Nicola Singleton

Psychiatric morbidity among adults living in private households, 2000

This report presents the findings of a survey of psychiatric morbidity among adults aged 16 to 74 living in private households in Great Britain. The survey was carried out between March and September 2000. It was commissioned by the Department of Health, the Scottish Executive and the National Assembly for Wales. It is one of a series of surveys of different population groups which began in 1993 and is a repeat of the first of these surveys which covered adults aged 16 to 64 living in private households. The report describes the prevalence of a range of mental disorders, including personality disorder, in the general household population. It also considers the extent to which the prevalence of some of these disorders has changed since the earlier survey in 1993. It describes how people with particular disorders differ for those without any disorder on a range of factors: their background and personal characteristics, including employment and accommodation, physical health, current treatment and service use. The report includes a description of the survey methods use and aims to provide an overview of the main topics covered.

Debt, income and mental disorder in the general population

BACKGROUND The association between poor mental health and poverty is well known but its mechanism is not fully understood. This study tests the hypothesis that the association between low income and mental disorder is mediated by debt and its attendant financial hardship. METHOD The study is a cross-sectional nationally representative survey of private households in England, Scotland and Wales, which assessed 8580 participants aged 16-74 years living in general households. Psychosis, neurosis, alcohol abuse and drug abuse were identified by the Clinical Interview Schedule--Revised, the Schedule for Assessment in Neuropsychiatry (SCAN), the Alcohol Use Disorder Identification Test (AUDIT) and other measures. Detailed questions were asked about income, debt and financial hardship. RESULTS Those with low income were more likely to have mental disorder [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.68-2.59] but this relationship was attenuated after adjustment for debt (OR 1.58, 95% CI 1.25-1.97) and vanished when other sociodemographic variables were also controlled (OR 1.07, 95% CI 0.77-1.48). Of those with mental disorder, 23% were in debt (compared with 8% of those without disorder), and 10% had had a utility disconnected (compared with 3%). The more debts people had, the more likely they were to have some form of mental disorder, even after adjustment for income and other sociodemographic variables. People with six or more separate debts had a six-fold increase in mental disorder after adjustment for income (OR 6.0, 95% CI 3.5-10.3). CONCLUSIONS Both low income and debt are associated with mental illness, but the effect of income appears to be mediated largely by debt.

Psychiatric and social aspects of suicidal behaviour in prisons

BACKGROUND Suicidal behaviour and completed suicide are serious problems within British prisons, leading to significant morbidity and mortality, and are the focus of major efforts towards their prevention. AIM To explore the demographic, social and psychiatric correlates of suicidal behaviour in prisons in England and Wales and their relationship with health service use; and to develop a combined psychosocial model of risk. METHOD This report analyses the prevalence of suicidal ideation and suicide attempts in the ONS National Prison Survey, and their association with the presence of psychiatric disorders, personality disorder, substance abuse and social risk factors. These data were compared with data from the second national survey of psychiatric morbidity in adults living at home. In both surveys, a two-phase interviewing procedure was used, covering general health, health service use, assessment of psychiatric disorders, life events, social supports, suicidal behaviour, activities of daily living, sociodemographic data, substance abuse and intelligence. RESULTS Suicidal thoughts and suicide attempts were commoner in prisons than in the general population and these were significantly associated with higher rates of psychosis, neurosis and personality disorder in prisons. In addition, demographic and factors such as being young, single, white, leaving school early and experiencing poor social support and significant social adversity were important risk factors for suicidal thoughts. Crucially, there was no separate category of people at suicidal risk who did not have psychiatric disorders. CONCLUSIONS The high rates of suicidal behaviour in prisons cannot be addressed without adequate attention to the high rates of psychiatric disorder and vulnerability factors in prisoners.

