Social psychiatry

We previously reported 24-fold risk (OR) of violent crime and 17-fold risk for criminal offending among adult children of homicide recidivistic offenders (HR). However, there exist neither published data on the quantitative risk for crime or violent offending among parents of violent offenders, nor data on the transmission of the increased prevalence of crime across three generations. In this naturalistic case-control cohort study all HR subjects (G2, n = 35) were extracted from the total of 1584 homicide offenders who were convicted in Finland during 1981–1993. The criminal records and prison documents from their parents (G1, n = 68), and the matched controls (n = 136), were studied, and compared with the previously published data from their children (G3, n = 11) and the controls (n = 220). Among the G1 parents of HR, the odds ratio (OR) for committing any crime was 5.0 (95% CI = 1.3–23.1) but the risk for violent offending was not significantly increased (OR = 3.1, 95% CI = 0.3–37.6). The prevalence of index persons convicted for any crime (versus controls) was 13.2% (versus 2.9%) in G1 and 36.4% (versus 3.2%) in G3. Only 4.4% (versus 1.5%) of G1 index parents, as compared to 18.2% (versus 0.9%) of G3 had convictions for violent crimes. The disparity of the proportions of criminal offenders between index versus control groups had increased across generations (P = 0.0023). This was also the case with violent offenders (P = 0.0019). The homicide recidivistic offenders had parents with 5-fold risk for any crime but, without significant risk for violent offending. The results provide the first evidence of transmission of crime across three generations, and also of the increased risk of crime among parents of violent offenders.

Many patients with schizophrenia have a desire for shared decision-making (SDM). However, in clinical practice SDM often does not take place. One cause might be that many patients behave passively in the medical encounter, therefore not facilitating SDM. It was the aim of the study to evaluate the effects of a patient directed SDM-training on patients’ communicative behavior in the consultation, their attitudes towards decision-making and their long-term adherence. Randomized-controlled trial comparing a five-session SDM-training for inpatients with schizophrenia with five sessions of non-specific group training. The SDM-training sessions included motivational (e.g. prospects of participation, patient rights) and behavioral aspects (e.g. role plays) and addressed important aspects of the patient–doctor interaction such as question asking or giving feedback. N = 264 patients were recruited in four psychiatric hospitals in Germany. The SDM-training yielded no group differences regarding the main outcome measure (treatment adherence) at 6 and 12 months after discharge. However, there were short-term effects on patients’ participation preferences, their wish to take over more responsibility for medical decisions and (according to their psychiatrists’ estimate) their behavior in psychiatric consultations. While there was no effect regarding treatment adherence, the shared decision-making training for inpatients with schizophrenia has been shown to increase patients’ active behavior in psychiatric consultations during their inpatient treatment. When implemented it should be combined with complementary SDM interventions (decision support tools and communication training for professionals) to yield maximum effects.

Although it is well established that people with schizophrenia have markedly high rates of unemployment, less is known about the prevalence and clinical correlates of unemployment in patients newly diagnosed with first-episode psychosis. This analysis documented the prevalence of unemployment and examined previously reported clinical correlates of unemployment in patients with first-episode psychosis hospitalized in an urban, public-sector setting in the southeastern US. Participants (n = 181) were assessed as part of an overarching study of first-episode psychosis using a variety of standardized research instruments. The rate of unemployment was compared to that documented in the general population according to US census data. Bivariate tests of associations between employment status and a number of variables of interest were followed by a multiple logistic regression model based on a previous study from Dublin, Ireland. Some 65.0% of first-episode patients were unemployed in the month prior to hospital admission, which is substantially higher than the rate of unemployment during the same period in the two counties in which recruitment took place. In bivariate tests, unemployment was associated with younger age, fewer years of educational attainment, lower global functioning scores, and more severe negative symptoms. In the logistic regression model, only age and global functioning were independently significant correlates. The remarkably high rate of unemployment in this young, first-episode sample, and the evidence of associations between unemployment, greater symptomatology, and poorer functioning, argue for further research and development on supported employment programs for such patients.

