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Background:Higher levels of religious involvement are? modestly associated with better health, after taking account of other influences. However, most research takes little account of spiritual beliefs that are not tied to personal or public religious practice.Objectives: To compare prevalence and characteristics of religious and spiritual views of life in representative samples of all principal ethnic groups in England and to examine associations between these views and common mental disorders (CMD).Method: Face-to-face interviews with 4281 adults from six ethnic groups living in private households in England. Data were collected on common mental disorders, religious and spiritual beliefs, quality of life, social function and support, and psychotic symptoms.Results: There was no difference in prevalence of CMD between people who were religious and those who were not. However, people who held a spiritual life view but without religious practice were more likely to have CMD (OR = 2.01, CI 1.15, 3.51) than people who held a religious life view, after adjustment for relevant confounding variables.Conclusions: Lack of religious belief was associated with a higher prevalence of CMD, but only in people who reported having a spiritual life view.Declaration of interest: None. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To develop an end-of-life attitudes questionnaire for use in a large community-based sample of older people. DESIGN: Nominal groups and standardization of questions. PARTICIPANTS: Eighteen older people, ten academics and five specialist palliative care health professionals were involved in nominal groups. Thirty older people took part in initial pilot work and a further 50 were involved in reliability testing. RESULTS: A 27-item attitudes of older people to end-of-life issues (AEOLI) questionnaire. DISCUSSION: In modern times, death and dying predominantly occurs among older people and yet we know very little about older people's attitudes to end-of-life care. The AEOLI questionnaire can be used in large scale surveys to elicit attitudes on end-of life issues considered important by older people and health care professionals. [ABSTRACT FROM AUTHOR]

BACKGROUND: Carers' satisfaction with psychiatric services related to information and advice is generally poor. This may be particularly true for services trying to meet the needs of ethnically diverse communities. It is important that services attempt to ameliorate carers' concerns as early as possible. The authors aimed to assess the impact of a brief educational and advice support service on carers of patients with a first episode of psychotic illness. METHOD: Carers of all patients identified with a first episode of psychosis in a defined psychiatric catchment area of North London were invited to participate. Following consent from patients and relatives, relatives were randomly allocated to receive (in addition to usual services) a brief intervention comprising education and advice about the disorder from a support team or to usual care from community psychiatric services. RESULTS: One hundred and six carers were recruited to the study. Take-up of the intervention was less than expected and the intervention had little impact. The authors found no differences over time between the randomized arms for relatives' satisfaction (F = 23, p = 0 .4, df = 1) or number of days spent by patients in hospital over nine months from entry to the trial (F= 1.7, p= 0.18, df = 1). CONCLUSIONS: It was found that the support and advice intervention for families had little impact on their satisfaction or on patients' outcomes. However, failure to take up the intervention threatens the conclusions as the power to show an effect was reduced. Although family interventions, in general, are considered an important adjunct to the treatment of patients with chronic psychosis, there may be difficulties in providing an educational and support intervention shortly after first onset. How and when psychiatric services provide information and advice to carers of people newly diagnosed with a psychosis requires further study. [ABSTRACT FROM AUTHOR]

Subjects over 65 with DSM-III-R dementia and Living in the community (with carers) who were General Health Questionnaire (GHQ) cases were recruited. Subjects were assessed using the Mini Mental State Examination and the Geriatric Mental State (GMS). Carers were interviewed using the GMS or the CIS (Clinical Interview Scale). Information was collected on behavioural disturbance in their relatives using the Present Behavioural Examination: the most distressing behaviours were noted. A multidisciplinary team generated an individualized plan aiming to reduce the most distressing behaviours. Couples were then randomized into groups 1 and 2. For group 1, plans were implemented over 16 weeks and they were then reassessed using the same rating scales as before (phase 1). They were followed up a further 16 weeks later to see if the benefits of intervention were sustained (phase 2). Group 2 were assessed after a period as waiting list controls (phase 1). Their plans were then implemented and they were reassessed (phase 2). There was an improvement in carer mental health and in the behavioural difficulties of the person with dementia for group 1: the two measures of outcome were associated. For group 2, there was no improvement in either outcome measure. The findings are discussed in relation to their relevance for clinical practice. [ABSTRACT FROM AUTHOR]

Presents the results of a survey of psychiatrists' attitudes to assisted suicide in Great Britain. How most believe that suicide may be a rational act, and accept euthanasia; How most are unwilling to use their skills to exclude mental illness in people who request assisted suicide.

Background: Low rates of suicide in older men and high rates in young women have been reported in the South Asian diaspora worldwide. Calculating such suicide rates in the UK is difficult because ethnicity is not recorded on death certificates., Aims: To calculate the South Asian origin population suicide rates and to assess changes over time using new technology., Method: Suicide rates in England and Wales were calculated using the South Asian Name and Group Recognition Algorithm (SANGRA) computer software., Results: The age-standardised suicide rate for men of South Asian origin was lower than other men in England and Wales, and the rate for women of South Asian origin was marginally raised. In aggregated data for 1999-2003 the age-specific suicide rate in young women of South Asian origin was lower than that for women in England and Wales. The suicide rate in those over 65 years was double that of England and Wales., Conclusions: Older, rather than younger, women of South Asian origin seem to be an at-risk group. Further research should investigate the reasons for these changes and whether these patterns are true for all South Asian origin groups.

