIs) have been reported in many developed countries. We used data from the second British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) to investigate the frequency of high-risk sexual behaviours and adverse sexual health outcomes in five ethnic groups in Great Britain. We did a stratified probability sample survey of 11161 men and women aged 16-44 years, resident in Great Britain, using computer-assisted interviews. Additional sampling enabled us to do more detailed analyses for 949 black Caribbean, black African, Indian, and Pakistani respondents. We used logistic regression to assess reporting of STI diagnoses in the past 5 years, after controlling for demographic and behavioural variables. We noted striking variations in number of sexual partnerships by ethnic group and between men and women. Reported numbers of sexual partnerships in a lifetime were highest in black Caribbean (median 9 [IQR 4-20]) and black African (9 [3-20]) men, and in white (5 [2-9]) and black Caribbean (4 [2-7]) women. Indian and Pakistani men and women reported fewer sexual partnerships, later first intercourse, and substantially lower prevalence of diagnosed STIs than did other groups. We recorded a significant association between ethnic origin and reported STIs in the past 5 years with increased risk in sexually active black Caribbean (OR 2.74 [95% CI 1.22-6.15]) and black African (2.95 [1.45-5.99]) men compared with white men, and black Caribbean (2.41 [1.35-4.28]) women compared with white women. Odds ratios changed little after controlling for age, number of sexual partnerships, homosexual and overseas partnerships, and condom use at last sexual intercourse. Individual sexual behaviour is a key determinant of STI transmission risk, but alone does not explain the varying risk across ethnic groups. Our findings suggest a need for targeted and culturally competent prevention interventions.

Reported Sexually Transmitted Disease Clinic Attendance and Sexually Transmitted Infections in Britain: Prevalence, Risk Factors, and Proportionate Population Burden

We examined attendance at sexually transmitted disease (STD) clinics and the prevalence, distribution, and associated demographic and behavioral factors of self-reported sexually transmitted infections (STIs) in a population survey of sexual attitudes and lifestyles. We analyzed data from stratified probability sample surveys obtained through the British National Surveys of Sexual Attitudes and Lifestyles (Natsal), which was undertaken in 1990 (n=13,765) and 2000 (n=11,161) among men and women aged 16-44 years. National STD surveillance data for 1999 were used to determine disease- and risk factor-specific proportionate population burden (PPB). Between 1990 and 2000, the number of subjects who reported having attended an STD clinic during the past 5 years increased from 4.3% to 7.6% among men and from 3.3% to 6.6% among women. In 2000, 3.0% of men and 4.0% of women reported having received a diagnosis of an STI during the past 5 years; 77.6% of men and 60.3% of women with an STI had attended an STD clinic. Reported STI acquisition was independently associated with age, increasing numbers of sex partners, male homosexual partners, and partners from abroad (for women only). Of all reported STIs during the past 5 years (PPB, 10.2%), 10.2% were reported by the 2.9% of men who reported having had homosexual partners during the past 5 years. Of all reported STIs in the past 5 years (PPB, 41.6%), 41.6% were reported by the 4.0% of women who reported having > or =10 sex partners during that time. Analysis of national STI surveillance data showed that the PPB for new episodes of Chlamydia trachomatis diagnosed among homosexual men was 2.8%, that for gonorrhea was 17.4%, and that for syphilis was 32.1%. Numbers and types of sexual partnerships remain the dominant individual and population risk factors for STI acquisition. Combined population behavior and surveillance data demonstrate the high PPB for STIs attributable to key risk factors. PPB may be a useful indicator of epidemic "phase" and may help target resources and guide prevention strategies.

Prevalence and characteristics of nosocomial infections in a Turkish university hospital

The purpose of this study is to estimate the prevalence of nosocomial infections in a university hospital, as well as determining the groups at high risk of such infections. Two surveys based on a modification of the British National Survey protocol for nosocomial infection were conducted in July and December 1998. In the first survey, hospital infections were found in 41 (13.4%) of the patients, and in the second survey in 34 (10.9%). The study showed that the risk of nosocomial infection was associated with being in the intensive care unit, undergoing surgery, and invasive procedures. Prevalence data are consistent with results reported in many other regions of the world. These findings provide the principal information for future surveillance in association with prevention programs in Turkish hospitals.

