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Textbook of Psychiatric Epidemiology ebook

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The new edition of this critically praised textbook continues toprovide the most comprehensive overview of the concepts, methods,and research advances in the field; particularly the application ofmolecular genomics and of neuroimaging. It has been revised andenhanced to capitalize on the strengths of the first and secondeditions while keeping it up-to-date with the field of psychiatryand epidemiology. This comprehensive publication now includeschapters on experimental epidemiology, gene-environmentinteractions, the use of case registries, eating disorders,suicide, childhood disorders and immigrant populations, and theepidemiology of a number of childhood disorders. As in the first and second editions, the objective is to providea comprehensive, easy to understand overview of research methodsfor the non-specialist. The book is ideal for students ofpsychiatric epidemiology, psychiatric residents, generalpsychiatrists, and other mental health professionals. The book features a new editor, Peter Jones, from the Universityof Cambridge, who joins the successful US team of Ming Tsuang andMauricio Tohen.

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Table of Contents

Title Page

Copyright

List of Contributors

Chapter 1: Introduction to Epidemiologic Research Methods

1.1 What is Epidemiology?

1.2 Causation in Medicine

1.3 Causal Inference

1.4 The Future for Psychiatric Epidemiology

References

Chapter 2: Analysis of categorical data: The odds ratio as a measure of association and beyond

2.1 Introduction

2.2 Inference for a Single Proportion

2.3 Analysis of 2 × 2 Contingency Tables

2.4 Analysis of Sets of 2 × 2 Contingency Tables

2.5 Logistic Regression

2.6 Advanced Topics

2.7 Concluding Remarks

2.8 Further Reading

References

Chapter 3: Genetic Epidemiology

3.1 Introduction

3.2 The Chain of Psychiatric Genetic Research

3.3 Psychiatric Genetics and Psychiatric Epidemiology

3.4 Acknowledgements

References

Further Reading

Chapter 4: Examining Gene–environment Interplay in Psychiatric Disorders

4.1 Introduction

4.2 The Process of Genetic Epidemiology

4.3 Gene–environment Interplay Takes Different Forms

4.4 Gene–environment Correlation

4.5 Gene–environment Interaction

4.6 Measurement of Genotype, Environmental Exposure and Pathological Phenotype

4.7 Models of GxE

4.8 Which Scale Should We Use to Measure GxE ?

4.9 Study Designs for the Detection of GxE

4.10 Threats to the Validity of Epidemiological GxE Studies

4.11 Epigenetic Mechanisms

References

Chapter 5: Reliability

5.1 Introduction

5.2 The Reliability Coefficient

5.3 Designs for Estimating Reliability

5.4 Statistical Remedies for Low Reliability

5.5 Reliability Theory and Binary Judgements

5.6 Reliability Statistics: General

5.7 Other Reliability Statistics

5.8 Summary and Conclusions

References

Chapter 6: Moderators and Mediators: Towards the Genetic and Environmental Bases of Psychiatric Disorders

6.1 Introduction

6.2 Current Methodological Barriers

6.3 Moderation, Mediation and Other Ways in Which Risk Factors ‘Work Together’

6.4 Extensions

6.5 Beyond Moderators and Mediators

References

Chapter 7: Validity: Definitions and Applications to Psychiatric Research

7.1 Introduction

7.2 Validity of a Construct

7.3 Validity of the Relationships Between Variables

7.4 Summary

7.5 Acknowledgements

References

Chapter 8: Use of Register Data for Psychiatric Epidemiology in the Nordic Countries