Background: Facilitation uses personal contact between the facilitator and the professional to encourage good practice and better service organisation. The model has been applied to physical illness but not to psychiatric disorders., Aim: To determine if a non-specialist facilitator can improve the recognition, management, and outcome of psychiatric illness presenting to general practitioners (GPs)., Method: Six practices were visited over an 18-month period by a facilitator whose activities included providing guidelines and organising training initiatives. Six other practices acted as controls. Recognition (identification index of family doctors), management (psychotropic prescribing, psychological consultations with the GP, specialist mental health treatment, and the use of medical interventions and investigations), and patient outcome at four months were assessed before and after intervention., Results: The mean identification index of facilitator GPs rose from 0.51 to 0.64 following intervention, while that of the control GPs fell from 0.67 to 0.59 (P = 0.046). The facilitator had no detectable effect on management or patient outcome., Conclusions: The facilitator improved recognition of psychiatric illness by GPs. Generic facilitators can be trained to take on a mental health role; however, the failure to achieve more fundamental changes in treatment and outcome implies that facilitator intervention requires development.

Proposed joint inspectorates of care homes open the way for health input into residential care. An investigation into quality-of-care measures concluded that health professionals should be included in inspectorate teams, particularly in view of the increasing dependency of residents. No association was shown between cost and quality, but higher costs were associated with short-term car provision. When costing residential care, the impact on community and primary healthcare services may need to be taken into account.

Insomnia in elderly people has traditionally been regarded as inevitable and trivial. A longitudinal study was undertaken to examine the prevalence of sleep disturbance among elderly people in an inner London community and its association with demographic variables, depression, dementia and disability. Those aged 65 years and over living at home were interviewed using a validated and reliable semi-structured interview schedule. A total of 705 people were interviewed in 1987-88 and 524 were re-interviewed in 1990. Subjective sleep disturbance was found to be common (33% and 43%, respectively). Sleep disturbance was associated with being a woman, being unmarried, living alone, disability, and current and future depression, but not with dementia or older age. The best predictor of future depression in elderly people who were not depressed was current sleep disturbance. In the presence of current sleep disturbance, the traditional predictors of depression--being a woman, having a disability, being unmarried, living alone and being older--did not contribute further. This study has shown that sleep disorder is associated with pathology. Insomnia in elderly people requires assessment and this must be accompanied by the treatment of underlying disorders and monitoring of future health.

An attempt was made to assess in detail subjects screened as suffering from dementia among a North London community sample of elderly people. Forty-eight (80%) subjects were interviewed, 7 (12%) were found to have died and 5 (8%) either refused interview or were lost to follow-up. By clinicians' diagnosis of the 48 interviewed, 22 subjects (46%) had probable Alzheimer's disease, one had multi-infarct dementia, five had mixed dementia, five had secondary dementia, 10 had a dementia which could not be further classified and 5 were not demented. No subject had a reversible condition. The prevalence rate for clinical dementia was 6.1%, and for Alzheimer's disease 3.1%. According to AGECAT diagnosis the prevalence of organicity was 5.7%. The AGECAT diagnoses and psychiatrists' diagnoses were significantly associated (P less than 0.003) and AGECAT was more likely to identify as organic those subjects with dementia diagnosed by psychiatrists as Alzheimer's disease, than those not so diagnosed (P less than 0.04). A short psychometric battery, including the MMSE in two versions, was administered and its acceptability to a community sample evaluated. This detailed clinical investigation showed that the Dementia Diagnostic Scale of the Short-CARE was a specific predictor of clinical dementia or death at the time of follow-up, whereas the more inclusive Organic Brain Syndrome scale was a more satisfactory first phase screening instrument.

The steps to setting up a population register of elderly residents are described. Based upon this, 87.2% of the elderly residents of an inner-city electoral area were screened for memory disorder, depression and activity limitation using the Short CARE. Contact with medical and social agencies was also recorded; 4.7% were classed as cases by the dementia diagnostic scale, sufferers being older and not living alone. Of the residents 15.9% were classed as depressed, this state being more prevalent in those not currently married. The depressed were, in contrast to the demented residents, likely to be in recent contact with hospital and general practitioner. Thirty-two per cent of the population showed impairment in daily activity, these individuals were usually older, not married and receiving hospital care. Sleep disorder and complaint of many somatic symptoms were associated with a diagnosis of depression. In contrast, most respondents with a subjective complaint of memory disorder, which was common in this population, were neither suffering from depression nor dementia. With this accurate sampling frame and a good response rate, the prevalence rate of clinical depression must be seen as disturbingly high. The prevalence rate of dementia approximated to that of other surveys. This study also indicated that general practitioners' lists may be inaccurate and that non-responders to first approaches for interview, although similar in demographic features to those responding, may contain among them many suffering from dementia.

The Gospel Oak Project surveyed a community sample of elderly people. Prevalence rates of depression and dementia were determined. Cases were assessed in detail and subject to long-term follow-up. Demographic information and morbidity data identified details of health service, social service and informal service contact. This paper reports the findings of the first survey of this population completed in 1987. It examines the effect of the increase in the very elderly on the need for health and social services, including contact with general practitioners. Duplication of service contacts are explored and the dependent elderly people not in receipt of services are identified. Finally, the survey investigates the effect of informal care on the level of service contact. Results confirm that contact increases with age, especially multiple service contact, implying a need for an expansion in future services. Although most depressed residents do not usually complain of depression, they have increased contact with health services but are not treated with anti-depressant medication. Few dependent elderly people receive no services; conversely there is no evidence of service duplication. Finally, receipt of informal care affected attendance at a day centre but no other service provision.