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Beverley Raphael explains why a population health approach, which encompasses both public health and clinical services interventions, is eminently suitable to address the emotional and behavioural problems, mental health problems [...]

General practitioners can help patients with symptoms of stress when they take time to listen and develop a treatment strategy. Stress responses are highly individual, and can result in physical and psychological symptoms following major, minor, and ongoing life events. A physician should consider the unique manifestations of stress in each patient, listening to complaints and discussing the patient's perceptions. Stress management may include deep breathing, progressive muscle relaxation, biofeedback, as well as cognitive therapy and changes in lifestyle that might reduce symptoms.

Byline: Gwenneth L Roberts, Brian I O'Toole, Beverley Raphael, Joan M Lawrence, Richard Ashby Abstract: Study objective: In 1992, a study of the prevalence and predictors of domestic violence victims among individuals who presented to a major public hospital emergency department was conducted to replicate a study conducted by the authors in the same setting 12 months previously. The second study aimed to investigate more accurately the presentation of current victims of domestic violence to the ED. Methods: In a retrospective, cross-sectional study, a screening questionnaire was administered to participants to establish the prevalence of a history and current presentation of domestic violence problems among patients who presented to the ED of a major public hospital. The study group comprised a representative sample of 670 male and 553 female adults (older than 16 years) who presented to all sections of a public hospital ED during 53 randomly selected 8-hour nursing shifts over an 8-week period in 1992. Results: The results of the second prevalence study confirmed those of the first study. Of the 1,223 respondents in the study, 15.5% disclosed a history of adult domestic violence (8.5% of men, 23.9% of women). Women were at greater risk than men for abuse as adults (raw relative risk [RR], 3.27; 95% confidence interval [CI], 2.23 to 4.79; RR adjusted for age, history of child abuse, and country of birth, 4.13; CI, 2.86 to 5.95). Women were at greater risk than men for being doubly abused (as a child and as an adult) (raw RR, 2.17; CI, 1.33 to 3.53). The second prevalence study confirmed what had been indicated in the first study: that 2.0% of women who presented to the ED (11.6% of all women with a history of adult domestic violence) were current victims of domestic violence and that these women presented mainly between the hours of 5 pm and 8 am, when no social work services were available for referral of victims. Conclusion: These Australian studies support the findings of prevalence studies of domestic violence victims in ED in the United States. The prevalence and risk factors indicate the need for training of physicians and nurses in the ED about domestic violence and for provision of appropriate backup referral services such as after-hours social work services. [Roberts GL, O'Toole BI, Raphael B, Lawrence JM, Ashby R: Prevalence study of domestic violence victims in an emergency department. Ann Emerg Med June 1996;27:747-753.] Article History: Received 3 January 1996; Accepted 7 March 1996 Article Note: (footnote) [star] From the Department of Psychiatry, University of Queensland*, and the Royal Brisbane Hospitala , Herston, Queensland, Australia., [star][star] Supported by grants from the Queensland Department of Family Services and Aboriginal and Islander affairs, the Criminology Research Council, and Queensland Health., a The views expressed are the responsibility of the authors and are not necessarily those of the Departments or the Council., aa Address for reprints: Gwenneth Roberts, PhD, Trauma Studies Group, Department of Psychiatry, Edith Cavell Building, Royal Brisbane Hospital, Herston 4029, Queensland, Australia, 61-7-3365 5570, Fax 61-7-3365 5466, E-mail gwenneth.roberts@mailbox.uq.oz.au, acents Reprint no. 47/1/73229

The emerging themes related to the mental health of Aboriginal children and adolescents arising from focus groups conducted in Sydney, New South Wales, are explored. Clinicians working with Aboriginal young people should consider the critical importance of family and identity issues and also should analyze the physical health or social factors that might complicate the diagnosis.

The impact of the recent Victorian bushfires on the Australian doctors, nurses and other health professionals is discussed. The support that the people are receiving and the precautions that should be taken to avoid such incidences are also talked about.

