British Journal of Psychiatry (1990),156,475-478
Psychiatric
Emergencies,
Scotland and the World Cup Finals
GEORGE MASTERTON and ANTHONY J. MANDER
Reductionsin emergencypsychiatricpresentationsto hospitaloccurredduringand after the finalsof the WorldCupfootballcompetitions,an effect evidentin womenas well as men, and more markedamongthe mentallyill than those who were not. Increasesin the numbersof schizophrenicandneuroticmenpresentingbefore,andalcoholicmenduring,the competitions can be attributed to the football. The generalisedreductionsduringand after could reflect an indirectetfect uponhelp-seeking,althoughactual relapserates of mental illnessesmight be affected. Thesechangescouldarisefrom enhancementof nationalidentityandcohesion.
The finals of the four World Cup football competi tions since 1974 in which Scotland participated have consistently coincided with a fall in the frequency of parasuicide in both sexes, which has been sustained for at least eight weeks after the last game (Masterton & Strachan, 1987). We now report what happens to the frequency and nature of another form of psychosocial crisis, emergency psychiatric presentations to hospital, before, during, and after the tournaments.
allcases seenaroundthe1978(26days), 1982(30days), and 1986 (30 days) finals of the World Cup. Intervening
years acted as controls, using the corresponding dates in 1979/80 for 1978, 1981/83 for 1982, and 1984/85 for 1986;
the 1982tournament began two weekslater than those in 1978 and 1986, which started in the first week in June.
The method adopted was to aggregate the three World Cup years and test for differences from the combined six
controlyears,basedupon the assumptionthat the numbers of cases in each time interval should represent the same proportion of the annual totals. The percentage difference between
World
Cup
and
other
years
was evaluated
statistically by calculation of the 95'!. confidence interval. This technique was applied to the number of emergency
Method Since July 1977systematic information upon all emergency and out-of-hours presentations to the Royal Edinburgh
presentationsin total and by sex during the competitions and in the two four-weekperiods before and three four week periods afterwards. Then changes within diagnostic
Hospital (with a catchment population of 470000)which
categories were examined, confining this analysis to the
serves the entire city, has been collected for the Lothian
commonest primary diagnoses and four weeks either side of the tournaments.
Psychiatric
Case Register. This source provided data upon
TABLE I
The number
of psychiatric
emergencies and percentage difference
in proportion
of the annual
total:
World
Cup v. otheryears weeksMalesn:
—¿8to—4 weeks—4toO
weeksWorldCupOto+4
World Cup272 (457)(other) years‘!,difference+
(535)231
(446)238
(524)210
14%95%
5%+
7010—
6%—
+27%Femalesn: CI—7to
+17%—6to
+21%-l8to
weeks+4to+8 (543)225 20%—
weeks+8to+12 (552)252 16°lo+
+6%—32to —¿8%—27to —¿4%—lto
(409)180 (382)(other) World Cup188 (401)197 (422)191 years‘1. difference+2%+5%—7%—1%—18%+2°!.95% +16%Totaln:CI—12 to + 16%— 10 to + 19°lo—21 to + 6%— 14
(417)191
to
+
13°lo—30
(504)179 to —¿ 6%—
13
to
World Cup460 (936)428 (855)418 (946)401 (960)416 (1056)431 (839)(other) years¾ difference+4'!.6'!.—7%—12°!.—17°!.+9°!.95% +3%—21 to —¿3%—25to —¿8°!.—l to +19% CI—6to +13°!.—4to +16%—l6to 475
476
MASTERTON
Resufts
AND MANDER indicating a general stability in the frequency of presentation
and diagnostic system. Thiswasnotthecasefortheremainder ofthediagnoses,
Frequency
where the annual total in World Cup years was significantly
Before the tournaments there were more presentations than expected,
but this fell during
the finals
and
substantially
further in the subsequent eight weeks. The effect was more marked in males, who had 14°!. fewer presentations in the eight weeks after the tournaments compared with before,
againsta 12%increasein control years.The fall in females was principallydue to changes in control years (+ 14%), with only a 1% drop betweenthe same periods in World
less than expected. Part of the explanation may lie in changes in the classification introduced in 1983, but probably more important were developments in the management
of some categories of emergency, notably drug
dependence and organic states. The main findings were excess presentations of schizo phrenia before the tournaments,
and reductions in all illness
categories during and afterwards (with the exception of
alcoholism during), whichcontrasts withlackofchange years. in the non-illness category. The statistically significant The reductions occurred consistently after each competi tion but not during (during: 1978= —¿ 19°!.,1982= —¿2%, differencesby sexwereincreasesbefore the tournament in 1986= +3%; Oto +4 weeks: 1978= —¿7%, 1982= —¿9%, male schizophrenics (+65%) and neurotics (+ 133¾),and l986=—l7°!o;+4 to +8 weeks: 1978=—28%, reductions during of female affective psychosis (—35'!o), 1982= —¿9%, 1986= —¿ 14%). and after of male neurotics (—5601.). Cup
That these effects were not due to other differences
The commonest presentation, males with an alcohol
between the years nor subsequently compensated for is indicated in Table II. World Cup years differ significantly for annual totals but not when the period during and after the tournament is excluded.
