Levels Of Psychiatric Morbidity Research Articles

Psychiatric morbidity among human immunodeficiency virus test seekers attending the integrated counseling and testing center facility of a tertiary care hospital in South India.

Background:Testing for human immunodeficiency virus (HIV) infection has become a mandatory and routine regimen for various reasons. Literature suggests that the level of psychiatric morbidity is high among HIV-infected individuals. However, often psychiatric problems are undetected and untreated among these people and this is possible by the simple measure of screening when these people contact a health-care facility such as an integrated counseling and testing center (ICTC). The paucity of published data in this arena necessitates exploring the facts related to this issue. Hence, this study was aimed to identify the psychiatric morbidity among people undergoing HIV testing by a screening method.Methods:A cross-sectional, descriptive study was carried out among 384 individuals, those who were undergoing HIV testing at an ICTC facility of a tertiary care hospital in South India. They were assessed for psychiatric morbidity by a structured clinical diagnostic interview using mini international neuropsychiatric interview. Those people who were identified as having psychiatric problem were referred to psychiatric clinic for further management.Results:The mean age of the patients was 40 (±13.27) years and the males (n = 254, 66.1%) predominated than the females (n = 130, 33.9%). Psychiatric illness was identified in many patients (n = 91, 24%) including major depressive disorder (n = 64, 16.7%), suicidal ideas (n = 31, 8%), panic disorder (n = 26, 6.8%), and substance abuse (n = 15, 3.9%).Conclusion:The findings imply the need to integrate screening and referral services for the people undergoing HIV testing. Early screening of psychiatric morbidity among individuals utilizing the ICTC facility may help identify and treat the illness at an early stage.

Mental Health Act transfers from prison to psychiatric hospital over a six-year period in a region of England

Purpose There are high levels of psychiatric morbidity amongst people in prisons. In England and Wales, prisoners who present with the most acute mental health needs can be transferred to hospital urgently under part III of the Mental Health Act 1983. This project reviewed all such transfers within one region of England, with an emphasis on differences across levels of security. Design/methodology/approach Over a six-year period (2010–2016) within one region of England, 930 psychiatric referrals were received from seven male prisons. From these referrals, 173 (18.5%) secure hospital transfers were required. Diagnostic and basic demographic information were analysed, along with hospital security categorisation (high secure, medium secure, low secure, psychiatric intensive care unit and other) and total time to transfer in days. Findings There were substantial delays to urgent hospital transfer across all levels of hospital security. Prisoners were transferred to the following units: medium security (n = 98, 56.9%); psychiatric intensive care units (PICUs) (n = 34, 19.7%); low secure conditions (n = 20, 11.6%); high secure conditions (n = 12, 6.9%); other (n = 9, 5.2%). Mean transfer times were as follows: high secure = 159.6 days; other = 68.8 days; medium secure = 58.6 days; low secure = 54.8 days; and psychiatric intensive care = 16.1 days. Research limitations/implications In keeping with the wider literature in this area, transfers of prisoners to hospital were very delayed across all levels of secure psychiatric hospital care. Mean transfer times were in breach of the national 14-day timescale, although transfers to PICUs were quicker than to other units. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved. Originality/value This paper extends the available literature on the topic of transferring prisoners with mental illness who require compulsory treatment. There is a small but developing literature in this area, and this paper largely confirms that delays to hospital transfer remain a serious problem in England and Wales. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved. This could include different referral and transfer models as a component of service-based and pathways research or combining referral pathways across units to improve their efficacy.

Determinants of Infertility among Married Women Attending Dessie Referral Hospital and Dr. Misganaw Gynecology and Obstetrics Clinic, Dessie, Ethiopia.

