Psychiatric Epidemiology
At its most basic level, the discipline of
psychiatric epidemiology is the study of the patterns of mental disorders,
including how frequently disorders occur, how they are distributed in
populations, and what are associated risk factors. Psychiatric epidemiology
also defines the time course of mental disorders including their onset,
duration and recurrence. Recently, the field has greatly expanded and now
includes detailed examinations of the natural history of psychiatric disorders,
genetic epidemiology, the relationships between physical and mental disorders,
and studies of the use and outcomes of mental health treatments. This expansion
has required significant advances and developments in psychiatric epidemiologic
methods (Tsuang and Tohen, 2002).
Important characteristics that distinguish
psychiatric epi-demiological research from other clinical investigations are
the in-clusion of representative samples and the application of systematic
methods for determining diagnosis or outcome. The specific type of sample and
choice of mental health measure depend on the goal of the study. Three types of
samples are generally used in epidemiology. For studies aimed at establishing
prevalence and incidence rates, the population-based survey is the optimal method.
Complex sampling procedures have been developed to ensure random selection for
both single-stage and two-stage studies. For studies of rare disorders,
iden-tified patients are usually ascertained from registries or a
represent-ative set of psychiatric treatment facilities. However, because only
a minority of individuals with diagnosable disorders are ever treated for
psychiatric problems within the mental health care system (Regier et al., 1993; Kessler et al., 1994; Wang et al., 2000), these sources
may omit true case patients who do not present for treatment.
The development of structured diagnostic interview
sched-ules tailored to clear operationalized diagnostic criteria was the
crucial element underlying the recent progress in psychiatric epi-demiology. As
a result of the development of structured diagnostic interview schedules, the
need to establish the prevalence of specific disorders was finally realized, at
least within the limits of our current ability to operationalize mental
disorders and within the constraints inherent in interview data (Fennig and
Bromet, 1992). Estimates suggest that approximately 12% of children (Institute
of Medicine, 1989) and 15% of adults (Regier et al., 1988) currently meet criteria for one or more mental
disorders. More precise estimates will be possible as more sensitive diagnostic
tools become available.
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