This study was undertaken 6-7 months after the 1999 Athens earthquake with the aim of exploring the differences in post-traumatic stress disorder (PTSD), anxiety and depression symptoms between a group of children exposed to earthquake with a group of children not exposed to it, but with both groups potentially exposed to the same levels of post-earthquake adversities. The study included 2037 children, aged 9-17 years, who were assessed with self-completed questionnaires. The directly exposed group (N=1752) had significantly higher anxiety and PTSD scores than the indirectly exposed group (N=284), but no significant group differences were found in depression scores. Girls in both groups reported significantly more PTSD, anxiety and depressive symptoms than boys. Younger children reported significantly more PTSD and anxiety symptoms than the older ones. No significant interactions were found between direct exposure to earthquake, age group and gender. The severity of PTSD symptoms was most strongly predicted by greater perceived threat during the earthquake, whereas depression was most strongly predicted by the level of post-earthquake adversity. The severity of anxiety symptoms was most strongly predicted by female gender. These findings are discussed in relation to the need for screening and intervention following earthquake events.

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This paper describes a qualitative research study which compared accounts from interviews with families where difficulties had evolved into serious problems with those where an escalation into pathology has been avoided. These accounts confirm that family life is commonly seen to be problematic and stressful, particularly during transitional stages. Specifically, it appears that it is not simply the severity of the initial stresses and problems that distinguishes families, but the meanings that these evoke and the corresponding patterns of responses, especially the 'attempted solutions' that are set in motion. These responses, fuelled by external interventions, can launch families along pathological pathways. It is suggested that the meanings ascribed to difficulties and the ensuing responses are predominantly shaped and constrained by three factors: the dominant societally shared discourses of mental health and distress; the emotional resources and attachments of family members; and systemic interpersonal processes. Some therapeutic implications, especially the importance of assisting families to resist pathologizing processes are indicated.

Mental health promotion clinic funding was introduced with the new general practice 1990 contract and has been extensively used to fund counsellors and stress management clinics in primary care. This funding has been withdrawn. A postal survey was conducted on all 142 general practices in East Sussex in order to assess the impact of the introduction and withdrawal of mental health promotion clinic funding on the employment of counsellors and on stress management clinics. One hundred and forty practices participated and it was found that there was an increase from 33 to 70 counsellors employed and five to 36 stress management clinics run by January 1993. Many GPs did not know what would happen to their service and it was estimated that 44 (63%) of counsellors and 13 (36%) stress management clinics would be lost.