The oral examination: a study of academic and non-academic factors.

The oral examination in psychiatry for final-year medical students at Wellington and Dunedin School of Medicine, University of Otago, was studied. Between December 1989 and April 1990, 40 medical students were videorecorded during such an examination. The transcripts of the recording of each oral, and at a later date the videorecordings, were individually scored by a panel of six research psychiatrists who were experienced examiners. In addition verbal and non-verbal behaviour was rated using visual analogue scales and the students completed personality and anxiety questionnaires. There was a low level of agreement between research psychiatrists in the allocation of oral marks. The oral score was positively associated with the level of confidence of the student and negatively with anxiety in men.

Behavioural sensitisation and steroid-induced psychosis.

As yet, there is no satisfactory model with which to understand steroid-induced mental disorder. It is suggested that a case of prednisone-induced psychosis in an adolescent female with Crohn's disease can be best understood in terms of behavioural sensitisation to steroid therapy.

Alcohol-related problems in New Zealand women.

As total alcohol consumption has increased this half century in most developed countries, alcohol-related problems have become more frequent. Most research has either studied only men or failed to mention gender. This study examined the prevalence of alcohol problems and their socio-demographic associations in a random sample of New Zealand women. Women of younger age, who were unmarried, well educated, in employment, with child care support and who lived in rural communities saw themselves as having more problems with alcohol. Women who had experienced physical or sexual abuse as adults had increased rates of alcohol problems as did those with more psychiatric morbidity as assessed by the General Health Questionnaire and the short Present State Examination. However, women with multiple social roles, particularly caring responsibilities, were less likely than women with one or two social roles to view themselves as having alcohol problems. The data provided no support for the role strain hypothesis of alcohol abuse. It is argued that the findings support a social explanation for alcohol problems based on varying social sanctions on drinking and alcohol availability rather than a psychoanalytic one of unconscious conflicts over femininity, sexuality or female social roles.

Screening for psychiatric morbidity in men and women.

This paper describes the use of the general health questionnaire (GHQ) to screen a random sample of men for psychiatric morbidity. The results are contrasted with those from the earlier Otago Women's Health Survey, an investigation into the sociodemographic determinants of psychiatric morbidity in Otago women. The level of psychiatric morbidity found in the men was equal to that found in the women which is in contrast to most overseas studies where men have been found to have lower levels of psychiatric morbidity to women. Significant differences were found in male and female demographic subgroups. High GHQ scores were found in separated, widowed and divorced men, men in higher socioeconomic status groups and those unemployed. High GHQ scores were found among the women aged 18-34, women who had never married, those in lower socioeconomic status groups and those unemployed. This study illustrates that gender needs to be considered alongside traditional sociodemographic factors when studying psychiatric morbidity and symptomatology.

Which women seek help for their psychiatric problems?

The avenues of help used by adult women with minor psychiatric morbidity were investigated in a random community survey from five Otago electoral rolls. A random subsample (n = 314) was subsequently interviewed in their homes. Information on a wide range of sociodemographic items pertinent to women's social roles was collected. Psychiatric illness was determined using a recognised structured diagnostic interview. Some 7.8% of the original population was found to have depressive, anxiety or phobic disorders at the symptom intensity level likely to be found in a psychiatric outpatient clinic. Of these women, just over one-third only (35%) said that they had sought help for their illness from any source. Most (86%) getting help received it from their general practitioner. However, unlike overseas studies where virtually all persons with psychiatric disorder consult their general practitioners for some reason, 13% reported that they had not visited their general practitioners at all in the preceding six months. Alternative therapies were infrequently sought. There was no evidence that health services were being inappropriately used by women with nonmedical problems. The results show that the majority of women are not getting treatments they require for their psychiatric illnesses. The low level of help seeking was particularly marked for young women. The findings suggest poor community awareness of the symptoms of minor psychiatric morbidity and the associated psychosocial consequences.

Variety and views in general practice.

Ninety general practitioners described their practices and gave their views on their work. The differences between urban and rural general practices were found to be greater than those between single practices, partnerships and group practices. Rural doctors were on call more frequently (50% being on call more than 11 nights per month and 54% at least every third weekend), had lower adult fees, were more likely to have hospital appointments (54%) and expressed more concern about their independence than urban doctors. Most of the general practitioners (94.5%) said that their surgeries usually ran over time (44% up to an hour, 5.5% longer), longer consultations and extra patients being seen as the prime causes. The general practitioners particularly enjoyed their involvement with people and the variety in their work (34% and 22% of comments respectively), but felt overworked and found difficulties with particular people (33% and 20% of comments respectively). In their general comments the general practitioners wanted to see an improved image for family doctors (23%) and more support for doctors (17%). Fifteen percent of the comments affirmed the quality of general practice.

