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Biomedical subjects

S Weich

Publications and source records attributed to S Weich.

At least 19 recordsLinked to original sources
PubMed2003

Contextual risk factors for the common mental disorders in Britain: a multilevel investigation of the effects of place.

STUDY OBJECTIVE: To test hypotheses about associations between area level exposures and the prevalence of the most common mental disorders (CMD) in Britain. A statistically significant urban-rural gradient was predicted, but not a socioeconomic gradient, in the prevalence of CMD after adjusting for characteristics of individual respondents. The study tested the hypothesis that the effects of area level exposures would be greatest among those not in paid employment. DESIGN: Cross sectional survey, analysed using multilevel logistic and linear regression. CMD were assessed using the General Health Questionnaire (GHQ). Electoral wards were characterised using the Carstairs index, the Office of National Statistics (ONS) Classification of Wards, and population density. SETTING: England, Wales, and Scotland. PARTICIPANTS: Nearly 9000 adults aged 16-74 living in 4904 private households, nested in 642 electoral wards. MAIN RESULTS: Little evidence was found of statistically significant variance in the prevalence of CMD between wards, which ranged from 18.8% to 29.5% (variance 0.035, SE 0.026) (p=0.11). Associations between CMD and characteristics of wards, such as the Carstairs index, only reached statistical significance among those who were economically inactive (adjusted odds ratio for top v bottom Carstairs score quintile 1.58, 95% CI 1.08 to 2.31) (p<0.05). CONCLUSIONS: There may be multiple pathways linking socioeconomic inequalities and ill health. The effects of place of residence on mental health are greatest among those who are economically inactive and hence more likely to spend the time at home.

Adolescent↗
PubMed2002

Income inequality and self rated health in Britain.

STUDY OBJECTIVE: Several studies have reported an association between income inequality and increased mortality, but few have used net income data, controlled for individual income, or evaluated sensitivity to the choice of inequality measure. The study tested the hypotheses that people in regions of Britain with the greatest income inequality would report worse health than those in other regions, after adjusting for individual socioeconomic circumstances. DESIGN: Cross sectional survey. SETTING: England, Wales, and Scotland. PARTICIPANTS: 8366 people living in private households. MAIN RESULTS: Regional income inequality, measured using the Gini index, was associated with worse self rated health, especially among those with the lowest incomes (adjusted OR 1.55, 95% CI 1.24 to 1.92) (p<0.001). This association was not robust to the choice of income inequality measure, being maximal for the Gini coefficient and weakest when using indices that are more sensitive to income differences among those at the top or bottom of the income distribution. CONCLUSIONS: The study found limited evidence of an association between income inequality and worse self rated health in Britain, which was greatest among those with the lowest individual income levels. As regions with the highest income inequality were also the most urban, these findings may be attributable to characteristics of cities rather than income inequality. The variation in this association with the choice of income inequality measure also highlights the difficulty of studying income distributions using summary measures of income inequality.

Cross-Sectional Studies↗
PubMed2001

Measuring the built environment: validity of a site survey instrument for use in urban settings.

There are few reliable measures of place with which to study the effects of socio-economic context on health. We report on the development and inter-rater reliability of a 27-item observer-rated built environment site survey checklist (BESSC). Across eleven 'housing areas' (defined as areas of homogeneity in housing form) and two raters, kappa coefficients were > or =0.5 for fifteen categorical items, and intra-class correlation coefficients exceeded 0.6 for a further three continuous measures. Ratings on several BESSC items were associated to a statistically significant degree with the prevalence of depression and residents' dissatisfaction with 'their area as a place to live'. BESSC items may prove to be valuable descriptors of the urban built environment in future studies.

Cohort Studies↗
PubMed2001

Social roles and the gender difference in rates of the common mental disorders in Britain: a 7-year, population-based cohort study.

BACKGROUND: It is not known why the most common mental disorders (CMD), anxiety and depression, are more prevalent among women. This gradient has not been explained by differences in the number or type of social roles occupied by men and women. Given the dearth of longitudinal studies, these negative findings could reflect reverse causality, if men with CMD relinquish social roles more readily than women. METHODS: Cohort study using data from the first seven (annual) waves of the British Household Panel Survey. The prevalence of CMD was assessed using the General Health Questionnaire (GHQ), 12 months after ascertaining occupancy of five social roles. Of 12379 participants aged 16-70, 9947 completed the GHQ on at least two consecutive occasions, resulting in 44139 paired observations. Random effects models adjusted for the correlation of repeated measures and for baseline GHQ score. RESULTS: The odds ratio for the gender difference in the future prevalence of CMD (adjusted for baseline GHQ score) was 192 (95% CI 1.75-2.10). Neither the number or type of social roles occupied, nor socio-economic status explained the gender difference in these conditions (adjusted OR 182, 95% CI 1.66-1.99). While CMD at baseline was associated with a subsequent reduction in social role occupancy, this did not vary between men and women. CONCLUSIONS: Gender differences in CMD were not explained by differences in the number or type of social roles occupied by men and women, or by reverse causality. Future studies should consider characteristics of social roles, such as demand, control and reward.

