No abstract

SynopsisA two-stage mental illness survey of a random sample of persons aged 17 years and over from a rural community in Cantabria, Spain, is described. In the first stage newly qualified doctors and final year medical students interviewed 1223 respondents (583 males and 640 females) at their homes, using the General Health Questionnaire (GHQ-60) and other psychopathological and social questionnaires. In the second stage senior psychiatrists carried out an at-home interview on a sample composed of all those who in the first stage scored above the cut-off point on the GHQ, and of a similar number of persons selected at random from two independent batches of below-threshold scorers on the GHQ. Because of this design the prevalence figures have to be weighted in order to represent the whole first stage sample.Of the total population, 14·7% (8·1% of the men and 20·6% of the women) had psychiatric disorders as defined by the PSE-ID system. In males depression accounted for about twice as many cases as anxiety states, but in females there was a predominance of a combination of anxiety, phobic and obsessive conditions. Men presented a higher prevalence of disorders over the age of 35, with a peak around the age of forty, while in women the rise of prevalence was over the age of 45. There was, however, no significant association with marital status.Unemployment was related to mental illness in males but not in females, while the reverse was true of the type of work. In both sexes the presence of children under fourteen in the household was not related to a rise in prevalence. Women exhibited a high rate of mental illness in the low educational level and in the low social and religious integration groups, but in men a rise in prevalence was found in the low social status, low educational level and low social integration groups. Lastly, in both sexes the presence of physical illness was related to mental disorders.

The aims of the present study were to determine the acceptability of the Spanish version of the Short Form (SF-36) health survey questionnaire for its use in mental health research on the general population, and to evaluate its internal and external validity, using data obtained from a representative community sample of 1250 adults of working age. The internal consistency of the different dimensions of the questionnaire was high. Concurrent validity was tested by examining its correlation with the 12-item General Health Questionnaire (GHQ-12). Construct validity was determined by studying the extent to which scores on different variables reflected the expected distribution of health status for and between certain groups. Our findings provide strong evidence for the acceptability and validity of the SF-36 when used as part of a community mental health survey.

By comparison with the PSE-ID system, we showed that the GHQ-60 could be used with good results as a screening instrument in the first of a two stage community survey. Unlike the sensitivity and negative predictive values, the specificity and positive predictive rates reach low figures in this study. The global efficiency and positive and negative predictive values of the test are significantly improved by raising its cut-off score, but at the expense of great reduction in sensitivity. The revised scoring system failed to provide better prediction of 'caseness' than conventional scoring. The GHQ does not distinguish fully between persons in the community afflicted by 'transient states of distress' and those whose symptoms would classify them as 'cases' by the PSE.