The Department of Health and UK funding bodies have suggested that clinical academics work closely with mental health service users in research projects. Although there are helpful guidelines on the issues that have to be dealt with, there have been few examples of how this partnership research might be undertaken.

To illustrate the challenges in joint research projects.

We subjected the process of user involvement to ten questions which arose in the development of a joint research project. The answers are an amalgamation of the user and clinical researcher considerations and are affected by hindsight.

The involvement of the user-researcher changed the focus of the study and its design and content. More attention was paid to the intervention itself and the way in which it was delivered. This process increased the amount of time taken to carry out and write up the project as well as incurring financial costs for user consultation payments and dissemination.

This experience has clarified the contribution that users can make, for example by raising new research questions, by ensuring interventions are kept ‘user friendly’, and the selection of outcome measures.

In England and Wales, persons of African–Caribbean origin are more likely to be both imprisoned and admitted to secure hospitals.

To estimate population-based rates of imprisonment in different ethnic groups, and compare criminal behaviour and psychiatric morbidity.

We examined Home Office data on all persons in prison, and carried out a two-stage cross-sectional survey of 3142 remanded and sentenced, male and female, prisoners in all penal establishments in England and Wales in 1997.

We confirmed high rates of imprisonment for Black people and lower rates for South Asians. Different patterns of offending and lower prevalence of psychiatric morbidity were observed in Black prisoners.

Despite increased risks of imprisonment, African–Caribbeans show less psychiatric morbidity than White prisoners. This contrasts with the excess of African–Caribbeans in secure hospitals, an inconsistency possibly in part due to the effects of ethnic groups on admission procedures.

The high rates of psychiatric morbidity in prisoners vary between ethnic groups.

To compare early environmental risks, stressful daily living experiences and reported use of psychiatric services in prisoners from different ethnic groups.

Cross-sectional survey of 3142 prisoners in all penal establishments in England and Wales in 1997.

Fewer Black and South Asian male prisoners reported childhood traumas and conduct disorder, and fewer Black prisoners experienced stressful prison experiences, than White prisoners. Fewer Black women had received previous psychiatric treatment, and fewer Black men had their psychiatric problems identified in prison. Black prisoners were less likely to have received psychiatric treatment than Whites.

The lower prevalence of psychiatric morbidity observed in Black prisoners corresponds with reduced exposure to risk factors. Higher rates of imprisonment might be explained by higher rates of conduct disorder, adolescent-onset criminality and disadvantage within the criminal justice system.

The most damaging effect of stigma is the internalisation of others' negative valuations.

To explore the factors that mediate patients' emotional and cognitive responses to stigma.

Based on responses to 10 open-ended questions about stigma appended to the Chinese version of the Camberwell Family Interview, trained coders rated the effect of stigma on both patients and family members in 1491 interviews conducted with 952 family members of 608 patients with schizophrenia at 5 sites around China from 1990 to 2000.

Family members reported that stigma had had a moderate to severe effect on the lives of patients over the previous 3 months in 60% of the interviews, and on the lives of other family members in 26% of the interviews. The effect of stigma on patients and family members was significantly greater if the respondent had a high level of expressed emotion, if the patient had more severe positive symptoms, if the respondent was highly educated and if the family lived in a highly urbanised area.

Clinicians should assess the effect of stigma as part of the standard work-up for patients with mental illness, and help patients and family members reduce the effect of stigma on their lives.

Stigma affects not only people with mental illnesses, but their families as well. Understanding how stigma affects family members in terms of both their psychological response to the ill person and their contacts with psychiatric services will improve interactions with the family.

To investigate factors of psychological significance related to stigma of the relatives.

In a Swedish multi-centre study, 162 relatives of patients in acute psychiatric wards following both voluntary and compulsory admissions were interviewed concerning psychological factors related to stigma.

A majority of relatives experienced psychological factors of stigma by association. Eighteen per cent of the relatives had at times thought that the patient would be better off dead, and 10% had experienced suicidal thoughts. Stigma by association was greater in relatives experiencing mental health problems of their own, and was unaffected by patient background characteristics.