Cohort Studies↗
PubMed2001

Income inequality and the prevalence of common mental disorders in Britain.

BACKGROUND: It has been hypothesised that the association between greater income inequality and increased mortality is mediated by poor psychosocial health. AIMS: To test the hypothesis that individuals in regions of Britain with the highest income inequality have a higher prevalence of the common mental disorders, after adjusting for individual income. METHOD: Cross-sectional survey of 8191 adults aged 16-75 in private households in England, Wales and Scotland. The prevalence of common mental disorders was assessed using the General Health Questionnaire. RESULTS: The association between income inequality and prevalence of the common mental disorders varied with individual income level. Among persons with the highest incomes, common mental disorders were more frequent in regions with greater income inequality (as indicated by high Gini coefficient) (adjusted OR 1.31,95% C1 1.05-1.65; P: = 0.02). The opposite was true for those with the lowest incomes. CONCLUSIONS: Income inequality was associated with worse mental health among the most affluent individuals.

Adolescent↗
PubMed1998

Poverty, unemployment, and common mental disorders: population based cohort study.

OBJECTIVE: To determine whether poverty and unemployment increase the likelihood of or delay recovery from common mental disorders, and whether these associations could be explained by subjective financial strain. DESIGN: Prospective cohort study. SETTING: England, Wales, and Scotland. SUBJECTS: 7726 adults aged 16-75 living in private households. MAIN OUTCOME MEASURES: Common mental disorders were assessed using the general health questionnaire, a self assessed measure of psychiatric morbidity. RESULTS: Poverty and unemployment (odds ratio 1.86, 95% confidence interval 1.18 to 2.94) were associated with the maintenance but not onset of episodes of common mental disorders. Associations between poverty and employment and maintenance of common mental disorders, however, were much smaller than those of cross sectional studies. Financial strain at baseline was independently associated with both onset (1.57, 1.19 to 2.07) and maintenance (1.86, 1.36 to 2.53) even after adjusting for objective indices of standard of living. CONCLUSIONS: Poverty and unemployment increased the duration of episodes of common mental disorders but not the likelihood of their onset. Financial strain was a better predictor of future psychiatric morbidity than either of these more objective risk factors though the nature of this risk factor and its relation with poverty and unemployment remain unclear.

Adolescent↗
PubMed1998

The comparison of latent variable models of non-psychotic psychiatric morbidity in four culturally diverse populations.

BACKGROUND: Factor analysis has been employed to identify latent variables that are unifying constructs and that parsimoniously describe correlations among a related group of variables. Confirmatory factor analysis is used to test hypothesized factor structures for a set of variables; it can also, as in this paper be used to model data from two or more groups simultaneously to determine whether they have the same factor structure. METHOD: Non-psychotic psychiatric morbidity, elicited by the Revised Clinical Interview Schedule (CIS-R), from four culturally diverse populations was compared. Confirmatory factor analysis was employed to compare the factor structures of CIS-R data sets from Santiago, Harare, Rotherhithe and Ealing. These structures were compared with hypothetical one and two factor (depression-anxiety) models. RESULTS: The models fitted well with the different data sets. The depression-anxiety model was marginally superior to the one factor model as judged by various statistical measures of fit. The two factors in depression-anxiety model were, however, highly correlated. CONCLUSIONS: The findings suggest that symptoms of emotional distress seem to have the same factor structure across cultures.

Adolescent↗
PubMed1998

HIV-associated brain pathology: a comparative international study.

Little is known about the frequency and variation of HIV-associated brain pathology in different geographical centres. To assess whether there is an association between the frequency of disease and demographic factors we examined the neuropathological findings in four European and two American cities. The cities included London, Edinburgh, Paris, Budapest, Baltimore and Newark. Information was collected on a total of 1144 cases. HIV encephalitis was the most common observation in all the centres. although its frequency varied between them (P < 0.01). Furthermore, there were significant differences (P < 0.001) between the various categories of exposure and the frequency of HIV encephalitis in Edinburgh and other centres. The occurrence of toxoplasmosis, progressive multifocal leukoencephalolpathy (PML) and cryptococcal infection also differed between the various centres (P < 0.01). None of the findings was attributable to age, sex, or ethnic origin, but the introduction of anti-retroviral treatment, such as Zidovudine, may have been important. Overall, this study highlights geographical variability and the potential importance for group of exposure and anti-retroviral medication as factors affecting the development of various HIV-associated brain lesions.

