Few studies have investigated large population-based cohorts for an association between alcohol consumption and suicide.

To investigate the possible association between alcohol intake and suicide.

We used nationwide population-based cohort data from the Japan Public Health Centre-Based Prospective Study cohort. Atotal of 43 383 men aged 40–69 years participated. Death from suicide was defined according to ICD–10 as codes X60-X84.

Duringthe367817person-years of follow-up, there were 168 suicides. Compared with occasional drinkers, the pooled multivariate relative risk (RR; with 95% CI) of suicide for non-drinkers and regular heavy drinkers was 2.3 (1.2–4.6) and 2.3 (1.2–4.7) respectively. The RR increased with the amount of alcohol consumed (P for trend =0.004).

There is a U-shaped association between alcohol consumption and subsequent suicide.

Few randomised controlled trials have been aimed specifically at substance use reduction among people with psychotic disorders.

To investigate whether a 10-session intervention consisting of motivational interviewing and cognitive-behavioural therapy (CBT) was more efficacious than routine treatment in reducing substance use and improving symptomatology and general functioning.

A community sample of people with a psychotic disorder and who reported hazardous alcohol, cannabis and/or amphetamine use during the preceding month was recruited. Participants were randomly allocated to motivational interviewing/CBT (n=65) or treatment as usual (n=65), and were assessed on multiple outcomes at baseline, 15 weeks, 6 months and 12 months.

There was a short-term improvement in depression and a similar trend with regard to cannabis use among participants who received the motivational interviewing/CBT intervention, together with effects on general functioning at 12 months. There was no differential benefit of the intervention on substance use at 12 months, except for a potentially clinically important effect on amphetamine use.

The motivational interviewing/CBT intervention was associated with modest improvements.

Previous studies of people convicted of homicide have used different definitions of mental disorder.

To estimate the rate of mental disorder in people convicted of homicide; to examine the relationship between definitions, verdict and outcome in court.

A national clinical survey of people convicted of homicide (n=1594) in England and Wales (1996–1999). Rates of mental disorder were estimated based on: lifetime diagnosis, mental illness at the time of the offence, contact with psychiatric services, diminished responsibility verdict and hospital disposal.

Of the 1594, 545 (34%) had a mental disorder: most had not attended psychiatric services; 85 (5%) had schizophrenia (lifetime); 164 (10%) had symptoms of mental illness at the time of the offence; 149 (9%) received a diminished responsibility verdict and 111 (7%) a hospital disposal – both were associated with severe mental illness and symptoms of psychosis.

The findings suggest an association between schizophrenia and conviction for homicide. Most perpetrators with a history of mental disorder were not acutely ill or under mental healthcare at the time of the offence. Some perpetrators receive prison sentences despite having severe mental illness.

The provision of early intervention services for people with psychosis is UK government policy, although evidence for benefit of such services is sparse.

To evaluate the effects of a service providing specialised care for early psychosis (the Lambeth Early Onset team) on clinical and social outcomes, and on service user satisfaction.

One hundred and forty-four people with psychosis, presenting to mental health services for the first or second time (if previously failed to engage in treatment), were randomly allocated to care by the early onset team or to standard care. Information was obtained on symptoms, treatment adherence, social and vocational functioning, satisfaction and quality of life. Relapse and rehospitalisation data have been reported separately.

Outcomes for the participants treated by the early onset team were significantly better at 18 months for aspects of social and vocational functioning, satisfaction, quality of life and medication adherence. Symptom improvement did not significantly differ between the groups.

The provision of specialised care for early psychosis can achieve better outcomes. The study therefore provides support for current policy.

A randomised controlled trial comparing group interpersonal psychotherapy with treatment as usual among rural Ugandans meeting symptom and functional impairment criteria for DSM–IV major depressive disorder or sub-threshold disorder showed evidence of effectiveness immediately following the intervention.

To assess the long-term effectiveness of this therapy over a subsequent 6-month period.

A follow-up study of trial participants was conducted in which the primary outcomes were depression diagnosis, depressive symptoms and functional impairment.