Objective:To explore factors associated with high psychological distress among Aboriginal and non‐Aboriginal Australians and their contribution to the elevated distress prevalence among Aboriginal people. Methods:Questionnaire data from 1,631 Aboriginal and 233,405 non‐Aboriginal 45 and Up Study (NSW, Australia) participants aged ≥45 years were used to calculate adjusted prevalence ratios for high psychological distress (Kessler‐10 score ≥22) for socio‐demographic, health and disability‐related factors, and to quantify contributions to differences in distress prevalence. Results:While high‐distress prevalence was increased around three‐fold in Aboriginal versus non‐Aboriginal participants, distress‐related risk factors were similar. Morbidity and physical disability had the strongest associations; high distress affected 43.8% of Aboriginal and 20.9% of non‐Aboriginal participants with severe physical limitations and 9.5% and 3.9% of those without limitations, respectively. Differences in distress prevalence between Aboriginal and non‐Aboriginal participants were essentially attributable to differences in SES, morbidity, disability/functional limitations and social support (fully‐adjusted PR 1.19 [95% 1.08, 1.30]); physical morbidity and disability explained the bulk. Conclusions:The markedly elevated prevalence of high distress among older Aboriginal Australians appears largely attributable to greater physical morbidity and disability. Implications for public health:Addressing upstream determinants of physical morbidity and improved integration of social and emotional wellbeing care into primary care and chronic disease management are essential.

Time for randomised controlled trials Some people believe strongly that talking through traumatic or stressful experiences may help the psychological recovery of those who have suffered psychological wounding. This belief [...]

Although childhood trauma and family adversity can increase vulnerability to serious mental health problems, uncertainty exists about the nature and prevalence in a clinical population. This embedded research aims to establish the prevalence of trauma and adversity in young people seeking help from Child and Adolescent Mental Health Services (CAMHS). All children, adolescents, and their parents/guardian attending their initial assessment at a CAMHS service were invited to participate in the ‘Stressful Life and Family Difficulties study’ and a clinical interview. 162 families participated in the study. It was more common for young people to experience multiple adversities (three or more) in the last 12 months than single events. Mothers self-reported a greater number of family adversities than fathers. According to clinicians, the most frequent adversities experienced by young people were having a parent with a mental illness (66%), being bullied (63%) and parental divorce or separation (43%). Overall, clinicians reported that 69% of CAMHS clients had experienced a potentially traumatic experience (any physical, emotional or sexual abuse, child neglect or traumatic event). Moreover, young people with trauma histories were significantly more likely to have a parent with a history of trauma.

Objectives:To assess the cross‐cultural validity of two Kessler psychological distress scales (K‐10 and K‐5) by examining their measurement properties among older Aboriginal and Torres Strait Islanders and comparing them to those in non‐Aboriginal individuals from NSW Australia.

Images of Trauma is an intelligent and challenging book and one that is difficult to review: it sweeps across a wide canvas of theoretical constructs to examine the relation between [...]

The evident and unresolved health disparity between Aboriginal and other Australians is testament to a history of systematic disenfranchisement. Stigma, lack of appropriate services and the expense of delivering services in remote settings make it impossible to adequately address mental health needs, including suicide, solely using a mainstream medical approach. Nor do mainstream approaches accommodate the relationship between Aboriginal health and connectedness to land, whether traditional or new land, remote or metropolitan. This review describes how caring-for-country projects on traditional lands in remote locations may provide a novel way to achieve the linked goals of climate change adaptation with co-benefits for social and emotional wellbeing.

To determine the perceived threat of terrorist attack in Australia and preparedness to comply with public safety directives.

Cannabis is one of the most commonly used illicit drugs, and its effects have traditionally been seen as less harmful than outcomes associated with the highly prevalent use of alcohol and other illicit substances (e.g., cocaine and amphetamines), and injecting drugs. Consequently, less attention has been focused on developing and evaluating interventions in this area. However, current research supports the idea that cannabis does pose a number of acute and chronic health risks to the individual and to society. The authors review findings concerning the physiological and neurological effects of cannabis, prevalence of use, and studies concerning its possible role as a "gateway" drug. Diagnostic criteria for cannabis dependence and abuse are discussed, with a focus on whether a cannabis withdrawal syndrome exists and if so how it can be diagnosed. There is strong support for a link between cannabis and the development and exacerbation of psychosis and other mental health conditions (e.g., anxiety, depression). Further research is needed to determine the underlying neurochemical processes and their possible contribution to etiology, as well as the social factors that contribute to the increasing use of cannabis by young people. In addition there is a need for systematic evaluation using randomized controlled trials to determine effective prevention and treatment strategies. A number of public health programs that address cannabis use are reviewed along with available evidence for their effectiveness.