AIDS Dementia Complex↗
PubMed1998

Material standard of living, social class, and the prevalence of the common mental disorders in Great Britain.

STUDY OBJECTIVE: To test the hypothesis that poor material standard of living is independently associated with the prevalence of the common mental disorders after adjusting for occupational social class, and to estimate the population impact of poor material standard of living on the prevalence of these disorders. DESIGN: Cross sectional survey. Prevalence of the common mental disorders was assessed using the General Health Questionnaire, a self administered measure of psychiatric morbidity. PARTICIPANTS: 9064 adults aged 16-75 living in private households in England, Wales, and Scotland. MAIN RESULTS: The common mental disorders were significantly associated with poor material standard of living, including low household income (OR 1.24, 95% CI 1.00, 1.54) and not saving from income (OR 1.29, 95% CI 1.15, 1.45), after adjusting for occupational social class and other potential confounders. An independent association was also found with occupational social class of the head of household among women, but not men, after adjusting for material standard of living. The adjusted population attributable fraction for poor material standard of living (using a five item index) was 24.0%. CONCLUSIONS: Like mortality and physical morbidity, common mental disorders are associated with a poor material standard of living, independent of occupational social class. These findings support the view that recent widening of inequalities in material standards of living in the United Kingdom pose a substantial threat to health.

Adolescent↗
PubMed1998

Social roles and gender difference in the prevalence of common mental disorders.

BACKGROUND: It is not known why the most common mental disorders, anxiety and depression, are more prevalent among women then men. The aim was to test the hypothesis that this gender difference could be explained by differences between men and women in social role occupancy, after adjusting for age and socio-economic status. METHOD: A cross-sectional survey of 8979 adults aged 16-74 years living in private households in England, Wales and Scotland was carried out. Prevalence of common mental disorders was assessed using the General Health Questionnaire. RESULTS: The gender difference in the prevalence of the common mental disorders (unlike social role occupancy) did not vary with age to a statistically significant degree (unadjusted odds ratio 1.35, 95% CI 1.23-1.48) (P < 0.0001). Although those of either gender occupying the fewest, and women occupying the most social roles (after adjusting for age) had the highest prevalence of common mental disorders, neither number of social roles, occupancy of traditional 'female' caring and domestic roles, nor socio-economic status explained the gender difference in these conditions (adjusted OR 1.26, 95% CI 1.14-1.41) (P < 0.001). CONCLUSIONS: The gender difference in the prevalence of the common mental disorders is not explained by differences between men and women in the number or type of social roles occupied.

Adolescent↗
PubMed1997

HIV-associated brain pathology in the United Kingdom: an epidemiological study.

OBJECTIVES: To examine the epidemiology of HIV-associated neuropathology in the United Kingdom and to investigate whether the prevalence of different forms of HIV-associated brain pathology varies with exposure category. DESIGN: The study was a cross-sectional survey; data was analysed from the Medical Research Council National AIDS Neuropathology database. SETTING: Information was gathered from throughout England, Scotland and Wales. SUBJECTS: Individuals who died from AIDS in the United Kingdom and had a postmortem examination. The database comprised 7% of all AIDS deaths in the United Kingdom between 1982 and 1993. MAIN OUTCOME: Neuropathological diagnoses based on internationally accepted neuropathological terminology of AIDS-related brain lesions. RESULTS: HIV encephalitis was the most prevalent pathological diagnosis, occurring in 25.3% [95% confidence interval (CI), 21.0-29.6] of the study sample. Statistically significant independent associations for the occurrence of HIV encephalitis were found for injecting drug use (odds ratio, 6.86; 95% CI, 2.91-16.17), and age less than 30 years at death (odds ratio, 3.58; 95% CI, 1.99-6.44). Vascular lesions were significantly higher among blood product recipients, 95% of whom were haemophiliacs. CONCLUSIONS: This was the first epidemiological investigation of HIV-associated brain pathology in the United Kingdom. HIV encephalitis appeared to occur more frequently in injecting drug users and those who died younger. Whereas the findings must be interpreted cautiously, one hypothesis was that differences in the route of transmission may have affected the manifestation of HIV-associated brain damage.

AIDS Dementia Complex↗
PubMed1997

Do socio-economic risk factors predict the incidence and maintenance of psychiatric disorder in primary care?

