Cl Hart

Gender differences in self-reported minor mental disorder and its association with suicide. A 20-year follow-up of the Renfrew and Paisley cohort.

Background: Suicide rates are around three times higher in men than women; in contrast women have a higher prevalence of community-diagnosed depression. To investigate this paradox we examined the association of General Health Questionnaire (GHQ)-caseness (score ≥ 4), a measure of possible minor mental disorder, with suicide risk in a general population cohort. Methods: Data were derived from a cohort study based on the 8,466 men and women in the Renfrew and Paisley cohort who completed a 30-item GHQ in the period from 1972 to 1976 and who were followed up to 1995 for all-cause and suicide mortality. Results: The long-term suicide risk associated with possible minor mental disorder was higher in men [hazard ratio 6.78 (1.36–33.71)] than women [hazard ratio 1.66 (0.43–6.45)]; test for interaction between gender and GHQ with respect to suicide risk: p = 0.09. Conclusion: These findings indicate either that the long-term risk of suicide in the context of a past episode of minor mental disorder is higher in males than females or that there are sex differences in the validity of responses to mental health screening questionnaires. Further research is required to replicate our finding in larger studies and, if confirmed, clarify which explanation underlies it.

Social mobility, health, and cardiovascular mortality

R S BHOPAL (Department of Epidemiology and Public Health, University of Newcastle upon Tyne) Introduction The description ofhuman characteristics, including health, by racial group has beguiled researchers in many disciplines, including epidemiology. Some careers have been ruined in hindsight by racist, prejudiced, or simply misguided work in this highly complex and controversial arena of research. With the concept of race under attack, ethnicity has now occupied the vacated ground. Ethnicity has become a key, almost routine, epidemiological variable and there is strong pressure on researchers to collect information on it. There have been repeated and enthusiastic claims, by researchers, policy makers, and health planners, about the value of ethnicity and health research. This paper presents a critical analysis of the past and potential value of ethnicity, race, and health research based on epidemiological methods. The key questions are whether such research can inform our understanding of disease causation or help develop appropriate health services (enlightenment), add to our collection of unexplained associations (blackbox epidemiology), or is merely information of little value (junk). Approach to the paper A historical analysis will subject the claims of race and health researchers in the past to the reality of today. In addition, hypotheses will be extracted from the epidemiological literature of the 1970s and 1980s. The number of hypotheses which have been pursued and either rejected or supported by subsequent work will be the critical factor in assessing the value of ethnicity and health research in understanding disease causation. Furthermore, the quality of the research that has been done and is underway will be explored in relation to the definition of terms, validity of measurement of ethnicity, quality control of data collection, and the statement of hypotheses which permits their testing. The extent to which studies done in the late 1970s and early 1980s have been used to create appropriate health policy and health plans will be reviewed. Results of the analysis to date The work for this paper is not complete but the preliminary findings are that claims of race, ethnicity, and health researchers are highly exaggerated and that information from these studies is hard to utilise for aetiological or service applications. There are grave problems with the way researchers have collected and presented information on ethnicity and health, and with the validity of data collection used in cross cultural studies. The health services have found it difficult to respond to meet the needs of ethnic minority groups and it is unclear whether research has helped or hindered. From a historical point of view it will be argued that race research has done more harm than good, with many studies breaching research ethics and principles. It is highly pertinent to examine whether ethnicity and health research may also be breaching such principles. This analysis will argue for a deeper analysis of the value of ethnicity and health research in epidemiology so that its strengths and limitations can be more widely understood; exaggerated claims are not made; and expectations of researchers, policy makers, and ethnic minorities are maintained at realistic levels.