New South Wales (NSW) School-Link is a landmark initiative aimed at enhancing the identification, treatment and prevention of depression and related disorders in adolescents in NSW, Australia. The initiative has been outstanding in forging collaboration between two systems, health and education. The School-Link Training Program has been an important focus, assisting in consolidating the initiative at state and local levels.

Significant progress has been made in Australia in the fields of promotion, prevention and early intervention in mental health. These initiatives have been supported through national policy directions under the National Mental Health Strategy, as well as at state and local levels. The population health model has been important in ensuring that promotion, prevention and early intervention initiatives are targeted across the lifespan, are underpinned by evidence, and occur alongside individual clinical mental health care. Initiatives under way across Australia are discussed.

To provide prevalence data on several key mental health indicators for young people aged 15 to 24 years.

Based on a literature review of the current research in prevention initiatives for child and adolescent mental health, it includes: initiatives aimed at the prevention of mental health problems, early intervention programs and services for young people with depression and related disorders, and first onset psychosis and suicide prevention.

Building the capacity for promotion, prevention and early intervention in mental health—to contribute to reducing the burden associated with mental health problems—requires a number of approaches. This article discusses three specific areas: establishing the policy context; building the capacity of the community to promote their own mental health; and enhancing the capacity of the workforce for promotion, prevention and early intervention in mental health.

Older widowers have high rates of completed suicide but have rarely been the subject of systematic inquiry. We investigated the prevalence of depressive symptoms and major depressive episodes (MDEs) in recently widowed older men over the first 13 months after bereavement. We employed a matched-pairs longitudinal design and recruited subjects from a suburban community population. Fifty-seven recently widowed older men were identified from official death records and 57 matched married men were identified from the electoral roll. Subjects were assessed for the presence of current DSM-III-R MDEs using the Composite International Diagnostic Interview (CIDI), a fully structured psychiatric interview. Widowers were assessed at 6 weeks after bereavement (T1) and 13 months after bereavement (T2). Married men were assessed at similar intervals. At T1, seven widowers (12.3%) and no married men were found to have CIDI cases of current MDE. At T2, one widower (1.9%) and no married men were found to have CIDI cases of current MDE. Current MDE was not predicted by a past history of dysphoria. At T1, 14.0% (8/57) of widowers reported specific suicidal thoughts or actions. At T2, 15.4% (8/52) of widowers reported suicidal thoughts or actions. We conclude that health workers should monitor closely the clinical course of MDEs in recently widowed older men. Routine inquiry about suicidal ideation should be an essential component of the clinical assessment of recently widowed older men.

Various models and concepts of abnormal grief are reviewed and empirical data to support these is critically appraised. It is concluded that the majority of findings support a concept of abnormal grief reflecting prolonged intense separation distress, preoccupation with images of the deceased and distress or avoidance at reminders. Although depressive phenomena and disorders, and anxiety disorders may occur after bereavement, with some populations being at greater risk, these are distinct from abnormal grief. Management of abnormal grief needs to take into account such issues.

This longitudinal study aimed to establish a firmer scientific basis for recognition and treatment of post-traumatic psychiatric morbidity associated with domestic violence. The study used a sample of 335 women (mean age 45.5 years) recruited from the Royal Brisbane Hospital Emergency Department. This paper reports baseline data. The outcome measures of lifetime psychiatric diagnoses (DSM-111-R classification), showed that women who reported lifetime adult intimate abuse (n=162) received significantly more diagnoses of generalised anxiety, dysthymia, depression, phobias, current harmful alcohol consumption and psychoactive drug dependence than those who reported no abuse ever (n=173). Of the 191 women tested for lifetime post-traumatic stress disorder, those who reported lifetime abuse (n=115) received significantly more diagnoses than those who reported no abuse (n=76). Crude prevalence rates of psychiatric diagnoses for women who reported double abuse as child and adult were significantly higher than for women who reported adult intimate abuse only. Adjusted rates showed that doubly abused women had significantly greater risk of current harmful alcohol consumption and lifetime drug dependence than women who reported adult abuse only. A significant independent factor for lifetime psychiatric diagnoses was reporting abuse between a woman's parents. Measurement of the population attributable risk found that one-third of the psychiatric diagnoses were attributable to domestic violence.