problem, was perhaps the most interesting, with a 19% excess of presentations during the competitions, not quite statistically significant (95% CI —¿4 to + 41¾) but sufficiently influential against the trend to explain why the overall decrease was less during the World Cup than in the
subsequent eight weeks. Indeed, with male alcoholics
Dlagnosb
Of 4008 emergency presentations during the 12weeks under consideration in the years 1978—86,3288 (82%) were accounted
for by alcoholism
(736 males,
discounted the reduction during the World Cup becomes statisticallysignificantnot only for males(—18¾,—¿31 to —¿4%) but also overall (—12%, —¿22 to —¿2%).
183 females),
schizophrenia (382, 225), affective psychosis (187, 329),
Discussion
neurosis(125, 242),and no mental illness(378, 501).The last grouping comprised personality disorder, adjustment reaction, and no psychiatric disorder, and reflects a suggestion for a hybrid category of uncertain illness status
discussedin connection with ICD-lO (Cooper, 1988). The annual totals for all specifieddiagnosticcategories differed by 2% or lessfrom expectedin World Cup years,
We are confident that our main finding, a reduction in the numbers of emergency psychiatric presentations during and after World Cup fmal competitions, is a valid result. We feel more circumspect about the findings within diagnostic groups, our method being
TABLE II
The total number of psychiatric emergenciesin World Cup (other) years with percentagedifferencefor World Cup
years v. all years, 1978—86 Annual totals
Annual totals excluding contribution from World Cup
finals and subsequenteight weeks Malesn: (4105)¾ World Cup (other) years2766 1.3°!.95% difference from expected—
+4.9%Femalesn: CI—5.3 (3510)¾ World Cup (other) years2235 from expected— +0.7%Totaln: CI—8.7% 3.2%95% difference
(7615)°!. World Cup (other) years5001(10577)3766 difference from expected—
0.7%95¾
CI—5.9to
(5724)2093 2.3%+
to +0.8%—2.3
to
(4853)1673 5.4%—
to —¿2.1%—7.0
to
3.7°!.—
—¿1.5%—3.4to
+1.9%
THE WORLD CUP AND SCOTTISH PSYCHIATRIC EMERGENCIES
477
III
ThenumberofotherSchizophreniaAffective psychiatricemeTABLE rgencies andpercentage djfference inproportion oftheannualtotal: W yearsand WorldCup v.allyears fortheannualtotalorld mentalOtherpsychosis Neurosis
Alcoholism
Cup v.
No
illnessdiagnosesBefore (—4toO weeks)n: (164)Cup(other) World76
(104)57
(115)
45 (78)
89 (196)
96 (198)65
years¾ —¿5%—1%95'!. difference+51%+3% 23%DuringWorld 23 to + 79%—23 CI+ Cupn: (213)Cup World60
(140)48
to + 29%
+17% —¿15 to + 48%
(120)
—¿7% —¿26 to + 12°!. —¿24 to + 14%—25
31(88)
114 (200)
to +
95 (185)70
(other)years‘!.difference—11¾—17% +1%—18%95% 0%After CI—34
to + l2°!o—41 to
+ 7%
—¿29% —¿56 to —¿ 2%
+17% 0 to + 33¾ —¿ 19 to + 21%—36
to
to+4(0 weeks)n:
(159)Cup World69 (other)years¾
(158)55
(121)
—¿17%—23%95¾CI—3lto difference—10¾—6¾ +16%—46to0%Annual +12%—3Oto +19%
35 (90) —¿21% —¿49to +6%
92 (228)
101(204)49
—¿35to0% —¿2lto
totalsn:
(2221)Cup World760 (other)years‘1.
