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A technique for studying psychiatric morbidity in in-patient and out-patient series and in general population samples

  • J. K. Wing (a1)
Synopsis

Many surveys of general populations have suggested a high untreated psychiatric morbidity, variously referred to as mental illness, pre-clinical neurosis, minor neurosis, untreated depression, etc.

An Index of Definition of psychiatric disorders is described which incorporates cut-off points on the basis of symptoms rated in the Present State Examination. Eight degrees of definition are specified. At the ‘borderline disorder’ level and above, disorders are sufficiently well defined to apply the CATEGO program of clinical classification. This procedure enables in-patients, out-patients and samples of the general population to be compared.

Data from surveys in south-east London are presented in order to illustrate the technique. The main conclusion at this stage is that it is possible to identify, by strictly defined and repeatable procedures, a substantial proportion of people in the general population who have ‘borderline disorders’ that can be tentatively classified in terms of the ICD. Whether it is clinically useful to do so requires further investigation.

It is also suggested that techniques of this kind can be scientifically useful in comparing the level of morbidity in various populations, both referred and non-referred, and in testing theories concerned with the causes and treatment of various types of psychiatric disorders.

Copyright
COPYRIGHT: © Cambridge University Press 1977
Corresponding author
1Address for correspondence: Professor J. K. Wing, MRC Social Psychiatry Unit, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF.
References
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Brown, G. W., Bhrolchain, M. & Harris, T. (1975). Social class and psychiatric disturbance among women in an urban population. Sociology 9, 225–254.
Cooper, J. E., Kendell, R. E., Gurland, B. J., Sharpe, L., Copeland, J. R. M. & Simon, R. (1972). Psychiatric Diagnosis in New York and London, Maudsley Monograph no. 20. Oxford University Press: London.
Gleisner, J., Hewett, S. & Mann, S. (1972). Reasons for admission to hospital. In Evaluating a Community Psychiatric Service (ed. Wing, J. K. & Hailey, A. M.), pp. 199–220. Oxford University Press: London.
Goldberg, D. P. (1972). The Detection of Psychiatric Illness by Questionnaire. Oxford University Press: London.
Goldberg, D. P. (1974). Screening for disease: psychiatric disorders. Lancet iv, 1245–1247.
Goldberg, D. P., Cooper, B., Eastwood, M. R., Kedward, H. B. & Shepherd, M. (1970). A standardized psychiatric interview for use in community surveys. British Journal of Preventive and Social Medicine 24, 18–23.
Kendell, R. E., Everitt, B., Cooper, J. E., Sartorius, N. & David, M. E. (1968). Reliability of the Present State Examination. Social Psychiatry 3, 123–129.
Luria, R. E. & McHugh, P. R. (1974). Reliability and clinical utility of the ‘Wing’ Present State Examination. Archives of General Psychiatry 30, 866–871.
Shepherd, M., Cooper, B., Brown, A. C. & Kalton, G. W. (1966). Psychiatric Illness in General Practice. Oxford University Press: London.
Srole, L., Langner, T. S., Michael, S. T., Opler, M. K. & Rennie, T. A. C. (1962). Mental Health in the Metropolis: The Midtown Manhattan Study. McGraw-Hill: New York.
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Vaughn, C. & Leff, J. P. (1976). The influence of family and social factors on the course of psychiatric illness. British Journal of Psychiatry 129, 125–137.
Wing, J. K., Birley, J. L. T., Cooper, J. E., Graham, P. & Isaacs, A. (1967). Reliability of a procedure for measuring and classifying ‘Present Psychiatric State’. British Journal of Psychiatry 113, 499–575.
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974). The Description and Classification of Psychiatric Symptoms: An Instruction Manual for the PSE and Catego System. Cambridge University Press: London.
Wing, J. K. & Hailey, A. M. (eds.) (1972). Evaluating a Community Psychiatric Service. The Camberwell Register, 1964–1971. Oxford University Press: London.
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