Jane Hurry

The List of Threatening Experiences: a subset of 12 life event categories with considerable long-term contextual threat.

In a survey of a random sample of the general population recent life events, collected and rated for long-term contextual threat according to the methods of Brown & Harris (1978), were also recorded where possible on an inventory of life event categories (Tennant & Andrews, 1977). Of the 82.5% of all events collected which were covered by the inventory, 12 of the 67 event categories accounted for 77% of life events with an aetiologicaly significant rating of marked or moderate long-term threat. Where practical and economic constraints oblige research workers to choose the inventory method, a brief list of event categories, such as the List of Threatening Experiences, is recommended in preference to much longer lists.

Parental death in childhood and risk of adult depressive disorders: a review

The authors review the evidence that parental death in childhood predisposes to depressive disorders in later life. The findings in general are quite inconsistent; this is due in part to the methodological limitations of most studies, principally that of inadequate control of potentially confounding variables. Where experimental and control samples were most rigorously matched, no association was found between childhood parental bereavement and depression in later life. Parental death in childhood appears to have little effect on adult depressive morbidity.

PSYCHIATRIC-DISORDERS IN SELECTED IMMIGRANT GROUPS IN CAMBERWELL

SummaryThis paper reports on psychiatric disorder amongst West Indians and Irish-born residents of Camberwell in South London. National figures suggest high rates of severe functional disorders in West Indians with relatively few minor disorders. Among the Irish, however, mania is rare, schizophrenia shows high rates in women but not in men and the milder affective disorders are more common than in the native born (Cochrane 1977). The current study uses both hospital-based data from the Camberwell registrar and data from a community survey and essentially substantiates these findings. It is suggested that these persistent opposing patterns in these two groups of immigrants could be in large part explained by culturally determined patterns of response to adversity.

Adversity and the nature of psychiatric disorder in the community

It is argued that in their account of mood disturbances, psychiatrists have traditionally distinguished their concepts of depressive illness from distress on the grounds that social adversity provides a completely adequate explanation for the latter, but not for the former. We have already shown in our comparison of a psychiatric out-patient sample with a community sample from the same area that symptoms in the former were more likely to be multiple, severe and of diagnostic significance (J.K. Wing et al. 1981a). In this paper we test the hypothesis that disorders in the community are more likely to be cases of distress. We predict that the association between such cases and social adversity will be stronger than for psychiatric out-patients and that the difference will be accounted for by the differences in clinical picture between the groups. In general our data confirm these predictions.

The contextual threat of life events: the concept and its reliability

The reliability of Browns contextual measure of threat is assessed and found to be highly satisfactory. Previously inexperienced raters achieve highly reliable ratings after only brief training. The implications for the concept of the threat of life events are discussed.

THE PRESENT STATE EXAMINATION USED BY INTERVIEWERS FROM A SURVEY AGENCY - REPORT FROM THE MRC CAMBERWELL COMMUNITY SURVEY

A random sample of 800 men and women between the ages of 18 and 64 living in Camberwell, south-east London, were interviewed using a short form of the Present State Examination (PSE). The interviewers were from a professional Agency and had received a shortened version of the usual PSE training course. A further interview was sought one month later with all subjects who were above the threshold on the Index of Definition, and a sample of those below the threshold. At this interview the full PSE was administered by members of the MRC Social Psychiatry Unit. Forty-nine audiotapes of Agency interviews were available for the members of the MRC team to rate. This paper reports the reliability between interviewers. Techniques of comparison were chosen which enabled interviewer reliability to be assessed, without making the assumption that individual subjects would display the same symptom levels over a period of one month. There is strong evidence that at least 2 of the 8 Agency interviewers had thresholds that were lower than those of the MRC team for rating many of the common minor symptoms such as irritability, also the key symptom of depressed mood. At least 4 of the Agency interviewers, however, were rating in a similar manner to the MRC team. There was no marked tendency for thresholds to change over the 6-month period of interviewing.

SOCIO-DEMOGRAPHIC ASSOCIATIONS WITH SOCIAL DISABLEMENT IN A COMMUNITY SAMPLE

SummaryThe associations between social disablement and socio-demographic factors have been examined in a random sample of 310 adults drawn from the general population of Camberwell, South London. Neither paternal social class nor the subjects own social class are associated with social disablement in either men or women, except that men (but not women) of very low social class show significantly poorer social performance. Age and sex are not associated with social disablement, despite the fact that women in the general population have consistently been found to have higher rates of psychiatric disorder than men. For a given level of psychiatric disorder men show poorer social performance than women. Men who do not have children at home, or who live entirely alone have significantly poorer social performance, as do men who are widowed, separated or divorced, but these factors are not associated with poor social performance in women. By contrast, an unsatisfactory marital relationship is significantly associated with disablement in women, but not in men. The demographic factors associated with poor social performance are all indices of social disadvantage or social isolation.

The risk of minor depression before age 65: results from a community survey

Data from a general population survey of psychiatric disorder in Camberwell were used to calculate the risk of a CATEGO-defined depressive episode before the age of 65, using a modification of Strömgrens method. Current depression was defined as cases within the relevant categories of the CATEGO program and at threshold level or above on the Index of Definition (Wing et al. 1978). A past history of depression was elicited using key symptoms such as persistent tearfulness and depressed mood, already enquired after in the course of the PSE, to identify potential episodes, followed by questions to determine accessory symptoms, duration, and degree of social impairment. Clinical judgement was then used to decide whether the disturbance constituted a significant depressive episode. Risk under one set of assumptions was 46% for men and 72% for women. Using another method based on (untenably) conservative assumptions, it became 16% and 30% respectively. The status and implications of these high values are discussed, particularly for genetic studies.

Female Vulnerability to Neurosis: The Influence of Social Roles

Studies of prevalence of neurotic disorders show women to be far more vulnerable than men. Biological factors cannot account for this marked sex difference; social factors are clearly implicated. Findings from a community study in London show that social roles, especially those relating to marriage, are implicated. It appeared that lack of employment outside the home was deleterious for both sexes, while a poor marital relationship was deleterious for women alone. Although care of young children was associated with neurosis in women, it did so by virtue of depriving women of employment outside the home.

Adversity and the Symptoms of Depression

Data from a community survey were used to test the proposition that pathological guilt and vegetative symptoms of depression were less likely to be associated with stressful life events and difficulties than non-specific symptoms like tension and worry. Two types of analysis were carried out: the first took only cases, defined as ID5 + on the Index of Definition program, the second was based on all subjects. Only the second analysis provided support for our predictions.