Psychiatric morbidity among young offenders in England and Wales

third of the respondents had been working prior to coming to prison. The remainder mostly said they had been unemployed and looking for work or living off crime. More than eight out of 10 of the young offenders in the sample said that they currently smoked cigarettes. Just over one in 10 respondents said they had never drunk alcohol in the year before coming to prison, while over a quarter said they drank alcohol four or more times a week during that time. More than six out of 10 said they had used some illicit drug in the month before coming to prison. Very few of the young offenders had been in prison for two or more years during their current prison term (less than 2%) and the majority had been in prison for less than a year. Over half the young offenders were being held for acquisitive offences— burglary, robbery, and theft—while about one in five were being held for a violent offence. Among the women drug offences were also common: about one in five of the sample were being held for these offences.

Psychopathy among prisoners in England and Wales.

Most research into psychopathy among prisoners is based on selected samples. It remains unclear whether prevalences are lower among European populations. This study aimed to measure the prevalence of psychopathy, and the distribution and correlates of psychopathic traits in a representative national sample of prisoners. Psychopathy was measured using the revised Psychopathy Checklist (PCL-R) in a second stage, cross-sectional survey of prisoners in England and Wales in 1997 (n=496). Poisson regression analysis was carried out to examine independent associations between correlates and PCL-R total and factor scores. The prevalence of categorically diagnosed psychopathy at a cut off of 30 was 7.7% (95%CI 5.2-10.9) in men and 1.9% (95%CI 0.2-6.9) in women. Psychopathic traits were less prevalent among women. They were correlated with younger age, repeated imprisonment, detention in higher security, disciplinary infractions, antisocial, narcissistic, histrionic, and schizoid personality disorders, and substance misuse, but not neurotic disorders or schizophrenia. The study concluded that psychopathy and psychopathic traits are prevalent among male prisoners in England and Wales but lower than in most previous studies using selected samples. However, most correlates with psychopathic traits were similar to other studies. Psychopathy identifies the extreme of a spectrum of social and behavioral problems among prisoners.

The British Mental Health Survey Programme: achievements and latest findings.

TheBritish National Psychiatric Morbidity Survey Programme (http://www.mentalhealthsurveys.co.uk/) started in 1993, and it seems timely now, with the publication of the most recent survey [39], to take stock of its impact on our understanding of mental disorders and of what the next steps should be. The survey programme was designed to improve knowledge and understanding of mental illness, its causes and consequences, in order to inform governmental objectives for mental health [18]. These comprised prevention, treatment and rehabilitation of mental disorders; improvement of quality of life; prevention of mortality; provision of services and interventions; mental health promotion; tackling fear, ignorance and stigma around mental illness; and continued research into the causes, consequences and care of specific mental disorders, together with their contribution to social exclusion. The survey programme has provided a key source of continuous information to government, commissioners and researchers. Most recently it has informed the Foresight Report on Mental Capital and Wellbeing (www.foresight.gov.uk, [8]).

Primary group size, social support, gender and future mental health status in a prospective study of people living in private households throughout Great Britain

BACKGROUND Structural characteristics of social networks such as primary group size have received less attention than measures of perceived social support. Previous research suggests that associations between social network size and later common mental disorder status may differ according to sex and initial mental state. METHOD Adults participating in the 2000 British National Household Survey of psychiatric morbidity were randomly selected for follow-up 18 months later. The revised Clinical Interview Schedule (CIS-R) and the Interview Measure of Social Relations (IMSR) were administered at baseline and follow-up. Primary group size was defined as the total number of close relatives and friends. A four-level scale of common mental disorder was modelled with ordinal logistic regression, based on weighted data (n=2413). FINDINGS After adjusting for confounders, a primary group size of three or less at time 1 predicted worse mental health at time 2. This effect was greatest in men who were initially non-cases at baseline (averaged odds 4.5) and in women who were initially cases at baseline (average odds 2.9). Primary group size at time 2 was significantly predicted by level of common mental disorder at time 1 in women but not in men. Thus, confounding by baseline disorder does not explain risk of developing poor mental health in socially isolated men. CONCLUSION This study replicates the strong effects of primary group size on future mental health that emerge when men and women are studied separately and when subjects are categorized according to baseline mental health status.

