Objectives - a) To investigate the factor structure of the 12-item General Health Questionnaire (GHQ-12) in a sample of 18-year-old males; b) to test the ability of the standardized factor scores in discriminating between subjects who were suffering from emotional disturbance according to the psychiatrist's ratings and those who were not. Design - A sample of 363 subjects was selected during the medical examination for military service and invited to fill in the GHQ-12 and to be independently interviewed by a psychiatrist. Completed data were available for 320 subjects (88% of the selected sample). Results - The unrotated factor matrix allowed for the identification of two principal components with eigenvalues greater than 1, jointly accounting for 46.7% of the variance in the data. The first component, on which each item of the questionnaire showed a positive coefficient, was interpreted as measuring the overall severity of psychiatric disorder among respondents. The second component was bipolar with «positive» items having positive coefficients and «negative» items having negative coefficients. These findings suggest that the GHQ can assess both the negative (symptoms) and positive (subjective well-being) aspects of mental health. After Vari- max rotation each item of the questionnaire loaded significantly on one factor only, except for item 12 whose loading was lower than 0.500 on both factors. Factor A contained the «negative» items of the GHQ-12 and was termed as «general dysphoria»; factor B included 5 of the 6 «positive» items and was termed as «well-being/social functioning». The best discrimination between «cases» and «non-cases» was offered by the standardized factor scores on the «general Epidemiologia e Psichiatria Sociale, 2, 3, 1993 dysphoria» factor; no advantage was gained by the combination of the scores on the two factors. Conclusions - A better understanding of the GHQ-12 factor structure might provide useful information along with that offered by a single severity score resulting from the simple adding of positive responses and improve the description of emotional disorders beyond the traditional distinction between «cases» and «non-cases».

Objective - To analyse suicide trends in Italy and to correlate suicide rates with psychosocial indicators. Design - Cross-sectional analysis of aggregate data at national level (1960-1990). Setting - Italy. Main outcome measures - Mortality rates (deaths for suicide, mental disorders and homicide), hospital admission rates (for schizophrenia, neurosis and affective psychosis), unemployment rates, alcohol consumption. Principal components of the correlation matrix calculated on the psychosocial indicators. Results - The study indicates that a slight increate in suicide rates has been recorded among males (+10,7%) but not among females. The regions with the highest suicide rate are the Northern ones (up to twice the national average). The age groups with the highest suicide risk are those over 70 years. In females and males over 65 between 1974 and 1989 the suicide rate rose by 70% and 77% respectively. Between 1978 and 1989, the suicide rate among the people in search of a first job rose by 25%, among the employed it rose by 35%, while among the people in search of a new job it rose by 594%. Correlation between admission and suicide rates shows negative figure both for affective psychosis and neurosis, wherelse the correlation with schizophrenia is positive. The correlation with death both by mental disorders and homicide is positive. The correlation with death both by mental disorders and homicide is positive. The correlation between suicide and alcohol consumption is negative, while that with unemployment is positive. Principal components analysis showed a first component, wich explained more then 60% of the general variation, highly correlated with suicide rates.

Objective - To discuss some theoretical and practical problems related to classification in the medical and psychiatric fields, and to present the general structure of the Tenth Revision of the International Classification of Diseases (ICD-10), officially adopted as from January 1993. Results - This paper discusses the epistemological basis of classification, the various classification strategies adopted in the medical and psychiatric fields and the main theoretical models employed in this area. The problems related to the reliability and validity of psychiatric diagnoses are then reviewed, and the different strategies to be used in order to improve them are presented. Finally the principles which have led the development of the ICD-10, and the field trials carried out in order to test the appropriatness of this system are discussed. Conclusions - In the psychiatric field classification is essential in order to make possible an ordered systematization of new knowledge and to facilitate the communication between health workers and users of services. The ICD-10 represents the biggest effort ever carried out at an international level to build a reliable classification incorporating different psychiatric traditions.

Objective - To survey and analyse the extent of utilization of «Non Pharmacological Interventions» (NPI) in the public mental health services of a large city. Setting - Inteview of the entire medical staff employed in 1991 in 10 Departments of Mental Health in the urban area of Naples, Italy. Main measures - A «ad hoc» questionnaire was prepared to gather informations on prevalence of use on NPI in different therapeutic settings, the selected technique according to the different diagnostic categories and the degree of professional training of the interviewed medical personnel. Result - The NPI, as the only treatment, was preferred by the large majority (86%) of the medical staff. The patients treated with NPI was double in outpatient than in inpatient. Although the medical staff did not use the same diagnostic criteria (ICD-9, DSM-III, others) anxiety (49%) and personality disorders (14,3%) were the diagnostic categories most commonly selected for NPI. At the time of the survey 24% of the patients were treated with psychotherapy. Support psychoterapy, psychoanalysis, family therapy were the most frequently employed. The support psychotherapy was mainly used in treatment of schizophrenia. Near to 50% of the medical staff reported a combined use of up to five different NPI. By and large choice of NPI was found dependent on the type of training and inversly correlated with the degree of seniority. Conclusions - The data obteined from the present survey show the large use and variability in NPI employed in public mental health services. The analysis of psycotherapy used suggests a different approach between public and private sector.