Stress management begins with actively listening to the patient and proceeds through a detailed assessment of the patient's needs

This paper presents the results of a community health survey of people living near a hazardous chemical waste site in Kingston, Queensland. In comparison with a matched control group, people near the site were no more likely to report serious diseases, and reports of cancer and mortality rates did not differ in the two groups. Kingston residents reported higher rates of symptoms of general poor health, high levels of stress and anxiety and a higher incidence of miscarriages. The reports of poor physical health appear to be independent of proximity to the hazardous waste site and duration of residence in the area. Symptom prevalence and perceived recent decline in health correlate most strongly with the stress and anxiety measures. While long‐term investigation is necessary, it appears at this stage that the chemical waste is not associated with an increase in major diseases as reported by those who were interviewed. When health in a broader sense is considered, however, it is clear that the situation has had a negative impact.

The prevalence of minor psychiatric morbidity (MPM) was investigated in 523 adults presenting to the casualty section of an Australian public hospital. Relationships between subject characteristics and the level of MPM were also examined, together with the acceptability of an offer of short-term intervention and the effectiveness of this intervention in reducing distress. Threshold morbidity on initial presentation to casualty was 41% (using the GHQ-12 with the customary 1/2 cut-off point) and the probable prevalence was estimated to be about 27%. The intervention was initially offered to a random sample of those identified as being ‘under stress’ (GHQ of three or above), but as there was a 90% rejection rate, it was offered to all symptomatic subjects. Overall, 26% accepted our offer of intervention. Those who accepted intervention and those who rejected it did not differ in their improvement in MPM during the subsequent six months. However, these groups improved slightly more than the group that was eligible for intervention but to whom it was not offered. Forty-seven per cent of subjects who were ‘under stress’ on initial presentation to casualty fell below the GHQ-12 threshold at the six-month follow-up; this compared with a shift of only 26% in the opposite direction (i.e., non-stressed to stressed). Regression to the mean offered the most parsimonious explanation for these GHQ changes.

Earlier descriptions of pathological grief are reviewed. From the study of recently bereaved widows major forms of pathological grief are outlined. These are suppressed or inhibited grief and distorted grief, including forms with extreme anger or extreme guilt. Other grief variants are noted. The management of pathological grief is outlined; specifically the encouragement of the expression of suppressed affects especially sadness, anger and guilt; as well as the going over of memories and feelings to do with the lost relationship. Consideration is given to: the establishment of the therapeutic contract; the specific exploration of the response to the death and the preexisting relationship; resistances; interpretation of defences; assessment of progress of mourning; social network factors; termination; and transference and counter-transference.

Adolescent responses to three areas of life change, or crisis are described. It is proposed that these responses may both reflect and accentuate patterns of response to the adolescent developmental crisis. Twenty-two recently bereaved adolescents showed denial, anger, possibly withdrawal and were often threatened by the new roles into which they were forced by their fathers' deaths, particularly the oedipal aspects of these roles. Of 22 adolescent girls experiencing their first pregnancy, 50% showed evidence of some emotional disorder. They showed also feelings of denial and anger and often prematurely considered they had become “adult” because they were becoming “parents”. Seventeen girls seeking termination of pregnancy were evaluated. Denial, rationalisation and ambivalent feelings were marked. It is concluded that these are areas of important potential for preventive intervention in the form of specific ego support. Such intervention would be aimed at decreasing the incidence of subsequent health impairment in those at risk.

A primary prevention program implemented immediately following a major rail disaster is described. Because of the high mortality, services were oriented towards the provisions of preventive counselling for bereaved families as well as support for the injured. Emergency counselling services were provided at the City Morque. Subsequently, coordinating consultative and educative programmes were instituted in the affected health region. Counselling bereaved families was continued through appropriate specialised community services. High-risk groups of bereaved were delineated and special emphasis given to individual care of these persons. Recommendations are made concerning the relevance of such a programme to the personal disasters of life.

This paper reports data based on interviews with parents of congenitally developmentally disabled infants, including parental perceptions and reactions to professional services. The role of early support programmes is also examined and its relation to parental perceptions. Overall, family distress scores on interview showed a significant relationship (r = 0.64, p#lt0.001) to family grief scores on an unresolved grief inventory reported in an earlier paper (Nicholas & Lewin, 1986). Results also suggest that early intervention programmes extend the social network of the family and provide parents with skills to manage their baby. In so doing, such programmes may ameliorate the intensity of the parental grief response.