(1573)675
(1400)
+1%—14%fromexpected95¾C1—8to+4¾—9to+4¾ difference—2¾—2%
461(931)
1137 (2329)
—¿1%
1080 (2123)888
—¿ 2%
—¿8to+7% —¿7to+4% —¿4to+7%—2Oto—9°1.
less stringent for two reasons. Firstly, the number of patients admitted over any four weeks was small in some categories, resulting in imprecision expressed
being largely confmed to men. Similarly, the increase in alcohol-associated male presentations during the tournaments surely reflects a direct, immediate
as a wide confidenceinterval. Secondly,theinter rater reliability forthediagnostic systemisunknown,
consequence
although it is likely to be satisfactory given its basis of simplification and abbreviation from the International
Classification of Diseases.Additionally, the areaof poorest reliability (with DSM—III at least) is in differentiating personalitydisorder,adjustment reaction, and no psychiatric illness (Williams& Spitzer, 1980), and ofcoursethiswas avoidedinour analysis by combiningthesecategories. Itseemslogical thata periodof anticipation and increasing excitement, asintheweeks leadingup to an importantevent,willrepresent anotherstress upon thementallyvulnerable, and thenatureofthis event,footballmatches, probably explainsthe increase in schizophrenic and neurotic presentations
of excessive
alcohol
consumption
at
such times, and the association of Scotsmen and alcohol with football matches ought to come as no surprise. The firm fmding of reduced emergency psychiatric presentations
during
and
after
the
tournaments,
which accords with the changes reported for parasuicide (Masterton & Strachan, 1987), has a less obvious explanation, and the fact that both sexes are affected for several months after the final whistle suggests
that
this
is not
directly
attributable
to
football. There are few outlets which permit a wide and acceptable expression of Scottish nationhood sport is perhaps the most powerful, and football is the national game. The World Cup finals enhance a sense of national identity as well as representing
478
MASTERTONAND MANDER
a focusof purposeand excitement, and itwas this been established —¿ the only study retrieved in a that prompted our investigations. We would speculate comprehensive literature search (Rost et a!, 1975)
that such a common interest and endeavour, fused with a surge of nationalism, might enhance social cohesion in the manner proposed by Durkheim (1952) to explain the decreased suicide rates that accompany times of war. Why this effect should be more pronounced in parasuicide and those who are mentally ill, rather than those who are not, is intriguing. If this is indeed the case it suggests complex changes in help-seeking among people in crisis. Perhaps people are less liable to be introspective or to despair, more likely to tolerate and cope, and to deal with any crisis more
reported increased risks of cardiac arrhythmias and high blood pressure in West German men watching the 1974 tournament - but then they were winning!
recurrences (Leff& Wing, 1971). Inconclusion, our findings indicate thatnational participation in the World Cup finalfootball competitions exertsa broad and stabilising effect upon human behaviourwhichextendsintothefield of primarily biologically determined mental illnesses. Whether physicalhealthisalsoaffectedhas not
MAS11RTON,0. & SmAca@N, J. (1987) Parasuicide,
Acknowledgements Wethank ProfessorI. Oswaldfor hiscommentsupon a draft and Mrs Sheila Miller for providing data from the Lothian Psychiatric Case Register. References
Coopait, J. E. (1988) The structure and presentation of conteinpor ary psychiatric classifications with special reference to ICD-9 directly. While strategies adopted in crisis probably and 10. British Journal 0/Psychiatry, 152 (suppi. 1), 21-28. change, it is also possible that the reductions E. (1952) Suicide: A Study in Sociology (trans. J. A. observedacrossa rangeof mentaldisorders could Duiuuw.u.i, Spaulding & 0. Simpson). London: Routledge & Kegan Paul. be due to a directactionupon therateof relapse, Larr, 3. P. & WINO,J. K. (1971)Trial of maintenancetherapy in schizophrenia. British Medical Journal, iii, 599-604. giventhatsocial factors areknown toinfluence such Scotland,
and
the World Cup. BritishMedicalJournal, 295, 368. ROST, R., HECK, H. & Howbw@, W. (1975) Kreislaufreaktioner
und Gefahrdung van Fernsehzuschauernbei Spielen 6cr Fussball - Weltmeisterschaft. Medizinische Welt, 26, 670-672. WILLIAMS,3. B. W. & Spnzan,
R. L. (1980) DSM-III
field trials:
inter-rater reliability and list of project staff and participants.
