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Background: A study of the influence of life-event stress on the onset and course of acute somatisation in primary care.Method: Forty-four somatisers were compared with 11 subjects who had psychiatric disorder but complained only of psychological symptoms, 39 patients who had 'mixed' conditions involving independent physical and psychiatric illness, 90 patients who had physical illness, and 123 healthy members of the general population.Results: Severely threatening life events were more common among all subjects with psychiatric disorder. A novel contextual rating of the potential of stressors to produce symptoms for 'secondary gain' was developed. In the 38 weeks before symptom onset, somatisers and psychologisers were more likely to have experienced at least one event which had this potential. Somatisers were also less likely to adopt neutralising coping efforts when faced with such a crisis.Conclusions: The likelihood of adopting neutralising efforts was closely related to the presence of a joint index of parental problems in care and exposure to physical illness in the subject's childhood. In a two-year follow-up, subsequent functional illnesses were also associated with experiences which had secondary-gain potential, and subjects with childhood risk factors continued to have higher rates of crises with secondary-gain potential and to fail to adopt neutralising coping strategies. [ABSTRACT FROM AUTHOR]

Surveys using clinical-type interviews have documented a high rate of depression among working-class women, and this is discussed in the light of a recent survey in an inner-city area. While women with caseness of depression contacting a psychiatrist did not differ in number of core depressive symptoms from those who did, they did in certain characteristics that would make them worrying for a general practitioner to deal with. It is concluded that there is a considerable overlap in the severity of depressive conditions between those seen by psychiatrists and those defined as cases in population surveys; any differences that do exist may relate more to the way symptoms are expressed than to the severity of the depressive disorder as such. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article about somatization disorder.

Life events and difficulties were recorded for the year preceding onset of abdominal pain in 135 consecutive referrals to three gastrointestinal clinics, and for the equivalent time period in a matched, healthy community comparison series. Fifty-six patients were found to have an organic gastrointestinal disorder. Severely threatening events and major difficulties known to play a critical aetiological role in clinical depression, occurred with much the same frequency during the 38 weeks before onset of non-organic ('functional') gastrointestinal disorder. There was no such relationship between the severity of threat and organic disorder. A measure of 'goal frustration' reflecting the degree to which the subjects aims and ambitions were insurmountably obstructed by the occurrence of the event, was significantly associated with organic disorder. This finding may explain the often reported association between life stress and organic gastrointestinal disorder.

Over the last 15 years the use of standardized clinical-type psychiatric interviews has been extended to the general population and we have a much better understanding of the extent of affective disorder and factors of aetiological importance. The surveys have revealed a worrying amount of affective disorder, of much the same order of severity as those treated in out-patient clinics, particularly among working-class women in inner-city areas. Relatively few are seen at any point by psychiatric services although half the conditions at any one point in time are chronic. Despite the increasing interest in this work relatively few studies have yet been published. The scientific status of the instruments and the generalizability of the current findings and some of their implications are discussed.

The effects of establishing an ease of access 'walk-in' service on General Practitioner referrals to the ambulatory services of a catchment area psychiatric service are outlined. The characteristics of the patients referred are described. GPs made immediate and sustained use of the walk-in service and its creation expanded use of the ambulatory services by an overall 50%. Individual GPs were found to use the ambulatory services disproportionately and to discriminate between their use of the walk-in service and the coexisting traditionally run outpatient clinic. The walk-in service also allowed patients to refer themselves; a policy which did not result in a flood of inappropriate referrals but enabled patients, already familiar with the service, to re-establish contact in times of distress. The findings are discussed in terms of the current growth of Community Mental Health Centres in the United Kingdom and their implications for GP/Psychiatric Service liaison.