The London Depression Intervention Trial. Randomised controlled trial of antidepressants v. couple therapy in the treatment and maintenance of people with depression living with a partner: clinical outcome and costs.

BACKGROUND: Relapse of depression is associated with a criticising attitude of the patient's partner. AIMS: To compare the relative efficacy and cost of couple therapy and antidepressant drugs for the treatment and maintenance of people with depression living with a critical partner. METHOD: A randomised controlled trial of antidepressant drugs v. couple therapy. The subjects were 77 people meeting criteria for depression living with a critical partner. RESULTS: Drop-outs were 56.8% [corrected] from drug treatment and 15% from couple therapy. Subjects' depression improved in both groups, but couple therapy showed a significant advantage, according to the Beck Depression Inventory, both at the end of treatment and after a second year off treatment. Adding the costs of the interventions to the costs of services used showed there was no appreciable difference between the two treatments. CONCLUSIONS: For this group couple therapy is much more acceptable than antidepressant drugs and is at least as efficacious, if not more so, both in the treatment and maintenance phases. It is no more expensive overall.

An investigation of shame and guilt in a depressed sample.

A self-report measure of proneness to shame and guilt was administered to 86 patients with moderate to severe depression, with the prediction that there would be a positive correlation of shame with severity of depression. Contrary to other, non-clinical studies, we found that guilt but not shame was associated with levels of depression. Shame-proneness demonstrated a unique association with a stable attributional style for negative outcomes, global negative self-evaluation, submissive behaviour and internalized anger. Contrary to prediction, no relationship was found between shame- or guilt-proneness and a reported history of childhood sexual abuse.

A study of the ethnicity and the aetiology of schizophrenia - background and objectives

High rates of schizophrenia have been repeatedly reported among the African-Caribbean population in Britain. There has been no satisfactory explanation for these increased rates and while migrants in general are thought to be at increased risk, the incidence of schizophrenia is especially raised among African-Caribbean population that was born in Britain (second generation). Preliminary data from the Caribbean also suggest that there is a specific pathological process occuring in Britain. The available evidence in Britain also suggest that there are environmental factors which are selectively affecting the African-Caribbean population in Britain that are making them more vulnerable to schizophrenia. The study of high risk groups can be very instrumental in the elucidation of the aetiology of disease and therefore the study of this population may shed light on the aetiology of schizophrenia as a whole. In addition, this increased incidence of schizopherenia places a heavy demand both on the families of an already disadvantaged group as well as on the psychiatric services, particularly in the inner cities where the majority of African Caribbean people live in Britain. An understanding of the determinants of this increased risk of schizophrenia would lead to appropriate intervention strategies especially in the areas of prevention and provision of effective care. The study will be a population based case control study of the first contact schizophrenia in African-Caribbeans and the remaining population in three British centres. The research hypotheses are that the African-Caribbeans psychotic patients will show more evidence of risk increasing social factors, in particular adverse life events and a marked discrepancy between expectations and achievement. Their siblings will also show a high risk for psychosis suggesting that certain families are more susceptible to the social adversity associated with migration. The study will combine two strategies; the first to determine the absolute risk of the disorder, and the other to identify the risk factors which mediate the onset and course of the illness. We will also carry out a one year outcome study to examine the needs for mental health care in the African-Caribbean population and the extent to which treatment is appropriate.(AU)

Expressed emotion and depression. A longitudinal study.

BACKGROUND: Previous studies show that criticism by relatives during acute depressive illness predicts relapse over nine months, but the course of criticism over time and its relation to the course of illness, have not been examined in depressed patients. METHOD: Thirty-nine depressed patients and their partners, were interviewed separately at three-monthly intervals over about one year. Illness was assessed by Research Diagnostic Criteria and Hamilton Depression Rating Scale. Criticism was measured by the Camberwell Family Interview. RESULTS: Criticism when patients were most depressed predicted neither remission nor subsequent relapse. Patients who fully recovered, with or without later relapse, had partners who were consistently uncritical, or critical only at presentation. Patients with residual symptoms during remission had more persistently critical partners. CONCLUSIONS: The nature of the association between criticism and depression could not be unequivocally established, although it appeared likely that continuing criticism was a result of continuing depression. Relatives' understanding of the illness may mediate between levels of criticism and the course of depression.

Investigation of motivational and behavioural factors influencing men who have sex with other men in public toilets (cottaging).

One-hundred-and-thirty-four individuals engaging in cottaging returned postal questionnaires. The sample was mainly urban and gay identified. Cottagers reported that cottaging was one way of meeting partners amongst a range of others they used. Most enjoyed it and felt in control of their cottaging. The majority of cottagers engaged in safer sexual activity, but there were a significant number who engaged in unsafe sexual activity last time they cottaged. Of those who had been voluntarily tested in the past and reported their serostatus, 23% were seropositive. Unsafe sexual activity was unrelated to whether tested or not, known serostatus or knowledge of the risks of transmission.

PIP: Cottaging, the meeting of prospective sex partners in public bathrooms, takes place virtually everywhere enclosed pubic toilets are available throughout Europe, North America, and Australia. References to cottaging in the United Kingdom date back to at least 1729, although the practice remains clandestine and very difficult to research. 400 questionnaires were distributed in gay clubs, gay pubs, public lavatories, gay organizations, and through individuals known to researchers primarily in London, but also in Bath, Brighton, Bristol, Manchester and Cardiff. 77% of the 134 people who ultimately mailed in completed questionnaires were from London, 7% from Brighton, and 6% from Bristol. They were of mean age 31.9 years with a range of less than 21 years to 64 years. 90% self-identified as gay, 9% bisexual, and 1% unidentified. 57% were currently in a primary sexual relationship with a man, of whom 32% were living with a man. Cottaging in this sample is therefore not enjoyed by men who fail to find sex partners through other avenues or by those who can not maintain long-term relationships. Cottaging is just one way to meet partners for anonymous, non-committed casual sex. 50% of those in a sexual relationship reported their partner knew they cottaged 2% were currently married; 7% reported having sex with women in the past year; and 29% had had a sexual relationship with a woman lasting at least 6 months. Of the 131 who reported on their frequency of cottaging, 20% cottaged daily, 43% weekly, and 37% less than weekly. At last occasion, 41% left the cottage with a partner they had met there. Sexual activity involved primarily masturbation, with giving and receiving fellatio without ejaculation ranking 2nd; 32 had anal intercourse at last cottage. The sample was generally quite knowledgeable about HIV. 80 has been tested for HIV, with 30 (37%) testing seropositive at the time of testing. 32 reported that they were definitely untested; the rest did not answer the question. Cottagers cited danger, excitement, and the sheer opportunity for casual sex as motivating factors for their activity, not drugs and alcohol. Most respondents enjoyed their sexual experiences and felt in control of their behavior. The occurrence and frequency of unsafe sexual activity were unrelated to whether individuals were tested or not to known serostatus, or to knowledge of the risks of transmission.