Objective - This paper reports on acceptability and test-retest reliability of the Verona Expectations for Care Scale (VECS) and the Verona Service Satisfaction Scale (VSSS), two newly developed, multidimensional instruments which measure expectations and satisfaction with community-based psychiatric services (CPS) in patients and their relatives. Instruments - VECS and VSSS consist of various sections and include questions eliciting spontaneous answers and an 82-item multidimensional questionnaire on various aspects of clients' interaction with psychiatric services. Setting - The South-Verona community-based psychiatric service. Subiects - The patients were selected among those who, according to the South-Verona Psychiatric Case Register, were living with their families in the South-Verona catchment area and had had more than 18 contacts with the South-Verona CPS in the three years preceeding the interview. For each patient, the relative identified by professionals and patients as primarily involved in caring for the patient in the given period was asked to participate. Results - Acceptability of VECS and VSSS to subjects was good: most items were easily understood and all subjects cooperated and gave accurate evaluations. The test-retest reliability (1-2 weeks interval) of VECS and VSSS was good in patients and relatives both when considering item-by-item percentage agreement and Cohen's weighted kappa in each dimension. Conclusions - The findings presented in this paper demonstrate that it is possible to measure subjective aspects of the interaction with a psychiatric service such as expectations and satisfaction in an acceptable and reliable way and that VECS and VSSS have good performance in the psychometric properties studied.

Scope - To discuss, after a description of the main attempts of classification of schizophrenic disorders made from the last century up to now, the main features of the ICD-10 classification of schizophrenia and related dis-orders. The main features of this chapter of the ICD-10 are then compared to the ICD-9 and DSM-III-R classifications. Results - The ICD-10 diagnostic criteria for schizophrenia require a duration of only 1 month (compared to the 6 month duration criterion of the DSM-III-R); positive symptoms of psychosis, in particular Schneiderian symptoms, are given more prominence than they are in the DSM-III-R. Moreover, it is foreseen the possibility of a favourable outcome of the disorder; this has been based on the results of several follow-up studies, including some major WHO multicentric studies showing a positive outcome in substantial proportion of patients. Conclusions - On the whole, ICD-10 broadens the diagnostic concept of schizophrenia in comparison to other diagnostic systems, whereas the emphasis placed on Schneiderian first-rank symptoms tends to overweight this tendency and makes the criteria for inclusion more narrow.

Objective - To discuss, after a description of the main models of classification of affective disorders, the main features of the ICD-10 classification of these disorders, the main differences between ICD-10 and ICD-9 and a comparison with DSM-III-R classification. Results - The analysis of the classification of these disorders as reported in ICD-10 shows that their nosographic sistematization is a complex task. In any case ICD-10 represents a significant improvement compared to ICD-9 and has included many of the guidelines of DSM-III-R. Conclusions - ICD-10 proposes a syntesis between different schools and traditions taking into account the results emerged by research in this field over the last twenty years.

Objective - This paper reports on sensitivity, and content validity of the Verona Expectations for Care Scale (VECS) and the Verona Service Satisfaction Scale (VSSS), two newly developed, multidimensional instruments which measure expectations and satisfaction with community-based psychiatric services (CPS) in patients and their rela- tives. Instruments - VECS and VSSS consist of various sections and include questions eliciting spontaneous answers and an 82-item multidimensional questionnaire on various aspects of clients' interaction with psychiatric services. Setting - The South-Verona community-based psychiatric service. Subiects - The patients were selected among those who, ac- cording to the South-Verona Psychiatric Case Register, were living with their families in the South-Verona catchment area and had had more than 18 contacts with the South-Verona CPS in the three years preceeding the interview. For each patient, the relative identified by professionals and patients as primarily involved in caring for the patient in the given period was asked to participate. Results - We demonstrated the higher sensitivity of VECS and VSSS question- naires compared to unstructured interviews in measuring service expectations and satisfaction and the higher sensitivity of a domain-specific measurement vs. an overall one. VECS and VSSS proved to be sensitive to variation both between groups and across dimensions. Content validity of the questionnaires, according to patients and relatives views, was very good; moreover we demonstrated that a key-characteristic of content validity is the questionnaire's multidimension- ality. Conclusions - The findings presented in this and in a companion paper demonstrate that it is possible to measure subjective aspects of the interaction with a psychiatric service such as expectations and satisfaction in an acceptable, reliable, sensitive and valid way and that VECS and VSSS have good psychometric properties.