Crisis is a term finding frequent usage in our everyday language. As such it conveys the meaning of a turning point, a period of change with the implication of stress and frequently upheaval. In psychological usage this meaning is defined more specifically, for crisis is used in a theoretical framework with many implications for health care professionals.

Objective:To examine the effect of clinical depression on recovery from stroke. Method:We examined a cohort of inpatients with stroke initially at two months after their stroke and again 14 months later. Patients were included if they: (i) provided informed consent; (ii) were able to understand the interview questions; and (iii) survived to follow‐up without suffering another stroke or major medical illness. Of 61 consecutive patients, 49 met these criteria. Depression was diagnosed using a structured clinical interview. Three aspects of recovery were measured: (i) functional status; (ii) activities of daily living; and (iii) cognitive performance. Results:Twenty (41%) of the 49 patients were depressed at initial assessment. There were no significant differences in demographic, clinical, stroke or lesion characteristics between the depressed and non‐depressed patients. At follow‐up, depressed patients improved less than non‐depressed patients in functional status (mean change from baseline, 23% versus 48%) (P=0.001) and cognitive performance (–1% versus 11%) (P= 0.096). Mean recovery in activities of daily living was not different between the two groups (33% versus 32%) but more of the depressed patients deteriorated over time (20% versus 0%) (P= 0.047). Conclusion:Clinical depression occurring soon after stroke is associated with impaired recovery when patients are assessed 14 months later. Depression has a negativeeffect on recovery in functional status and cognitive performance and may produce deterioration in physical capacity in a number of patients. Physicians would be well advised to be alert for depression and intervene early. Effective treatment of depression may enhance stroke rehabilitation.

Objective: This study compares the psychological symptoms and bereavement distress of individuals bereaved by AIDS with a group bereaved by a cancer death, and addresses the question of whether an AIDS death is associated with a higher rate of adverse psychosocial factors that may increase risk of psychological morbidity in the bereaved individuals.Method: AIDS (n= 28) and cancer (n= 30) bereaved individuals (all within 3 months of the bereavement) completed measures of psychological morbidity and measures addressing a range of other adverse factors, e.g., number of losses, levels of social support and stigma.Results: The cancer and AIDS bereaved were essentially similar on all psychological symptom measures. The AIDS group reported lower levels of social support in response to the bereavement than cancer bereaved individuals; a greater number of bereavements, were more likely to conceal the cause of death from significant others including their own family and perceived, in some instances, a greater level of rejection from others. The AIDS group reported higher levels of social support from friends than from family.Conclusions: At three months following bereavement, AIDS and cancer bereaved were similar in levels of distress. While this may change with the progress of grief over time, it suggests essentially similar early bereavement responses. Those bereaved by AIDS reported a range of other adverse factors such as a greater number of losses, lower social support, stigma, and less open disclosure of the cause of death.

Psychosocial factors associated with young women's own alcohol consumption, and that of their fathers, were assessed in a sample of 231 females (mean age: 18.0 years) from the Hunter Region, NSW, Australia. Consistent with prior research, we found some evidence of poorer adjustment in girls who drank heavily and among daughters of high drinkers. In addition, we found that the "psychosocial profiles" associated with girls' and fathers' drinking were quite different, which argues against a simple additive model which might predict poorer adjustment in high drinking daughters of high drinking men. One interesting finding was that discordance between girls' and fathers' drinking patterns was independently related to some psychosocial problems.

This paper reports on part of a study which was aimed at assessing the views of leading researchers, theorists or clinicians working in the field of bereavement on key issues including, as reported here, concepts of different forms of grief as well as favoured theoretical orientations. Of a range of conceptual models the most favoured, by a large margin, were attachment theory and the psychodynamic model.The views of the "experts' were canvassed with respect to the use of seven selected terms used to denote some variant of the grieving process. There was, on the part of the respondents, reasonable support for the syndromes of "delayed', "chronic', "anticipatory' and "absent' grief. "Inhibited' and "unresolved' grief tended to be described using one of the four terms already supported, while the use of the term "distorted grief' attracted little support.

The influence of psychiatric risk factors on the development of depression following stroke was examined in 88 patients undergoing inpatient rehabilitation. In this sample, 34 patients (38%) had a diagnosis of major or minor depression. Older age and a personal or family history of affective or anxiety disorder were associated significantly with major depression. Minor depression was more common among males and those patients with greater physical disability. Severity of depressive symptoms was associated with a personal or family history of affective or anxiety disorder and higher pre-stroke personality neuroticism. We conclude that certain psychiatric risk factors for affective disorder are strongly associated with poststroke depression. The implications of these findings for anticipating and managing poststroke depression are discussed.

