Background. Empathy plays a key role in social understanding, but its empirical measurement has proved difficult. The Empathy Quotient (EQ) is a self-report scale designed to do just that. This series of four studies examined the reliability and validity of the EQ and determined its factor structure.

Method. In Study 1, 53 people completed the EQ, Social Desirability Scale (SDS) and a non-verbal mental state inference test, the Eyes Task. In Study 2, a principal components analysis (PCA) was conducted on data from 110 healthy individuals and 62 people reporting depersonalisation (DPD). Approximately 1 year later, Study 3, involved the re-administration of the EQ (n=24) along with the Interpersonal Reactivity Index (IRI; n=28). In the last study, the EQ scores of those with DPD, a condition that includes a subjective lack of empathy, were examined in depth.

Results. An association was found between the Eyes task and EQ, and only three EQ items correlated with the SDS. PCA revealed three factors: (1) ‘cognitive empathy’; (2) ‘emotional reactivity’, and (3) ‘social skills’. Test–retest reliability was good and moderate associations were found between the EQ and IRI subscales, suggesting concurrent validity. People with DPD did not show a global empathy deficit, but reported less social competence.

Conclusions. The EQ is a valid, reliable scale and the different subscales may have clinical applications.

Background. Neuroticism and somatic complaints are linked, and the aim of this study is to disentangle which mechanisms may be responsible for this association.

Method. In a stratified sample of 7076 adults (18–65 years), neuroticism, 22 self-reported chronic somatic conditions and five broad CIDI-diagnosed psychiatric syndromes were assessed at baseline and, in 3625 (51%) subjects, 3 years later. Using path analysis we examined whether neuroticism has direct links with future somatic morbidity and, conversely, whether morbidity at baseline is linked with higher neuroticism later on.

Results. Neuroticism at baseline is associated with psychiatric and somatic morbidity at follow-up after 3 years (31% and 24%, respectively, are direct associations, i.e. unmediated by each other or neuroticism at follow-up and independent of morbidity at baseline). Conversely, somatic and psychiatric morbidity at baseline are associated with increased neuroticism at follow-up (27% and 15%, respectively, are direct associations).

Conclusions. Neuroticism raises risk for psychiatric and somatic morbidity but also results from them. It represents a central nexus in the process of morbidity accumulation.

Background. In the Finnish Adoptive Family Study of Schizophrenia, adoptee thinking disorders have been shown to be a joint effect of genetic liability for schizophrenia spectrum disorders and adoptive rearing-parent communication patterns. However, longitudinal predictions of clinical psychiatric disorders of the adoptees have not been reported.

Method. Adoptees (n=109) who had no DSM-III-R disorder at initial assessment (median age 18 years) were selected from the total sample of the Finnish Adoption Study of Schizophrenia. They were defined as at high versus low genetic risk based upon the lifetime diagnoses of their biological, adopting-away mothers – schizophrenia spectrum disorder versus no spectrum disorder. At initial assessment, adoptive rearing parents were independently evaluated from tape-recorded Rorschach protocols scored as manifesting either high or low Communication Deviance (CD), a composite index of communication patterns that distract and befuddle listeners. Adoptees were independently re-diagnosed after a median interval of 14 years and followed-up from national registers for an additional 7 years.

Results. The main effects of genetic liability (G) and CD of the adoptive parents (E), each taken separately, predicted significantly for psychiatric disorders of the adoptees as adults. However, when G, E, and their joint interaction effect were entered into the same logistic model, only the interaction effect was significant. The sample included seven adoptees with schizophrenia spectrum disorders, but a separate analysis to predict them was non-significant.

Conclusion. Genetic liability for schizophrenia spectrum disorder and an adoptive family rearing variable interact, predicting longitudinally and significantly to broadly defined adoptee psychiatric disorder.

Background. Telephone interviewing has economic and logistical advantages but has not been widely used in the UK. Most studies comparing face-to-face and telephone psychiatric assessment have been carried out in the US, often restricted to a population with known psychiatric disorder and involving comparisons between two separate sample groups rather than repeat interviews with the same group. The aim of the present study was to compare face-to-face and telephone administration of the 12-item General Health Questionnaire and the Revised Clinical Interview Schedule in a UK general practice sample.

Method. Ninety-eight consecutive attenders at two general practices were assessed twice within 48 h. The order of face-to-face and telephone interviews was alternated.

Results. There was no evidence that the mode of administration led to a bias in scores on the CIS-R. For the GHQ, those aged over 60 tended to score higher on the telephone. There was good agreement between face-to-face and telephone scores for both GHQ and CIS-R and good agreement for case definition. Participants had a strong preference for face-to-face interviews.