At 6 months, participants receiving the group interpersonal psychotherapy had mean depression symptom and functional impairment scores respectively 14.0 points (95% CI 12.2–15.8; P < 0.0001) and 5.0 points (95% CI 3.6–6.4; P < 0.0001) lower than the control group. Similarly, the rate of major depression among those in the treatment arm (11.7%) was significantly lower than that in the control arm (54.9%) (P < 0.0001).

Participation in a 16-week group interpersonal psychotherapy intervention continued to confer a substantial mental health benefit 6 months after conclusion of the formal intervention.

The cost-effectiveness of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) has not been compared in a prospective study in primary care.

To determine the relative cost-effectiveness of TCAs, SSRIs and lofepramine in UK primary care.

An open-label, three-arm randomised trial with a preference arm. Practitioners referred 327 patients with incident depression.

No significant differences were found in effectiveness or cost-effectiveness. The numbers of depression-free weeks over 12 months (on the Hospital Anxiety and Depression Scale) were 25.3 (95% CI 21.3–29.0) for TCAs, 28.3 (95% CI 24.3–32.2) for SSRIs and 24.6 (95% CI 20.6–28.9) for lofepramine. Mean health service costs per patient were $762 (95% CI 553–1059) for TCAs, $875 (95% CI 675–1355) for SSRIs and $867 (95% CI 634–1521) for lofepramine. Cost-effectiveness acceptability curves suggested SSRIs were most cost-effective (with a probability of up to 0.6).

The findings support a policy of recommending SSRIs as first-choice antidepressants in primary care.

Cannabis use is associated with mental health problems, and young people in particular are at risk.

To investigate the association between cannabis use and mental health in adolescence.

Data from 5551 adolescents aged 12–16 years were drawn from the Dutch Health Behaviour in School-Aged Children school survey, carried out as part of the international 2001 World Health Organization project.

After adjusting for confounding factors, cannabis use was linked to externalising problems (delinquent and aggressive behaviour) but not to internalising problems (withdrawn behaviour, somatic complaints and depression). An increasing frequency of use resulted in stronger links. No significant gender or age by cannabis interaction effects were found.

In a country with a liberal drug policy like The Netherlands, cannabis use is associated with aggression and delinquency, just as in other countries. Cannabis use was not associated with internalising problems. Alcohol use and regular smoking were strong confounding factors.

Psychological therapy groups for people with dementia are widely used, but their cost-effectiveness has not been explored.

To investigate the cost-effectiveness of an evidence-based cognitive stimulation therapy (CST) programme for people with dementia as part of a randomised controlled trial.

A total of 91 people with dementia, living in care homes or the community, received a CST group intervention twice weekly for 8 weeks; 70 participants with dementia received treatment as usual. Service use was recorded 8 weeks before and during the 8-week intervention and costs were calculated. A cost-effectiveness analysis was conducted with cognition as the primary outcome, and quality of life as the secondary outcome. Cost-effectiveness acceptability curves were plotted.

Cognitive stimulation therapy has benefits for cognition and quality of life in dementia, and costs were not different between the groups. Under reasonable assumptions, there is a high probability that CST is more cost-effective than treatment as usual, with regard to both outcome measures.

Cognitive stimulation therapy for people with dementia has effectiveness advantages over, and may be more cost-effective than, treatment as usual.

Substance use may be a risk factor for the onset of schizophrenia.

To examine the association between substance use and age at onset in a UK, inner-city sample of people with recent-onset schizophrenia.

The study sample consisted of 152 people recruited to the West London First-Episode Schizophrenia Study. Self-reported data on drug and alcohol use, as well as information on age at onset of psychosis, were collected. Mental state, cognition (IQ, memory and executive function) and social function were also assessed.

In total, 60% of the participants were smokers, 27% reported a history of problems with alcohol use, 35% reported current substance use (not including alcohol), and 68% reported lifetime substance use (cannabis and psychostimulants were most commonly used). Cannabis use and gender had independent effects on age at onset of psychosis, after adjusting for alcohol misuse and use of other drugs.

The strong association between self-reported cannabis use and earlier onset of psychosis provides further evidence that schizophrenia may be precipitated by cannabis use and/or that the early onset of symptoms is a risk factor for cannabis use.

