Objectives - a) To investigate the factor structure of the 12-item General Health Questionnaire (GHQ-12) in a sample of 18-year-old males; b) to test the ability of the standardized factor scores in discriminating between subjects who were suffering from emotional disturbance according to the psychiatrist's ratings and those who were not. Design - A sample of 363 subjects was selected during the medical examination for military service and invited to fill in the GHQ-12 and to be independently interviewed by a psychiatrist. Completed data were available for 320 subjects (88% of the selected sample). Results - The unrotated factor matrix allowed for the identification of two principal components with eigenvalues greater than 1, jointly accounting for 46.7% of the variance in the data. The first component, on which each item of the questionnaire showed a positive coefficient, was interpreted as measuring the overall severity of psychiatric disorder among respondents. The second component was bipolar with «positive» items having positive coefficients and «negative» items having negative coefficients. These findings suggest that the GHQ can assess both the negative (symptoms) and positive (subjective well-being) aspects of mental health. After Vari- max rotation each item of the questionnaire loaded significantly on one factor only, except for item 12 whose loading was lower than 0.500 on both factors. Factor A contained the «negative» items of the GHQ-12 and was termed as «general dysphoria»; factor B included 5 of the 6 «positive» items and was termed as «well-being/social functioning». The best discrimination between «cases» and «non-cases» was offered by the standardized factor scores on the «general Epidemiologia e Psichiatria Sociale, 2, 3, 1993 dysphoria» factor; no advantage was gained by the combination of the scores on the two factors. Conclusions - A better understanding of the GHQ-12 factor structure might provide useful information along with that offered by a single severity score resulting from the simple adding of positive responses and improve the description of emotional disorders beyond the traditional distinction between «cases» and «non-cases».

Objective - This paper reports on acceptability and test-retest reliability of the Verona Expectations for Care Scale (VECS) and the Verona Service Satisfaction Scale (VSSS), two newly developed, multidimensional instruments which measure expectations and satisfaction with community-based psychiatric services (CPS) in patients and their relatives. Instruments - VECS and VSSS consist of various sections and include questions eliciting spontaneous answers and an 82-item multidimensional questionnaire on various aspects of clients' interaction with psychiatric services. Setting - The South-Verona community-based psychiatric service. Subiects - The patients were selected among those who, according to the South-Verona Psychiatric Case Register, were living with their families in the South-Verona catchment area and had had more than 18 contacts with the South-Verona CPS in the three years preceeding the interview. For each patient, the relative identified by professionals and patients as primarily involved in caring for the patient in the given period was asked to participate. Results - Acceptability of VECS and VSSS to subjects was good: most items were easily understood and all subjects cooperated and gave accurate evaluations. The test-retest reliability (1-2 weeks interval) of VECS and VSSS was good in patients and relatives both when considering item-by-item percentage agreement and Cohen's weighted kappa in each dimension. Conclusions - The findings presented in this paper demonstrate that it is possible to measure subjective aspects of the interaction with a psychiatric service such as expectations and satisfaction in an acceptable and reliable way and that VECS and VSSS have good performance in the psychometric properties studied.

Objective - This paper reports on sensitivity, and content validity of the Verona Expectations for Care Scale (VECS) and the Verona Service Satisfaction Scale (VSSS), two newly developed, multidimensional instruments which measure expectations and satisfaction with community-based psychiatric services (CPS) in patients and their rela- tives. Instruments - VECS and VSSS consist of various sections and include questions eliciting spontaneous answers and an 82-item multidimensional questionnaire on various aspects of clients' interaction with psychiatric services. Setting - The South-Verona community-based psychiatric service. Subiects - The patients were selected among those who, ac- cording to the South-Verona Psychiatric Case Register, were living with their families in the South-Verona catchment area and had had more than 18 contacts with the South-Verona CPS in the three years preceeding the interview. For each patient, the relative identified by professionals and patients as primarily involved in caring for the patient in the given period was asked to participate. Results - We demonstrated the higher sensitivity of VECS and VSSS question- naires compared to unstructured interviews in measuring service expectations and satisfaction and the higher sensitivity of a domain-specific measurement vs. an overall one. VECS and VSSS proved to be sensitive to variation both between groups and across dimensions. Content validity of the questionnaires, according to patients and relatives views, was very good; moreover we demonstrated that a key-characteristic of content validity is the questionnaire's multidimension- ality. Conclusions - The findings presented in this and in a companion paper demonstrate that it is possible to measure subjective aspects of the interaction with a psychiatric service such as expectations and satisfaction in an acceptable, reliable, sensitive and valid way and that VECS and VSSS have good psychometric properties.

Objective and Setting - The mortality of patients admitted to the General Hospital Psychiatric Ward of Pavia, Italy was studied for the period 1.1.1986-31.12.1991. Main outcome measures - Mortality was assessed using the standardized mortality ratio. The number of observed deaths was compared by sex, age group and cause of death with the number of expected deaths if the general population mortality of the same area were applied to our sample. Results - The result of this comparison was that the mortality through inpatients was three times higher than that of the general population. This overmortality has been observed with respect to natural causes of death as well as to unnatural causes. Particularly deaths from circulatory diseases, mental disorders and deaths by injuries and poisoning are overrepresented in both sexes.

Objective - To collect data on the interface between general practice and psychiatry in Southern Italy and to shed light on attitudes, opinions and behaviours of general practitioners regarding psychological/psychiatric problems. Design - Postal questionnaire survey on the management of patients with psychological/psychiatric problems and on its correlation with demographic and other professional characteristics of the partecipant physicians. Setting - General practices in Bari (a Southern Italy's town). Main outcome measures - Comparison between responders and total population using chi-square test and percentages of answers to the different questions. Results - 20% of practition- ers returned the questionnaire, with a significantly higher number of those who specialized than in the total population. Training activities in psychiatry, demanded by 94% of the sample practitioners, are quite regularly pursued by no more than 13% of them actually. 56% report a 10-30% psychiatric morbility in their practices. Only 19% do agree to regard law 180 as «a real advancement in psychiatric care». 53% use to refer to the pychiatrist less than 10% of their psychiatric patients (60% of these showing anxious-depressive symptoms). 25% of psychosomatic disorders are prescribed an antispasmodic drug while «cerebroactive» and «tonic» (non-specific) compounds are respectively used in 75 and 23% of cases of psychic fatigue and poor cognitive performance. Conclusions - The data obtained may be not easily applied to the general source population due to the low percentage of responders. According to the sample, the perception of the difficulties in the management of psychic disturbances (which are still very common in the everyday practice), the demand for larger opportunities of specific training and of co-operation with psychiatrists (differently from the presently poor interaction) and the need of a greater rationalization of pharmacological treatments seem worth being underlined.