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Biomedical subjects

T K Craig

Publications and source records attributed to T K Craig.

At least 19 recordsLinked to original sources
PubMed2000

Homeless youth in London: II. Accommodation, employment and health outcomes at 1 year.

BACKGROUND: While there is considerable evidence of a high prevalence of psychiatric disorder among homeless youth, much less is known about its long-term course or the impact it may have on accommodation outcomes. METHOD: A random sample of 161 homeless people 16-21 years of age were recruited from consecutive attendees at two of London's largest facilities for homeless young people. These young people were traced and re-interviewed a year later to examine accommodation, occupation and health outcomes. RESULTS: A total of 107 (67%) people were successfully re-interviewed. Psychiatric disorder was identified in 55% at follow up. Two thirds of those with a psychiatric disorder at index interview remained symptomatic at follow-up. Persistence of psychiatric disorder was associated with adverse childhood experiences and rough sleeping. Satisfactory accommodation outcomes were achieved by 45 subjects (42%). Better accommodation outcomes were associated with three variables measured at the index assessment: ethnic minority status; educational achievement; and, the presence of accommodation plans negotiated through a resettlement agency. While psychiatric disorder at index interview was not associated with accommodation outcome, persistent substance use in the follow-up year was associated with poor accommodation outcome. Over half of the young people had been involved in petty crime and just under a third had been convicted for more serious criminal activity. Offending and antisocial behaviour in the follow-up year were related to a history of conduct disorder, persistent substance abuse and poor accommodation outcomes. CONCLUSIONS: Young homeless people are characterized by multiple social and medical needs. Successful resettlement of this population may depend upon integrated services that address problems of persisting substance use and mental illness as well as the immediate housing need.

Adolescent↗
PubMed1998

Homeless youth in London: I. Childhood antecedents and psychiatric disorder.

BACKGROUND: There has been an increase in the numbers of homeless young people in Britain. Little is known of the health and social welfare needs of this population. METHOD: This case-control study compares a random sample of homeless people aged under 22 years recruited from consecutive attenders at two of London's largest facilities for homeless young people with a contemporaneous sample of domiciled young people recruited through general practice registration lists. The homeless and domiciled groups were compared on measures of childhood care, education and psychiatric disorder. RESULTS: One hundred and sixty-one homeless people (88% of those approached) and 107 domiciled subjects (60% of those approached) were interviewed. Sixty-nine per cent of homeless and a third of the domiciled subjects reported a childhood lacking in affection, with indifferent and often violent carers. Psychiatric disorder was identified in 62% of homeless respondents and a quarter of the domiciled population. A fifth of homeless and 5 domiciled respondents had attempted suicide in the previous year. Multivariate analysis suggest that childhood adversity, low educational attainment and the prior presence of psychiatric disorder all independently increase the likelihood of homelessness in a youthful population. CONCLUSIONS: The evidence presented in this paper supports the hypotheses that characterize the young homeless population as experiencing higher rates of childhood adversity and psychiatric disorder than their domiciled contemporaries. A tentative model is suggested whereby childhood experiences, educational attainment and the prior presence of psychiatric disorder all independently increase the likelihood of homelessness in a youthful population.

Adolescent↗
PubMed1994

The South London Somatisation Study. II. Influence of stressful life events, and secondary gain.

BACKGROUND: A study of the influence of life-event stress on the onset and course of acute somatisation in primary care. METHOD: Forty-four somatisers were compared with 11 subjects who had psychiatric disorder but complained only of psychological symptoms, 39 patients who had 'mixed' conditions involving independent physical and psychiatric illness, 90 patients who had physical illness, and 123 healthy members of the general population. RESULTS: Severely threatening life events were more common among all subjects with psychiatric disorder. A novel contextual rating of the potential of stressors to produce symptoms for 'secondary gain' was developed. In the 38 weeks before symptom onset, somatisers and psychologisers were more likely to have experienced at least one event which had this potential. Somatisers were also less likely to adopt neutralising coping efforts when faced with such a crisis. CONCLUSIONS: The likelihood of adopting neutralising efforts was closely related to the presence of a joint index of parental problems in care and exposure to physical illness in the subject's childhood. In a two-year follow-up, subsequent functional illnesses were also associated with experiences which had secondary-gain potential, and subjects with childhood risk factors continued to have higher rates of crises with secondary-gain potential and to fail to adopt neutralising coping strategies.

Adaptation, Psychological↗
PubMed1993

The South London Somatisation Study. I: Longitudinal course and the influence of early life experiences.

In a two-year longitudinal study, a two-stage screening procedure was used to identify subjects in primary care with emotional disorder presenting with a recent onset of physical symptoms and a comparison sample of patients presenting with physical symptoms only. Somatisers (n = 44) were defined as subjects who had an emotional disorder but who presented with physical symptoms that could not be attributed to organic disease. The course and outcome of these conditions were compared with those of pure emotional disorder (n = 11), pure physical disorder (n = 90) and 'mixed' conditions (n = 39). The physical symptoms of somatisers were less likely to improve and lagged behind those of the other groups, and 16 of these acute somatisers went on to develop chronic somatoform disorders. Among somatisers, changes in physical symptom levels throughout the follow-up closely mirrored changes in emotional arousal. Emotionally disordered subjects reported more instances of parental lack of care, but somatisers were also more likely than other groups to report parental physical illness and to have had more physical illness themselves in childhood. A logistic regression suggests that adult somatisation is best modelled by parental lack of care followed by childhood illness.