Psychiatric morbidity among women in urban and rural New Zealand: psycho-social correlates.

A random community survey into psychiatric disorder among women in urban and rural New Zealand found urban women to be more often at age extremes, not married, better educated, in more paid employment, and to have better household and child-care facilities. There were no overall urban-rural differences in the GHQ-28 score, total PSE score or PSE case rates. A multiple regression found the same three factors accounted for most of the explained variance in both the urban and the rural total PSE scores: these were the quality of social networks, difficulties with alcohol, and the past experience of childhood sexual abuse. Low socioeconomic status, poor physical health, and adult experiences of sexual and physical abuse were also associated with increased psychiatric morbidity in both samples. Other individual sociodemographic items were correlated with psychiatric morbidity for the urban or rural sample only.

Psychological sequelae of induced abortion.

This article reviews the scientific literature on the psychological sequelae of induced abortion. The methodology and results of studies carried out over the last twenty-two years are examined critically. The unanimous consensus is that abortion does not cause deleterious psychological effects. Women most likely to show subsequent problems are those who were pressured into the operation against their own wishes, either by relatives or because their pregnancy had medical or foetal contraindications. Legislation which restricts abortion causes problems for women with unwanted pregnancies and their doctors. It is also unjust, as it adversely most affects lower socio-economic class women.

PIP: A review of empirical studies on the psychological sequelae of induced abortion published since 1965 revealed no evidence of adverse effects. On the other hand, this review identified widespread methodological problems--improper sampling, lack of data on women's previous psychiatric history, a scarcity of prospective study designs, a lack of specified follow-up times or evaluation procedures, and a failure to distinguish between legal, illegal, and spontaneous abortions--that need to be addressed by psychiatric epidemiologists. Despite these methodological weaknesses, all 34 studies found significant improvement rather than deterioration in mental status after induced abortion. There was also a high degree of congruity in terms of predictors of adverse reactions after abortion--ambivalence about the procedure, a history of psychosocial instability, poor or absent family ties, psychiatric illness at the time of the pregnancy termination, and negative attitudes toward abortion in the broader society. As expected, criminal abortion is more likely than legal abortion to be associated with guilt, and women who have been denied therapeutic abortions report significantly greater psychosocial difficulties than those who have been granted abortion on the grounds of their precarious mental health. Overall, the research clearly attests that abortion carried out at a woman's request has no deleterious psychiatric consequences. Problems arise only when the woman undergoes pregnancy termination as a result of pressure from others. Legislation that undermines the ability of the pregnant woman to assess herself the impact of an unwanted pregnancy on her future impedes mental health and should be opposed by the psychiatric profession.

Validity of the GHQ-28 in New Zealand women.

The GHQ-28 was validated against the short PSE in a New Zealand community study of female psychiatric morbidity. The GHQ-28 total scores were significantly correlated with the PSE scores. Higher coefficients were obtained using the scoring method of Goodchild and Duncan-Jones than with the standard scoring method. In this data set, the 3/4 cutoff had the best sensitivity and specificity. The correlations of the GHQ-28 subscales with ICD diagnostic classes and ad hoc PSE sub-scores were also statistically significant. Because the distribution of the GHQ-28 scores is positively skewed, non-parametric statistics may be preferable to the traditional Pearson's correlation coefficient. Overall, the results from this study confirm the GHQ-28 to be a valid and practical screen for presence or absence of psychiatric disorder in New Zealand women.

Bipolar affective disorder: causes and prevention of relapse.

The majority of patients with bipolar affective disorder relapse at least once during their lifetime, most several times, often with disastrous consequences. In this review we examine those factors which appear to play a facilitatory and in some cases, a causal role in determining whether a relapse will occur and, if so, when. Such factors include: the season of the year, with most admissions for mania in the British Isles occurring in the summer months; change in endocrine status, as after childbirth or when there is impaired thyroid function; treatment with drugs affecting central monoamine, particularly dopamine, neurotransmission; untoward life events. We evaluate the relative efficacy of treatments for the prevention of relapse, such as lithium, carbamazepine and antipsychotics, in the context of social and psychological support systems.

Marriage, motherhood and psychiatric morbidity in New Zealand.