Prevalence and correlates of self-reported psychotic symptoms in the British population.

The psychosis phenotype is generally thought of as a categorical entity. However, there is increasing evidence that psychosis exists in the population as a continuum of severity rather than an all-or-none phenomenon. To investigate the prevalence and correlates of self-reported psychotic symptoms using data from the 2000 British National Survey of Psychiatric Morbidity. A total of 8580 respondents aged 16-74 years were interviewed. Questions covered mental health, physical health, substance use, life events and socio-demographic variables. The Psychosis Screening Questionnaire (PSQ) was used to identify psychotic symptoms. Of the respondents, 5.5% endorsed one or more items on the PSQ. Factors independently associated with psychotic symptoms were cannabis dependence, alcohol dependence, victimisation, recent stressful life events, lower intellectual ability and neurotic symptoms. Male gender was associated with paranoid thoughts, whereas female gender predicted hallucinatory experiences. Self-reported psychotic symptoms are less common in this study than reported elsewhere, because of the measure used. These symptoms have demographic and clinical correlates similar to clinical psychosis.

The Sensitivity of Estimates of the Change in Population Behaviour to Realistic Changes in Bias in Repeated Surveys

SummaryThe first British National Survey of Sexual Attitudes and Lifestyles (NATSAL) was conducted in 1990–1991 and the second in 1999–2001. When surveys are repeated, the changes in population parameters are of interest and are generally estimated from a comparison of the data between surveys. However, since all surveys may be subject to bias, such comparisons may partly reflect a change in bias. Typically limited external data are available to estimate the change in bias directly. However, one approach, which is often possible, is to define in each survey a sample of participants who are eligible for both surveys, and then to compare the reporting of selected events that occurred before the earlier survey time point. A difference in reporting suggests a change in overall survey bias between time points, although other explanations are possible. In NATSAL, changes in bias are likely to be similar for groups of sexual experiences. The grouping of experiences allows the information that is derived from the selected events to be incorporated into inference concerning population changes in other sexual experiences. We use generalized estimating equations, which incorporate weighting for differential probabilities of sampling and non-response in a relatively straightforward manner. The results, combined with estimates of the change in reporting, are used to derive minimum established population changes, based on NATSAL data. For some key population parameters, the change in reporting is seen to be consistent with a change in bias alone. Recommendations are made for the design of future surveys.

Psychosis, victimisation and childhood disadvantage: evidence from the second British National Survey of Psychiatric Morbidity.

Adverse early circumstances may be more common in people who later develop psychotic disorders. To use data from the second British National Survey of Psychiatric Morbidity to examine associations between psychotic disorders and a number of early victimisation experiences. Psychiatric disorders were identified through structured assessment of adults resident in private households in Britain (n=8580). Respondents were asked whether they had experienced selected events displayed on cards. Compared with respondents with other psychiatric disorders or with none, the prevalence of every experience bar one was significantly elevated in those with definite or probable psychosis. The largest odds ratio was for sexual abuse. Controlling for depressed mood somewhat reduced the odds ratios for the individual experiences. In people with psychosis, there is a marked excess of victimising experiences, many of which will have occurred during childhood. This is suggestive of a social contribution to aetiology.

Tomato consumption and plasma lycopene concentration in people aged 65 y and over in a British national survey.

Assessment of consumption of raw and processed tomatoes, plasma lycopene concentration and their interrelationship in a nationally representative sample of elderly British people. : A 1994-1995 National Diet and Nutrition Survey: a nationwide cross-sectional sample of people aged 65 y and over living in mainland Britain, either in the community ("free-living", n=1275) or in institutions such as nursing homes (n=412). Consumption of raw and processed tomatoes (including those in tomato-containing composite foods) was recorded by a 4-day dietary record for each participant. Plasma lycopene concentration was assayed by HPLC. Sociodemographic and lifestyle information was recorded by trained interviewers. In all, 29% of free-living people and 24% of those living in institutions did not consume any raw or processed tomatoes during the 4-day recording period. Free-living participants were more likely to consume raw tomatoes (26 vs 16%). Plasma lycopene concentration was positively associated with the weight of raw and processed tomatoes consumed, especially with processed tomatoes and their products, alcohol consumption and with plasma total (as well as HDL and non-HDL) cholesterol concentrations. Among free-living participants, increased age, cigarette smoking habit and manual occupational social class were all associated with lower plasma lycopene concentration. In the current population, consumption of raw and processed tomatoes varied by sociodemographic and lifestyle characteristics, and made a significant contribution to plasma lycopene concentration. Determinants of plasma lycopene concentration were age, plasma cholesterol concentration and smoking habit.