In a sample of ninety-nine patients seen two months post-stroke, 18 percent were diagnosed as having minor depression and 14 percent major depression. At follow-up, fifteen months later, the prevalence of depressive disorder had declined substantially, to 12 percent overall. Major depression was characterized by an average duration of thirty-nine weeks, a mortality rate of 23 percent and was associated with positive family history of affective or anxiety disorder. Among patients with left hemisphere lesions, major depression was associated with cognitive impairment. Minor depression had a shorter average duration (twelve weeks) and was more common in males. These two syndromes may define distinct types of post-stroke depression with implications for treatment interventions.

Immediately following a rail disaster in Sydney, Australia, on January 18, 1977, in which 83 people were killed, an attempt was made to organize a preventive psychiatry outreach program for the relatives of the bereaved and the survivors. Bereavement counseling was offered to all families considered to be at risk for development of postbereavement morbidity. A follow-up study was performed 15 to 18 months later to assess the level of functioning of the bereaved relatives. The next of kin of 36 victims (43 per cent of the total number killed) were interviewed and filled in questionnaires (general health, Goldberg's General Health Questionnaire, loss, and social support). They included 15 widows, nine widowers, 11 mothers, and eight fathers who had lost children. The trends were for the bereaved spouses to have done better than bereaved parents; the widowers to have done better than the widows; those with a supportive network to have done better than those without one; those who saw the body to have done better than those who did not; and, in addition, there was a tendency for those who had bereavement counseling to do better than those who had no such intervention.

• To study the effectiveness of preventive intervention in lowering postbereavement morbidity, 200 widows were assessed in the early weeks following their husbands' deaths. Subjects at risk for postbereavement morbidity were selected and randomly allocated to experimental (N = 31) and control (N = 33) groups. Specific support for grief and encouragement of mourning was carried out with the experimental group during the first three months; no intervention was given to the control group. All were followed up 13 months later with a validated health questionnaire. There was a significant lowering of morbidity in the intervention group as compared to the control group (P <.02). The most significant impact of intervention occurred with the subgroup of intervention and control subjects who perceived their social networks as very nonsupportive during the bereavement crisis (P <.001).

Objective:To determine the prevalence and predictors of domestic violence victims among attenders at the emergency department at Royal Brisbane Hospital in 1991. Design:Cross‐sectional study in which randomly selected nursing shifts were used to screen attenders. Results:Of all attenders at the emergency department, 14.1% disclosed a history of domestic violence. Women were more likely than men to disclose domestic violence ("raw" relative risk, 2.31; 95% confidence interval [CI], 1.83‐2.91; relative risk adjusted for age and history of child abuse, 4.50; 95% CI, 3.02‐6.71). The greatest risks for being an adult victim of domestic violence were being female and having experienced abuse as a child. Most of those who had experienced domestic violence within the last 24 hours (1.1% of attenders) came to the department after‐hours when social work staff were unavailable for referral. Conclusions:The prevalence and risk factors have implications for the training of doctors and nurses in domestic violence problems and for the provision of adequate resources to deal with the psychosocial aspects of domestic violence.

The aims of this study were (i) to determine the frequency of emotional lability following first ever stroke, and (ii) to identify factors associated with this condition. Sixty-six consecutive inpatients with first ever stroke were surveyed two months post stroke for the presence of emotional lability. Demographic, clinical, psychiatric and stroke lesion characteristics were also assessed. Emotional lability was present in 12 of the 66 patients (prevalence: 18%). Emotional lability occurred independently of post stroke depression. Single lesions located in anterior regions of the cerebral hemispheres had four times the odds of emotional lability than lesions located anywhere else (p<0.05). Emotional lability is a common emotional-behavioural syndrome following stroke and is probably a separate condition from post stroke depression. The aetiology of this condition is possibly related to the consequences of injury to anterior regions of the cerebral hemispheres.

Eleven women in various specialities, including the academic and administrative spheres, were interviewed with regard to their experiences throughout their career. These women all held senior positions in Medicine and represent a broad age range (35–69 years). Information gathered during the interviews was analysed thematically in an attempt to develop a basis for further research examining predictors of success for women in medicine.