The prevalence of psychiatric disorder, as assessed by both the GHQ-28 and the short PSE, is described for a random community sample of New Zealand women. In contrast to previous studies, married and widowed women and mothers showed lower rates than the never married and childless women. A plausible explanation is provided by available analysis of New Zealand gender roles. Such an explanation would reconfirm the importance of socio-cultural factors in community psychiatric disorder.

Mothers' perceptions of access to medical care for children in Otago.

Three hundred urban and 350 rural mothers were surveyed about their subjective perceptions of the availability of a doctor for their child. A third of rural mothers and a quarter of urban mothers expressed concern about lack of access. Shared parenting, a high socioeconomic status of mother and her partner and further training on leaving school, were associated with a greater satisfaction with existing services. Mothers with chronic psychiatric morbidity were more likely to express concern. Approximately one quarter of mothers expressed satisfaction with services overall. Specific improvements for child health services included reduced costs and waiting times together with an increase in the range of services available.

Impact of sexual and physical abuse on women's mental health.

The level of psychiatric symptomatology was assessed with the General Health Questionnaire and the Present State Examination in a random community sample of women. Subsequently it was ascertained which of the women had been the victims of sexual or physical abuse, in either childhood or adult life. Women with a history of being abused were significantly more likely to have raised scores on both measures of psychopathology and to be identified as psychiatric cases. 20% of women who had been exposed to sexual abuse as a child were identified as having psychiatric disorders, predominantly depressive in type, compared with 6.3% of the non-abused population. Similar increases in psychopathology were found in women who had been physically or sexually assaulted in adult life. These findings indicate that the deleterious effects of abuse can continue to contribute to psychiatric morbidity for many years.

PIP: A study conducted in New Zealand examined the relation between women's mental health and past experiences of sexual and physical abuse in a randomly selected community sample. The level of psychiatric symptomatology was assessed using the General Health Questionnaire (GHQ) and the Present State Examination (PSE). About 13.1% of the women interviewed and 9.9% of the original random sample reported having some form of sexual abuse as a child. About 4.6% of the subjects interviewed and some 3.5% of the original sample reported experiencing sexual abuse as an adult. About 20.1% of the interviewed sample and 16.2% of the original sample identified themselves as having been physically abused as an adult. These women with histories of abuse have higher GHQ and PSE scores than the nonabused and were more likely to be identified as psychiatric cases. Psychiatric disorders were identified in 20% of women who experienced childhood sexual abuse; similar increases in psychopathology were found in women who had been abused as an adult. The results of this study indicate that the harmful effects of abuse can continue to contribute to the psychiatric morbidity of women for many years.

A study of women who refused to participate in a community survey of psychiatric disorder.

The bias resulting from nonresponse causes problems for all epidemiological research. This study investigated the characteristics of those who refused to participate in a community survey of female psychiatric disorder. The demographic characteristics of refusers were similar to those previously reported. When compared to responders, those who refused tended to be older, never married and not widowed, of lower socioeconomic status and urban dwellers. No differences in physical illness requiring hospitalization or inpatient and outpatient psychiatric illness, as assessed through hospital records, were discerned between refusers and responders. Reasons for refusal are discussed. The bias problem may get worse as changing community attitudes to privacy and patients' rights lead to greater refusal rates.

Improvements urban and rural women wish to see in their health care services.

This study asked 2000 women randomly selected from the community to comment on their health services. Three-quarters did so; one-quarter were satisfied with currently available services but 45% specified changes they would like to see. The criticisms fell into three broad groups: (a) hospital services where delays, centralisation and referral paths were criticised; (b) general practice where doctor-patient communication was mentioned; and (c) cost of certain health services. Women who criticised currently available services tended to be younger, better educated with higher socioeconomic status, to be in paid employment and to have more often poor health or a close relative with poor health than the women who made no comment. These findings are seen as constructive comments from a thoughtful and informed group of health consumers.

Impact of a handicapped child on mental health of parents.

In a cross sectional study the mental health of parents of physically and mentally handicapped preschool children was compared with that of parents of healthy preschool children. The social networks of the parents with handicapped children were also studied to determine factors that might influence psychiatric morbidity. The mothers of the handicapped children showed significantly more psychiatric morbidity than the control mothers, but the fathers did not show the same deleterious effect on mental health.

A critique of a New Zealand health care service by parents of handicapped preschool children.

Parents of intellectually and physically handicapped preschool children were asked to nominate helpful and unhelpful elements in the care of their child. Their subjective responses are described. A large proportion were critical of medical services. Doctors seen as helpful recognised and verbally acknowledged the parental contribution to the child's welfare.