In Diagnostic andStatistical Manualof MentalDisorders (3rd edn). Washington:AmericanPsychiatricAssociation.
°GeorgeMasterton, BSc,MD,MRCPsych,Consultant Psychiatrist, Department of Psychological Medicine, Royal Infirmaryof Edinburgh,4 LauristonPlace,EdinburghEH3 9YW; Anthony J.Mander, MB CuB, MPhil, MRCPsych, Lecturer,
‘¿Correspondence
Department
of Psychiatry,
University
of Edinburgh
Psychiatric emergencies, Scotland and the World Cup finals. G Masterton and A J Mander BJP 1990, 156:475-478. Access the most recent version at DOI: 10.1192/bjp.156.4.475
References Reprints/ permissions You can respond to this article at Downloaded from
This article cites 0 articles, 0 of which you can access for free at: http://bjp.rcpsych.org/content/156/4/475#BIBL To obtain reprints or permission to reproduce material from this paper, please write to [email protected] /letters/submit/bjprcpsych;156/4/475 http://bjp.rcpsych.org/ on July 25, 2016 Published by The Royal College of Psychiatrists
To subscribe to The British Journal of Psychiatry go to: http://bjp.rcpsych.org/site/subscriptions/
Psychiatric
Emergencies,
Scotland and the World Cup Finals
GEORGE MASTERTON and ANTHONY J. MANDER
Reductionsin emergencypsychiatricpresentationsto hospitaloccurredduringand after the finalsof the WorldCupfootballcompetitions,an effect evidentin womenas well as men, and more markedamongthe mentallyill than those who were not. Increasesin the numbersof schizophrenicandneuroticmenpresentingbefore,andalcoholicmenduring,the competitions can be attributed to the football. The generalisedreductionsduringand after could reflect an indirectetfect uponhelp-seeking,althoughactual relapserates of mental illnessesmight be affected. Thesechangescouldarisefrom enhancementof nationalidentityandcohesion.
The finals of the four World Cup football competi tions since 1974 in which Scotland participated have consistently coincided with a fall in the frequency of parasuicide in both sexes, which has been sustained for at least eight weeks after the last game (Masterton & Strachan, 1987). We now report what happens to the frequency and nature of another form of psychosocial crisis, emergency psychiatric presentations to hospital, before, during, and after the tournaments.
allcases seenaroundthe1978(26days), 1982(30days), and 1986 (30 days) finals of the World Cup. Intervening
years acted as controls, using the corresponding dates in 1979/80 for 1978, 1981/83 for 1982, and 1984/85 for 1986;
the 1982tournament began two weekslater than those in 1978 and 1986, which started in the first week in June.
The method adopted was to aggregate the three World Cup years and test for differences from the combined six
controlyears,basedupon the assumptionthat the numbers of cases in each time interval should represent the same proportion of the annual totals. The percentage difference between
World
Cup
and
other
years
was evaluated
statistically by calculation of the 95'!. confidence interval. This technique was applied to the number of emergency
Method Since July 1977systematic information upon all emergency and out-of-hours presentations to the Royal Edinburgh
presentationsin total and by sex during the competitions and in the two four-weekperiods before and three four week periods afterwards. Then changes within diagnostic
Hospital (with a catchment population of 470000)which
categories were examined, confining this analysis to the
serves the entire city, has been collected for the Lothian
commonest primary diagnoses and four weeks either side of the tournaments.