Adolescent↗
PubMed1991

The development of community mental health centres in the U.K.

This paper describes a survey of British Community Mental Health Centres (CMHCs). CMHCs are by far the most visible manifestation of the implementation of community mental health care policies of the 1980s. While these centres have demonstrated achievements in terms of accessibility, co-ordination and responsiveness to clients, they have also been bedevilled by ambiguity. The vast majority of CMHCs aim to serve the needs of all forms of mental illness within their catchment area, yet in practice, they have frequently failed to meet the needs of people with long term severe disorders and concentrate instead on providing assessment and counseling services for neurotic and transient situational disorders. It appears that this is a function of an early failure of multidisciplinary teams to delineate boundaries and priorities. If the British CMHC movement sharpens its focus and combines this with a determination to address the complexities involved in both rationing and enhancing choice, it could begin to improve upon rather than simply repeat the history of similar developments in America.

Community Mental Health Services↗
PubMed1991

The 1978 Italian mental health law--a personal evaluation: a review.

"The author discusses the sociopsychiatric consequences of the 1978 Italian mental health law. He also reviews the international scientific ideas that led up to it. The sociopolitical psychiatric views of the late Franco Basaglia, pioneer of the change in the mental health system of the Italian Republic, are described. Statistical reports and critical analyses are reported. Objective data, based on the author's personal experience as a practising psychiatrist in Rome, Italy, from 1969 to 1987, are given."

Activities of Daily Living↗
PubMed1989

Stress and relapse of breast cancer.

To elucidate the association between stressful life events and the development of cancer the influence of life stress on relapse in operable breast cancer was examined in matched pairs of women in a case-control study. Adverse life events and difficulties occurring during the postoperative disease free interval were recorded in 50 women who had developed their first recurrence of operable breast cancer and during equivalent follow up times in 50 women with operable breast cancer in remission. The cases and controls were matched for the main physical and pathological factors known to be prognostic in breast cancer and sociodemographic variables that influence the frequency of life events and difficulties. Severely threatening life events and difficulties were significantly associated with the first recurrence of breast cancer. The relative risk of relapse associated with severe life events was 5.67 (95% confidence interval 1.57 to 37.20), and the relative risk associated with severe difficulties was 4.75 (1.58 to 19.20). Life events and difficulties not rated as severe were not related to relapse. Experiencing a non-severe life event was associated with a relative risk of 2.0 (0.62 to 7.47), and experiencing a non-severe difficulty was associated with a relative risk of 1.13 (0.38 to 3.35). These results suggest a prognostic association between severe life stressors and recurrence of breast cancer, but a larger prospective study is needed for confirmation.

Adult↗
PubMed1988

General practitioner referrals to an ambulatory psychiatric service. The effects of establishing an ease of access service.

The effects of establishing an ease of access 'walk-in' service on General Practitioner referrals to the ambulatory services of a catchment area psychiatric service are outlined. The characteristics of the patients referred are described. GPs made immediate and sustained use of the walk-in service and its creation expanded use of the ambulatory services by an overall 50%. Individual GPs were found to use the ambulatory services disproportionately and to discriminate between their use of the walk-in service and the coexisting traditionally run outpatient clinic. The walk-in service also allowed patients to refer themselves; a policy which did not result in a flood of inappropriate referrals but enabled patients, already familiar with the service, to re-establish contact in times of distress. The findings are discussed in terms of the current growth of Community Mental Health Centres in the United Kingdom and their implications for GP/Psychiatric Service liaison.

Community Mental Health Centers↗
PubMed1986

Psychiatric cases in community studies: how important an issue?

Over the last 15 years the use of standardized clinical-type psychiatric interviews has been extended to the general population and we have a much better understanding of the extent of affective disorder and factors of aetiological importance. The surveys have revealed a worrying amount of affective disorder, of much the same order of severity as those treated in out-patient clinics, particularly among working-class women in inner-city areas. Relatively few are seen at any point by psychiatric services although half the conditions at any one point in time are chronic. Despite the increasing interest in this work relatively few studies have yet been published. The scientific status of the instruments and the generalizability of the current findings and some of their implications are discussed.

Community Mental Health Services↗
PubMed1985

The development of a short observation method for the study of the activity and contacts of old people in residential settings.

Data from a non-participant, 'event-sampling', direct observation study of 32 elderly persons in residential care were simplified and re-analysed, with the aim of developing a short, practical method of observation for use in research and training in residential care. A single, nominated hour's observation seemed to fit the data satisfactorily. This method, when applied to data from two newly observed contrasting samples, revealed the same important differences as had been found from a whole day's observation. A practical, short observation method thus emerged for use in research and training.

Activities of Daily Living↗
PubMed1985

Depression: distress or disease? Some epidemiological considerations.

Surveys using clinical-type interviews have documented a high rate of depression among working-class women, and this is discussed in the light of a recent survey in an inner-city area. While women with caseness of depression contacting a psychiatrist did not differ in number of core depressive symptoms from those who did, they did in certain characteristics that would make them worrying for a general practitioner to deal with. It is concluded that there is a considerable overlap in the severity of depressive conditions between those seen by psychiatrists and those defined as cases in population surveys; any differences that do exist may relate more to the way symptoms are expressed than to the severity of the depressive disorder as such.

Adolescent↗