Epidemiological and clinical studies suggest that increased intake of eicosapentaenoic acid (EPA) alleviates unipolar depression.

To examine the efficacy of EPA in treating depression in bipolar disorder.

In a 12-week, double-blind study individuals with bipolar depression were randomly assigned to adjunctive treatment with placebo (n=26) or with 1g/day (n=24) or 2 g/day (n=25) of ethyl-EPA. Primary efficacy was assessed by the Hamilton Rating Scale for Depression (HRSD), with changes in the Young Mania Rating Scale and Clinical Global Impression Scale (CGI) as secondary outcome measures.

There was no apparent benefit of 2g over 1g ethyl-EPA daily. Significant improvement was noted with ethyl-EPA treatment compared with placebo in the HRSD (P=0.04) and the CGI (P=0.004) scores. Both doses were well tolerated.

Adjunctive ethyl-EPA is an effective and well-tolerated intervention in bipolar depression.

Major depression is associated with activation of the inflammatory response.

To examine C-reactive protein levels in depression and to determine the impact of selective serotonin reuptake inhibitor (SSRI) therapy.

Atwo-part study. In study 1, which used a between-subjects design, C-reactive protein was measured in 32 patients (20 currently depressed, 12 euthymic) with a history of DSM–IV major depression, all of whom were treated with an SSRI, and in a healthy comparison group (n=20). Study 2 employed a within-subject design: C-reactive protein was measured in 20 patients with major depression both before and after SSRI treatment.

In study 1, C-reactive protein levels did not differ between the group with depressive disorder (either currently depressed or euthymic) treated with SSRIs and the healthy group. In study 2 the protein levels dropped significantly following treatment with antidepressant medication.

Following SSRI treatment for major depression there is a significant drop in C-reactive protein concentrations whether or not the depression resolves. These findings indicate that antidepressants induce an anti-inflammatory response independent of antidepressant action.

Relapse rates may be as high as 50% in people with major depressive disorder (MDD) previously treated to remission.

Duloxetine, an inhibitor of serotonin and noradrenaline reuptake that is licensed in Europe, the USA and elsewhere for the treatment of depressive episodes, was evaluated with regard to its efficacy, safety and tolerability in the prevention of relapse of MDD.

Adult out-patients with MDD received duloxetine (60 mg daily) for 12 weeks (n=533). Patients who responded to the drug were then randomised to duloxetine (60 mgdaily) (n=136) or placebo (n=142) for 26 weeks. The primary measure of efficacy was time to relapse.

Patients who received duloxetine (60 mg daily) experienced significantly longer times to relapse of MDD, and better efficacy global well-being, and quality-of-life outcomes compared with patients who received placebo. It should be noted that adverse events which occur in discontinuation may mimic some signs of depressive relapse, and were not specifically elicited in this study.

Duloxetine (60 mg daily) is effective in the prevention of relapse of MDD during continuation treatment.

Some UK studies have reported an urban excess in the prevalence of the most common mental disorders of anxiety and depression.

To investigate rural/non-rural differences in the onset and maintenance of episodes of common mental disorders, after adjusting for the characteristics of respondents and their households.

A 12-month cohort study of 7659 adults aged 16–74 years living in 4338 private households, nested within 626 electoral wards in England, Wales and Scotland. Common mental disorders were assessed using the General Health Questionnaire (GHQ). Electoral wards were characterised by Office for National Statistics classification and by population density. Data were analysed using multilevel statistical modelling.

Rural residents had slightly better mental health than non-rural counterparts. The effects of geographical location on the mental health of participants were neither significantly confounded nor modified by socioeconomic status, employment status or household income.

There are small but statistically significant differences in rates of common mental disorders between urban and rural residents. Quantifying between-place differences using population density alone risks missing important contextual effects on mental health.

Data on effectiveness of acute day hospital treatment for psychiatric illness are inconsistent.

To establish the effectiveness and costs of care in a day hospital providing acute treatment exclusively.

In a randomised controlled trial, 206 voluntarily admitted patients were allocated to either day hospital treatment or conventional wards. Psychopathology, treatment satisfaction and subjective quality of life at discharge, 3 months and 12 months after discharge, readmissions to acute psychiatric treatment within 3 and 12 months, and costs in the index treatment period were taken as outcome criteria.

