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Smoking is associated with poorer mental health according to a study in Australia. A study was carried out in Canberra to find the relationship of smoking to depression and anxiety symptoms and to depression risk factors. Physicians trying to help patients give up smoking should be aware that some of them may have underlying mental health problems that should be treated. Even when stressors, socioeconomic characteristics and other factors were allowed for statistically, the association between smoking and psychiatric symptoms could be seen in the study. Smokers did have more stressors and came from lower socioeconomic strata.

General practitioner (GP) use by elderly Australians, those over 70, is discussed with presentation of evidence for the existence of an unmet need for care among elderly men. Despite significant levels of morbidity, a group of men had not been in the presence of a GP in a year and would likely benefit from GP consultation.

Objective: In preparing for the publication of ICD-10, the Division of Mental Health of the World Health Organization developed several versions of chapter V, which deals with mental and behavioral disorders. The version for research purposes is called the Diagnostic Criteria for Research (ICD-10 DCR) and gives operational criteria for the diagnosis of mental disorders. This article describes the results of international field trials undertaken to evaluate the draft criteria and refine them further. Method: Data were obtained to assess interrater agreement, the confidence with which diagnoses could be made, and the ease of use of the criteria. Additional substudies examined the concordance between ICD-10 DCR, ICD-10 Clinical Descriptions and Diagnostic Guidelines, and other national classification systems (e.g., DSM-IV). The field trials were carried out at 151 clinical centers in 32 countries by 942 clinician/researchers who conducted 11,491 individual assessments of patients. Results for cases assessed by at least two raters are reported here. Results: Most clinician/researchers found the criteria to be explicit and easy to apply. Interrater agreement was high for most diagnostic categories. For some categories, such as those dealing with certain polymorphic psychotic disorders or milder forms of affective disorders, the criteria were rated as somewhat difficult to use, and reliability was lower. Comparison of the results of these field trials with those of the ICD-10 Clinical Descriptions and Diagnostic Guidelines demonstrated that there are increases in interrater agreement when the operational criteria are used. Conclusions: The use of internationally accepted research criteria enhances the reliability of diagnosis of mental disorders made in research settings worldwide.

Objective: To examine disability associated with community cases of the more commonly occurring eating disorders and with particular eating disorder behaviours.

Objective:To investigate the association of obesity with anxiety, depression and emotional well‐being (positive and negative affect) in three age groups. Methods:A cross‐sectional survey was carried out in Canberra and the neighbouring town of Queanbeyan, Australia, with a random sample from the electoral roll of 2,280 persons aged 20–24, 2,334 aged 40–44, and 2,305 aged 60–64. Results:Self‐reported height and weight were used to classify participants as underweight (body mass index of less than 18.5), acceptable weight (18.5 to less than 25), overweight (25 to less than 30) or obese (30 and over). Obesity in women was associated with more anxiety and depression symptoms and less positive affect, but there were only weak and inconsistent associations in men. When factors that might mediate any association were controlled (physical ill health, lack of physical activity, poorer social support, less education and financial problems), a different picture emerged, with the underweight women having more depression and negative affect and the obese and overweight women tending to have better mental health than the acceptable weight group. Controlling for physical ill health alone accounted for the association of obesity with anxiety and depression in women. Conclusions:Obesity has an association with anxiety, depression and lower well‐being in women, but not in men. The results are consistent with physical ill health playing a mediating role. Implication:Reducing obesity in the population is unlikely to have any direct effect on mental health or emotional well‐being.

In studies that used mixed volunteer samples, Lerman et al. [1999: Health Psychol 18:14–20] and Sabol et al. [1999: Health Psychol 18:7–13] reported on an association of smoking with a polymorphism of the dopamine transporter gene. We attempted to replicate this association in a nonvolunteer community sample of 861 Caucasians. No associations were found with either smoking initiation or smoking cessation. Sabol et al. [1999] also reported on an association of the dopamine transporter polymorphism with the personality trait of novelty seeking. However, we failed to find any associations with a range of personality traits, including a scale of fun seeking that correlates with novelty seeking. These negative findings suggest that either the original associations are not replicable or that any association is very small. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:331–334, 2000. © 2000 Wiley-Liss, Inc.