Background Infertility is the inability to become pregnant after one year of sexual intercourse without the use of contraception. Epidemiological data suggest that 10 to 15% of couples around the world are suffering from infertility. The exact meaning of marriage is mainly fulfilled if the couple conceives and bears children. Failure of this often leads to unhappy married lives, divorces, and high levels of psychiatric morbidity. There is scarcity of data about determinants of infertility in Ethiopia. Therefore, the aim of this study is to identify the determinants of infertility among married women attending Dessie Referral Hospital and Dr. Misganaw gynecology and obstetrics specialty clinic, Dessie, Ethiopia, 2019. Methods An institution-based case-control study was conducted on 281 participants. The participants were selected by a systematic random sampling technique. Data were collected using a structured interviewer-administered questionnaire. Data were entered into EpiData version 3.1 and exported to SPSS version 23 for analyses. Variables with p < 0.25 in bivariable logistic regression were entered into multivariable logistic regression. Odds ratio with its 95% confidence interval was estimated to measure the direction and strength of the association. The level of statistical significance was set at p < 0.05. Results The determinants of women's infertility were age at the first pregnancy (AOR = 2.89; 95% CI: 1.105, 7.564), age at menarche (AOR = 3.2; 95% CI: 1.278, 7.975), menstruation flow in days (AOR = 4.17; 95% CI: 0.062, 0.929), multiple sexual partners (AOR = 5.33; 95% CI: 2.124, 13.397), and history of STI (AOR = 2.79; 95% CI: 1.088, 7.159). Conclusion Age at the first pregnancy, age at menarche, multiple sexual partners, number of days of menstruation flow, and history of STI were determinants of women's infertility. Infertility may bring about unhappy married lives, divorces, and high levels of psychiatric morbidity. Therefore, couples need to have heath education about risk factors for infertility.

Screening for mental disorder using the UK national offender assessment system

Probation officers have large caseloads with high levels of psychiatric morbidity but receive minimal training in recognising/managing mental health problems. In the UK, there is no national screening procedure for mental illness among offenders that is considered effective. This study’s aim was to develop a screening system for mental/personality disorders using the Offender Assessment System. Seven screens for mental disorder were developed using items from assessments on 574 prisoners: alcohol misuse, drug dependence, antisocial personality disorder, psychopathy, learning difficulties, psychosis and severe mood disturbance. Internal validation showed that the screens performed well across accuracy estimates. Prevalence of mental disorders identified with the screens in test and validation samples was similar. However, the psychopathy and severe mood disturbance screens may be more effective in screening for true negatives. The screens are an economical method for prioritising mental health needs of the UK prison and probation population using routinely collected data.

The mental health of fire-fighters: An examination of the impact of repeated trauma exposure.

Emergency workers, such as fire-fighters, are routinely exposed to potentially traumatic events. While a number of studies have examined the occurrence of post-traumatic stress disorder, the role of multiple traumas on other mental health sequelae, such as depression and alcohol misuse, among emergency workers remains unclear. This study aimed to assess the prevalence of post-traumatic stress disorder, depression and alcohol misuse in a sample of current and retired fire-fighters and examine their relationship with cumulative trauma exposure. A cross-sectional survey was completed by current (n = 488) and retired (n = 265) fire-fighters from Fire and Rescue New South Wales, Australia. Demographic and occupational information was collected, including the number of fatal incidents fire-fighters reported attending across years of service. Validated, self-report measures were used to determine probable caseness for post-traumatic stress disorder, depression and heavy drinking. Among current fire-fighters, rates of post-traumatic stress disorder and depression were 8% and 5%, respectively, while 4% reported consumption of more than 42 alcoholic drinks per week. Retired fire-fighters reported significantly greater levels of symptomatology, with the prevalence estimates of post-traumatic stress disorder at 18% (p = 0.001), depression at 18% (p < 0.001) and heavy drinking at 7%. There was a significant positive linear relationship between the number of fatal incidents attended and rates of post-traumatic stress disorder, depression and heavy drinking. Fire-fighters suffer from high rates of mental disorders, with rates of post-traumatic stress disorder, depression and heavy drinking continuing to rise in a linear manner with each additional trauma exposure. The level of psychiatric morbidity among retired fire-fighters appears to be particularly high. Our findings have important implications for the ongoing debates surrounding the detection of mental disorders in high-risk occupations and for policy considerations around the welfare of current and retired emergency workers.