Psychiatric
Case Register. This source provided data upon
TABLE I
The number
of psychiatric
emergencies and percentage difference
in proportion
of the annual
total:
World
Cup v. otheryears weeksMalesn:
—¿8to—4 weeks—4toO
weeksWorldCupOto+4
World Cup272 (457)(other) years‘!,difference+
(535)231
(446)238
(524)210
14%95%
5%+
7010—
6%—
+27%Femalesn: CI—7to
+17%—6to
+21%-l8to
weeks+4to+8 (543)225 20%—
weeks+8to+12 (552)252 16°lo+
+6%—32to —¿8%—27to —¿4%—lto
(409)180 (382)(other) World Cup188 (401)197 (422)191 years‘1. difference+2%+5%—7%—1%—18%+2°!.95% +16%Totaln:CI—12 to + 16%— 10 to + 19°lo—21 to + 6%— 14
(417)191
to
+
13°lo—30
(504)179 to —¿ 6%—
13
to
World Cup460 (936)428 (855)418 (946)401 (960)416 (1056)431 (839)(other) years¾ difference+4'!.6'!.—7%—12°!.—17°!.+9°!.95% +3%—21 to —¿3%—25to —¿8°!.—l to +19% CI—6to +13°!.—4to +16%—l6to 475
476
MASTERTON
Resufts
AND MANDER indicating a general stability in the frequency of presentation
and diagnostic system. Thiswasnotthecasefortheremainder ofthediagnoses,
Frequency
where the annual total in World Cup years was significantly
Before the tournaments there were more presentations than expected,
but this fell during
the finals
and
substantially
further in the subsequent eight weeks. The effect was more marked in males, who had 14°!. fewer presentations in the eight weeks after the tournaments compared with before,
againsta 12%increasein control years.The fall in females was principallydue to changes in control years (+ 14%), with only a 1% drop betweenthe same periods in World
less than expected. Part of the explanation may lie in changes in the classification introduced in 1983, but probably more important were developments in the management
of some categories of emergency, notably drug
dependence and organic states. The main findings were excess presentations of schizo phrenia before the tournaments,
and reductions in all illness
categories during and afterwards (with the exception of
alcoholism during), whichcontrasts withlackofchange years. in the non-illness category. The statistically significant The reductions occurred consistently after each competi tion but not during (during: 1978= —¿ 19°!.,1982= —¿2%, differencesby sexwereincreasesbefore the tournament in 1986= +3%; Oto +4 weeks: 1978= —¿7%, 1982= —¿9%, male schizophrenics (+65%) and neurotics (+ 133¾),and l986=—l7°!o;+4 to +8 weeks: 1978=—28%, reductions during of female affective psychosis (—35'!o), 1982= —¿9%, 1986= —¿ 14%). and after of male neurotics (—5601.). Cup
That these effects were not due to other differences
The commonest presentation, males with an alcohol
between the years nor subsequently compensated for is indicated in Table II. World Cup years differ significantly for annual totals but not when the period during and after the tournament is excluded.
problem, was perhaps the most interesting, with a 19% excess of presentations during the competitions, not quite statistically significant (95% CI —¿4 to + 41¾) but sufficiently influential against the trend to explain why the overall decrease was less during the World Cup than in the
subsequent eight weeks. Indeed, with male alcoholics
Dlagnosb
Of 4008 emergency presentations during the 12weeks under consideration in the years 1978—86,3288 (82%) were accounted
for by alcoholism
(736 males,
discounted the reduction during the World Cup becomes statisticallysignificantnot only for males(—18¾,—¿31 to —¿4%) but also overall (—12%, —¿22 to —¿2%).
