While mental health care is still considered in developing countries to be something of a luxury in the face of inadequate provisions for acute, life-threatening physical illness, in the ageing population of Europe it has become increasingly important. This is firstly due to the fact that medical care, while reducing the lethality of chronic disease, has had relatively little effect on its incidence. Health care providors thus face the dual problems of managing an increasing prevalence of physical dependancy in conjunction with the ethical and legal problems implied in assuming the decision-making functions of the individual. Mental illness also raises a number of secondary problems; persons with psychiatric disorders are at increased risk from death due to accidents and other causes, are at increased risk of physical and mental abuse and engender high rates of morbidity in care-givers. From an international survey of health priorities, the mental-health sub-committee of Euro-REVES established that the problems of senile dementia, schizophrenia, depression, suicide, mental retardation, substance abuse and chronic homelessness are presently the principal concerns of clinicians and health care providers.

Case detection of mental illness remains a significant problem. There have been significant advances in recent decades in our understanding of the biological mechanisms underlying mental disorder with genetic studies suggesting for example linkage for bipolar disorder on loci on chromosomes 6 and 11, for schizophrenia on chromosome 5, and for Alzheimer's disease on chromosomes 21, 19, 14 and 1. Research into neural systems have also pointed to cytoarchitectural changes in the limbic system and neurotransmitter deficits in depression, senile dementia and schizophrenia. Biological research in this area remains, however, both inconsistent and inconclusive. Meanwhile at a clinical level competing conceptualizations of mental illness and reliance on non-specific behavioural indicators of dysfunction have led to considerable disagreement at the levels of nosology, differential diagnosis and management. It is therefore not surprising that psychiatric illness in Europe is both underdiagnosed and undertreated. On the other hand comorbidity rates are probably over-estimated due to overlapping diagnostic systems that divide complex syndromes into multiple, highly correlated components.

The World Health Organization and the American Psychiatric Association have made significant contributions towards the standardization of nomenclature and diagnostic criteria through the development of international classification systems. As a result, studies applying these algorithms show greater consistency even across cultures. Attempts are also presently being made conjointly by the U.S. National Institute of Health and WHO to better adapt the International Classification of Impairments, Disabilities and Handicaps to the problems of mental illness. The development of cross-cultural population indicators of mental health such as Health Expectancies is now feasible provided workers in this area are prepared to adhere to these common classification systems. The second Euro-REVES conference to be held in London this year will courageously be devoted to mental health issues and the first results of mental health expectancy calculations will be presented along with an undoubtedly lively debate relating to study design, field instruments and calculation methods. We look forward to participation from persons working in all fields of mental health and from all those who care about the mind of Europe.

Karen Ritchie *

Carol Jagger **

* INSERM, Equipe vieillissement cognitif, Centre Val d'Aurelle, Parc Euromédecine

34298 Montpellier Cedex 5 , France

Tel: (33) 67 61 30 26 ; Fax: (33) 67 61 30 47

** University of Leicester, Dept Epidemiology and Public Health, 22-28 Princess Road West

LE1 6TP Leicester , United Kingdom

Tel: 44 (116) 252 32 11 ; Fax: 44 (116) 252 32 72; E-mail: mjh18@le.ac.uk

Sub-committee on Mental Health

A census of Mental Health Surveys

As part of the Euro-REVES project for harmonization of health expec-tancy calculations across Europe we are presently conducting a census of European Mental Health Studies. This covers both purely epidemio-logical studies and national Health Surveys containing mental health questions, conducted since 1980.

The census is organized by the Mental Health Sub-Committee of Euro-REVES, which aims, through consensus, and by developing and promoting calculations and instru-ments, to facilitate more cross-cultural comparison. The first step towards this is to find out the mental health priorities across Europe. The most common priorities for national mental health research indicated so far are dementia and depression, and although there is an enormous range of different instruments in use, certain ones such as Mini-Mental State Examination and Cambridge Examination for Mental Didorders of the Elderly are common all over Europe.

Details of 50 studies have been collected to date with a median size of 2,500 people and range from 100 to 25,000. The age ranges covered are birth to over 100, although most of the surveys concentrate on the over-65s. Twenty surveys were locally based, 13 were regionally based and 11 were national surveys. Twenty-six were longitudinal, with 12 cross-sectional and 5 containing elements of both. The results of this survey so far, combined with evidence from the recent Mental Health Sub-Committee meeting in Leiden, the Netherlands, show a good consensus on instruments in use. With this in mind we intend to produce an inventory of scales and symptoms/ADLs currently in use, compared across ICD-10 categories, as part of our aim to become a resource centre for cross-cultural comparison of mental health indicators, encouraging greater inter-national discussion and cooperation on this topic.

We would very much like to hear from other researchers with relevant studies, especially in Portugal, Italy, Finland, Greece and Austria. The questionnaire is two A4 sheets obtainable from Carol Jagger either by mail, by fax or by e-mail. (See address hereabove).