8.1 Introduction

8.2 Registers for Use in Psychiatric Research

8.3 Register Research in Denmark

8.4 Register Research in Finland

8.5 Register Research in Norway

8.6 Register Research in Sweden

8.7 Discussion

8.8 Acknowledgements

References

Chapter 9: An Introduction to Mental Health Services Research

9.1 Introduction

9.2 What is Mental Health Services Research?

9.3 A Framework for Mental Health Services Research

9.4 Key Concepts in Mental Health Services Research

9.5 Examples of Mental Health Services Research Studies

9.6 Conclusion

References

Chapter 10: The Pharmacoepidemiology of Psychiatric Medications

10.1 Introduction

10.2 Overview of Psychopharmacoepidemiology

10.3 Sources of Data

10.4 Examples of Recent Psychopharmacoepidemiologic Studies

10.5 Conclusions

10.6 Acknowledgements

References

Chapter 11: Peering into the Future of Psychiatric Epidemiology

11.1 Introduction

11.2 Levels of Causation: A Historical Overview

11.3 Levels of Causation

11.4 Causation Over (Life) Time

11.5 Examples

11.6 Framing the Future

References

Chapter 12: Studying the Natural History of Psychopathology

12.1 Introduction

12.2 Onset

12.3 Course

12.4 Outcome

12.5 Methodological Concepts for Studying the Natural History of Psychopathology

12.6 Conclusion

12.7 Acknowledgements

References

Chapter 13: Symptom Scales and Diagnostic Schedules in Adult Psychiatry

13.1 Introduction

13.2 North American Instruments for Epidemiological Research

13.3 North American Instruments for Psychiatric Services and Primary Care

13.4 European Instruments for Psychiatric Services and Primary Care

13.5 European Instruments for Epidemiological Research

13.6 Summary

13.7 Acknowledgements

References

Chapter 14: The National Comorbidity Survey (NCS) and its Extensions

14.1 Introduction

14.2 The Baseline NCS

14.3 The NCS Follow-up Survey (NCS-2)

14.4 The NCS Replication Survey (NCS-R)

14.5 The NCS-R Adolescent Supplement (NCS-A)

14.6 The WHO WMH Surveys

14.7 Overview

14.8 Acknowledgements

References

Chapter 15: Experimental Epidemiology

15.1 Introduction

15.2 Limitations of Non-randomised Evidence

15.3 RCTs: The Translation of the Experimental Design into the Real World

15.4 Importance and Control of Systematic Error or Bias

15.5 Importance and Control of Random Error and Noise

15.6 Reporting the Results of Clinical Trials—the CONSORT Statement

15.7 Different Clinical Questions will Prioritise Control of Different Threats to Validity and Confidence

15.8 The Classification of RCTs

15.9 Effectiveness Trials in Schizophrenia

15.10 Department of Veterans Affairs Co-operative Study on the Cost-effectiveness of Olanzapine (Rosenheck)

15.11 The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Study

15.12 Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1)

15.13 European First-episode Schizophrenia Trial (EUFEST)

15.14 The Size and Cost of Experimental Studies in Psychiatry

15.15 Clinical Trials in the Future

References

Chapter 16: Epidemiology of Schizophrenia

16.1 Introduction

16.2 Methods

16.3 The Burden of Schizophrenia

16.4 Natural History

16.5 Demographic Correlates

16.6 Social Risk Factors

16.7 Biological Risk Factors

16.8 Prevention

16.9 Discussion

References

Chapter 17: Epidemiology of Depressive Disorders

17.1 Introduction

17.2 Major Depression

17.3 Dysthymia

17.4 Summary

17.5 Appendix 17.A Measurement of Major Depression in the NLAES and NESARC

References

Chapter 18: Epidemiology of Anxiety Disorders

18.1 Introduction

18.2 Anxiety Disorders

18.3 Panic Disorder

18.4 Agoraphobia

18.5 Social Phobia

18.6 Generalised Anxiety Disorder

18.7 Obsessive–compulsive Disorder

18.8 Anxiety and Affective Disorders and Mass Disasters

18.9 Future Developments

18.10 Acknowledgements

References

Further Reading

Chapter 19: Epidemiology of Bipolar Disorder in Adults and Children

19.1 Introduction

19.2 Epidemiology of Bipolar Disorder

19.3 Patterns of Comorbidity of Bipolar Disorder

19.4 Risk Factors

19.5 Future Directions

19.6 Summary

References

Chapter 20: Epidemiology of Eating Disorders

20.1 Introduction

20.2 Case Definition

20.3 Major Prevalence Studies

20.4 Incidence Studies

20.5 Comorbidity

20.6 Mortality from Eating Disorders

20.7 Risk Factors

20.8 Future Directions

References

Chapter 21: Epidemiology of Alcohol Use, Abuse and Dependence

21.1 Introduction

21.2 Population Estimates of Per Capita Consumption

21.3 Survey-based Estimates of the Prevalence of Drinking

21.4 Alcohol-related Mortality and Morbidity

21.5 Alcohol and Injury

21.6 Alcohol and Chronic Disease

21.7 Diagnostic Classification of Alcohol Use Disorders

21.8 Population Estimates, Prevalence, Incidence and Natural Course of Alcohol Use Disorders

21.9 Comorbidity of DSM-IV Alcohol Use Disorders and Other Psychiatric Disorders

21.10 Summary

21.11 Acknowledgements

References

Chapter 22: Epidemiology of Illicit Drug Use Disorders

22.1 Introduction

22.2 Drug Consumption

22.3 Definitions

22.4 Rates of DSM-IV Abuse and Dependence

22.5 Global Rates of Drug Use Disorders

22.6 Comorbidities with Psychiatric Conditions

22.7 Genetic Epidemiology

22.8 Future Opportunities

22.9 Conclusions

22.10 Disclaimer

References

Chapter 23: The Epidemiology of Personality Disorders: Findings, Methods and Concepts

