Raymond Cochrane

The life events inventory: a measure of the relative severity of psycho-social stressors.

HOLMES AND RAHE [I] describe an instrument-the Schedule of Recent Experiences (S.R.E.)-which has been widely used for measuring life stresses retrospectively. It consists of a checklist of events with spaces for subjects or patients to indicate which, if any, of the events have happened to them in a stated period of time-usually the past year. Each event is assigned a weighting which is supposed to reflect the degree of disruption that would be caused should that event befall an average person. These weights are expressed in “life change units” (L.C.U.‘s); an individual’s score on the S.R.E. being the sum of the L.C.U.‘s of the events he reports having experienced. The original weights were obtained in a somewhat arbitrary fashion. Originally, samples of convenience were asked to act as judges and to assign a number between 1 and 100 to each event on the S.R.E. to indicate the amount of ‘turmoil, upheaval and social readjustment’ that would be occasioned by its occurrence. One of the items, usually Marriage was assigned an arbitrary weight of 50; the intention being that this would establish an anchoring point at the middle of the scale that would act as a common frame of reference for all judges. When judged by the criterion of interjudge agreement this procedure has been quite successful. Even when groups that vary on age, ethnicity and cultural backgrounds are used as judges, good agreement about the weights to be assigned to each event is obtained [2-71. The instrument has been shown to be reasonably reliable [5] and has been extensively used in studies of the antecedents of illness [6-121. To some extent this wide use may be more indicative of the lack of a suitable alternative measure of recent life stresses, than of the inherent quality of the S.R.E. The work reported here was undertaken to remedy what were seen as three important deficiencies that reduced the usefulness of the S.R.E. as a research tool.

The effects of physical activity and exercise training on psychological stress and well-being in an adolescent population

To determine whether participating in physical activity affects psychological well-being in an adolescent population, 147 adolescents completed self-reports of exercise and psychological stress and well-being. Analysis revealed that those who reported greater physical activity also reported less stress and lower levels of depression. Adolescents who experienced a higher incidence of life events also demonstrated a strong association between stress and anxiety/depression/hostility. To investigate the effects of exercise training on psychological well-being, adolescents were assigned to either high or moderate intensity aerobic training, flexibility training or a control group. The training groups met twice per week for 25-30 min. Aerobic fitness levels, heart rate, blood pressure and self-report of stress and well-being were measured prior to and following 10 weeks of training. Post-training fitness measures confirmed the effectiveness of the high intensity aerobic exercise and between groups differences for physiological and some psychological measures were found. Subjects undergoing high intensity exercise reported significantly less stress than subjects in the remaining three groups. The relationship between stress and anxiety/depression/hostility for the high intensity group was considerably weakened at the end of the training period. For the remaining subjects, however, this relationship was, if anything, strengthened. This experiment provides evidence to suggest that in an adolescent population, high intensity aerobic exercise has positive effects on well-being.

Mental illness in immigrants to England and Wales: An analysis of mental hospital admissions, 1971

SummaryA study has been made of all admissions to mental hospitals in England and Wales in 1971 by place of birth. After age/sex standardization of rates and reallocating those patients for whom place of birth was not recorded to appropriate categories, several surprising findings emerged. Compared to the native born, those born in Ireland and Scotland had very high rates of mental hospital admission. Poles also had high rates but West Indians and those born in the U. S. A. had rates comparable to the native born. Rates of mental hospital admission for immigrants from India, Pakistan, Germany and Italy were much lower than native born rates. All immigrant groups studied had higher rates of admission for schizophrenia than natives but much of this discrepancy can be explained by the age structures of the populations being compared. The Irish and Scots had extremely high rates of alcohol and drug related disorders and personality and behaviour disorders but West Indians were underrepresented in these diagnostic categories. Various explanations for these and other results are considered and it is concluded that the most tenable hypothesis is one of differential selection for migration — where migration is relatively easy the less stable members of a population self select for migration but where migration is relatively difficult only the most stable individuals can achieve migration.

Mental hospital admission rates of immigrants to England: A comparison of 1971 and 1981

SummaryThe present study compares admissions to mental hospitals in England in 1981 with comparable figures obtained for 1971. Patients were classified by place of birth and the two data sets reveal interesting similarities a decade apart. With schizophrenia the trend in 1981, as in 1971, is for the foreign born to have higher rates of admission in comparison to the native born; and as in 1971 the groups with the highest rate of admission are the Irish born and those born in the Caribbean and Poland. Overall rates of admission in 1981 for immigrants from India, Pakistan, Germany and Italy (like 1971) are lower than the native born rates. As in 1971 the Irish and Scots have extremely high rates of alcohol and drug related disorders, and although they also have high rates of personality disorders they are not as high as the 1971 rates. Those born in the Caribbean continue to show relatively low rates of admission for alcohol, drug and personality disorders. For Indian born males the 1981 figure for alcohol related admissions is twice that of 1971. There is an apparent increase in the rates of depression in 1981 compared to 1971 across all the groups which is affected by changes in recording procedures. There are other findings which are peculiar to only one sub-group, such as the very low re-admission rates for Pakistani women compared to the other groups. This paper provides some possible explanations to account for these variations in rates of admission.

Migration and schizophrenia: an examination of five hypotheses.