Many people with a mental disorder do not access help from mental health services. Internet websites may be a useful tool for disseminating mental health information to those who remain untreated, however little is known about people’s perceptions of websites as mental health information sources. The current study examined characteristics that may influence belief in the helpfulness of websites as modes of delivering information about mental health. The study compared belief in the helpfulness websites to two traditional sources (bibliotherapy and health educators). A total of 3,998 Australians aged 18 and above were surveyed. Logistic regression was used to explore the factors associated with rating a website, book and health educator as helpful sources of mental health information for a person described as having either depression, depression with suicidal thoughts, early schizophrenia or chronic schizophrenia. Factors investigated were demographics, exposure to mental illness, beliefs about dealing with mental illness alone, and personal and perceived stigmatising attitudes. Considerably more participants rated bibliotherapy and health educators as helpful in comparison to websites. Predictors of rating a website and book as helpful were identical; younger age, belief that it is helpful to deal with mental illness alone and being presented with depression and early schizophrenia vignettes in comparison to chronic schizophrenia. Predictors of rating a health educator as helpful were younger age, less personal stigma and being presented with a depression (without suicidal thoughts) vignette in comparison to chronic schizophrenia. These findings suggest the need for multiple modes of delivering mental health information. While many people feel that information delivered face-to-face is likely to be helpful, websites and other tools that maintain anonymity may be preferred by those who choose to or find themselves dealing with mental illness alone.

This article tests the hypothesis that remission from substance use disorders is associated with smoking cessation in nicotine dependent young adults. The sample was composed of 976 young adults with lifetime substance use disorders and nicotine dependence who were subjects in the national epidemiologic survey on alcohol abuse and related conditions (NESARC). The Associated Disabilities Interview Schedule-DSM-IV Version was used to assess lifetime and past year psychiatric disorders. Past year nicotine cessation was obtained by self-report. Remission from substance use disorders was defined as the past year absence of DSM-IV substance use disorders . This study found that remission from substance use disorders increased the likelihood of smoking abstinence (OR = 1.7). Our study found that remission from substance use disorders increased the likelihood of smoking abstinence in early adulthood. This finding is congruent with results from longitudinal studies.

From a survey of 40- to 49-year-old women from Chichester, West Sussex, 45 were selected whose mothers died before they were aged 11, 38 who were evacuated from their mothers during the 1939–1945 War and 45 who were separated from their mothers for other reasons for at least a year before they were aged 10. A series of 69 non-mother-bereaved or non-mother-separated controls of similar age-range was also collected. Each subject was interviewed at home and asked to complete the Middlesex Hospital Questionnaire, a modified Zung Depression Scale and the Navran Dependency Scale of the MMPI. There were significant differences between the groups in terms of place of birth, age of the mother at time of the initial break and size of the original sibship. Significantly more evacuees were cared for by foster mothers and significantly more of the “other” separations had a poor relationship with their natural mother. For all groups increased test scores were associated with lower parental social class and poor replacement care. Poor outcome was also associated with being later born for the early bereaved, having a poor relationship with the natural mother for the evacuees and being separated after age 4 for the “other” separations.

The high burden of witnessing traumatic events has been demonstrated in previous research in South Africa. However, previous work has focused on PTSD rather than a broader range of psychopathological outcomes. This study examined the association between witnessing trauma and multiple outcomes including mood, anxiety, and substance use disorders. Regression models measured the odds of mood, anxiety, and substance use disorders among those who reported witnessing in the South African Stress and Health Study. Discrete-time survival analysis was used to examine whether witnessing was associated with earlier onset of mental disorders. Witnessing trauma was more commonly reported among males and those with low-average education. Posttraumatic stress disorder, mood, and anxiety disorders varied significantly with witnessing status, and witnessing was associated with exposure to a higher number of traumatic events compared to other types of traumatic events. Respondents reporting witnessing trauma had elevated odds of mood and anxiety disorders, but not substance use disorders. Witnessing trauma is common in the South African population and results in increased risk of mood and anxiety disorders. Interventions aimed at reducing the burden of trauma and its outcomes must now increase their focus on bystanders and other observers, rather than just focusing on those directly affected.