Aim – To describe the rationale for introducing molecular genetic analyses to psychiatric epidemiology. This offers new possibilities for aetiological research on common mental disorders. Method – In addition to the traditional variables used in field surveys, it is now possible to include molecular genetic information. This is currently done by looking for allelic associations rather than by linkage analysis, and can be directed either at traits conferring susceptibility or at states. The purpose is to identify quantitative trait loci (QTLs) by examining candidate genes. An alternative strategy is genome scanning, which can identify genes by their chromosomal position with increasing resolution. Results – Some associations have already been reported in the literature, linking personality traits with particular alleles: extraversion or novelty-seeking with a polymorphism of the dopamine DRD4 receptor gene; and neuroticism with a polymorphism of the serotonin transporter gene. Conclusions – These findings are of major interest, but cannot yet be looked upon as confirmed. What is significant for epidemiology is the opportunity to link behavioural and psychiatric variables with genes influencing biochemical and physiological processes in the brain, and to do so at the population level. For further allelic association studies, there are four principal requirements: valid measures of phenotypes; replication of findings across diverse populations; more candidate genes; and exploration of the interaction between genotype and environmental exposures from conception to late life. Through such research, psychiatric epidemiology can now investigate biopsychosocial phenomena.

Aims — To describe the mental health system in Albania. Methods — Data were gathered in 2003 and in 2004 using a new WHO instrument, World Health Organization Assessment Instrument for Mental health Systems (WHO-AIMS), designed for collecting essential information on the mental health system of low and middle income countries. It consists of 6 domains, 28 facets and 156 items. Results — The information collected through WHO AIMS covered the key aspects of mental health system in Albania: the mental health policy and the legislative framework, the network of mental health services and the characteristics of the users, the role of the primary health care, the human resources, the public education and the links with other governmental sectors, monitoring and research. Conclusions — The data collection through WHO AIMS represented a needed step for a better in-depth knowledge of the system and for implementing actions to strengthen the system. Examples of planned actions were the improvement of the mental health component in primary care, a clear shift of resources from mental hospitals to community facilities, an increase of the outpatient care and an expansion of the mental health information system.

Declaration of Interest: none.

Objective To compare the prevalence of psychological discomfort in four groups of young people of different social status (metalworkers exposed and not exposed to mental health occupational risks, individuals unemployed or seeking their first job and full-time students). The study also evaluates among the same groups, six years after, the changes in status and in the rates of psychological discomfort. Design – The subjects, selected through an appropriate random procedure, are males, aged between twenty and twenty-nine, resident in the same geographical area for at least 10 years and still living with their families. 157 young men were involved, divided into the following four groups: metalworkers exposed to mental health occupational risks (n° = 30); metalworkers «not exposed» (n° = 57); unemployed (n° = 40); full-time students (n° = 30).

The prevalence of psychological discomfort has been compared in the four groups; six years after, within 116 subjects participating in the follow-up study, the changes in status and in psychological discomfort have been examinated. Setting – The survey was conducted in Cento (Ferrara, Northern Italy), an area with a healthy local economy and a comparatively low unemployment rate. In 1987 and in 1993 all young men were interviewed at home, after telephone contact, by the same psychologist. Main outcome measures - In the 1987 survey, to each subject were administered a «Social Position and Health Schedule» (SPH) and a previously validated questionnaire, to determine the index of psychological discomfort (IDP).

Through the «Occupational Risk Questionnaire» (ORQ) the metalworkers were also divided into two groups (exposed and not exposed to mental health occupational risks).

In 1993 the participants in the follow-up completed the same «IDP-Questionnaire» and a «Social and Occupational Position Schedule» (SOP) to give detailed informations on both labour turn-over and/or shifts in social status over the six years period. Results – In the 1987 survey significantly higher frequencies and averages were found in the group of metalworkers exposed to mental health risks, while no statistically significant results were noted in the other groups, including the group of unemployed. The main finding of the follow-up study relates to those metalworkers who, in the follow-up period, have changed their manual job to another type of employment and whose score visa-vis psychological discomfort was better than the rest of the group. Our findings indicate also that those young men seeking their first job who had found employment during the follow-up period, experienced an increase in psychological discomfort. Conclusion The most interesting aspect of our survey seems to concern the relationships between occupational prospects and mental health among young men living in an area characterized by a healthy local economy. Further studies on the students and the unemployed (and their possible occupational outcomes) are however needed.

The management of a health system is a matter of economics and business administration because of the costs induced by goods and services delivered. Economics teaches us that the positive effects induced by competition in free markets cannot be expected in health care, which is a classic example of market failure from both demand and supply sides. The most sensible key concepts to refer for managing a health system are funding and provision. While the logical solution for the first variable is universal coverage through general taxation, the second one requires a deeper understanding. Integrated care is the modern approach that better supports the choice in favour of the public sector also for service provision. A major threat against this approach is dual practice legally allowed for health professionals, which inevitably raises financial conflicts of interest. An exclusive contract of employment for civil servants should be the sine qua non for providing public services effectively and efficiently. Integrated care is particularly important for long-term chronic illnesses associated with high levels of disability, such as neurodegenerative diseases and mental disorders, where the mix of health and social services needed can be very complex. Nowadays the growing number of community-dwelling patients with multiple physical and mental health needs is the major challenge for the European health systems. This happens also in public health systems, which should provide universal health coverage in principle, and the case of mental disorders is striking. In the light of this theoretical exercise, we strongly believe that a public National Health and Social Service should be the most indicated model for both funding and providing health and social care in modern societies. The big challenge of the common model of European health system here envisaged would be to limit the negative influences of politics and bureaucracy.

Objective - Assessment of the «duration» of interventions in community services, or rather, of the time between subsequent contacts in community psychiatric services in Lombardy in 1990. The Authors relate the «duration» either to the different professional positions and to some variables, like resources and activities, obtained by the Regional Psychiatric Information System. Design - Descriptive analysis of data stored in the computerized database of the Regional Psychiatric Information System. The «duration» has been calculated on the basis of the ratio between working hours delivered by community services and the number of contacts provided in 1990. After trimming the observations, the «duration» has been related to other variables such as structure, staff and activities. Setting - 52 Regional Psychiatric Unit in Lombardy whose catchment area includes 99 Local Sanitary Districts (USSL) for a total population of 7.600.000 inhabitants. Results - A strong variability of «duration» has come out in differents USSL and for different professional competences. The «duration» is reduced by the increase of patients admitted to the Service, by the number of interventions and by the number of rooms available in the Unit. On the other hand, considering the working hours as a variable, the relation is not linear. Conclusion - Even though this index doesn't concern the quality of interventions, it can represent an useful starting point to evaluate community services. The «duration» seems to be an useful quantitative index to delineate the efficiency of services or rather the capability to provide interventions, saving resources or to deliver as many interventions as possible with such resources.