Neurotic symptoms and subjective well-being in a community sample: different sides of the same coin?

Community survey data on neurotic symptoms and subjective well-being scales were examined with principal components analysis. The two types of scales were found to load on separate, but negatively correlated, factors. Furthermore, some differential correlates of the two types of scale were found, but the differences were not great. It was concluded that neurotic symptom and well-being scales do largely measure different ends of a single continuum, but well-being scales seem to have an extraversion component not shared by neurotic symptom scales. Subjective well-being measures may be useful in epidemiological surveys where it is desirable to discriminate among low symptom scorers.

A model of stability and change in minor psychiatric symptoms: results from three longitudinal studies.

A statistical model designed to estimate the contributions of stable and changing symptomatology to levels of minor psychiatric symptoms is developed. This model is fitted to data obtained from three longitudinal studies. These studies involved subjects from Canberra (Australia), Christchurch (New Zealand) and Groningen (Holland). Data from all three data sets were shown to fit the proposed model adequately. However, there were systematic differences in the findings of the study. The findings from the Canberra and Groningen studies suggested that a large amount (50-75%) of the variance in symptom levels could be attributed to between subject difference in stable levels of symptomatology. In contrast the Christchurch study suggested a smaller contribution of stable symptomatology. These differences may be explained by the nature of the samples studied. All three studies showed evidence of strong correlations (0.79-0.94) between stable levels of symptomatology and the measure of trait neuroticism. It is concluded on the basis of this evidence that the neuroticism may be little more than a way of measuring the subject's characteristic level of minor psychiatric symptoms. The model also made it possible to secure estimates of the extent to which measures of neuroticism were contaminated by short-term mental state. Estimates of contamination effects varied between studies. For the Canberra data contamination was negligible, for the Groningen data mild contamination effects were present but for the Christchurch data contamination was larger. These differences may be explained by differences in the nature of the samples studied.

Methodological issues in the study of personality and psychiatric state in rheumatoid arthritis.

Many studies of personality and psychiatric state among patients with rheumatoid arthritis (RA) suffer from methodological weaknesses. This review considers these weaknesses, and suggests criteria that should be met for the sound design of studies that are intended to demonstrate a role for personality traits and psychiatric states in the aetiology and course of the disease. These criteria include the method used to diagnose RA, sample size, the appropriateness of the tests of personality and psychiatric state for use with RA, and the matching of RA subjects with controls.

The Parental Bonding Instrument (PBI): an epidemiological study in a general population sample.

The Parental Bonding Instrument (PBI) was used in a 2-wave community survey of 386 persons. The two factor structure of the instrument was confirmed, as well as the high stability of its scales over time. Respondents who had had children differed significantly from others. No association was found between social desirability, neuroticism or extraversion and either of the scales. No association was observed between the scales and psychiatric disorder, despite using covariance structure analysis to remove the effects of age and attenuation due to measurement error. Estimates of relative risk for affectionless control were low in contrast to estimates calculated from samples with psychiatric disorders. These findings may be characteristic of symptomatic persons in a general population. Because of the importance of the affectionless control construct, the findings invite further investigation in other community and treated samples.

An analysis of the re-test artefact in longitudinal studies of psychiatric symptoms and personality.

When general population samples are assessed on two occasions with psychiatric symptom or personality measures, a mean change in scores towards less psychopathology is often observed. This re-test artefact is a potential threat to the validity of longitudinal studies. Data from a longitudinal general population study were analysed to discover under what circumstances the re-test artefact occurs. It was found that the artefact is unrelated to the time lag between occasions, being equally strong at intervals ranging from 4 to 34 weeks. However, the artefact did not occur for all measures, but was confined to those assessing negative self-characteristics and administered orally by an interviewer. These findings are consistent with both the 'mechanical responding' and 'social desirability' hypotheses of the re-test artefact.

Detecting anxiety and depression in general medical settings.