Lone mothers, social exclusion and depression

In this paper, data from the British National Survey of Psychiatric Morbidity are used to assess depressive disorders and markers of social disadvantage in women bringing up children on their own. The household component of the British National Surveys of Psychiatric Morbidity was based on a stratified random sample of > 10000 subjects. This paper reports on 5281 women interviewed in person. Psychiatric symptoms and ICD-10 diagnoses were established by lay interviewers using the CIS-R. Results are presented in terms of depressive episode and mixed anxiety/depressive disorder. Housing tenure and access to a car were used as proxy measures of material status. The life event rate in the 6 months before interview was used to indicate overall exposure to stress, and subjects were asked in detail about perceived social support. Information was collected about various other sociodemographic attributes. Lone mothers were compared with supported mothers and with women not involved in care of children under 16. Lone mothers had prevalence rates of depressive episode of 7%, about three times higher than any other group. The milder condition, mixed anxiety/depression, was also increased in frequency. These increased rates of depressive conditions were no longer apparent after controlling for measures of social disadvantage, stress and isolation. Lone mothers are increasing in numbers as marital stability declines. Their high rates of material disadvantage and of depressive disorder may have considerable implications for psychiatric and social policy.

Weight from birth to 53 years: A longitudinal study of the influence on clinical hand osteoarthritis

To determine the influence of body weight throughout the life course on the development of clinical hand osteoarthritis (OA). A British national survey was used to perform a prospective cohort study of 1,467 men and 1,519 women born in 1946. Weight was measured at birth and at subsequent followup visits through childhood and adulthood. The main outcome measure was the odds ratio for the presence of hand OA at the age of 53 years. Two hundred eighty men (19%) and 458 women (30%) had OA in at least 1 hand joint. Hand OA was significantly associated with increased weight at ages 26 years, 43 years, and 53 years and with decreased weight at birth in men. Birth weight and adult weight showed independent effects, such that men with the highest risk for OA represented those who had been heaviest at age 53 years and lightest at birth. These findings were not explained by grip strength. There was no significant relationship between weight and hand OA in women. The results of this study show that increased adult weight is associated with, and may precede, development of hand OA in men. An association between hand OA and weight was not observed in women. The relationship between hand OA and decreased birth weight is a new finding and may reflect the persisting influence of prenatal environmental factors on adult joint structure and function.

Social support networks and type of neurotic symptom among adults in British households.

Current knowledge about associations between psychosocial factors and non-psychotic symptoms provide little information about their relationship to specific types of neurotic symptoms such as symptoms of fatigue, worry, phobic anxiety and obsessional symptoms. The British National Survey of Psychiatric Morbidity was based on a cross-sectional random sample of 10,108 householders. Neurotic symptoms were established by lay interviewers using the revised fully structured Clinical Interview Schedule (CIS-R). Subjects were asked about perceived social support, the size of their close primary social network and sociodemographic attributes. To assess possible associations between specific types of neurotic symptoms and psychosocial risk factors multivariate Huber logistic models (a modified form of repeated measures design modelling) was used taking account of correlation between symptom types and sampling design including clustering. After controlling for sociodemographic factors the risk of having a high total CIS-R score (> or = 12) was approximately doubled for both types of poor social functioning. Specific types of neurotic symptoms were associated both with a small primary group and with inadequate perceived social support. Depression, depressive ideas and panic symptoms had a higher prevalence in multivariate models. Poverty was associated with low support. Associations with deficiencies in social support and self-reported neurotic symptoms are better explained by symptom type and in particular by depression than by the total number of symptoms. If confirmed by longitudinal study findings this knowledge could be used to inform the development of interventions to improve social support in order to reduce specific neurotic symptom types.

