Personal appraisal of the experience of a depressive disorder.

In a prospective study, 61 patients receiving ongoing treatment for Major Depression rated the personal significance of the disorder by using the Personal Appraisal Inventory (PAI) (Bookless, Clayer & McFarlane, 2000) twice over a period of 7 months. The initial (Time 1) association between the individual items of the PAI and self-reported levels of depression, anxiety, disability, self-esteem and psychological distress was examined. It was found that these variables related to some items pertaining to appraisal of the harm and threat engendered by the disorder, but did not relate to appraisal of the positive and negative options for managing the disorder. Seven months later (Time 2) few significant changes were found in the way people appraised the impact of the disorder however, levels of depression, anxiety, disability and distress at Time 2 were predicted by several appraisal items. The clinical implications of these findings are discussed.

Posttraumatic stress disorder in a general psychiatric inpatient population.

This study examined the incidence of traumatic experiences and prevalence of lifetime posttraumatic stress disorder (PTSD) in a sample of 141 general hospital psychiatric inpatients. Sixty-one percent of the patients reported at least one traumatic event during their lifetime and 28% met the formal DSM-III-R criteria for a lifetime diagnosis of PTSD. A high degree of comorbidity between PTSD and other psychiatric disorders was found, but PTSD was the incident disorder in at least 50% of cases. The experience of trauma and its associated complex patterns of symptomatology suggest that PTSD complicates the process of recovery from another disorder.

Psychiatric disorder and disability in a rural community.

This study examined the relationship between psychiatric disorder and disability in a rural community and the use of formal and informal services in the management of such disabilities. It was found that of the 26% of the surveyed population who obtained a positive current psychiatric diagnosis, 48.3% had required assistance in managing at least one activity of daily living. The majority of those seeking assistance in managing these functional problems did so from family and friends rather than from formal agencies. Psychiatric disorder was found to lead to disability as frequently as did physical disorder, with almost 50% of those who had experienced mental health problems reporting that they were currently unable to carry out at least one activity of daily living. The finding that assistance was sought primarily from family and friends raises important questions about the nature of psychiatric disorder as a public health problem.

The phenomenology of traumatic reactions to psychotic illness.

This study investigated whether a psychotic illness was associated with posttraumatic stress disorder (PTSD) symptomatology in 45 subjects recovering from hospitalization for a psychotic episode. Previous studies have suggested that the experience of psychosis and hospitalization is distressing and that PTSD may be a useful paradigm for the psychological response. Subjects were given questionnaires to evaluate PTSD symptoms, anxiety symptoms, and distress and intrusive memories associated with aspects of treatment and psychosis. Treatment, especially experiences involving a loss of control such as detention, and psychotic symptoms, particularly persecutory delusions, passivity phenomena, and visual hallucinations, were perceived as highly distressing. Twenty-two subjects (52%) met the criteria for a postpsychotic PTSD, with implications for recognition and management of secondary morbidity related to psychosis.

Psychiatric morbidity following a natural disaster: an Australian bushfire.

This study investigated the prevalence of mental health problems after a major bushfire in Australia and examined the validity of the General Health Questionnaire (GHQ) (Goldberg 1978) against the Anxiety, Affective and Post-Traumatic Stress Disorder modules of the Diagnostic Interview Schedule (DIS; Robins et al. 1981). Study 1 was carried out 12 months after the Ash Wednesday bushfires and sought to include all the victims of the fires. Study 2 was conducted 20 months after the fires and included a sample of victims who had experienced major losses in the fires. Twelve months after the fires, 42% (n = 1,526) of the victims were defined as a potential psychiatric case using the GHQ. This rate indicated a significantly greater level of morbidity than found in communities that have not experienced a natural disaster. Twenty months after the fires, 23% (n = 43) were defined as "cases". The 28-item GHQ was found to be a valid instrument for defining the presence of psychiatric disorder in a disaster-effected community. The findings demonstrated that lasting psychiatric morbidity is associated with natural disasters.

Prevalence of psychiatric disorders in rural South Australia.

OBJECTIVE: To determine the prevalence of psychiatric disorders and use of medical services in a South Australian rural community. DESIGN: Survey based on structured self-administered questionnaires. SETTING: Riverland region of South Australia, between May and November, 1991. SUBJECTS: A probability sample of 1009 residents (71.1%) response stratified for age and sex (with replacement) aged 18 years and over from the State electoral roll. OUTCOME MEASURES: DSM-III-R-defined psychiatric disorders diagnosed by means of the University of Washington's Diagnostic Interview Schedule Screening Instrument (DISSI), physical disorders and use of health and allied services. RESULTS: Twenty-six percent had at least one psychiatric disorder in the six months before interview. Prevalence did not differ with sex or age, but was higher in the unemployed (P=0.0001). Those with a current psychiatric disorder were significantly more likely to report a lifetime physical disorder (p=0.0001). The most common disorders were major depression and dysthymia (10.8%), anxiety disorder (9.8%), phobic disorder (7.8%), alcohol abuse and dependence (7.0% and somatisation syndrome (5.3 During the year before interview, 88.5% of those diagnosed with a current psychiatric disorder had consulted a general practitioner and 4.2% a psychiatrist or psychologist. CONCLUSIONS: The prevalence of psychiatric disorders in the Riverland region was comparatively high. General practitioners were the primary care-providers for those with psychiatric disorders. These issues need to be addressed by service providers and health planners.

Neurosis and conscious symptom exaggeration: its differentiation by the Illness Behaviour Questionnaire.

In an attempt to develop an instrument to differentiate conscious exaggerators of symptoms from normals and neurotics, the Illness Behaviour Questionnaire (IBQ) was administered to 164 members of a public utility, half of whom were instructed to fill it out as conscious exaggerators, and 82 individuals who presented at a hospital pain clinic with pain considered to be neurotically determined. Four IBQ subscales differentiated the three groups, and a new 21-item scale (CE-scale) was developed which achieved wide separation between the conscious exaggerators, neurotics and normals. It is suggested that the CE-scale may have considerable utility in assessing conscious exaggerators and compensation neurotics, and that further studies should assess its predictive value.