To aid general practitioners and other non-psychiatrists in the better recognition of mental illness short scales measuring anxiety and depression were derived by latent trait analysis from a standardised psychiatric research interview. Designed to be used by non-psychiatrists, they provide dimensional measures of the severity of each disorder. The full set of nine questions need to be administered only if there are positive answers to the first four. When assessed against the full set of 60 questions contained in the psychiatric assessment schedule they had a specificity of 91% and a sensitivity of 86%. The scales would be used by non-psychiatrists in clinical investigations and possibly also by medical students to familiarise them with the common forms of psychiatric illness, which are often unrecognised in general medical settings.

Development of long term use of psychotropic drugs by general practice patients.

From 1984 to 1986 a prospective study was conducted of 104 general practice patients who started treatment with a benzodiazepine or an antidepressant drug. The duration of reported use of the drugs was two months for 45% of patients, four months for 17% of patients, and six months for 15%. Type of drug, age, and level of education were found to be predictive of continuing use. General practitioners have a significant effect on their patients' use of drugs and, with careful selection and review when prescribing, may help to prevent dependence on psychotropic drugs.

The relationship between symptoms and diagnoses of minor psychiatric disorder in general practice.

In an earlier paper (Goldberg et al. 1987) 36 common symptoms of minor psychiatric disorder in general practice were analysed using the technique of latent trait analysis. From this analysis two dimensions of illness emerged, corresponding to anxiety and depression. In the present paper, this symptom-based representation of minor psychiatric illness is used as a framework for comparing four diagnostic systems: General Practitioner (GP) diagnoses, the ID-CATEGO diagnostic system, the DSM-III system and the Bedford College diagnostic system. This analysis clarifies the reasons for disagreement among systems of diagnostic criteria and examines the practical effects of alternative diagnostic algorithms.

Dimensions of neuroses seen in primary-care settings.

This study uses methods of latent trait analysis to examine the relationship between psychiatric symptoms that constitute the common psychiatric disorders encountered in primary-care setting. Two highly correlated symptom dimensions of anxiety and depression are shown to underlie these disorders. Neurovegetative symptoms of depression are shown to be on the same dimension as psychic symptoms of depression, but to represent a more severe manifestation of depression.

The utility of latent trait models in psychiatric epidemiology.

Latent trait modelling is a recent psychometric technique with great potential for the construction and refinement of psychiatric instruments. It provides a greater insight into the nature of measurement in psychiatry and the statistical machinery for improving it. This expository paper starts with a non-technical outline of the latent trait model, gives a detailed analysis of the 12-item General Health Questionnaire (GHQ) and examines points raised by the empirical analysis through computer stimulation. It is shown that the latent trait model can give a good representation of empirical data and uncover new aspects of a familiar instrument. It provides a precise methodology for evaluating the functioning of a questionnaire and for developing better short instruments. It highlights the need, and provides the means, to tailor instruments for different tasks, such as (a) screening, and (b) measuring over the whole range of the population. We examine scoring in the light of the model, and show that simple scoring is often adequate. While points for further methodological development are noted, it is argued that the method is already sufficiently developed for general application.

Chronicity and the General Health Questionnaire.

We propose a new scoring for Goldberg's (1972) General Health Questionnaire. We argue that the response 'no more than usual', to an item describing pathology, should be treated as an indicator of chronic illness rather than of good health, and we score these responses accordingly. We give evidence that this set of responses is associated with other measures of neurotic illness, and that the revised scoring provides a better prediction of caseness than the conventional scoring. The revised scoring is more strongly associated with trait neuroticism, and is more stable in repeated measurement. It is recommended in preference to the conventional scoring for most research and epidemiological purposes.

The reliability of the Geriatric Mental State Examination. Community survey version.

A version of the Geriatric Mental State Examination has been prepared for use in community surveys. Its reliability has been investigated on a sample of geriatric day-patients (n = 52). Two psychiatrists separately examined each patient and audiotaped the interviews. It is argued that unless certain requirements in the data from such a study are fulfilled, interpretable reliability statistics cannot be calculated for individual items. Where the data were sufficient in this study, the mean phi coefficient was 0.84 within interviews and 0.56 between interviews. The reliability of individual items has been assessed as a basis for further improvement in the instrument.

