SynopsisThis paper explores the hypothesis that depression in chronic schizophrenia is in part a psychological response to an apparently uncontrollable life-event, namely the illness and its long-term disabilities. It is suggested that depression is linked to patients' perception of controllability of their illness and absorption of cultural stereotypes of mental illness. Clinically and operationally diagnosed schizophrenic and manic-depressive patients receiving long-term maintenance treatment were studied. The cross-sectional prevalence of depression in schizophrenics was 29% and 11% for patients with bipolar affective illness. The hypothesis was supported. Multivariate analyses revealed that patients' perception of controllability of their illness powerfully discriminated depressed from non-depressed psychotic patients. Although those patients who accepted their diagnosis reported a lower perceived control over illness and an external locus of control, label acceptance was not associated with lowered depression, self-esteem or unemployment. The cross-sectional nature of the study makes the direction of causality and the role of intrinsic illness variables difficult to ascertain; however, the results set the scene for prospective and intervention studies and the various possibilities are discussed.

To understand the beneficial aspects of a psychoeducational group, parents living with HIV participated in two telephone interviews.Twelve parents answered open-ended questions about program processes, components, and activities. Study participants identified five processes: focused and motivated; learn from each other; share freely with people who understand; support and care about each other; respect each other's privacy; and protect each other. The identified knowledge areas-self-care, parenting, and goalsetting-were consistent with the program's focus. Components noted were those activities designed to develop comfort between participants, share ideas, and practice skills. Goal-setting and monitoring progress represented a primary task that brought focus to the group's endeavors and around which knowledge was shared and feedback and support were provided, strengthening the bonds between the participants. As people with HIV are living longer, programming can take a future orientation, supporting parents in raising children and leading productive lives.

The needs of acute psychiatric patients have been less studied than those of long-term patients. A pilot study of needs assessment using the MRC Needs for Care Assessment Schedule is reported in 35 consecutive acute inpatients who had been in hospital for 1 month or more. Unmet clinical needs included treatment of drug side effects and dangerous and socially embarrassing behaviour. Unmet social needs were widespread and included household shopping, cooking meals, occupation and money management. Although the MRC Needs for Care Assessment was found unsuitable for assessing needs in very acutely ill patients whose mental status was rapidly changing, we did find it a useful instrument in more stable acute patients, both on an individual basis and for identifying service underprovision.

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