Unequal access and unmet need: neurotic disorders and the use of primary care services

In this paper we use data from the National Survey of Psychiatric Morbidity to examine how many people with neurotic disorders receive professional evaluation, and how this is affected by clinical and sociodemographic differences. We hypothesized that psychiatric symptoms and attendant dysfunctions would both have an effect on contacting, and that key demographic variables would not. The household component of the British National Surveys of Psychiatric Morbidity was based on a random sample of >10,000 subjects. Lay interviewers using the CIS-R established psychiatric symptoms and ICD-10 diagnosis. Social dysfunction was tapped by asking about difficulties in performing seven types of everyday activity. We examined symptom score, ADL deficit score, and demographic variables in relation to contact with primary care physicians for psychiatric symptoms. The major determinant of contacting a primary care physician was severity, mainly due to the level of psychiatric symptoms, but with an independent contribution from social dysfunction. There were also significant contributions from sex, marital status, age, employment status, and whether the subject had a physical condition as well. The major influence on whether people seek the help of their family doctors for mental health problems is the severity of disorder. Although there are some social inequalities in access to family doctors, these are less important. The most salient finding from our study is that even people suffering from high levels of psychiatric symptoms very often do not have contact with professionals who might help them.

To what extent are ethnic minorities in Britain over‐educated?

For the total population there is evidence of substantial over‐education in the sense that workers possess higher qualifications than are strictly required for the job. Using the fourth wave of the British National Survey of Ethnic Minorities, this paper attempts to ascertain whether ethnic minorities suffer from higher over‐education than whites due to possible discrimination. The results suggest a differential effect across various ethnic groups and a tendency for foreign qualifications to be rewarded less.

The accuracy of reported sensitive sexual behaviour in Britain: exploring the extent of change 1990–2000

Objectives: The 1990–1 British national probability sample survey of sexual attitudes and lifestyles (Natsal 1990) was repeated in 1999–2001 (Natsal 2000) to update population estimates of risk behaviours, and assess...

Unequal access and unmet need: neurotic disorders and the use of primary care services.

In this paper we use data from the National Survey of Psychiatric Morbidity to examine how many people with neurotic disorders receive professional evaluation, and how this is affected by clinical and sociodemographic differences. We hypothesized that psychiatric symptoms and attendant dysfunctions would both have an effect on contacting, and that key demographic variables would not. The household component of the British National Surveys of Psychiatric Morbidity was based on a random sample of > 10,000 subjects. Psychiatric symptoms and ICD-10 diagnosis were established by lay interviewers using the CIS-R. Social dysfunction was tapped by asking about difficulties in performing seven types of everyday activity. We examined symptom score, ADL deficit score and demographic variables in relation to contact with primary care physicians for psychiatric symptoms. The major determinant of contacting a primary care physician was severity, mainly due to the level of psychiatric symptoms, but with an independent contribution from social dysfunction. There were also significant contributions from sex, marital status, age, employment status and whether the subject had a physical condition as well. The major influence on whether people seek the help of their family doctors for mental health problems is the severity of disorder. Although there are some social inequalities in access to family doctors, these are less important. The most salient finding from our study is that even people suffering from high levels of psychiatric symptoms very often do not have contact with professionals who might help them.

Dietary intakes and nutrient status of vegetarian preschool children from a British national survey.

BACKGROUND: Dietary intakes and nutrient status were compared in meat-eaters and non-meat-eaters from the National Diet and Nutrition Survey of children aged 1.5-4.5 years. METHODS: Children (n = 1351) were categorized as 'omnivores' or 'vegetarians', according to whether they consumed meat or meat products during a 4-day dietary record. Blood samples were also obtained for analysis of haematological and biochemical nutrient status. RESULTS: Three per cent of children were 'vegetarian'. They consumed higher proportions of milk and milk products, although this was significant only in older children (P = 0.007), owing to high consumption by the high proportion of Asian children. In vegetarians, energy intakes tended to be lower in both age groups. Percentage energy from protein and fat were lower, while that from carbohydrate was higher compared with omnivores. Cholesterol intakes were lower, significantly so for younger children (P < 0.001). Intakes of micronutrients were either higher (vitamins C and E, potassium) or lower (niacin and sodium) in younger vegetarians compared with omnivores. Energy-adjusted intakes of iron and zinc did not differ significantly from those of omnivores, although both intakes were low in many children (6-20% < LRNI), particularly in the younger group. Haematological and biochemical nutrient status indices showed few differences. Serum ferritin was lower in vegetarians, significantly so in younger children (P = 0.002). Antioxidant vitamin (A, C and E) status tended to be higher in vegetarians, while vitamin B12 intakes and status were more than adequate. Apart from poorer vitamin D intake and status in older Asian vegetarians, very few ethnic differences were observed. CONCLUSIONS: Nutrient intakes and status were generally adequate in preschool children who did not eat meat. Although serum ferritin levels were inferior (particularly in vegetarians under 3 years old), the lower intakes of fat, cholesterol and sodium, and higher antioxidant vitamin intakes and status indices were potentially beneficial. Given a balanced diet, adequate nutrient intakes and status can be maintained without consuming meat.