Day hospital patients showed significantly more favourable changes in psychopathology at discharge but not at follow-up. They also reported higher treatment satisfaction at discharge and after 3 months, but not after 12 months. There were no significant differences in subjective quality of life or in readmissions during follow-up. Mean total support costs were higher for the day hospital group.

Day hospital treatment for voluntary psychiatric patients in an inner-city area appears more effective in terms of reducing psychopathology in the short term and generates greater patient satisfaction than conventional in-patient care, but may be more costly.

The effect of recent increases in antidepressant prescribing on population suicide rates is uncertain.

To investigate the relationship between antidepressant sales and trends in suicide rates.

Graphical and quantitative assessment of trends in suicide and antidepressant sales in Norway, Sweden, Denmark and Finland.

Suicide rates declined in all four countries during the 1990s, whereas antidepressant sales increased by 3- to 4-fold. Decreasing suicide rates in Sweden and Denmark preceded the rise in anti-depressant sales by over 10 years, although the reductions accelerated between 1988 and 1990. In Norway, a modest but short-lived decline in suicide rates began around the time of the increase in antidepressant sales. In Finland, decreases in male suicide rates and to a lesser extent in female suicide rates began around the time of increased antidepressant sales. In all four countries decreases in suicide rates appeared to precede the widespread use of SSRIs.

We found mixed evidence that increases in antidepressant sales have coincided with a reduction in the number of suicides in Nordic countries.

Several studies document an excess of psychiatric symptoms among veterans of the 1991 Gulf War. However, little is known about the prevalence of psychiatric disorders in those who were deployed to that conflict.

To compare the 12-month prevalence and associated risk factors for DSM Axis I psychiatric diagnoses between random samples of Gulf War-deployed veterans and veterans of the same era notdeployed to the Persian Gulf (era veterans).

Interview data from 967 Gulf War veterans and 784 era veterans were examined to determine current health status, medical conditions, symptoms and Axis I psychiatric disorders. Logistic regression models evaluated risk factors for psychiatric disorder.

Gulf War veterans had a significantly higher prevalence of psychiatric diagnoses, with twice the prevalence of anxiety disorders and depression. Lower rank, female gender and divorced or single marital status were significant independent predictors of psychiatric disorder.

Deployment to the Gulf War is associated with a range of mental health outcomes more than 10 years after deployment.

There has been little reported research into the effect of war on the behaviour and emotional well-being of pre-school children.

To investigate the relationship between exposure to war trauma and behavioural and emotional problems among pre-school children.

Atotal of 309 children aged 3–6 years were selected from kindergartens in the Gaza Strip, and were assessed by parental reports in regard to their exposure to war trauma, using the Gaza Traumatic Checklist, and their behavioural and emotional problems, using the Behaviour Checklist (BCL) and the Strengths and Difficulties Questionnaire (SDQ).

Pre-school children were exposed to a wide range of traumatic events. The total number of traumatic events independently predicted total BCL and SDQ scores. Exposure to day raids and shelling of the children's houses by tanks were significantly associated with total behavioural and emotional problems scores.

Direct and non-direct exposure to war trauma increases the risk of behavioural and emotional problems among pre-school children, which may present as non-specific psychopathology.

Psychological treatments have been shown to be effective in patients with psychosis. However, the studies published to date have included participants across wide age ranges, so few conclusions can be reached about the effectiveness of such treatments in relation to age.

To evaluate outcomes by age in a randomised controlled trial designed to evaluate the effectiveness of cognitive-behavioural therapy (CBT), supportive counselling and treatment as usual.

Outcomes were evaluated in terms of symptoms, social functioning, insight and therapeutic alliance according to age at 3- and 18-month follow-up.

Younger participants responded better to supportive counselling than to treatment as usual and CBTover 3 months. Older participants responded better to CBT than to supportive counselling over 18 months. Younger participants showed a greater increase in insight after CBT compared with treatment as usual and supportive counselling, and were more difficult to engage in therapy.

Young people may have different needs with regard to engagement in psychological treatments. Treatment providers need to take age-specific factors into account.