Conclusions. Telephone assessment of mental health using the GHQ and CIS-R is a reasonable method to be used in primary care research in the UK with the limitation that telephone responses from older people might be different from face-to-face assessments for the GHQ. However, telephone interviewing appeared less acceptable and should probably be used in the context of established or ongoing personal contact between researcher and subject.

Background. In primary care the General Health Questionnaire (GHQ) is used to provide an independent assessment of probable caseness of psychological disorder against which to test the ability of the general practitioner (GP) to recognize patients with current emotional problems.

Method. The aim of the present study was to identify those clinical and psychosocial data on patients that increase the likelihood of GPs' attribution of emotional distress (GP model) and those that predict patients' emotional distress as defined by the GHQ-12 (GHQ model). The associations were explored using a classification tree technique (CHAID) and compared using bivariate logistic regression. Six GPs and 444 primary care patients took part.

Results. The accuracy indices of the hierarchical GP and GHQ models were 72% and 69% respectively. The availability of information on patients' psychopharmacological and psychiatric/psychological treatment in the last year was the most important predictor of attribution. Occupational, financial and housing problems and life events of loss were the most important predictors of the GHQ-12 case definition. The overall accuracy of the bivariate model was 73%. Compared with the GHQ-12, GPs gave significantly more importance to psychiatric treatment, psychopharmacological drug use and chronic illness.

Conclusions. The findings suggest that to improve the detection of current emotional distress in primary care patients GPs should pay foremost and systematic attention to social problems and recent life events of loss. These problems are important clues for the possible presence of emotional distress, whereas critical patient data, in particular psychiatric history and psychopharmacological treatment, increase the probability of attribution errors.

Background. Little is known about the psychological and behavioural consequences of road traffic accidents for children. The study aimed to determine the outcome of road traffic accidents on children and their mothers.

Method. A 1-year cohort study of consecutive child attenders aged 5–16 years at an Accident and Emergency Department. Data were extracted from medical notes and from interview and self-report at baseline, 3 months and 6 months.

Results. The children had an excellent physical outcome. Fifteen per cent suffered acute stress disorder; 25% suffered post-traumatic stress disorder at 3 months and 18% at 6 months. Travel anxiety was frequent. Post-traumatic consequences for mothers were common.

Conclusion. Psychological outcome was poor for a minority of children and associated with disability, especially for travel. There were significant family consequences. There is a need for changes in clinical care to prevent, identify and treat distressing and disabling problems.

Background. To examine the familial associations of overt and covert antisocial behavior within the diagnosis of conduct disorder (CD) in families ascertained by referred children with attention-deficit hyperactivity disorder (ADHD), and to test if these familial associations differed between male and female probands.

Method. Subjects were clinically-referred male and female ADHD children (n=273) and their first-degree biological relatives (n=807). Scores for overt and covert conduct problems were calculated by summing the DSM-III-R conduct disorder symptoms, as derived from structured diagnostic interviews. Familial aggregation analyses were conducted with multivariate regression modeling methodology.

Results. Proband overt scores significantly predicted the overt scores of their relatives, and proband covert scores significantly predicted the covert scores of their relatives. There was no evidence of covert symptom scores predicting overt scores or vice versa. There was some evidence that the aggregation of covert symptoms was stronger in the families of female probands.

Conclusions. These results provide preliminary evidence that overt and covert conduct disorder symptoms are independently transmitted through families and may represent distinct familial syndromes.

Background. Elaboration of the concept of cytokine-induced sickness behaviour in recent years has opened new avenues for understanding brain involvement in sickness and recovery processes. Additionally, this has led to much speculation about the role of the immune system in neuropsychiatric syndromes, including depression and chronic fatigue. However, few studies have examined this phenomenon as it naturally occurs in sick humans, and none has attempted to document the quantitative relationships between cytokine levels and non-specific symptoms. The aim of this research was to examine human sickness behaviour and its immunological correlates in documented Epstein–Barr virus (EBV), Q fever or Ross River virus (RRV) infections.

Method. We studied two separate samples. The first consisted of 21 patients with acute Q fever. The second included 48 patients with acute RRV or EBV infection. Psychological and somatic symptom profiles were derived from self-report measures completed at enrolment. Quantification of pro-inflammatory cytokines [interleukin (IL)-1β and IL-6] in sera and supernatants of peripheral blood mononuclear cell (PBMC) cultures was undertaken by specific ELISAs.

Results. Levels of IL-1β and IL-6 spontaneously released from PBMC cultures were consistently correlated with reported manifestations of acute sickness behaviour including fever, malaise, pain, fatigue, mood and poor concentration.