Objective: The aim of this study was to assess health professionals' beliefs about the helpfulness of a broad range of possible interventions for mental disorders.Method: The study involved a postal survey of 872 general practitioners (GPs), 1128 psychiatrists and 454 clinical psychologists. These health practitioners were presented with a vignette describing either a person with schizophrenia or one with depression. The vignettes were taken from an earlier survey of the general public. Respondents were asked to rate the likely helpfulness of various types of professional and non-professional help and of pharmacological and non-pharmacological interventions.Results: Two-thirds or more of each profession agreed that the person with schizophrenia would be helped by GPs, psychiatrists, clinical psychologists, antipsychotic agents and admission to a psychiatric ward. Similarly, two-thirds agreed that the person with depression would be helped by GPs, psychiatrists, clinical psychologists, antidepressants, counselling and cognitive-behavioural therapy. However, there were also areas of disagreement. Psychiatrists were less likely than GPs and clinical psychologists to rate psychological and lifestyle interventions as helpful, while clinical psychologists were less likely to rate specifically medical interventions as helpful. Younger members of the professional groups and female members (who also tended to be younger) tended to rate a wider range of interventions for each disorder as likely to be helpful.Conclusions: Despite areas of broad agreement about treatment, health practitioners were more likely to endorse the interventions associated with their own profession. However, younger members of each profession tended take a broader view. If these age differences represent a cohort effect, health professionals may in the future show greater acceptance of the helpfulness of interventions offered outside their profession. These conclusions are limited by the methodology of the survey, which involved a questionnaire designed for the public rather than professionals.

Objectives: To assess the public's recognition of mental disorders and their beliefs about the effectiveness of various treatments (“mental health literacy”). Design: A cross‐sectional survey, in 1995, with structured interviews using vignettes of a person with either depression or schizophrenia. Participants: A representative national sample of 2031 individuals aged 18–74 years; 1010 participants were questioned about the depression vignette and 1021 about the schizophrenia vignette. Results: Most of the participants recognised the presence of some sort of mental disorder: 72% for the depression vignette (correctly labelled as depression by 39%) and 84% for the schizophrenia vignette (correctly labelled by 27%). When various people were rated as likely to be helpful or harmful for the person described in the vignette for depression, general practitioners (83%) and counsellors (74%) were most often rated as helpful, with psychiatrists (51%) and psychologists (49%) less so. Corresponding data for the schizophrenia vignette were: counsellors (81%), GPs (74%), psychiatrists (71%) and psychologists (62%). Many standard psychiatric treatments (antidepressants, antipsychotics, electroconvulsive therapy, admission to a psychiatric ward) were more often rated as harmful than helpful, and some nonstandard treatments were rated highly (increased physical or social activity, relaxation and stress management, reading about people with similar problems). Vitamins and special diets were more often rated as helpful than were antidepressants and antipsychotics. Conclusion: If mental disorders are to be recognised early in the community and appropriate intervention sought, the level of mental health literacy needs to be raised. Further, public understanding of psychiatric treatments can be considerably improved.

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Based on a community sample, to assess the reasons disabled elderly people need care, the type of formal services they receive, the characteristics of their carers and the degree of psychological morbidity in these carers. A community survey of people aged 70 or more years living in Canberra or Queanbeyan. Survey participants were asked to nominate informants, who were interviewed about the subjects’ state of health. The informants provided information on need for care, services received and the role of carers. Informants also reported on their own health, including symptoms of anxiety and depression. Elderly people needed care because of physical disability more often than behavioural disability. Those with physical disability received more formal services and more help from health professionals than those with behavioural disability. Contact with general practitioners was high for both disabled and non‐disabled subjects. Carers of the physically disabled had raised levels of anxiety and symptoms of depression, and poorer self‐rated health, but carers of the behaviourally disabled did not. Wives, daughters and husbands made up the biggest categories of carers and around two‐thirds of carers were women. Family carers play an important role in maintaining disabled elderly people in the community and this role is often stressful. Formal services have to be aimed as much at the needs of the carers as at the disabled people themselves.

Objective:To estimate the prevalence of persistent insomnia and its correlates in samples of people living in the community and in institutional settings. Methods:Respondents were interviewed in their place of residence by trained interviewers using the Canberra Interview for the Elderly, a structured psychiatric examination. Results:Information about sleeping habits was obtained from 874 community and 59 institutional residents. Insomnia was persistent in 16% of the community‐dwelling population and 12% of the institutional residents, with 15% and 40%, respectively, regularly taking a hypnotic. Of those without insomnia, 10% in the community but over a third in institutions were using a hypnotic. Insomnia was associated with depression, pain and poor physical health. Conclusions:Persistent insomnia in the elderly, as in other age groups, is strongly associated with depressed mood, as well as with physical disease. Because of this, insomnia should not be dismissed as a normal part of ageing, and therefore ignored as a significant symptom. Continued surveillance is needed in general practice, geriatric services and nursing homes of the routine use of hypnotics by the elderly.

Objectives:To determine whether pet ownership by elderly people is associated with lower use of health services. Design:Survey of physical and mental health, and retrospective 12‐month review of Medicare records of the number of general practitioner and specialist services. Participants and Setting:Elderly people living in Canberra (Australian Capital Territory) and Queanbeyan (New South Wales), surveyed in 1994 for the second stage of a larger longitudinal study. Results:Elderly pet owners did not differ from non‐owners on any of the physical or mental health measures or in use of health services. Conclusion:Given the high use of health services by older people, our findings suggest that the claim that pet ownership leads to savings in health services should be viewed with caution.