183 females),
schizophrenia (382, 225), affective psychosis (187, 329),
Discussion
neurosis(125, 242),and no mental illness(378, 501).The last grouping comprised personality disorder, adjustment reaction, and no psychiatric disorder, and reflects a suggestion for a hybrid category of uncertain illness status
discussedin connection with ICD-lO (Cooper, 1988). The annual totals for all specifieddiagnosticcategories differed by 2% or lessfrom expectedin World Cup years,
We are confident that our main finding, a reduction in the numbers of emergency psychiatric presentations during and after World Cup fmal competitions, is a valid result. We feel more circumspect about the findings within diagnostic groups, our method being
TABLE II
The total number of psychiatric emergenciesin World Cup (other) years with percentagedifferencefor World Cup
years v. all years, 1978—86 Annual totals
Annual totals excluding contribution from World Cup
finals and subsequenteight weeks Malesn: (4105)¾ World Cup (other) years2766 1.3°!.95% difference from expected—
+4.9%Femalesn: CI—5.3 (3510)¾ World Cup (other) years2235 from expected— +0.7%Totaln: CI—8.7% 3.2%95% difference
(7615)°!. World Cup (other) years5001(10577)3766 difference from expected—
0.7%95¾
CI—5.9to
(5724)2093 2.3%+
to +0.8%—2.3
to
(4853)1673 5.4%—
to —¿2.1%—7.0
to
3.7°!.—
—¿1.5%—3.4to
+1.9%
THE WORLD CUP AND SCOTTISH PSYCHIATRIC EMERGENCIES
477
III
ThenumberofotherSchizophreniaAffective psychiatricemeTABLE rgencies andpercentage djfference inproportion oftheannualtotal: W yearsand WorldCup v.allyears fortheannualtotalorld mentalOtherpsychosis Neurosis
Alcoholism
Cup v.
No
illnessdiagnosesBefore (—4toO weeks)n: (164)Cup(other) World76
(104)57
(115)
45 (78)
89 (196)
96 (198)65
years¾ —¿5%—1%95'!. difference+51%+3% 23%DuringWorld 23 to + 79%—23 CI+ Cupn: (213)Cup World60
(140)48
to + 29%
+17% —¿15 to + 48%
(120)
—¿7% —¿26 to + 12°!. —¿24 to + 14%—25
31(88)
114 (200)
to +
95 (185)70
(other)years‘!.difference—11¾—17% +1%—18%95% 0%After CI—34
to + l2°!o—41 to
+ 7%
—¿29% —¿56 to —¿ 2%
+17% 0 to + 33¾ —¿ 19 to + 21%—36
to
to+4(0 weeks)n:
(159)Cup World69 (other)years¾
(158)55
(121)
—¿17%—23%95¾CI—3lto difference—10¾—6¾ +16%—46to0%Annual +12%—3Oto +19%
35 (90) —¿21% —¿49to +6%
92 (228)
101(204)49
—¿35to0% —¿2lto
totalsn:
(2221)Cup World760 (other)years‘1.
(1573)675
(1400)
+1%—14%fromexpected95¾C1—8to+4¾—9to+4¾ difference—2¾—2%
461(931)
1137 (2329)
—¿1%
1080 (2123)888
—¿ 2%
—¿8to+7% —¿7to+4% —¿4to+7%—2Oto—9°1.
less stringent for two reasons. Firstly, the number of patients admitted over any four weeks was small in some categories, resulting in imprecision expressed
being largely confmed to men. Similarly, the increase in alcohol-associated male presentations during the tournaments surely reflects a direct, immediate
as a wide confidenceinterval. Secondly,theinter rater reliability forthediagnostic systemisunknown,
consequence
although it is likely to be satisfactory given its basis of simplification and abbreviation from the International
Classification of Diseases.Additionally, the areaof poorest reliability (with DSM—III at least) is in differentiating personalitydisorder,adjustment reaction, and no psychiatric illness (Williams& Spitzer, 1980), and ofcoursethiswas avoidedinour analysis by combiningthesecategories. Itseemslogical thata periodof anticipation and increasing excitement, asintheweeks leadingup to an importantevent,willrepresent anotherstress upon thementallyvulnerable, and thenatureofthis event,footballmatches, probably explainsthe increase in schizophrenic and neurotic presentations
of excessive
alcohol
consumption
at
such times, and the association of Scotsmen and alcohol with football matches ought to come as no surprise. The firm fmding of reduced emergency psychiatric presentations
during
and
after
the
tournaments,
which accords with the changes reported for parasuicide (Masterton & Strachan, 1987), has a less obvious explanation, and the fact that both sexes are affected for several months after the final whistle suggests
that
this
is not
directly
attributable
to
football. There are few outlets which permit a wide and acceptable expression of Scottish nationhood sport is perhaps the most powerful, and football is the national game. The World Cup finals enhance a sense of national identity as well as representing
478
MASTERTONAND MANDER
a focusof purposeand excitement, and itwas this been established —¿ the only study retrieved in a that prompted our investigations. We would speculate comprehensive literature search (Rost et a!, 1975)
that such a common interest and endeavour, fused with a surge of nationalism, might enhance social cohesion in the manner proposed by Durkheim (1952) to explain the decreased suicide rates that accompany times of war. Why this effect should be more pronounced in parasuicide and those who are mentally ill, rather than those who are not, is intriguing. If this is indeed the case it suggests complex changes in help-seeking among people in crisis. Perhaps people are less liable to be introspective or to despair, more likely to tolerate and cope, and to deal with any crisis more
reported increased risks of cardiac arrhythmias and high blood pressure in West German men watching the 1974 tournament - but then they were winning!