The impact of contact with suicide-related behavior in prison on young offenders.

Prison suicide rates are high, and suicide-related behaviors (SRBs) higher, but effects of contact with such behaviors in prison have not previously been examined. To compare the mental state of young men witnessing a peer's suicide-related behavior in prison with that of men without such experience, and to test for factors associated with morbidity. Forty-six male prisoners (age 16-21 years) reporting contact with another's suicide-related behavior in prison were interviewed 6 months after the incident, with validated questionnaires, as were 44 without such contact at least 6 months into their imprisonment. Significantly higher levels of psychiatric morbidity and own suicide-related behaviors were found in the witness group, even after controlling for their higher levels of family mental illness and pre-exposure experience of in-prison bullying. Some personal factors were associated with higher morbidity; incident and institutional factors were not. Findings of heightened vulnerabilities among young men exposed to suicide-related behaviors in prison suggest a need for longitudinal study to clarify temporal relationships and inform strategies to prevent or limit development of morbidity and further harm.

Does primary care mental health resourcing affect the use and costs of secondary psychiatric services?

Collaborative care models for treatment of depression and anxiety disorders in primary care have been shown to be effective. The aim of this study was to investigate at the municipal level to what extent investment in mental health personnel at primary care health centres in the study area is reflected in the costs and use of secondary psychiatric services. Furthermore, we analysed whether the service provision and use of secondary psychiatric care correlates with the socioeconomic indicators of need. We found significant variation in the amount of mental health personnel provided at the health centres, uncorrelated with the indicators of need nor with the costs of secondary psychiatric care. The amount of mental health nurses at the health centres correlated inversely with the number of secondary psychiatric outpatient visits, whereas its relation to inpatient days and admission was positive. The costs of secondary psychiatric care correlated with level of psychiatric morbidity and socioeconomic indicators of need. The results suggest that when aiming at equal access of care and cost-efficiency, the primary and secondary care should be organized and planned with integrative collaboration.

Are there differences in psychiatric contacts among refugee children compared with their native Danish peers? – A registry-based Danish cohort study

A Barghadouch, M Kristiansen, SS Nielsen, E Montgomery, A Hjern, M Norredam Danish Research Centre for Migration, Ethnicity, and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark DIGNITY Danish Institute Against Torture, Copenhagen, Denmark Centre for Health Equity Studies (CHESS), Karolinska Institutet/Stockholm University, Stockholm, Sweden Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden Contact: amina.barghadouch@sund.ku.dk Background Studies show a high level of psychiatric morbidity among asylum-seeking children and resettled refugee children. However, most of these findings are based on small populations and do not compare with local-born children. Our aim was to study resettled refugee children’s contacts to psychiatric healthcare in comparison with their native Danish peers. Methods Our registry-based study cohort was obtained through the Danish Immigration Service. Refugees were included if they had obtained residence permission in Denmark between 1.1.1993 and 31.12.2010. We identified 25,122 refugees <18 years who were matched 1:6 on age and sex with 150,732 native 126 European Journal of Public Health, Vol. 23, Supplement 1, 2013

Psychiatry morbidity in patients attending neurological outpatient department

Background: Neurological disorders are often associated with psychological, emotional, and other psychiatric disturbances and may impede recovery of patient, making early identification and treatment of potential importance. Aims & Objective: The objective of the study was to see the psychiatric morbidities in in patients attending neurological outpatient department. Material and Methods: The study was conducted in the Neurological Outpatient department in the Department of Medicine in Shri Maharaja Singh Hospital (SMHS) Hospital of Government medical college Srinagar. This was a cross sectional study. Five hundred cases of neurological patients were taken up for the study. Psychiatric diagnosis was done by using MINI plus scale which was structured interview. Morbidity in were analysed by the Pearson chi-squared test and t test. Results: Males constituted 46.6% i.e. 233 and females constituted 53.4% i.e. 267 of sample and mean age of the patients was 35.85 ± 9.475. The maximum number of patients, 40% (n=200) belong to 16-30 years age group ,Total patients 300 patients (60%) out of 500 had psychiatric diagnosis. The presence of psychiatric disorder was maximum in age group of 16-30 years. Conclusion: The results indicate that neurological patients have high levels of psychiatric morbidity. Screening patients with thyroid disorders for psychiatric problems and timely psychiatric intervention can go a long way in improving the quality of life of these patients.