SummaryData are presented on rates of admission for schizophrenia for the native born and the four largest foreign born populations living in England in 1981 (Irish, Indian, Pakistani and Caribbean born). These data show that, in general, the foreign born have higher rates of admission for schizophrenia, and a higher proportion of all diagnoses accounted for by this disorder than do the native born. The exception is Pakistani born women who have conspicuously low rates. Five hypotheses are examined to account for these differences. The apparently high rates of schizophrenia found for the Indian born of both sexes, and Pakistani born men can be accounted for to a large extent by the demographic differences that exist between them and the native born. The Irish born residents of England have rates comparable with the Irish in Ireland who also show much higher rates than do the native English. There is no completely satisfactory account for the very high rates found for Caribbean born men and women but a combination of adverse post migration experiences and tendency to misdiagnose schizophrenia in this group is offered as a tentative explanation for at least some of the excess. The low rates of admission for schizophrenia of Pakistani women is attributed to a tendency on their part to opt out of the formal mental health system after an initial encounter, possibly to return to their native land.

The effects of aerobic and anaerobic training on fitness, blood pressure, and psychological stress and well-being

To determine whether fitness alters psychological and physiological indices of well-being, male police officers were assigned to either an aerobic or anaerobic training condition or to a no treatment control group. The training groups met three times per week in 45 min sessions aimed at improving either cardiovascular endurance or muscle strength. Aerobic fitness level, heart rate, blood pressure and self-report of stress and well-being were measured prior to and following 10 weeks of training. Post-training fitness measures confirmed the effectiveness of training and between group differences for physiological and self-report measures were found. Subjects undergoing aerobic training evinced larger changes on the self-report measures of well-being and stress than the anaerobic trainers and both groups showed significant improvement when compared to controls. This experiment provides support for the hypothesis that exercise, and in particular aerobic exercise, has positive effects of well-being. It is suggested that future research might usefully explore the particular contribution of different aspects of the training situation to these effects.

A mediational model of quality of life for individuals with severe mental health problems

BACKGROUND Despite the increasing importance of quality of life in the mental health field, the theoretical conceptualization of the construct remains poorly developed. A proposed mediational model of quality of life, which links subjective quality of life with self-related constructs, is examined with a group of long-term psychiatric hostel residents. The present study aims to develop a measure of quality of life based on the proposed model, to explore the data and their implications for service development and finally to conduct a preliminary analysis of the models predictions. METHODS A cross-sectional research design was employed. Quality of life interviews, using a modified version of Lehmans Quality of Life Interview, were carried out with 54 psychiatric residents in Greece. The models predictions were examined by using a series of regression analyses. RESULTS The results indicate that perceived improvements in lifestyle, greater autonomy and positive self-concept are significantly and directly associated with better quality of life. In contrast, a direct relationship between objective indicators and subjective quality of life was not found. CONCLUSIONS The traditional two-part quality of life model that includes objective indicators of life circumstances and subjective indicators is extended to included the constructs of self-concept and perceived autonomy. The present extended mediational model of quality of life for individuals with long-term mental health problems appears to have important implications for the planning and delivery of mental health programmes.

Psychological and social adjustment of Asian immigrants to Britain: A community survey

SummaryA community survey of 50 Indian and 50 Pakistani born residents of Birmingham and 100 matched native controls has been completed. Asians were selected so that the sample corresponded to the known demographic characteristics of the immigrant population and were interviewed in their native languages in their own homes. Measures of psychological disturbance, social adjustment, family relationships, housing and employment history as well as attitudinal measures were employed to test some hypotheses concerning the relationship between migration and adjustment. Analysis revealed that on most indices (psychological symptoms, life events, employment, housing, satisfaction) Asian immigrants were better adjusted than their British neighbours. There were strong indications, however, that the British control groups employed were not representative of the British population at large because of their residence in high immigrant concentration areas. The British groups interviewed may have been less well adjusted than a representative British group would have been and so have exaggerated the difference between British and Asian groups. Within the immigrant groups psychological adjustment was related to age and social class among Pakistani males; experiencing disruptive life events was most important for Pakistani females and British controls, crowding correlated with symptoms for Indian and Pakistani females but not for males, and length of residence in Britain was negatively related to symptom levels for Indian males.

Psychological symptom levels in Indian immigrants to England--a comparison with native English.

A national community survey of psychological symptom levels among samples of Indian immigrants and natives is reported. Using a quasi-random sampling procedure, a sample of 200 Indian-born residents of large towns in England was selected to match the age and sex structure of the total Indian immigrant population. An indigenous population, selected in the same way, was matched with the immigrants for comparison purposes. Psychological disturbance was measured with the Langner 22-Item Scale which has previously been specifically validated for use in this context. Other indices were constructed to test specific hypotheses. The pattern revealed by mental hospital admission statistics was strongly supported by the survey. Indian immigrants as a group experience far less psychological disorder than natives, despite the experiences of migration and of being an immigrant. On other measures Indians also manifested an adjustment superior to that of natives. Among the Indian sample stable psychological adjustment was related to being young at migration, being acculturated to life in England and being socially integrated. A subgroup of higher social status, Indian females who had been upwardly socially mobile, emerged as the only group with a higher than average symptom level. However, even this group was at least as well adjusted as its English counterpart.

A comparative evaluation of the Symptom Rating Test and the Langner 22-item Index for use in epidemiological surveys.

A systematic evaluation was made of the reliability, validity and psychometric properties of the Symptom Rating Test and Langner 22-Item Scale in order to determine whether they are suitable for use in community surveys of psychiatric epidemiology. On the basis of studies on several samples (total N = 846), both scales were shown to be suitable for this purpose. Although the subscale structure of the Symptom Rating Test was not confirmed, it appeared superior in most respects to the Langner Scale.