Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-17T23:27:50.746Z Has data issue: false hasContentIssue false
  • English
  • Français

Hierarchical patterns in the distribution of psychiatric symptoms

Published online by Cambridge University Press:  09 July 2009

Elizabeth Sturt
Elizabeth Sturt*
Affiliation:
MRC Social Psychiatry Unit, Institute of Psychiatry, London
*
1 Address for correspondence: Dr E. Sturt, MRC Social Psychiatry Unit, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF.
Get access Rights & Permissions [Opens in a new window]

Synopsis

The occurrence of hierarchical patterns in the incidence of psychiatric symptoms in individual patients and community subjects is investigated. Data obtained from interviewing a sample of people from the population of Camberwell, south-east London, using the Present State Examination (PSE), were analysed as were similar data concerning three series of patients referred to different kinds of psychiatric service.

The population series showed that each of the common PSE symptoms tends to occur in association with other symptoms. Symptoms that are rarer in the general population are associated with the presence of many other symptoms or with other symptoms present to a severe degree. The rarer the symptom, the higher is the total symptom score indicated by its presence. The more indicative symptoms are also associated with a measure of social disability derived from the MRC Social Performance Schedule, which asks about serious problems in functioning in each of 8 role areas.

The implication of this study is that total symptom score is a valid measure of the current severity of the disorder. The hierarchy model of Foulds & Bedford (1975) is discussed and is shown to be a more specific formulation of the same idea.

Investigation of the referred series confirmed these conclusions. When compared with community subjects, patients tend to have a much higher total PSE score; they display symptoms which are very rare in the community; they tend to be disabled socially. However, they are less likely to fulfil the requirements of a specific formulation for the presence of minor symptoms. In particular, only about half of psychotic subjects display specific neurotic symptoms, although virtually every subject with ‘specific’ symptoms of some sort displayed non-specific neurotic symptoms.

Type
Research Article
Information
Psychological Medicine , Volume 11 , Issue 4 , November 1981 , pp. 783 - 794
Copyright
Copyright © Cambridge University Press 1981

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Bagshaw, V. E. (1977). A replication study of Foulds and and Bedford's hierarchical model of depression. British Journal of Psychiatry 131, 53–55.CrossRefGoogle ScholarPubMed
Bagshaw, V. E. & McPherson, F. M. (1978). The applicability of the Foulds and Bedford hierarchy model to mania and hypomania. British Journal of Psychiatry 132, 293–295.CrossRefGoogle Scholar
Bebbington, P., Hurry, J., Tennant, C., Sturt, E. & Wing, J. K. (1981). The epidemiology of mental disorders in Camberwell. Psychological Medicine 11, 561–579.CrossRefGoogle ScholarPubMed
Bedford, A. & Presley, A. S. (1978). Symptom patterns among chronic schizophrenic in-patients. British Journal of Psychiatry 133, 176–178.CrossRefGoogle ScholarPubMed
Cronbach, J. L. (1951). Coefficient alpha and the internal structure of tests. Psychometrika 16 (3), 297–334.CrossRefGoogle Scholar
Foulds, G. A. & Bedford, A. (1975). Hierarchy of classes of personal illness. Psychological Medicine 5, 181–192.CrossRefGoogle ScholarPubMed
Gibbons, J. S., Elliot, J., Urwin, P. & Gibbons, J. L. (1978). The urban environment and deliberate self-poisoning: trends in Southampton 1972–1977. Social Psychiatry 13, 159–166.CrossRefGoogle Scholar
Hirsch, S. R., Platt, S., Knights, A. & Weyman, A. (1979). Shortening hospital stay for psychiatric care: effect on patients and their families. British Medical Journal i, 442–446.CrossRefGoogle Scholar
Hurry, J. & Sturt, E. (1981). Social performance in a population sample: relation to psychiatric symptoms. In What is a Case? The Problem of Definition in Psychiatric Community Surveys (ed. Wing, J. K., Bebbington, P. E. and Robins, L.), pp. 202–213. Grant MacIntyre: London.Google Scholar
Hurry, J., Sturt, E., Bebbington, P. & Tennant, C. (1981 a). The relationship between social disability and sociodemographic factors in a community sample. (In preparation.)Google Scholar
Hurry, J., Bebbington, P. & Tennant, C. (1981 b). Psychiatric symptoms and social disablement as determinants of illness behaviour. (In preparation.)Google Scholar
Kendell, R. E. (1973). Psychiatric diagnoses; a study of how they are made. British Journal of Psychiatry 122, 437–445.CrossRefGoogle Scholar
Kendell, R. E. (1976). The classification of depressions: a review of contemporary confusion. British Journal of Psychiatry 129, 15–28.CrossRefGoogle ScholarPubMed
Maxwell, A. E. (1972). Difficulties in a dimensional description of symptomatology. British Journal of Psychiatry 121, 19–26.CrossRefGoogle Scholar
McPherson, F. M., Antram, M. C., Bagshaw, V. E. & Carmichael, S. K. (1977). A test of the hierarchical model of personal illness. British Journal of Psychiatry 131, 56–58.CrossRefGoogle ScholarPubMed
Sturt, E., Bebbington, P., Hurry, J. & Tennant, C. (1981). The Present State Examination used by interviewers from a Survey Agency: report from the MRC Camberwell Community Survey. Psychological Medicine 11, 185–192.CrossRefGoogle ScholarPubMed
Surtees, P. G. & Kendell, R. E. (1979). The hierarchy model of psychiatric symptomatology: an investigation based on Present State Examination ratings. British Journal of Psychiatry 135, 438–443.CrossRefGoogle ScholarPubMed
Wing, J. K. & Contractor, N. (1981). A hierarchical component in psychiatric diagnosis, (In preparation.)Google Scholar
Wing, J. K. & Sturt, E. (1978). The PSE-ID-CATEGO System: A Supplementary Manual. Institute of Psychiatry: London (Mimeo).Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974). Measurement and Classification of Psychiatric Symptoms. Cambridge University Press: Cambridge.Google Scholar
Wing, J. K., Mann, S. A., Leff, J. P. & Nixon, J. M. (1978). The concept of a case in psychiatric population surveys. Psychological Medicine 8, 203–217.CrossRefGoogle ScholarPubMed