Social origins of depression: a reply

Many of the criticisms of our work made by Tennant & Bebbington in the current edition of this journal touch on issues which have already been discussed in our recent book Social Origins of Depression. We do not think that any of their points pose significant threats to our aetiological model of depression. We welcome this opportunity to clarify their questions about our data, and to use their re-analysis of our material as a basis for a wider discussion of certain general aspects of the statistical analysis and interpretation of data and the pitfalls which await the unwary.

Further studies on interviewer training and inter-rater reliability of the Present State Examination (PSE)

The Present State Examination (PSE) is discussed with regard to its use in surveys of subjects who are not psychiatric patients. Although the PSE was originally developed for use by psychiatrists with patients with obvious mental illness, the interview also contains sections dealing in considerable detail with the commoner and less severe complaints and symptoms that are found in a significant proportion of 'normal subjects'. A shortened version of the PSE (8th edition) is described, limited to these sections, which has been used in population surveys, by interviewers who are not psychiatrists, The training of such interviewers is described, and information on a reliability and repeatability study is presented. This shows that with proper training, non-psychiatric interviewers can achieve standards of inter-rater reliability that are comparable to those previously reported between psychiatrists.

Depression and loss

Recent losses occurring in the two years before onset of depression in women are distinguished from past losses occurring at any time before this. Of past losses only loss of mother before II is associated with greater risk of depression--both among women treated by psychiatrists and among women found to be suffering from depression in a random sample of 458 women living in London. Past loss of a father or sibling before 17 (or a mother between II and 17), or a child or husband, is not associated with a greater chance of developing depression. However, among patients all types of past loss by death are associated with psychotic-like depressive symptoms (and their severity) and other types of past loss with neurotic-type depressive symptoms (and their severity). It is argued that these associations probably reflect direct causal links, and a sociopsychological theory to explain them is discussed.

A Contribution to the Pathological Anatomy of Pneumonokoniosis (Chalicosis pulmonum)

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