Conclusions. IL-1β and IL-6 produced as part of the host response represent sensitive markers of sickness behaviour in humans with acute infection. Further work is needed to systematically characterize the spectrum and natural history of sickness behaviour in humans and to elucidate its biological basis.

Background. Anxious depression, defined as Major Depressive Disorder (MDD) with high levels of anxiety symptoms, may represent a relatively common depressive subtype, with distinctive features.

Objective. The objective of this study was to determine the prevalence of anxious depression and to define its clinical correlates and symptom patterns.

Method. Baseline clinical and sociodemographic data were collected on 1450 subjects participating in the STAR*D study. A baseline Hamilton Rating Scale for Depression (HAM-D) Anxiety/Somatization factor score of [ges ]7 was considered indicative of anxious depression. The types and degree of concurrent psychiatric symptoms were measured using the Psychiatric Diagnostic Screening Questionnaire (PDSQ), by recording the number of items endorsed by study participants for each diagnostic category. MDD symptoms were assessed by clinical telephone interview with the 30-item Inventory of Depressive Symptomatology (IDS-C30).

Results. The prevalence of anxious depression in this population was 46%. Patients with anxious MDD were significantly more likely to be older, unemployed, less educated, more severely depressed, and to have suicidal ideation before and after adjustment for severity of depression. As far as concurrent psychiatric symptoms are concerned, patients with anxious depression were significantly more likely to endorse symptoms related to generalized anxiety, obsessive compulsive, panic, post-traumatic stress, agoraphobia, hypochondriasis, and somatoform disorders before and after adjustment for severity of depression. Anxious-depression individuals were also significantly less likely to endorse IDS-C30 items concerning atypical features, and were significantly more likely to endorse items concerning melancholic/endogenous depression features.

Conclusion. This study supports specific clinical and sociodemographic correlates of MDD associated with high levels of anxiety (anxious depression).

Background. There is little population-based evidence on ethnic variation in the most common mental disorders (CMD), anxiety and depression. We compared the prevalence of CMD among representative samples of White, Irish, Black Caribbean, Bangladeshi, Indian and Pakistani individuals living in England using a standardized clinical interview.

Method. Cross-sectional survey of 4281 adults aged 16–74 years living in private households in England. CMD were assessed using the Revised Clinical Interview Schedule (CIS-R), a standardized clinical interview.

Results. Ethnic differences in the prevalence of CMD were modest, and some variation with age and sex was noted. Compared to White counterparts, the prevalence of CMD was higher to a statistically significant degree among Irish [adjusted rate ratios (RR) 2·09, 95% CI 1·16–2·95, p=0·02] and Pakistani (adjusted RR 2·38, 95% CI 1·25–3·53, p=0·02) men aged 35–54 years, even after adjusting for differences in socio-economic status. Higher rates of CMD were also observed among Indian and Pakistani women aged 55–74 years, compared to White women of similar age. The prevalence of CMD among Bangladeshi women was lower than among White women, although this was restricted to those not interviewed in English. There were no differences in rates between Black Caribbean and White samples.

Conclusions. Middle-aged Irish and Pakistani men, and older Indian and Pakistani women, had significantly higher rates of CMD than their White counterparts. The very low prevalence of CMD among Bangladeshi women contrasted with high levels of socio-economic deprivation among this group. Further study is needed to explore reasons for this variation.

Background. The purpose of this study was to demonstrate the influence of several risk factors (particularly physical and mental disorders, loneliness and housing conditions) on the wish to die in the elderly.

Method. Using data from a population-based sample of 516 senior citizens (70 to 103 years of age) in Berlin (Germany), we compared 54 persons with death wishes with 462 persons without death wishes on several psychosocial risk factors, physical health and psychiatric diagnoses. A logistic regression analysis was also conducted.

Results. The data indicate that the wish to die is strongly associated with the presence of a mental disorder, especially major depression, while higher age, female gender, subjective assessment of physical health and negative living conditions were all only moderately related to death wishes.

Conclusions. Our results emphasize the need for very careful diagnosis of death wishes in the very old and question the view that it is a normal and understandable phenomenon in older age.

Background. Recent research studies on the psychological processes underlying suicidal behaviour have highlighted deficits in social problem-solving ability, and suggest that suicide attempters may, in addition, be passive problem-solvers. The aim of this study was to examine problem-solving in suicide attempters (including passivity) and to see whether the deficits are mood-dependent.

Method. Two groups, a suicide attempter group and a non-suicidal psychiatric control group completed measures of depression, hopelessness, suicidal ideation and social problem-solving ability shortly after admission, and again 6 weeks later. In addition, a non-psychiatric control group provided baseline data at a single time point.