Identification of psychiatric disorders among human immunodeficiency virus-infected individuals in Taiwan, a nine-year nationwide population-based study

A previous survey had shown a high level of psychiatric morbidity among human immunodeficiency virus (HIV)-infected individuals, but the number of patients that are actually identified as having a psychiatric disorder in the medical service in Taiwan is unknown. Using the claims data of a nationally representative cohort from the Taiwan National Health Insurance Research Database, the diagnoses of psychiatric disorders among newly diagnosed HIV-infected individuals were investigated from 1998 through 2006. Two hundred and seventy-four (23.8%) of 1153 newly diagnosed HIV-infected patients were identified as having psychiatric disorders, with an average latency of 3.33±2.47 years after HIV infection. Anxiety and depressive disorders were the leading diagnoses. Male patients had lower morbidity (21.0% vs. 25.3%, p=0.056), but a shorter latency to be identified with a psychiatric disorder (2.1±2.13 vs. 3.9±2.40 years, p<0.001) than females. This first population-based cohort study showed a high morbidity of psychiatric disorders among HIV-infected individuals, but with a long latency after infection, and a gender effect was noted. Regular psychiatric evaluation and follow-up and prompt intervention are necessary for HIV-infected individuals.

Beyond equivalence: prisoners' right to health

SummaryPrisons have high levels of psychiatric morbidity and function as mental illness recognition centres. Their healthcare wings are not hospitals and timely transfers to hospital are often unavailable. The United Nations' right to the highest attainable standard of health is assessed according to whether healthcare services are available, accessible, acceptable and of good quality (AAAQ). It is proposed that the AAAQ framework goes beyond the principle of equivalence of care and provides a more sophisticated measure for exploring prison healthcare.

P01-320 - Feeling life is not worth living: A cross sectional study of Greek adolescents

IntroductionThoughts of feeling life is not worth living could be the initial stage of a continuum that might end in a suicide.ObjectivesPsychiatric morbidity is quite prevalent among adolescents and has been associated with suicidal ideation.AimsOur aim was to test the association between thoughts that life is not worth living and psychiatric morbidity in a sample of Greek adolescents.MethodsA two-phase cross sectional study of 5614 adolescents aged 16–18 years old attending 25 senior high schools in Greece. A stratified random sample of 2431 subjects was selected for a detailed interview at the second phase. Psychiatric morbidity and thoughts of life is not worth living were assessed with the revised Clinical Interview Schedule (CIS-R). Odds ratios adjusted for age and sex were computed for the association between such thoughts and CIS-R scores.Results3,72% of the adolescents (girls:5,11%, boys:2,36%, p &lt; 0.001) reported thoughts of feeling life is not worth living in the week before interview. Psychiatric morbidity correlated significantly with those thoughts (OR = 1.16, 95% Confidence Intervals: 1.14–1.19). The level of psychiatric morbidity was strongly associated with such thoughts with higher levels of distress showing a greater association (Table 1).[Table 1]ConclusionsPolicies aiming at preventing the overall burden of psychiatric disease in adolescence may reduce the frequency of thoughts that life is not worth living, which could eventually lead to a decrease in completed suicides.

