Ray Cochrane

Factors Influencing Successful Submission of PhD Theses.

This article examines the submission rates of 3579 postgraduate research students who studied for the traditional PhD degree at a single large civic university between 1984 and 1993. An examination is made of individual factors which may have an effect on students rate of completion, attempting to identify characteristics of the student most likely to succeed. The analysis excludes intrinsic student characteristics and institutional conditions. The only factor which emerged as a reliable predictor of successful submission within a 4-year period and within a 10-year period was whether a student was researching a science-based or an arts and humanities-based subject. Gender showed no predictive effect on submission. It is suggested that success in postgraduate research study is becoming more equally likely between different student groups, especially where international students, women and older students are concerned. Some differences between successful submission in the sciences and in the arts and humanities are identified and questions are raised about differences between fields of study.

Mental health care for Asian, black and white patients with non-affective psychoses: pathways to the psychiatric hospital, in-patient and after-care.

Background: This UK-based study compares the pathways to the psychiatric hospital and the provision of in-patient and after-care for Asian, black and white patients with non-affective psychoses. Methods: Two overlapping samples of 120 patients, 40 from each ethnic group, were drawn; one on admission and the other at discharge. In addition to socio-demographic data, details were obtained on the pathways to care and the in-patient episode. An assessment of needs and service provision was undertaken 3 months post-discharge. Patient satisfaction was ascertained at each stage. Results: Asian and especially black patients experienced more complex pathways and had higher levels of both involvement with the police and compulsory detention than their white counterparts. They were less likely to perceive themselves as having a psychiatric problem or as needing to go into hospital and expressed less satisfaction with the admission process. Black patients, as compared to Asian but especially white patients, were more often detained in hospital against their will, confined to the ward and treated within a secure environment. However, there were few differences in satisfaction with hospital care. Likewise, perceptions of unmet need, provision of after-care and satisfaction with services were similar across the ethnic groups. Conclusions: The implications of these findings are discussed. The potential of early intervention programmes and home treatment services to address the ethnic differentials identified in this study merit consideration.

Seasonal variations in hospital admissions for affective disorders by gender and ethnicity.

Abstract Hospital admission statistics for depression and mania have shown significant seasonal patterns. The present investigation was conducted to establish the pervasiveness of the impact of seasons on mood disorder presentation at Birmingham (52°North) by gender and ethnicity. Non-mood disorder admissions were examined as a control to determine the specificity of any seasonal variation to affective illness. Case notes for 992 admissions, during January-December 1995 inclusive, to an inpatient unit were reviewed retrospectively. Admission data were broken down by gender and into three ethnic groups: Asian, white and black. Seasonality in admissions for depression, bipolar disorder and non-mood disorders was tested by gender and ethnicity. Admission frequencies for depression showed significant seasonal pattern, with the incidence of depression being highest in winter. Total admissions, bipolar and non-mood disorders did not show any significant seasonal variability. A gender effect was evident on seasonality of admissions for affective illness, with significant winter peak for depression and summer peak for bipolar disorder in women only. The Asian group was the only ethnic group that showed significant seasonal variation in depression, with a greater number of depressive episodes in winter. Environmental variables were related significantly to the incidence of mood disorders. Specific seasonal effect for affective illness was evidenced by the non-existence of seasonality in other psychiatric disorders. The reverse seasonal pattern for depression and mania suggests a maladaptive response of vulnerable individuals to specific functions of seasons.

Depression in South Asian Women Living in the UK: A Review of the Literature with Implications for Service Provision

Research has shown that South Asian people in the UK underutilize health services compared with White people. Also, where services are accessed, they may not adequately meet cultural and religious needs. In exploring the relationship between the cultural and religious beliefs of South Asian service users about perceptions, beliefs about aetiology, cause and treatment of mental illness, past studies have illustrated a wide range of expectations, experiences, beliefs and attitudes. This article reviews research on depression in South Asian women in the UK, highlighting implications for services.

The needs of high and low expressed emotion families: a normative approach

SummaryComparison of the needs and characteristics of relatives classified as high and low expressed emotion (EE) across a range of measures including social functioning and indices of stress and family burden revealed that high EE relatives reported higher levels of disturbed behaviour, subjective burden, and perceived themselves as coping less effectively. Individuals from high-EE households were more impaired in terms of social functioning, particularly in terms of independence and interpersonal functioning. No difference in overall knowledge about schizophrenia was observed between high and low EE relatives, although high EE relatives possessed more information about hospital procedures. Analysis of needs assessment data, based on a normative approach to need, revealed that two-thirds of high EE relatives, as against one-third of low EE relatives had high needs in at least one or more of the following five areas: knowledge about schizophrenia, subjective burden, personal stress, behavioural disturbance and perceived coping. No low EE relative had high needs on all five criteria. The implications of the results for the meaning and genesis of EE and for service provision are considered.

