Based on the Psychiatric morbidity survey for England, Scotland and Wales carried out in 2000 (Singleton et al 2000)

11.1 Introduction

The survey of psychiatric morbidity among adults in private households was carried out in 2000 by the Office for National Statistics on behalf of the Department of Health, the Scottish Executive and the National Assembly for Wales. It is part of a series of such surveys among different population groups and is a repeat of the first survey in the series which was carried out in 1993.

The aims of the survey were to:

• estimate the prevalence of psychiatric morbidity according to diagnostic category among the adult household population of Great Britain;
• examine the varying use of services and receipt of care in relation to mental disorder;
• identify the nature and extent of disability associated with mental disorder;
• establish key current and lifetime factors which may be associated with mental disorder; and
• to provide information on changes in the prevalence of disorder and related factors between 1993 and 2000.

In this chapter we take the estimates of prevalence of psychiatric morbidity from the survey by age, sex and ethnicity and apply them to the populations of local authority areas in the West Midlands to give an estimate of the likely numbers and overall rates of various disorders in these areas.

The survey gives prevalence estimates of neurotic symptoms, neurotic disorders, personality disorders and overall prevalence of probable psychotic disorder in the adult population (aged 16-74).

11.2 Neurotic Symptoms

There are fourteen neurotic symptoms examined in the survey:

• Sleep problems
• Fatigue
• Irritability
• Worry
• Depression
• Concentration & forgetfulness
• Depressive ideas
• Anxiety
• Somatic symptoms
• Worry-Physical health
• Obsessions
• Phobias
• Compulsions
• Panic
  

These fourteen symptoms can then be aggregated to a composite measure called the CIS-R score (Lewis, Pelosi, 1990), (Lewis et al 1992) (the Revised Clinical Interview Schedule). The total score ranges from zero to 57, with a score of 12 or more indicating significant levels of neurotic symptoms and one of 18 or more being a level likely to require treatment

11.3 Neurotic Disorders

Six neurotic disorders are included in the survey:

• Mixed anxiety & depressive disorder
• Generalised anxiety disorder
• Depressive episode
• All phobias
• Obsessive compulsive disorder
• Panic disorder
• Any neurotic disorder
  
  

Diagnoses are obtained by looking at the answers to various sections of the CIS-R and applying algorithms based on the ICD-10 diagnostic criteria for research (World Health Organisation,1992). An individual may appear in more than one category of neurotic disorder.  Prevalence rates are shown as rates per 1,000 of the population in the past week, that is, where the respondent experienced symptoms of the disorder during the week before interview.

11.4 Personality Disorders

The prevalence rates presented here are based on the results of the second-stage SCID-II clinical interviews, which were undertaken by a sub-sample of the people who took part in the initial stage of the survey. The data from this sub-sample have been weighted to take into account non-response at both interview stages and the different sampling fractions used when selecting people for the second stage interviews. Because the prevalence is based on a sub-sample of only 626 interviews, prevalence rates are shown broken down by sex and broad age bands only and not by ethnic group or region. The disorders for which prevalence estimates were measured are:

• Obsessive-Compulsive
• Avoidant
• Schizoid
• Paranoid
• Borderline
• Antisocial
• Dependent
• Schizotypal
• Histrionic
• Narcissistic
• Any personality disorder

11.5 Synthetic Estimates

Synthetic estimates are estimates that have been derived from rates of one population applied to the population structure of another. In this chapter we have taken rates from a national survey and apply the age-sex and ethnicity-sex specific rates to the populations of the local authorities in West Midlands from the 2001 Census.

Synthetic estimates are useful where no other data exists on a particular subject at a local level. However they are useful only for certain purposes. They give an idea of the sort of numbers of people with conditions or factors in a local area, not a comparative performance measure. Therefore they can be used when planning the provision of services to help inform the level of provision likely to be required. However they should not be used for monitoring purposes as they merely reflect the local population mix, not the actual position locally, which will vary, especially if an intervention has been put in place.

They can also be useful in comparing to other sources of the same information as a quality control. For example, if a local survey suggests there is only 10% of the number of people with neurotic disorders as is suggested by the synthetic estimate, it may indicate an undercount from the survey.