Psychiatric morbidity among women prisoners in England and Wales

The ONS Survey of Psychiatric Morbidity among Prisoners in England and Wales was carried out in 1997 on behalf of the Department of Health (Singleton et al., 1998). The present report focuses on the findings relating to women prisoners and was commissioned by the Directorate of Health Care of the Prison Service. The main aim of this report is to bring together the results relating to women prisoners, both remand and sentenced, together with new analyses addressing additional areas not covered in the original report. The survey included assessment of personality disorder, neurosis, psychotic disorder, alcohol, and drug dependence, and the comorbidity of these disorders. Questions were also asked on medication and service use, and sociodemographic and other key current and lifetime factors that might be associated with mental disorders. Topics covered in this report include the prevalence of mental disorders and the personal and custodial characteristics associated with these. Other sections consider the prevalence of selfharm without suicidal intent, use of medication both before and in prison, illicit drug use and the characteristics of women who present behavioural and management problems in prison. A two-stage approach was used in the survey. All respondents who agreed to take part in the survey participated in an initial interview and, if they gave consent, data were also collected from their medical records. In addition, a random one in five sub-sample was asked to take part in a follow-up clinical interview, which focussed mainly on personality disorder and psychosis. All prisons in England and Wales were included in the survey. All inmates aged 16–64 years were eligible for selection in the sample. Women prisoners were a comparatively small proportion of the total prison population. Therefore, they were over-sampled to provide adequate numbers to allow separate analysis. Initial interviews were achieved with 771 (86%) of the 894 women prisoners selected to take part.

The mental health of early retirees: National interview survey in Britain

There is intense political interest in retaining older workers in the workforce, to fund lengthening retirements. While health is important in early exit from work, the health of early retirees has been little studied. The aim of this study was to compare the health status of economically active 50- to 64-year-olds with economically inactive former workers (termed early retirees). A total of 1,875 respondents to the 2000 Psychiatric Morbidity Survey of Great Britain were included in the analysis. Current common mental (neurotic) disorder presence was based on the revised Clinical Interview Schedule (CIS-R). Results In all, 71.2% of men and 66.4% of women early retirees reported having a long-standing illness. Of early retired men, 22.2% have a common mental disorder compared to 8.2% of those still in work (p value of difference <0.001). In contrast, the respective figures for women were 18.2% and 16.9%. In fully adjusted regression models for men, early retirees were more likely to have generalised anxiety disorders (OR 3.1: 95% CI: 1.2–7.8) and depressive disorders (OR 4.3: 95% CI: 1.7–11.0). There is a substantial burden of specific mental health disorders in early retiree men. Understanding the mechanisms of this excess of mental disorders in early retiree men may be a prerequisite to increasing the numbers seeking or staying in work up to age 65.

Borderline personality disorder: health service use and social functioning among a national household population

BACKGROUND It is unclear whether Axis II psychopathology or co-morbid clinical syndromes result in the treatment-seeking behaviour and social impairment of patients with borderline personality disorder (BPD). This study examined the independent associations between social functioning and service use and Axis I and Axis II disorders in persons with BPD in the national household population of Britain. METHOD The study was a cross-sectional survey of adults aged 16-74 years in households (n=8397). Data included self-reported consultations with health-care professionals and behavioural problems. Diagnosis was determined by computer-assisted interviews. Analyses included logistic regression adjusting for demography, co-morbid Axis I clinical syndromes and other Axis II disorders. RESULTS Consultation in the past year was reported by 57.5% of persons with BPD but only 13.4% reported lifetime psychiatric admission. BPD was not independently associated with impaired functioning but was associated with co-morbid psychotic, depressive and anxiety disorders. Only general practitioners (GPs) were consulted for problems independently due to BPD. CONCLUSIONS Functional effects of BPD are mediated through co-morbid clinical syndromes, not Axis II psychopathology. A subgroup do not have co-morbid disorders or seek treatment, and are high functioning.