[Are depression perceived by the public and depression described by DSM-III the same?]. / La dépression percue par le public et la dépression décrite par le DSM-III sont-elles les mêmes?

The public usage of the word depression does not correspond to the descriptions of depression proposed by classifications such as the DSM-III. Data from the pilot survey of Santé-Québec covering 3,291 persons distributed in two areas, one rural (D.S.C. of Rimouski) and other urban (D.S.C. of Verdun), allow to compare the use of the term depression between an informant reporting on a family member when this expression is included in a list of chronic illnesses, and an informant reporting on a self-administered questionnaire, symptoms similar to the diagnostics of depression and dysthymia of the DSM-III. Result show a low degree of correspondance between the term of depression as used by lay persons and as applied by medicine (14%); the small overlap mainly concerns the serious cases. Depression in its lay usage is refering less often to the psychic manifestations of the medical depression, i.e. lack of positive experiences, hopelessness, boredom, but it is often applied to persons who are not able any more to achieve social roles. The usage of the lay label varies according to sex and rural-urban origin. It applies more often to urban women under 40, even though these women are not showing the DSM-III signs of depression. On the other hand, rural men are almost never associated with this label even though a certain proportion meet the DSM-III criteria for depression. The discussion offers explanations for the different use of the label in urban and rural areas.

Urban-rural comparisons of depressive disorders in French Canada.

A field survey in French Canada confirmed the familiar finding that rural residents have lower rates of depression than metropolitan residents and showed that this difference remains even after allowing for sex, age, marital status, education, employment, and internal migration. However, no support was obtained for the hypothesis that the metropolitan sample was feeling less communally supported than the rural sample, and the rates in a small county center proved to be lower than in the rural area, not higher as would be predicted on the assumption that its life is urban. Finally, the rural-metropolitan differences proved to be concentrated in two minorities, the unemployed men and the unpartnered women, rather than spread widely. It is suggested for these reasons that the traditional urban-rural dichotomy may now be inappropriate for sociopsychiatric research.

[Theoretical and practical problems in the measurement of the mental health of populations. Quebec health survey]. / Problèmes théoriques et pratiques de mesure de la santé mentale de populations. L'enquête santé Québec.

The authors present the process of setting up a mental health inquiry. The "Enquête Santé Québec" was conducted at the request of the Ministry of Social Affairs in order to identify the problems, needs and priority intervention sectors in the health field. The inquiry was carried out on a large scale at the pilot stage, collecting information on 4,000 people in rural and urban areas. The principal options chosen are briefly discussed: type of mental health to be measured, sample methods, choice of instruments, validation work and some results.

Schizophrenia and religious affiliation in Northern Ireland.

First admissions for schizophrenia in Northern Ireland are significantly higher for the Roman Catholics than for the rest of the population, although not as high as in the Irish Republic. The excess of Catholic cases affects only the never-married, and derives much more from the rural west of the territory than from the industrial east. It does not appear to be accounted for by geography per se, by the differential use of services, diagnostic bias, social class distribution, or mean age at marriage. There are indications that some conflict around sex and marriage and, more doubtfully, a sense of relative deprivation may be contributing factors.

Blood pressure and culture. The contribution of cross-cultural comparisons to psychosomatics.

It is well known that mean blood pressure levels tend to be low in non-westernized tribal peoples and that these levels tend to rise, particularly in the older age groups, among persons of the same origins who come into more contact with modern Western life-styles. That tendency can be attributed to many factors - increased salt intake, increased obesity, acculturation anxiety, information overload, increased competitiveness, envious resentment, etc. Disentangling these various hypothesized factors is virtually impossible when studying patients or population samples from a single sociocultural group, but cross-cultural comparisons may under favorable circumstances permit some such disentangling. Using data from Micronesia, Polynesia, and East Africa, an attempt will be made to assess which types of psychological stress are most likely to conduce to hypertension, and how certain traditional cultures may have been reducing these stresses.

Traditionalism and mental health in the South Pacific: a re-examination of an old hypothesis.

Nineteenth-century theory held that mental disorder was rare in stable, traditional rural societies. Today most societies are rapidly changing, but Tonga still fits that model and the evidence suggests that the psychoses are genuinely infrequent there. It is proposed that both the theory and the evidence deserve further examination.