Symptoms of Turkish Patients with Depression in Ankara and Berlin

Numerous studies have investigated the potential impact of migration on psychiatric morbidity levels. Relatively little research has studied how the symptom profiles of patients with similar disorders and similar backgrounds are linked to the culture in which they live. Such research requires comparisons of immigrant patient samples with samples of patient who remain in their country of origin. In this study we compared symptoms in Turkish patients with depression living in Ankara, Turkey, and Berlin, Germany. To understand symptoms of patients with depression, not only the culture of origin but also the cultural context in which patients have been living needs to be considered as an important factor. The new culture can be associated with distinct, and not necessarily more serious, symptom profiles.

Stress and burnout in colorectal and vascular surgical consultants working in the UK National Health Service

It has been suggested that dealing with cancer is associated with increased stress and burnout in health-care professionals. The aim of this study is to examine the prevalence of psychiatric morbidity and burnout in surgeons working in the National Health Service (NHS), and the putative relationship between psychiatric morbidity, burnout and the amount of cancer-related work. All consultant colorectal and vascular surgeons identified from their professional societies were sent a booklet consisting of questions about cancer-related and specialty-specific work load, job satisfaction and socio-demographics. It also included the General Health Questionnaire (GHQ-12), the Maslach Burnout Inventory (MBI) and the Coping Questionnaire. Logistic regression analysis was used to identify independent predictors of psychiatric morbidity (GHQ), burnout (MBI) and retirement intentions. Five hundred and one questionnaire booklets were completed and returned (response rate 58.7%). The mean age of respondents was 47 years (range 31-65). The majority of the surgeons were male (460, 92%). One hundred and sixty-three (33%) surgeons scored in the positive range of the GHQ, and 154 (32%) had high burnout on at least one subscale of the MBI. Three hundred and eighty-three (77%) surgeons stated that they intended to retire before the statutory retirement age. Level of work satisfaction and perceived adequacy of training in communication and management skills were significantly negatively correlated with GHQ and MBI scores. Surgeons who planned to take early retirement or wished to retire as soon as they could afford to were more likely to have psychiatric morbidity and/or burnout. Surgeons who were married or cohabiting were less likely to have psychiatric morbidity, and younger surgeons were more likely to have higher levels of depersonalization (DP). Work satisfaction was negatively correlated with psychiatric morbidity and all three burnout scales. Colorectal surgeons had a greater cancer-related workload than vascular surgeons (48.6 vs 7.5%, respectively, U=2667, p<0.005). However, there were no significant differences between the two groups in psychiatric morbidity, personal accomplishment and emotional exhaustion. Vascular surgeons, however, had significantly higher levels of DP (p=0.04). Levels of psychiatric morbidity, burnout and work dissatisfaction are worryingly high in colorectal and vascular surgeons and are likely to impact adversely on patient satisfaction and service quality. The number of surgeons intending to retire early is also a cause for concern both in terms of the overall number of trained surgeons in the NHS and in the balance between senior and junior surgeons. Apart from DP, these indicators of stress, however, were unrelated to cancer workload.

The Neuropsychiatry of Adrenomyeloneuropathy

While the adult form of adrenoleukodystrophy (ALD) has been associated with an elevated rate of affective disturbance, the myeloneuropathic form of the disease known as adrenomyeloneuropathy (AMN) has been associated with only occasional cases of major mental illness. Given that cerebral involvement occurs in up to half of AMN sufferers, we hypothesized that rates of mental illness may match those with adult ALD. To describe the psychiatric, cognitive, and disability variables in a sample of Australian AMN sufferers. Ten genetically confirmed AMN sufferers underwent diagnostic psychiatric interview (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders), rating scales of psychiatric disturbance (Brief Psychiatric Rating Scale, Hospital Anxiety and Depression Scale, Beck Depression and Anxiety Inventories, and Short-Form 36), and cognitive function (the Neuropsychiatry Unit Cognitive Assessment Tool and Mini-Mental State Examination). While the group as a whole was generally cognitively intact, it demonstrated a higher than expected prevalence of lifetime and current major affective illness. Current symptom levels were low at the time of study participation. Psychopathology did not relate to adrenal status, nor to level of physical or functional impairment. This small sample suggests that the level of psychiatric morbidity in AMN patients is elevated, and the rate of affective disturbance approaches those of adult ALD sufferers. This may reflect that AMN is not a "pure" myeloneuropathy, and that mild cerebral involvement may be associated with affective illness.