23.1 Introduction

23.2 Substantive Findings

23.3 Course, Prognosis and Developmental Issues

23.4 Treated Prevalence

23.5 Prevalence of Specific Personality Disorders

23.6 Antisocial Personality Disorder

23.7 Conceptual Issues

23.8 Models of Personality Disorder

23.9 Methodological Issues

23.10 Future Directions

References

Chapter 24: The Epidemiology of Depression and Anxiety in Children and Adolescents

24.1 Introduction

24.2 Magnitude of Depression and Anxiety in Children and Adolescents

24.3 Correlates and Risk Factors

24.4 Service Patterns and Impact

24.5 Summary

References

Chapter 25: Epidemiology of Attention Deficit Hyperactivity Disorder

25.1 Introduction

25.2 Prevalence of ADHD

25.3 Pharmacoeconomics of ADHD

25.4 Comorbid Psychiatric Disorders

25.5 Demographic Risk Factors

25.6 Genetic Risk Factors

25.7 Environmental Risk Factors for ADHD

25.8 Summary and Conclusions

25.9 Future Directions

25.10 Acknowledgements

References

Chapter 26: The Epidemiology of Autism

26.1 Introduction

26.2 Background

26.3 Definition and Diagnosis

26.4 Natural History

26.5 Prevalence

26.6 Risk Factors

26.7 Genetic Factors

26.8 Public Health Impact

26.9 Associations and Causal Factors

26.10 Future Directions

26.11 Summary

References

Chapter 27: Mental Illness, Women, Mothers and Their Children

27.1 Introduction

27.2 The Epidemiology of Mental Illness in Women of Reproductive Age

27.3 Fertility and Fecundity in Women with Mental Illness

27.4 Maternal Mental Illness at the Time of Conception and During Pregnancy

27.5 Gene–environment Interactions and Offspring Outcomes

27.6 Obstetric Complications and Risk of Adult Onset Mental Disorder in Offspring

27.7 Parental Condition

27.8 Motherhood and Perinatal Mental Illness

27.9 Designing Studies Examining the Relationship Between Maternal Mental Illness and Outcomes for their Children

27.10 Conclusions

References

Further Reading

Chapter 28: Epidemiology of Suicide and Attempted Suicide

28.1 Introduction

28.2 Definitions

28.3 Prevalence of Suicide and Attempted Suicide

28.4 Risk Factors for Suicide and Attempted Suicide

28.5 Protective Factors

28.6 Conclusions

28.7 Acknowledgements

References

Chapter 29: Epidemiology and Geriatric Psychiatry

29.1 Introduction

29.2 Issues of Case Identification

29.3 The Distribution of Cases

29.4 Aetiological Studies

29.5 Outcome Studies

29.6 Historical Trends in the Epidemiology of Psychiatric Disorders in Late Life

29.7 Use of Health Care Services

References

Chapter 30: Recent epidemiological studies of psychiatric disorders in Japan

30.1 Introduction

30.2 Schizophrenia

30.3 Affective Disorders

30.4 Autism and Autism Spectrum Disorder

30.5 Summary

References

Chapter 31: Epidemiology of Migration and Serious Mental Illness: The Example of Migrants to Europe

31.1 Introduction

31.2 Defining the Constructs

31.3 High Rates of Psychosis in Migrants: A Genuine Finding or Methodological Artefact?

31.4 Possible Explanations

31.5 Biological Considerations

31.6 Cannabis Use

31.7 Adverse Social Experiences

31.8 Mechanisms

31.9 Implications

References

Chapter 32: Epidemiology of Migration Substance Use Disorder in Latin American Populations and Migration to the United States