The reliability of reports of early separations.

A random sample of adult community residents (n 244) was asked about separations in their childhood. Eight months later, the group was asked the same questions again. Only the death of a parent and the break-up of the parental marriage were reported with high reliability. These events made up one third of all reported separations.

Measuring social relationships. The Interview Schedule for Social Interaction.

It is generally recognized that social relationships occupy a central position in psychiatry. To examine the role of social relationships in the onset of minor psychiatric morbidity it is necessary to construct an instrument which will meet the need for a valid, reliable and comprehensive index of social relationships. Such an instrument has now been developed and used in a sample of the general population. The Interview Schedule for Social Interaction arose from a research need, and was constructed to assess the availability and perceived adequacy for any individual of a number of facets of social relationships. These consist both of persons and of the provisions obtained through them. Data from a general population sample suggest this instrument to be sufficiently valid and reliable, and also sensitive to predictable variations between sociodemographic groups, to justify its use in clinical and epidemiological studies, both in psychiatry and general medicine.

Depression and anxiety in the community: replicating the diagnosis of a case.

The diagnoses were reviewed of 866 women interviewed in 5 community surveys carried out by the Bedford College team. The diagnoses matched commonly held conceptions of who is a case in terms of both severity and type of syndrome. Two methods of replicating the diagnoses are prevented, one based on discriminant function analysis and the other based on a simple checklist.

Social relationships, adversity and neurosis: a study of associations in a general population sample.

A standardized study of the point prevalence of non-psychotic disorder was carried out on a systematic sample of Canberra residents (N = 756). Rates were estimated for PSE CATEGO diagnoses and the Index of Definition. The association between neurosis and deficiencies in social relationships was examined, using the Interview Schedule for Social Interaction (ISSI). An objective measure of exposure to adversity was also obtained at interview. Both attachment and social integration (affectionally close and more diffuse relationships) were found to be negatively associated with neurosis. This association holds in its own right, in addition to an interaction with the load of adversity. The associations are weaker for men. The significance of this work lies in its demonstration of an association between neurosis and the lack of social ties, and in its attempt to obtain a specification of those elements in social relationships which, when deficient, may be associated with neurosis. The direction of causality has now to be investigated.

The reliability of reporting adverse experiences.

The reliability of reporting of life-events was examined in 52 subjects attending clinics. An inventory of events and longer-standing difficulties was administered on 2 occasions, 7-14 days apart. High levels of reliability were found for the number of events, the mean score for distress or change over all events, and for the single event with highest score. The reporting of individual events was less reliable: only 70% of those events reported at either interview were reported under the same heading at both interviews. Subjective reactions to events differ in reliability according to the type of response, and they are less reliable for single events than overall. Lastly, the reliability of highly distressing events in fact lower than for the less distressing. These findings point to some of the shortcomings of inventory methods in life-event research.

Psychiatric disorder in Canberra. A standardised study of prevalence.

A standardised survey of prevalence has been carried out in a general population. The epidemiological method employed is innovative in its use of two established instruments, the GHQ and the PSE, harnessed together in a two-phase design. 756 persons were interviewed, giving a response rate of 85% in phase 1. 157 were then interviewed with the PSE in phase 2 within a few days, giving a response rate of 92% in this weighted subsample. The point prevalence of non-psychotic morbidity, based on the distribution of GHQ scores, is higher than elsewhere in Australia, the excess being in Canberra males. The PSE data weighted back to represent the total population, show a distribution of morbidity in women which is remarkably similar to that in the very different population of Camberwell. The overall point prevalence of threshold and definite cases is 9.0% +/- 3.2. Case rates did not vary significantly with age or sex, but were higher in the separated, the single and the widowed. This study represents an advance in the reliable and economical detection of psychiatric morbidity at specified levels of severity in general populations.