Results. The suicide attempter group displayed poorer problem-solving ability than matched psychiatric controls and this difference persisted despite change in mood. However, although suicidal patients were more passive in their problem-solving style than non-psychiatric controls, they were not significantly more passive than psychiatric controls. Problem-solving did not change with improving mood.

Conclusions. Although passivity is not unique to suicidal patients, in combination with the smaller number and less effective alternatives generated, it may increase vulnerability.

Background. Studies have been fairly consistent in finding a relationship between social support and depression. However, little is known about the relationship between depression and social support in the context of treatment for depression. This study examined the effects of treatment for depression on social support among patients with multiple sclerosis (MS).

Method. Sixty-three moderately depressed MS patients received 16 weeks of cognitive behaviour therapy (CBT), supportive expressive group psychotherapy (SEGP) or sertraline. Depression was measured using the Beck Depression Inventory and social support was measured using Arizona Social Support Interview Schedule.

Results. Treatment for depression was associated with significant increases in perceived social support, utilized social support and satisfaction with support, as well as reduction in need for emotional support. There were no significant changes in structural support or need for physical support. There were also no differences in change in social support across treatments. All changes in social support were fully explained by depression. Improvements in utilized social support and satisfaction with social support were fully mediated by improvements in depression. Baseline depression predicted improvements in perceived support and need for emotional support.

Conclusions. These findings suggest that improvements in social support among MS patients during treatment for depression can be explained by depression. However, different domains of social support may be differentially sensitive to changes in depression.

Background. Recent studies indicate that behavioral symptoms may play a key role in decisions to institutionalize persons with Alzheimer's disease (AD), but the specific types of behavior that contribute to this increased risk have not been reliably identified. The relationship between behavioral symptoms and time to institutionalization was evaluated in a 4-year longitudinal study.

Method. A total of 410 persons with the clinical diagnosis of AD completed annual clinical evaluations to assess cognitive impairment, functional limitations, delusions, hallucinations, depressive symptoms and physical aggression. Participation rates among survivors exceeded 90% for four follow-up evaluations with complete ascertainment of mortality and institutionalization. Time to institutionalization was evaluated using proportional hazards regression models in relation to time-varying clinical features.

Results. In multivariate models, adjusted for demographic and social variables, four clinical features emerged as the predominant predictors of institutionalization: cognitive impairment level, physical aggression, hallucinations and depressive symptoms. These associations were virtually unchanged in analyses controlling for mortality.

Conclusions. Specific behavioral symptoms are important independent risk factors for institutionalization in persons with AD. Because behavioral symptoms are susceptible to therapy, efforts to modify or prevent these symptoms deserve careful consideration as a means to delay institutionalization for persons with this disease.

Background. Despite the demonstrable influence of both genes and the family environment on children's behavioural and emotional development, the mechanisms by which these factors are transmitted from parents to their children are not known. Numerous aspects of the family have long been associated with behavioural and emotional problems in children; it is not clear, however, whether these family variables represent genuine environmental risks or secondary consequences of the underlying genetic liability shared between parents and their children.

Method. In this study we present a model for analysing the non-genetic contributions of family background to risk for childhood and adolescent depression and conduct disturbance using simulated data on adult MZ and DZ twins, their spouses and children.

Results. The twin offspring design provides substantial power to detect remarkably small non-genetic effects on parent–offspring resemblance against the background of genetic transmission. As presented, the model is able to resolve the direction of transmission from both parent to child (passive genotype–environment correlation) and child to parent (evocative genotype–environment correlation).

Conclusions. Unlike many other genetic studies, a study of twins and their children can sort out which putative family environmental risk factors do actually have a significant environmental impact on the child and which ones only appear to do so because they are associated with genetic mediation.

Background. Identifying endophenotypes of schizophrenia will assist in the identification of individuals who are at heightened risk for the disorder. Investigators have proposed antisaccade task deficits as an endophenotypic marker of schizophrenia. However, the diagnostic specificity and the temporal stability of the task deficit are unresolved issues. To date, there are few published reports of test–retest stability of antisaccade task performance in psychiatric patients.

Method. Twenty-three schizophrenia out-patients and 10 bipolar out-patients were administered two saccadic (antisaccade and refixation) tasks at two separate assessments, with an average test–retest interval of 33 months.

Results. The schizophrenia patients displayed high test–retest reliabilities of antisaccade task accuracy, despite changes in medication and clinical status. Additionally, the schizophrenia group's saccadic reaction times for antisaccade correct responses and task errors were moderately stable over time. In contrast, the bipolar patients did not show temporal stability in their antisaccade task accuracy or in their response latencies to either correct or incorrect antisaccade responses.