11.6 Tables included in this publication and on the accompanying CD

Tables shown in bold are included in both the printed document and on the accompanying CD. The tables in the light font are included only on the CD.

Table 11. 1.1    Estimated Prevalence of Neurotic Symptoms in Men by local authority
Percentage of Total Population Aged 16-74

Table 11. 1.2    Estimated Prevalence of Neurotic Symptoms in Women by local authority
Percentage of Total Population Aged 16-74

Table 11. 2.1    Prevalence of neurotic symptoms in Men by local authority (numbers)

Table 11. 2.2    Prevalence of neurotic symptoms in the Women by local authority (numbers)

Table 11. 3        Prevalence of neurotic symptoms in the adult population by local authority and age (numbers)

Table11. 4         Prevalence of neurotic symptoms in the adult population by local authority and ethnicity (numbers)

Table 11.5          CIS-R scores in the adult population by local authority and gender (rates)

Table 11. 6          CIS-R scores in the adult population by local authority and gender (numbers)

Table 11.7          CIS-R scores in the adult population by local authority and age (numbers)

Table 11. 8          CIS-R scores in the adult population by local authority and ethnicity (numbers)

Table 11. 9       Prevalence of neurotic disorders in the adult population by local authority and gender (rates)

Table 11.10      Prevalence of neurotic disorders in the adult population by local authority and gender (numbers)

Table 11.11          Prevalence of neurotic disorders in the adult population by local authority and age (numbers)

Table 11.12       Prevalence of neurotic disorders in the adult population by local authority and ethnicity (numbers)

Table 11.13.1   Prevalence of personality disorders in Men by local authority (rates)

Table 11.13.2   Prevalence of personality disorders in Women by local authority (rates)

Table 11.14.1  Prevalence of personality disorders in Men by local authority (numbers)

Table 11. 14.2  Prevalence of personality disorders in Women by local authority (numbers)

Table 11.15       Prevalence of personality disorders in the adult population by local authority and age (numbers)

Table 11.16      Prevalence of probable psychotic disorder in the adult population by local authority and gender (rates & numbers)

Table 11.01.01 –            Estimated Prevalence of Neurotic Symptoms in Men by Local Authority. Percentage of Total Population Aged 16-74

Table 11.01.02: Estimated Prevalence of Neurotic Symptoms in Women by Local Authority. Percentage of Total Population Aged 16-74

Table 11.02.01: Estimated Prevalence of Neurotic Symptoms in Men by Local Authority Number Aged 16-74

Table 11.02.02: Estimated Prevalence of Neurotic Symptoms in Women by Local Authority Number Aged 16-74

Table 11.05: Estimated Prevalence of CIS-R Scores in Men & Women by Local Authority Percentage of Total Population Aged 16-74

Table 11.06: Estimated Prevalence of CIS-R Scores in Men & Women by Local Authority Number Aged 16-74

Table 11.09: Estimated Prevalence of Neurotic Disorders in Men & Women by Local Authority Percentage of Total Population Aged 16-74

Table 11.10: Estimated Prevalence of Neurotic Disorders in Men & Women by Local Authority Number Aged 16-74

Table 11.13.01: Estimated Prevalence of Personality Disorders in Men by Local Authority Percentage of Total Population Aged 16-74

Table 11.13.02: Estimated Prevalence of Personality Disorders in Women by Local Authority Percentage of Total Population Aged 16-74

Table 11.14.01 Estimated Prevalence of Personality Disorders in Men by Local Authority Number Aged 16-74

Table 11.14.02: Estimated Prevalence of Personality Disorders in Women by Local Authority Number Aged 16-74

Table 11.16: Estimated Prevalence of Probable Psychotic disorder in Men & Women by Local Authority Percentage and Nuamber Aged 16-74

References

Singleton N, Bumpstead R, O’Brien M, Lee A, Meltzer H. (2004) Psychiatric morbidity among adults living in private households, 2000, TSO: London

Lewis G, and Pelosi AJ. (1990) Manual of the revised clinical interview schedule (CIS-R), Institute of Psychiatry: London

Lewis G, Pelosi AJ, Araya RC, and Dunn G. (1992) Measuring psychiatric disorder in the community: a standardised instrument for use by lay interviewers, Psychological Medicine, 22, 465–486