Hidden barriers to the diagnosis and treatment of alcoholism and other alcohol misuse.

Research into physician-patient contacts regarding alcohol-related problems suggests that patients are willing to reveal that these problems but not to ask for help, while physicians are prepared to tackle the matter only if their authority is acknowledged through a request for help.

European cultural offshoots in the new world: differences in their mental hospitalization patterns. Part II: German, Dutch, and Scandinavian influences.

The mental hospitalization rates for Canadians of German, Dutch, and Scandinavian origin are significantly below the rates for Canadians generally and even for Canadians of British origin, although the latter are the more advantaged in the society. The better-than-average picture proves to derive from the males much more than from the females, which weighs against a genetic explanation, and it is unlikely to be due to differences in use of psychiatric services. Examination of rates for subcategories of the population, and a review of the literature on these and other Canadian sub-cultures, suggests that the mental health advantages experienced by these males may be due in part to family structure and in part to religious influences.

Depression, witchcraft beliefs and super-ego development in pre-literate societies.

When guilt feelings and self-accusations made their first appearance as symptoms of depression in Europe and Africa, as noted in a previous paper, this followed a period of heightened witchcraft beliefs in both locations and was sometimes first noticed in the form of voluntary witchcraft confessions, raising the question of a possible connection between the two types of change. Using the concepts of "group ego" and "group super-ego" to which Eric Wittkower has contributed, it is suggested that the heightened witchcraft beliefs were a defence against an individualizing change which would eventually lead to the inward turning to aggression and reproach and hence to the symptoms mentioned.

Exploring a new type of alcoholism survey.

A new type of method for surveying alcoholism and alcohol-abuse was tested in a way designed to cover about 20% of adults in a town of 50 000. The method proved able to identify types of alcohol-abuser which other survey techniques have difficulty with; it made no undue demands on respondents; and it is much more economical than conventional household surveys. However, more work is still needed on it, and for certain types of information the customary self-report is still going to be required.

The advent of guilt feelings as a common depressive symptom: a historical comparison on two continents.

Historical shifts in the symptomatology of mental disease are surprisingly overlooked but common phenomena that should cast considerable light on the relation between social and intrapsychic processes. The enormous increase in chronicity and mortality in mental hospitals during the second half of the 19th century, and the shift from the shell-shock of the first World War to the battle fatigue of the second are examples which have been well documented but not well explained. The advent of guilt feelings in depression or melancholia is a lesser known instance but one with perhaps greater theoretical significance. Melancholia has been known almost throughout recorded history, but until the 16th century the number of recorded cases exhibiting exaggerated guilt feelings and self-accusations was very small, and the old physicians did not include them in their descriptions of the condition. In Asia and in Africa, moreover, it is claimed that these symptoms are rare even today, except among the Westernized. If we fully understood the other features of the disease or if the symptoms had no relevance to course and treatment, these facts might be treated simply as curiosities; but neither is the case. Depression is still not adequately understood, and some theories on it derive largely from the exaggerated guilt feelings and the psychic structure which is supposed to produce the latter. Hence it could be instructive to examine under what conditions these symptoms first became common in different societies.

Migration, culture and mental health.

The former belief that immigrants always suffer from an excess of mental disorder is no longer valid, and the old rivalry between social selection and social causation hypotheses has lost much of its relevance. The mental health of a migrant group is determined by factors relating to the society of origin, factors relating to the migration itself, and factors operating in the society of resettlement; and all three sets need to be considered if one seeks to reduce or merely to understand the level of mental disorder in any immigrant group. Illustrations from each set of factors are presented, with indications of whether they appear to have general relevance or be related to specific mental disorders.

Which neuroses need specialist care?

In order to differentiate the neurotic patient who both needs and responds to psychiatric care from the majority of neurotic patients, who do not need this, carefully matched pairs of neurotic patients being treated at psychiatric and nonpsychiatric clinics in Montreal were followed up for 1 year. Improvement was substantial regardless of treatment, and the psychiatrically treated, on the whole, improved only slightly more than the others. However, one type of patient improved greatly under psychiatric care while improving almost not at all without it--introverts who considered themselves unhealthy but found life manageable, had avoided taking time off work or using anxiolytic drugs and appeared to handle their frustrations without repressing their irritation or losing self-control. It is suggested that it is mainly this type of neurotic that should receive specialist referral.