In a prospective cohort study of consecutive primary care attenders in south London, the estimated prevalence of non-psychotic psychiatric disorder was 45.6%, using the Revised Clinical Interview Schedule (CIS-R). The estimated 12-month incidence rate was 15.7%. Extremely high stability was found in CIS-R scores over 12 months (r = 0.65) and 68.8% of cases at baseline were also cases 12 months later. A clear difference emerged in the types of risk factor which were associated with the incidence and maintenance of disorder in the study population: while socio-economic variables, especially low household income and not having a partner were associated with a worse outcome among prevalent cases at baseline, such variables were only weakly associated with the incidence of psychiatric disorder after adjusting for potential confounders. The latter, notably family psychiatric history and the severity of psychiatric symptoms at baseline were independently associated with the incidence of psychiatric disorder after adjusting for other risk factors, including measures of previous psychiatric disorder.

Adolescent↗
PubMed1997

Strategies for the prevention of psychiatric disorder in primary care in south London.

STUDY OBJECTIVE: To compare the potential impact of high risk and population based approaches to the prevention of psychiatric disorder, using a representative sample of general practice attenders as the target population. DESIGN: This was a prospective cohort study. SETTING: A health centre in south London. PARTICIPANTS: Three hundred and seven consecutive attenders aged 16-65, recruited at randomly selected general practice surgeries. MAIN RESULTS: A linear association was found between the number of different types of socioeconomic adversity reported at recruitment (T1) and the prevalence of psychiatric disorder one year later (T2). The population attributable fraction (PAF) for socioeconomic adversity at T1 was 37.4%. In theory, social interventions for high risk individuals at T1 would reduce the prevalence of psychiatric disorder at T2 by 9% at most, compared with a reduction of 18% if just one item of socioeconomic adversity were eliminated among those with any socioeconomic risk factors. CONCLUSIONS: Social interventions targeted at individuals at highest risk of the most common mental disorders are likely to be extremely limited in their capacity to reduce the prevalence of these conditions. A population based risk reduction strategy, modified according to individual risk, represents a potentially feasible and effective alternative.

Adolescent↗
PubMed1996

Mental health care costs: paucity of measurement.

For an evaluation of a mental health care programme to be comprehensive, it should include an economic component. However, very few cost instruments appear to exist, and only one has been fully described in the literature. This paper seeks to review the studies where costs have been calculated. For this exercise to be facilitated the different elements which make up overall cost are described. A number of areas have experienced economic evaluations, and the more important studies are described. The paper concludes that all too often evaluations either fail to measure costs or do so in an incomplete and inappropriate way.

Costs and Cost Analysis↗
PubMed1996

Centromere and telomere movements during early meiotic prophase of mouse and man are associated with the onset of chromosome pairing.

The preconditions and early steps of meiotic chromosome pairing were studied by fluorescence in situ hybridization (FISH) with chromosome-specific DNA probes to mouse and human testis tissue sections. Premeiotic pairing of homologous chromosomes was not detected in spermatogonia of the two species. FISH with centromere- and telomere-specific DNA probes in combination with immunostaining (IS) of synaptonemal complex (SC) proteins to testis sections of prepuberal mice at days 4-12 post partum was performed to study sequentially the meiotic pairing process. Movements of centromeres and then telomeres to the nuclear envelope, and of telomeres along the nuclear envelope leading to the formation of a chromosomal bouquet were detected during mouse prophase. At the bouquet stage, pairing of a mouse chromosome-8-specific probe was observed. SC-IS and simultaneous telomere FISH revealed that axial element proteins appear as large aggregates in mouse meiocytes when telomeres are attached to the nuclear envelope. Axial element formation initiates during tight telomere clustering and transverse filament-IS indicated the initiation of synapsis during this stage. Comparison of telomere and centromere distribution patterns of mouse and human meiocytes revealed movements of centromeres and then telomeres to the nuclear envelope and subsequent bouquet formation as conserved motifs of the pairing process. Chromosome painting in human spermatogonia revealed compacted, largely mutually exclusive chromosome territories. The territories developed into long, thin threads at the onset of meiotic prophase. Based on these results a unified model of the pairing process is proposed.

Animals↗
PubMed1996

Effect of early life experiences and personality on the reporting of psychosocial distress in general practice. A preliminary investigation.

BACKGROUND: About 25% of primary care attenders are 'somatic presenters'; individuals consulting for physically-attributed somatic symptoms in the presence of psychiatric morbidity. We tested the hypothesis that somatic presenters differed from psychological presenters on measures of personality ad childhood experience. METHOD: Case-control study of 'psychological presenter' and 'somatic presenters'. RESULTS: Psychological presenter reported significantly greater insecurity in intimate relationships, and recalled their fathers as significantly less caring and more over-protective, than somatic presenters. These difference remained after adjusting for differences in the severity and duration of psychiatric symptoms. CONCLUSIONS: Personality and childhood experiences may be associated with specific types of adult illness behaviour, independent of associations with the prevalence of psychiatric disorder.

Adolescent↗