British Co-operative Clinical Group national survey on diagnostic issues surrounding genital herpes. MSSVD Special Interest Group on Genital Herpes and the British Co-operative Clinical Group.

OBJECTIVES: To investigate the current use of diagnostic methods for genital herpes simplex virus (HSV) infection, to determine how information from these tests influences clinical practice, and to identify areas...

Estimation of the number of sexual partners for the nonrespondents to a large national survey.

For a random sample of 4548 respondents to the British National Survey of Sexual Attitudes and Lifestyles, item nonresponses were assessed by utilizing alternating least squares and optimal scaling. Of men who did not answer the question on number of lifetime partners, 61% were estimated to have had 10 or more partners, whereas 48% of female nonrespondents were estimated to have had no partners. Among the latter, the percentage of those with 10 or more partners was also elevated to the level almost twice that of respondents. However, the overall impact of the estimates on the distribution of lifetime partners was hardly noticeable due to the relatively small proportion of incomplete answers to this question. Those who did not respond to the question of number of lifetime partners were likely to be over 45 years, of lower social class, and poorer education in comparison with those who answered the question fully. A larger proportion of the former were of Asian extraction and non-Christian in comparison to the latter, particularly among women. Not providing a complete answer to the question on the number of lifetime partners was associated with the nonresponse rate in the range of 90% on the questions of STD clinic attendance and drug abuse. Heavy smoking was more prevalent among male nonrespondents in comparison to those who provided a full answer to the question on the number of lifetime partners.

Use of medicines by older people in a large British national survey, and their relation to vitamin status indices.

To describe the extent of use of medicines by older people living in Britain, and to explore relationships with vitamin status indices. The National Diet and Nutrition Survey of people aged 65 years and over collected data from a British sample during 1994-95. The present study has made novel use of it, to relate medicine use with biochemical indices of vitamin status. Eighty postcode areas, selected randomly from mainland Britain. 1506 people, 65 years and over gave information about use of medication, and a 4-day weighed food record. Three-quarters gave blood for status indices. 78% of those living in the community and 93% of those in institutions were using medication. Certain vitamin status indices: plasma retinol, erythrocyte folate and riboflavin, paradoxically suggested better status in users than in non-users of antihypertensive, gastrointestinal, central nervous system, corticosteroid or diabetic drugs. There was evidence of a link with renal insufficiency, especially for plasma retinol, but neither this nor increased nutrient intake, acute phase effects or haemoconcentration could explain the paradoxical associations. Caution is needed in interpreting certain vitamin status indices, especially in older people who are extensively using medicines. New vitamin indices are needed, to avoid confounding interferences.

Using national surveys: a review of secondary analyses with special reference to education

Summary The General Household Survey (GHS), the Labour Force Survey (LFS), the British Household Panel Study (BHPS), the Youth Cohort Study (YCS) and the National Child Development Study (NCDS) are British national surveys which provide general and demographic information, including information about employment, routes into the labour market, education, health, income and other major social indicators. Each includes a section about education, covering the current educational status, educational attainment and the establishment last attended full‐time by the respondents. This review of six years (1990‐95) of studies, which either used the data or cited previous secondary analyses, revealed that secondary analyses occurred more frequently in disciplines other than education. The LFS and the YCS are most frequently the subject of further analysis, whereas analyses of the NCDS data are more frequently cited, the most common strategy in educational research. The major thrust of secondary analyses is the effect of qualifications on employment as mediated by other social and educational factors. The potential for studies of educational progression and lifelong learning has not yet been exhausted.