Interventions are needed to reduce the negative effects of psychological factors related to stigma by association in relatives of people with mental illness.

Community-based epidemiological data on post-partum depression from developing countries are scarce.

To determine the incidence of and risk factors for developing post-partum depression in a cohort of women living in rural south India.

We assessed 359 women in the last trimester of pregnancy and 6–12 weeks after delivery for depression and for putative risk factors.

The incidence of post-partum depression was 11% (95% CI 7.1–14.9). Low income, birth of a daughter when a son was desired, relationship difficulties with mother-in-law and parents, adverse life events during pregnancy and lack of physical help were risk factors for the onset of post-partum depression.

Depression occurred as frequently during late pregnancy and after delivery as in developed countries, but there were cultural differences in risk factors. These findings have implications for policies regarding maternal and child-care programmes.

Post-natal depression is a common condition that can result in distress for the mother and deleterious effects on the development of the infant.

To estimate the economic costs of post-natal depression in a geographically defined cohort of women at high risk of developing the condition.

Unit costs were applied to estimates of health and social care resource use made by 206 women recruited from antenatal clinics and their infants. Net costs per mother–infant dyad over the first 18 months post-partum were estimated.

Mean mother–infant dyad costs were estimated at £2419.00 for women with post-natal depression and £2026.90 for women without post-natal depression, a mean cost difference of £392.10 (P=0.17). The mean cost differences between women with and without post-natal depression reached statistical significance for community care services (P=0.01), but not for other categories of service. Economic costs were higher for women with extended experiences of the condition.

The results of this study should be used to facilitate the effective planning of services by different agencies.

An advance directive is a statement of a person's preferences for treatment, should he or she lose capacity to make treatment decisions in the future.

To evaluate whether use of advance directives by patients with mental illness leads to lower rates of compulsory readmission to hospital.

In a randomised controlled trial in two psychiatric services in inner London, 156 in-patients about to be discharged from compulsory treatment under the Mental Health Act were recruited. The trial compared usual psychiatric care with usual care plus the completion of an advance directive. The primary outcome was the rate of compulsory readmission.

Fifteen patients (19%) in the intervention group and 16 (21%) in the control group were readmitted compulsorily within 1 year of discharge. There was no difference in the numbers of compulsory readmissions, numbers of patients readmitted voluntarily, days spent in hospital or satisfaction with psychiatric services.

Users' advance instruction directives had little observable impact on the outcome of care at 12 months.

This study sought to clarify the role of obstetric complications (OCs) and maternal recall bias for patients with first episodes of schizophrenia and those at increased risk of the disorder.

Subjects at high risk of schizophrenia were compared with people with first-episode schizophrenia and with healthy volunteers. Consenting mothers of subjects were interviewed using a standardised questionnaire for the recall of OCs, and OCs were also measured from records collected at the time of pregnancy and delivery.

High-risk subjects and first-episode patients had higher rates of OCs recalled by their mother than controls, but hospital records showed no differences in OCs between groups. The number of OCs recalled by mothers of the high-risk group was not related to whether the mother had schizophrenia or not, but was related to the maternally rated abnormal childhood behaviour as measured by the Child Behaviour Checklist.

These results suggest that studies that rely on maternal recall alone are susceptible to bias. The excess of OCs recalled by the mother could be related to abnormal behaviour in their child rather than maternal illness, family history or psychotic symptoms.

Early studies suggested that presentations with unexplained acute abdominal pain were associated with increased long-term rates of hospital attendance and self-harm, especially in women, but few studies were large enough for definitive findings.

To test the hypothesis that such presentations are followed by higher long-term utilisation rates of secondary health care even excluding further abdominal symptoms, and particularly for self-harm, than presentations with acute appendicitis.

New hospital attendance rates, liaison psychiatry attendances and self-harm attendances of patients with normal appendices at emergency appendicectomy were compared with those of appendicitis patients.

Attendance rates of all kinds were significantly higher for normal appendix patients than for appendicitis patients, with equal strengths of finding for males and females.

People with normal appendices at emergency appendicectomy show higher long-term rates of hospital attendance. This has implications for how these patients are best managed by health care systems.