recurrences (Leff& Wing, 1971). Inconclusion, our findings indicate thatnational participation in the World Cup finalfootball competitions exertsa broad and stabilising effect upon human behaviourwhichextendsintothefield of primarily biologically determined mental illnesses. Whether physicalhealthisalsoaffectedhas not
MAS11RTON,0. & SmAca@N, J. (1987) Parasuicide,
Acknowledgements Wethank ProfessorI. Oswaldfor hiscommentsupon a draft and Mrs Sheila Miller for providing data from the Lothian Psychiatric Case Register. References
Coopait, J. E. (1988) The structure and presentation of conteinpor ary psychiatric classifications with special reference to ICD-9 directly. While strategies adopted in crisis probably and 10. British Journal 0/Psychiatry, 152 (suppi. 1), 21-28. change, it is also possible that the reductions E. (1952) Suicide: A Study in Sociology (trans. J. A. observedacrossa rangeof mentaldisorders could Duiuuw.u.i, Spaulding & 0. Simpson). London: Routledge & Kegan Paul. be due to a directactionupon therateof relapse, Larr, 3. P. & WINO,J. K. (1971)Trial of maintenancetherapy in schizophrenia. British Medical Journal, iii, 599-604. giventhatsocial factors areknown toinfluence such Scotland,
and
the World Cup. BritishMedicalJournal, 295, 368. ROST, R., HECK, H. & Howbw@, W. (1975) Kreislaufreaktioner
und Gefahrdung van Fernsehzuschauernbei Spielen 6cr Fussball - Weltmeisterschaft. Medizinische Welt, 26, 670-672. WILLIAMS,3. B. W. & Spnzan,
R. L. (1980) DSM-III
field trials:
inter-rater reliability and list of project staff and participants.
In Diagnostic andStatistical Manualof MentalDisorders (3rd edn). Washington:AmericanPsychiatricAssociation.
°GeorgeMasterton, BSc,MD,MRCPsych,Consultant Psychiatrist, Department of Psychological Medicine, Royal Infirmaryof Edinburgh,4 LauristonPlace,EdinburghEH3 9YW; Anthony J.Mander, MB CuB, MPhil, MRCPsych, Lecturer,
‘¿Correspondence
Department
of Psychiatry,
University
of Edinburgh
Psychiatric emergencies, Scotland and the World Cup finals. G Masterton and A J Mander BJP 1990, 156:475-478. Access the most recent version at DOI: 10.1192/bjp.156.4.475
References Reprints/ permissions You can respond to this article at Downloaded from
This article cites 0 articles, 0 of which you can access for free at: http://bjp.rcpsych.org/content/156/4/475#BIBL To obtain reprints or permission to reproduce material from this paper, please write to [email protected] /letters/submit/bjprcpsych;156/4/475 http://bjp.rcpsych.org/ on July 25, 2016 Published by The Royal College of Psychiatrists
To subscribe to The British Journal of Psychiatry go to: http://bjp.rcpsych.org/site/subscriptions/