Carol Jagger,

Karen Ritchie

From: European J Public Health 1995;5:297

Dementia-free life expectancy calculations in Europe

Dementia-free life expectancy calcu-lations have already been made in three European countries, at a na-tional or local level, using compa-rable diagnostic criteria. The tables hereunder report the results of these calculations at ages 75 and 77, ages for which they are the most comparable. These results include severe and moderate dementia. The references of the original publications are given alongside the tables.

Dementia-free life expectancy calculations in Europe, at age 75

         Country                    Male                   Female         
                             LE    DemFLE    %      LE     DemFLE    %    
UK (Melton Mowbray), 1988   8,43    8,13    96,4  10,94    10,11    92,4  
Belgium, 1991               8,30    7,70    92,8  10,90     9,20    84,4  
Belgium (Flandre), 1991     8,49    7,86    92,6  11,06     9,37    84,7  

LE: Life expectancy; DemFLE: Dementia-free life expectancy, ie without severe or moderate dementia; %: DemFLE/ LE

Dementia-free life expectancy calculations in Europe, at age 77

         Country                    Male                  Female          
                             LE    DemFLE    %      LE    DemFLE     %    
France, 1988-1990           8,2      7,6    92,7   10,5     9,5    90,5   
France (Aquitaine),         8,3      7,7    92,5   10,7     9,7    90,9   
UK (Liverpool),             6,9      6,5    94,2   9,1      8,0    87,9   
UK (Cambridge),             7,4      6,5    87,8   9,6      8,6    89,6   
UK (Melton Mowbray), 1988   7,6      6,5    85,5   9,8      7,7    78,6   

LE: Life expectancy; DemFLE: Dementia-free life expectancy, ie without severe or moderate dementia; %: DemFLE/ LE

Bone MR, Bebbington AC, Jagger C, Morgan K, Nicolaas G. Health expectancy and its uses. London: HMSO, 1995. 90p.

Roelands M, Van Oyen H, Baro F. Dementia-free life expectancy in Belgium. European J Public Health 1994;4(1):33-37.

Roelands M, Van Oyen H. L'espérance de vie sans invalidité des personnes agées : une méthode de planning et de prise de décision dans le secteur des soins de santé. Bruxelles: Services Fédéraux des Affaires Scientifiques, Techniques et Culturelles, 1995. 142p.

Ritchie K, Robine JM, Letenneur L, Dartigues J. Dementia-free life expectancy in France. Am J Public Health 1994;84(2):232-236.

Ritchie K. International comparisons of dementia-free life expectancy: a critical review of the results obtained. In: Mathers C, McCallum J, Robine JM. Advances in health expectan-cies. Canberra: AIHW, 1994. p 271-279

2nd Euro-REVES meeting

The second Euro-REVES meeting will be held in London, at the Royal Society of Medicine, on 4-5 July 1996. It is organized by Carol Jagger and Karen Ritchie, for the Euro-REVES sub-committee on Mental Health. The central theme of the meeting is the application of health expectancies to the field of Mental Health with particular emphasis on international comparisons, problems of case detection, calculation methods and the potential uses of these indicators in the planning of health services. Additionally, time will be allowed in the programme for the presentation of other health expectancy calculations such as disability-free life expectancy. An optional meeting of the sub-committee on Research Design and Calculation Methods will be held on July 6th, in the morning, organized by Nicolas Brouard. It will be devoted to health expectancy calculations based on prevalence or incidence data.

Isabelle Romieu

Sub-committee on Policy relevance


As a joint activity of REVES and Euro-REVES, a discussion will be opened on Internet on selected topics of interest. This idea was launched at the last REVES meeting in Chicago. A closed, guided discussion will firstly be developed, followed by an open-discussion box. TNO Prevention and Health will organize the various discussions and manage its presentation. For each topic, experienced researchers from different parts of the world will be invited to write a discussion paper which will be distributed to discussion subscribers. The latter may send back comments. These comments will be organized into a final discussion paper that will be scheduled for a REVES and/or Euro-REVES meeting. Lois Verbrugge, University of Michigan and Trudy van den Bos, University of Amsterdam, have already accepted to prepare the first discussion paper which aims at selecting a limited number of global disability questions to enhance the possibilities for inter-national comparison of the occur-rence of disability and of the results of disability-free life expectancy calculations. The discussion will start in spring 1996 and we hope that a final proposal can be accepted by the REVES and Euro-REVES members during the REVES meeting in Rome in December 1996. A second discus-sion topic will be related to the achievement of consensus concerning the methodological question of multi-state life tables versus Sullivan's method based on longitudinal or cross-sectional data, and the conditions under which these methods can be used. The discussions will be open to members of REVES, Euro-REVES, the 'WHO/ CBS Consultation to develop common methods and instruments for Health Interview Surveys', people involved in the ICIDH revision and National Institutes of Statistics (NIS), and on request to others (to be accepted by the host). Members of these groups will soon receive further information. The discussion network has been given the name 'REVES-DREAM' (REVES Discussion on Relevance And Methodology). Anyone wishing to participate in the discussion is invited to subscribe to the discussion network by sending an E-mail message to majordomo@tno.nl including the words 'subscribe reves-dream'. Subscribers will receive a message of approval (for members of the three networks, this will be done automatically, but your subscription is necessary to get the right E-mail address).

