Children of incarcerated mothers are at increased risk of experiencing multiple adversity such as poverty, mental illness and contact with child protection services (CPS), including being taken into out of home care (OOHC). However, little is known about whether these children are at increased risk of suicide or self-harm compared to children not exposed to maternal incarceration or about the factors that may contribute to this. We aimed to investigate differences in the risk of suicide and self-harm between children exposed to maternal incarceration and those not exposed and examine how socio-demographic factors, maternal mental illness and CPS contact (with or without OOHC) may affect these outcomes.

We used a retrospective matched cohort study design, comparing 7674 children exposed to maternal incarceration with 7674 non-exposed children. We used multivariable Cox proportional hazards regression to compare the risk of suicide and self-harm between exposed and non-exposed groups, controlling for geographical remoteness, CPS contact and maternal mental illness.

There was no significant difference in the rate of suicide (rate ratio [RR] = 1.49; 95% confidence interval [CI]: 0.78, 2.87) or risk of suicide (adjusted hazard ratio [aHR] = 0.92; 95% CI: 0.43, 1.96) between the two groups. However, the exposed group had a significantly higher rate of self-harm (RR = 2.83; 95% CI: 2.50, 3.21) and a significantly higher risk of self-harm (aHR = 1.74; 95% CI: 1.45, 2.09) compared to those non-exposed. CPS contact with or without OOHC was independently associated with an increased risk of self-harm for both groups.

Children exposed to maternal incarceration are at an increased risk of self-harm and should be prioritized to receive targeted, multimodal support that continues after the mother’s release from prison. The association between CPS contact and self-harm warrants further research.

To estimate the association of catastrophic health expenditure (CHE) with the risk of depression in middle-aged and old people in China.

We used data of 2011, 2013, 2015 and 2018 from the China Health and Retirement Longitudinal Study, which covered 150 counties of 28 provinces in China. CHE was calculated as out-of-pocket health expenditure exceeding 40% of a household’s capacity to pay. Depression was measured by a 10-item Centre for Epidemiological Studies Depression Scale. We evaluated CHE prevalence and applied Cox proportional hazard models to estimate adjusted hazard ratios (aHRs) and 95% confident intervals (CIs) for the risk of depression among participants with CHE after controlling potential confounders, compared with those without CHE.

Among 5765 households included in this study, CHE prevalence at baseline was 19.24%. The depression incidence of participants with CHE (8.00 per 1000 person-month) was higher than that of those without CHE (6.81 per 1000 person-month). After controlling confounders, participants with CHE had a 13% higher risk (aHR = 1.13, 95% CI: 1.02–1.26) of depression than those without CHE. In subgroup analysis, the association of CHE with depression was significant in males and in people with chronic diseases, of younger age, living in rural areas and of lowest family economic level (all P < 0.05).

Nearly one of five middle-aged and old people in China incurred CHE, and CHE was associated with the risk of depression. Concerted efforts should be made to monitor CHE and related depression episode. Moreover, timely interventions about CHE and depression need to be implemented and strengthened among middle-aged and old people.

To validate the Italian version of the ‘depression attitude questionnaire’ (DAQ), to assess its psychometric properties and to evaluate the primary care physicians' (PCPs) opinion and attitude towards depression.

An Italian version of the DAQ was created and then administered to a representative sample of PCPs working in the Emilia-Romagna region.

The findings derived from the Italian version of the DAQ indicated a three-factor solution (professional confidence, negative viewpoint and biological stance), broadly similar to previous studies and with acceptable fit indices. Our results showed that the PCPs consider depression as an increasingly important issue for their daily clinical practice. A large majority of them believed in the effectiveness of antidepressants and considered psychopharmacological treatment as appropriate for the PCPs to undertake. However, most PCP respondents thought that psychotherapy should be left to the specialists. Our findings suggest a prevalent orientation to the biochemical aspects of depression and the use of antidepressant treatment.

The PCPs' attitude and opinion towards depression is an important aspect of their understanding and response to this common and disabling condition. The Italian version of the DAQ appears to be an appropriate and useful instrument to assist the understanding of the PCPs' views and potential need for further professional development.

Fino al 1978 erano praticamente assenti in Italia studi di valutazione dei servizi psichiatrici. Ciò per vari motivi: a) l'esiguo sviluppo che aveva avuto nel nostro paese, nel secondo dopoguerra, l'approccio di psichiatria sociale secondo il modello inglese e scandinavo, b) il sopravvento preso, negli anni '60 e '70 sulle ricerche valutative da un approccio socio-politico ai problemi della organizzazione dei servizi. Una eccezione importante è costituita dalla ricerca di Augusto Tamburini e collaboratori (1918), basata su valutazioni e dati statistici e che oggi cadrebbe sotto l'ampio dominio della valutazione e della pianificazione dei servizi. Dopo una breve revisione della piu significativa produzione scientifica italiana nel campo della psichiatria sociale e dopo aver illustrato le caratteristiche principali della nuova fase, assistenziale e scientifica, apertasi in Italia dopo la riforma del 1978, 1'A. presenta gli obiettivi della ricerca multicentrica i cui risultati sono pubblicati nei primi due fascicoli di EPS.

valutazione dei servizi, psichiatria sociale, riforma psichiatrica in Italia.

Until 1978 evaluative studies of psychiatric services in Italy were missing. The reasons were: a) the approach to social psychiatry according to the English-Scandinavian model was underrepresented in Italy and the tradition of epidemiological research in psychiatry was poor, b) the predominance, in the sixties and seventies, of the sociopolitical approach to the problems of service organization. An important exception was the study by Augusto Tamburini and his colleagues (1918), based on statistics and assessment which we would call today service evaluation and service planning. The A. of the present paper briefly reviews the most important Italian studies in the field of social psychiatry, describes the main characteristics of Italian psychiatry after the 1978 reform and outlines the aims of the multicenter case-register study published in the first two issues of EPS.