Psychological morbidity and burnout in palliative care doctors in Western Australia

Medicine and particularly palliative care are considered to be stressful professions, with risks of psychological morbidity and burnout. There is little published work quantitatively documenting their prevalence among medical practitioners practising in palliative care. Three questionnaires, including the General Health Questionnaire (GHQ-12) and the Maslach Burnout Inventory, were sent to palliative care practitioners in Western Australia. Forty-one of 43 (95%) practitioners completed the questionnaires. The mean score on the GHQ-12 was 1.9 (range 0-8), with 11 (27%) scoring 4 or more. On the Maslach Burnout Inventory, mean scores on the emotional exhaustion (EE, mean 17.5, range 1-47) and depersonalization subscales (DP, 4.5, 0-24) fell within the low range, with scores for personal accomplishment (39, 32-46) falling within the average range. Ten respondents (24%) scored high on either the EE subscale or the DP subscale, meeting criteria for burnout. GHQ-12 scores were associated with hours of work per week in palliative care (P = 0.004). The EE (P = 0.024) and DP (P = 0.006) components of burnout were associated with years of work in palliative care. Specialist practitioners were more likely to score in the high category for GHQ-12 (odds ratio = 4.8, P = 0.036) and EE (odds ratio = 8.33, P = 0.031). GHQ (P = 0.038) and DP (P = 0.006) scores were higher in those working in tertiary institutions, with tertiary practitioners more likely to be in the high EE category (odds ratio = 7.5, P = 0.034). Levels of psychiatric morbidity and burnout in palliative medicine are not higher than in other specialties.

Christopher M Callahan and German E Berrios, Reinventing depression: a history of the treatment of depression in primary care, 1940–2004, Oxford University Press, 2005, pp. xvii, 214, £30.50 (hardback 0-19-516523-3).

Over the last ten years, according to the WHO, depression has emerged as the leading cause of disability amongst young adults in developed countries. It is estimated that 3 per cent of the global population now suffer from the disease and over twenty million take Prozac. The apparent growth of this illness and the appearance of new treatments (especially the SSRIs) has attracted widespread critical comment. Sceptical psychiatrists, such as David Healey and Elliot Valenstein, have traced the role of the major pharmaceutical companies in the identification and marketing of psychiatric conditions and pharmaceutical solutions; bioethicists and therapists, such as Carl Elliott and Peter Kramer, have argued that we are entering an era of cosmetic pharmacology as new pharmaceutical treatments make possible new conceptions of identity and agency. Yet despite the considerable critical and philosophical comment that the rise of the new anti-depressant treatments has attracted, few have engaged in any serious examination of the actual coalface of depression treatment—the frontline prescribing work of general practitioners and family doctors in Britain and the USA. Reinventing depression does just this. It provides a welcome and necessary intervention in both the debate over anti-depressant use and the historiography of late-twentieth-century psychiatry. Callahan and Berrios argue that the persistence of depression in industrialized countries can be attributed to the ongoing attempt to treat mental illness as a clinical rather than a public health problem. The appearance of new pharmaceutical treatments has moved in tandem with the development of materialist models of the disease. This faith in neurobiological aetiologies has led, the authors argue, to our under-estimation of the social and psychological factors that contribute to the illness and to the under-recognition of the burden of depression in the wider community. The failure of our current approach to depression does not arise from any particular inadequacy in the newer forms of drug treatments or clinical investigation, rather it is an artefact of wider political changes in the status and organization of general practice and primary care psychiatry. In their exploration of the connections between our changing conceptions of depressive illness and the changing practice of primary care, Callahan and Berrios have produced an exemplary and deeply nuanced piece of medical history. They begin their case contesting the myths of the “old time doctor” and the idea (advanced by Edward Shorter) of a traditional empathic doctor–patient relationship. Instead they draw on early post-war surveys of primary care by J S Collings and Stephen Taylor to argue for a long tradition of overworked and under-funded local practitioners prescribing non-specific sedatives and hypnotics to patients presenting for psychological distress. They claim that levels of psychiatric morbidity in the community have remained fairly constant although they recognise that the clinical profiles of certain mental diseases are mutable and reflect wider social and environmental transformations. Callahan and Berrios make perceptive connections between the changing clinical profile of depression, new developments in pharmacology and epidemiology and the political organization of general practice. They demonstrate the limited impact of the new anti-depressants of the 1950s (chlorpromazine, imipramine and the monoamine oxidase inhibitors) outside asylum psychiatry, arguing that it was market driven promotion of the non-specific minor tranquillizers that established the treatment regime for emotional disorders in primary care. Likewise the development of new gradualist models of morbidity in cardiology (notably Pickering's work on hypertension) led to new measurements of the severity of depression, which in turn supported new epidemiological investigations into the under-reporting of emotional distress in the wider community. My only minor cavil with this sophisticated reading is that it tends to under-estimate the role of general practitioners themselves in the development of new psychiatric treatment regimes. Certainly many of the authors' arguments for the unique opportunities afforded to the general practitioner for longitudinal studies of the history and context of emotional disorder were made by visionary general practitioners like C A H Watts back in the early 1950s. Similarly the role of the Royal College of General Practitioners in fostering primary care research into psychiatric epidemiology is not acknowledged, which is surprising given that this contributed in part to the new assessment of psychiatric morbidity described in the volume. These are, however, very minor quibbles in what is an extremely thoughtful and impressive piece of work.