Conclusions. The results are supportive of the trait-like characteristics of antisaccade task deficits in schizophrenia patients. These findings also suggest that antisaccade task deficits may serve as an endophenotypic marker of schizophrenia.

Background. In situations of chronic stress vasopressin plays an important role in regulating the hypothalamic–pituitary–adrenal axis. The aim of the current study was to investigate the role of anterior pituitary vasopressin V3 receptors in maintaining the hypercortisolism seen in melancholic depression.

Method. Fourteen patients with major depression and 14 age- and sex-matched healthy comparison subjects were recruited. Desmopressin (ddAVP) 10 μg was given intravenously and ACTH and cortisol release was monitored for 120 min.

Results. The mean±S.E.M. ACTH response in the depressives was 28·4±4·3 ng/l and in the healthy subjects was 18·8±4·9 ng/l (P=0·04). The mean±S.E.M. cortisol response in the depressives was 261·8±46·5 nmol/l and in the healthy subjects was 107·3±26·1 nmol/l (P<0·01).

Conclusions. Patients with major depression have augmented ACTH and cortisol responses to desmopressin indicating enhanced V3 responsivity.

Background. Early separation of a child from the mother has been considered a risk factor for later depression. We investigated the association between very early separation and depression in adulthood in a unique dataset.

Method. The index cohort consisted of 3020 subjects born in 1945–1965 in Finland, isolated from their family due to tuberculosis in the family and placed in special nurseries, immediately after birth, for an average time of 7 months. Those subjects alive at 1 January, 1971 were identified. For every index subject two reference subjects were chosen, the matching criteria being sex, year of birth and place of birth. Data on depression were obtained from the Finnish Hospital Discharge Register by the end of year 1998.

Results. In males, 4·2% of the index subjects and 2·6% (Adjusted Rate Ratio RR 1·7, 95% CI 1·3–2·3) of the reference subjects had been treated in hospital due to a depressive episode. In females the respective figures were 3·9% for index subjects and 3·6% (RR 1·1, 95% CI 0·8–1·5) for reference subjects.

Conclusions. The index subjects had an elevated risk for hospital treated depression in adulthood. One explanation may be that the very early temporal separation from the mother at birth may have unfavourable effects on later psychological development. On the other hand, separation from the parents at birth was not found to be strongly associated with severe adulthood depression.

Background. We examined whether, in the UK, there is an increased risk of autism (AD) following exposures, in early life, to: (1) wild measles; (2) live attenuated measles, alone or in combination as MMR; and (3) the alteration of the mumps strain within MMR.

Method. We conducted time trend analyses of 2407 AD subjects born between 1959–93; and for comparison, 4640 Down's syndrome (DS) subjects born between 1966–93. Between 1968–86, we correlated variations in AD and DS births with wild measles incidence. Between 1959–93, we tested for abrupt changes in the long-term AD birth trend for the effects of introducing: (1) monovalent measles vaccines in 1968; (2) MMR immunization in 1988; and (3) the ‘overnight switch’ from mixed use of Urabe MMR to exclusive use of Jeryl–Lynn MMR in 1992. Incidence rate ratios (IRRs) were used as measures of association.

Results. We found no significant association between AD births and exposure (prenatal and post-natal up to 18 months age) to population rates of measles infections, and no ‘step-up’ increase in AD births associated with the introduction of monovalent measles and MMR vaccines, and changing mumps strain. An unexpected reduction in AD births of 21% (95% CI 6·9–33·3%; P=0·005) among the post-1987 birth cohorts was detected.

Conclusion. No increased risk of AD following exposures to wild measles and vaccinations with monovalent measles, and Urabe or Jeryl–Lynn variants of MMR was detected. The precise meaning of the detected AD births reduction is unclear. Our study cannot exclude rare complications of MMR, given its correlational design.

Background. The Social, Genetic and Developmental Psychiatry Centre was established by the Medical Research Council, in partnership with the Institute of Psychiatry, King's College London, in 1994.

Method and Results. The paper describes the origins of the Centre; the reasons why a new initiative was needed in the early 1990s; the thinking that led to the proposal for a major interdisciplinary research centre that integrated social, genetic and developmental research perspectives; the approach to international recruitment of world leaders; and the initial research accomplishments with respect to the basic goal of understanding nature-nurture interplay.

Conclusions. The structure and interdisciplinary approach of the Centre have proved a success and the initial accomplishments have begun to meet the objectives of showing how nature-nurture interplay is involved in the development of psychiatric disorders.