London Meeting

During the London Euro-REVES Meeting, policy makers in the field of mental health working at a national level, will be invited to participate in the discussion. Lessons learnt so far from the experiences with the use of health expectancy results - until now mainly covering physical health - will be presented as a starting point for this discussion. This meeting aims to stimulate the application of health expectancy calculations in the field of mental health and help in selecting appropriate instruments for measuring mental health from Health Interview Surveys. It is also hoped that the ties with the more physically oriented members of Euro-REVES will be promoted. It is the aim of Euro-REVES to ensure adequate coverage of the full spectrum of health from physical to mental aspects.

Second meeting of the sub-committee Policy Relevance

A second meeting of the sub-com-mittee Policy Relevance and Concep-tual Harmonization will be held during the REVES meeting in Rome in December 1996, in order to promote fruitful discussion between REVES and Euro-REVES members. Both groups confront similar (methodological) problems. All members of the sub-committee are invited to participate in this meeting. It is intended to organize one or two small seminars and a debate around a prepared paper with a view to achieving consensus. The preparation of this document is described in the section above (REVES-DREAM).

Harry P.A. van de Water

TNO Prevention and Health, P.O.Box 2215, 2301 CE Leiden, The Netherlands

Tel: +31 71 5181 778, Fax: +31 71 5181 920


Euro-REVES Info... Euro-REVES Info... Euro-REVES Info... Euro-REVES Info... Euro-Rev

9th REVES meeting

This year, the annual appointment with the International REVES Meeting will be in Europe.

In keeping with the REVES resolution to organise a meeting in Europe, every three years, taking turns with Asia and America, after Chicago and before Tokyo, the 9th meeting of the International Network on Health Expectancy will take place in Rome, from December 11 to 13, 1996.

The meeting will be organised by ISTAT (Italian National Statistics Institute) under the direction of Prof. V Egidi, and will address the theme: "Towards an integrated system of indicators to assess the health status of the population".

The scientific committee of REVES 9 is composed of the present host (V Egidi, ISTAT), the host of the previous REVES meeting (SJ Olshansky, University of Chicago), the coordinator of the network (JM Robine, INSERM) and two experts (A Golini, IRP Italy, and G Wunsch, Université Catholique de Louvain).

This meeting, besides providing the opportunity to expand the Network and to explore some issues that were not addressed in the previous meetings, will strongly focus on the necessity of constructing a unitary framework, in order to assess population's health status with the use of: (i) data sources integration methods; (ii) data processing integration and harmoni-sation; (iii) constructing a system of indicators which will be able to describe the various aspects of population health status.

Considerable discussion is expected on various topics, such as the multi-dimensionality of "health concepts", improvement of measures of health status, international harmonisation, information systems for an ageing society and policy relevance of health indicators.

As in previous meetings all presentations at REVES 9 will be scheduled to take place in a plenary session format.

Persons interested in participating are requested to contact the organisation (see address below)

Viviana Egidi


Direzione Centrale delle Statistiche su Popolazione e Territorio

Via Ravà 150

I-00142 Roma, Italy

Phone: +39-6-594 30 06

Fax: +39-6-594 32 57


Recent publications

Regidor E, Rodriguez C, Gutiérrez-Fisac JL. Indicatores de Salud. Tercera evaluacion en Espagna del Programa Regional europeo Salud para todos. Madrid: Ministerio de Sanidad y Consumo, 1995. 387p.

New calculations of healthy life expectancy and disability-free life expectancy calculations for Spain and autonomous communities.

de Bruin A, Picavet HSJ, Nossikov A (Eds). Health Interview surveys: towards international harmonization of methods and instruments. WHO/NCBS, 1996. (WHO Regional Publications, European Series, ndeg.58)

Editor: Jean-Marie Robine

Editorial staff: Isabelle Romieu

Emmanuelle Cambois

E-mail: euroreve@imaginet.fr

This book provides practical guidance on methods for health interview surveys, with the view of initiating the implentation of agreed common instruments allowing international comparison.

Nusselder W, van der Velden K, van Sonsbeek JLA, Lenior M, van den Bos GAM. The elimination of selected chronic diseases in a population: the compression and expansion of morbidity. Am J Public Health 1996;86(2):187-194.

The authors use Sullivan's method to calculate disability-free life expectancy due to elimination of a number of specific diseases in the Netherlands.

van de Water HPA, Boshuizen HC, Perenboom RJM. Health expectancy in the Netherlands, 1983-1990. European J Public Health 1996;6:21-28.

This article presents the results of health expectancy calculations for the Netherlands. Healthy life expectancy, based on self perceived health, and disability-free life expectancy, are calculated according to Sullivan's method. A trend study and an analysis of health expectancies by socioeconomic class are presented.

Isabelle Romieu