Establishing national mental health and well‐being indicators for Scotland

The growing interest in the mental health and well‐being of populations raises questions about traditional measures of public mental health, which have largely focused on levels of psychiatric morbidity. This paper describes work in progress to identify a set of national mental health and well‐being indicators for Scotland that could be used to establish a summary mental health profile, as a starting point for monitoring future trends. The process in taking this work forward involves identifying a desirable set of indicators, scoping the data that are currently collected nationally in Scotland, identifying additional data needs, and ensuring existing data collection systems include mental health and well‐being. It is expected that an indicator set for adults will have been identified by 2007. The paper presents some of the conceptual and practical challenges involved in defining and measuring positive mental health and is presented here as a contribution to ongoing debates in this field.

Terrorist detainees – psychiatry or morals?

Robbins et al ( Psychiatric Bulletin , November 2005, 29 , 407–409) describe the mental states of a number of men detained in HMP Belmarsh without trial or charge. They all appeared to be experiencing significant levels of psychiatric morbidity. The authors go on to state that this is a result of

Caregiving burden and psychiatric morbidity in spouses of persons with mild cognitive impairment

While the deleterious psychosocial and mental health effects of dementia caregiving are firmly established, very little is known about the burdens or psychiatric outcomes of providing care to a spouse with less severe cognitive impairment, such as mild cognitive impairment (MCI). We characterized the nature and level of caregiver burden and psychiatric morbidity in spouses of persons diagnosed with MCI. Interview assessments were completed on a cohort of 27 spouses of persons with a recent diagnosis of MCI. Patient medical records were reviewed to collect information regarding the MCI patient's medical history. Respondents endorsed elevated levels of both task-related responsibilities and subjective caregiver burden. Depression and anxiety symptom levels also showed some elevations. Measures of caregiver burden were significantly associated with depression and anxiety levels. In particular, even after controlling for demographic risk factors for distress, nursing task burden was correlated with elevated depressive symptoms, and greater lifestyle constraints were correlated with higher anxiety levels. Although caregiver burden and psychiatric morbidity levels were lower than those typically observed in family dementia caregiving samples, our findings suggest that MCI caregivers have already begun to experience distress in association with elevated caregiving burden. These individuals may be ideal targets for selective preventive interventions to maximize their psychological well-being as caregiving burdens related to their spouses' cognitive impairment increase.