Living with depression: Coping strategies used by South Asian women, living in the UK, suffering from depression

This brief study employed a qualitative, grounded theory approach within a constructivist paradigm, to explore the coping strategies used by Asian women suffering from depression. Ten Asian women were interviewed about their choice of coping strategies, factors affecting this and how this relates to treatment. The patients were interviewed individually using a brief semi-structured interview. The data were gathered and analysed according to the grounded-theory approach. Findings revealed that coping strategies included religion and prayer, talking, crying and self harm. The strategies were mediated by the individuals perception of the problem as depression, motivating factors and access to help. A distinction is made between general and culture-specific coping strategies and clinical implications for mental health services are also briefly discussed. Limitations of the study were also presented in line with qualitative research guidelines.

Preventing the entrenchment of high expressed emotion in first episode psychosis: early developmental attachment pathways

OBJECTIVEnAs part of a strategy to consider the options for preventing the developmental entrenchment of expressed emotion (EE), we examine the early ontogeny of EE in a first-episode sample of individuals with psychosis and its links with the process of adaptation to change.nnnMETHODSnThe key relatives of 50 first-episode psychosis patients from two locations were interviewed soon after patient referral and again 9 months later using measures of expressed emotion and loss.nnnRESULTSnThe developmental pathways of components of expressed emotion, particularly criticism and emotional over-involvement, were independent despite having a similar effect on outcome for patients. Initially, high levels of emotional over-involvement were reduced by follow up, with 37% resolving into high criticism. Overall expressed emotion status changed in 28.2% of key relatives (all parental), predominantly from high to low. High emotional over-involvement and low criticism are associated with significantly high levels of perceived loss in relatives. The metamorphosis of emotional over-involvement to criticism was linked to a reduction in perceived loss.nnnCONCLUSIONSnExpressed emotion is not a stable index in relatives of first-episode psychosis samples. Appraisals of loss by relatives may be driving high emotional over-involvement with implications for family intervention programs. Attachment theory may help to explain some of the processes underlying resistance to change in some of the high-EE behaviours measured by expressed emotion.

Maternal and child psychological sequelae in paediatric burn injuries

It is a commonly held belief that many children suffer psychological sequelae following burn injury. This six month controlled, prospective, follow up study was designed to investigate psychological sequelae in children and their mothers following paediatric burn injury. The study employed a sample of 40 children with burn injuries, and their mothers with three control groups, each of 40 children and their mothers: an acutely ill group, a fracture group and a non ill/injured group. Measures at initial contact and 6 month follow up included the Child Behaviour Checklist and the Hospital Anxiety and Depression Scale. The results demonstrated higher initial maternal anxiety scores in the burn, compared to the fracture and non ill/injured groups, which remained comparatively high 6 months later even though they decreased over time. Children with burn injuries, of the type included in this study, did not appear to develop significant psychological or behavioural sequelae. Following paediatric burn injury mothers appear to be at higher risk than children for developing psychological sequelae, which may have longer term implications for the childs outcome such as affecting compliance with treatment.

Seasonal changes in affective state in samples of Asian and white women

Seasonality of the affective state has been reported to vary in direct proportion to latitude in temperate regions. The frequency of seasonal affective disorder (SAD) and the severity of the symptoms associated with it have been reported to be greater in higher than in lower latitudes. In addition, recent research has suggested a genetic loading for SAD. Most of the research on the seasonality of affect has been done in high latitude areas, seasonal mood cycles have been infrequently investigated in tropical areas, and no study has so far measured and compared seasonal changes in affect and behaviour in indigenous and populations non-indigenous to high latitudes. To rule out the biases associated with retrospective designs, a prospective longitudinal study was designed to investigate seasonal mood variations in indigenous white and non-indigenous Asian populations. Since previous research has indicated the excessive vulnerability of women to winter depression, it was decided to measure seasonality of the affective state only in women. To examine the relative effects of genetic predispositions and physical environment, the Asian group was further divided into “Asian” and “Asian-British”. The former group comprised women who were living in England but who had been born and had spent considerably more time in their country of origin, while the latter group consisted of women who were born in England and who had lived there all their lives. The three groups of 25 women each were matched for age and socio-economic status, and were interviewed every month for 1 year using the Hospital Anxiety and Depression Scale (HAD), a Behavioural Change Inventory (BCI), the Ladder Scale of General Well-being (LSW) and a Monthly Stress Inventory (MSI). One retrospective scale was administered at the end of the study year to compare the extent of seasonal change in affect with that on the HAD-depression subscale. The results showed that seasonal depression peaked in winter in all three groups, with the incidence of winter depression being highest in the Asian group. Seasonal changes on several dimensiens of behaviour were in the direction of winter depression for all three groups. States other than depression (anxiety and general well-being) did not show any seasonal variation. Hours of daylight was found to be the best predictor of seasonal variation in mood among environmental and psychosocial variables. There was no evidence to support a genetic hypothesis for SAD.

Depression in South Asian women : Asian women's beliefs on causes and cures

A qualitative, grounded theory approach within a constructivist paradigm is employed to explore perceptions of causes and cures of depression in South Asian women. Ten Asian women suffering from depression and three of their carers were interviewed about their beliefs around the cause of their own and their relatives depression, and the implications of these beliefs for treatment. Findings suggested that understanding their experience of conflicting cultural expectations, distinctions between psychosocial, spiritual, physical health problems and communication problems (general and culture specific) were central to these womens experiences of depression The implications of results for services are discussed and limitations of the study considered in line with criteria developed for constructivist research.