32.1 Introduction

32.2 Definitions: What do we Understand by Migration?

32.3 Countries of Origin: Social, Political and Other Reasons that Trigger Migration

32.4 Living Conditions of Migrants in the United States

32.5 Alcohol and Drug Use in Countries of Origin and Receiving Communities

32.6 Dependence and Treatment Rates

32.7 The Process of Migrating

32.8 Migration, Substance Use and Access to Services

32.9 Returning Migrants and Families Left Behind

32.10 Conclusions

References

Chapter 33: Early detection and intervention as approaches for preventing schizophrenia

33.1 Introduction

33.2 Modelling Genetic and Phenotypic Heterogeneity

33.3 Defining a Syndrome of Liability Using Cognitive and Clinical Characteristics of Relatives

33.4 Gene-based vs. Genome-based Research

33.5 Future Directions

33.6 Clinical Implications

33.7 Acknowledgements

References

Index

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Library of Congress Cataloguing-in-Publication Data

Textbook of psychiatric epidemiology / [edited by] Ming T. Tsuang, Mauricio Tohen, Peter B. Jones. - 3rd ed.

p. ; cm.

Rev. ed. of: Textbook in psychiatric epidemiology / edited by Ming T. Tsuang, Mauricio Tohen. 2nd ed. c2002.

Includes bibliographical references and index.

ISBN 978-0-470-69467-1 (cloth)

1. Psychiatric epidemiology. I. Tsuang, Ming T., 1931- II. Tohen, Mauricio, 1951- III. Jones, Peter B. (Peter Brian), 1960- IV. Textbook in psychiatric epidemiology.

[DNLM: 1. Epidemiologic Methods. 2. Mental Disorders-epidemiology. 3. Mental Disorders-diagnosis. WM 140]

RC455.2.E64T49 2011

362.2'0422-dc22

2010046396

ISBN: 978-0-470-69467-1

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats:

ePDF: 978-0-470-97672-2; Wiley Online Library: 978-0-470-97673-9; ePub: 978-0-470-97740-8.

List of Contributors

Kathryn M. Abel

Centre for Women's Mental Health, 3rd Floor East, Jean McFarlane Bdg, University of Manchester, Oxford Road, Manchester M13 9PL, UK

Judith Allardyce

Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, EURON, SEARCH, Maastricht University Medical Centre, PO BOX 616 (VIJV), 6200 MD Maastricht, The Netherlands

Jordi Alonso

Carrer del Doctor Aiguader, 88, Edifici PRBB, E-08003 Barcelona, Spain

Dan G. Blazer

Department of Psychiatry and Behavioral Sciences, Center for the Study of Aging and Human Development, Box 3003, Duke University Medical Center, Durham NC 27710, USA

Guilherme Borges

Ramon de la Fuente National Institute of Psychiatry, Calzada Mexico Xochimilco 101, DF 14370, Mexico

Michaeline Bresnahan

Mailman School of Public Health, Columbia University, Department of Epidemiology, 600 West 168th Street, New York NY 10032, USA

Evelyn J. Bromet

Dept of Psychiatry, SUNY Stony Brook University, PutnamHall—South Campus, Stony Brook NY 11794-8790, USA

Alan M. Brookhart

Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston MA 02115, USA

Monica Charalambides

Institute of Psychiatry, Psychological Medicine, King's Institute, De Crespigny Park, Denmark Hill, London SE5 8AF, UK

Chuan-Yu Chen

National Health Research Institutes, Institute of Population Health Sciences, Division of Mental Health and Addiction Medicine, Taiwan

Sara Cherkerzian

Departments of Psychiatry and Medicine at Brigham and Women's Hospital (BWH), Harvard Medical School, Boston, MA, USA

Wilson M. Compton

Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, 6001 Executive Blvd., MSC 9589, Bethesda MD 20892-9589, USA

Kevin P. Conway

Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, 6001 Executive Blvd., MSC 9589, Bethesda MD 20892-9589, USA

Dianne Currier

Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY 10032, USA

Deborah A. Dawson

Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Suite 514, Willco Building, 6000 Executive Boulevard, MSC 7003, Bethesda MD 20892-7003, USA

William W. Eaton

Dept of Mental Health, Bloomberg School of Public Health, John Hopkins School of Hygiene and Public Health, John Hopkins University, 615 N. Wolfe Street, Baltimore MD 21205, USA

Stephen V. Faraone

Center for NeuroPsychiatric Genetics, SUNY Upstate Medical University, Weiskotten Hall 3285, Syracuse NY 13210, USA

Miriam C. Fenton

New York State Psychiatric Institute 1051 Riverside Drive, New York, NY 10032, USA

Anna Fernández

Fundacío Sant Joan de Déu Research and Development Unit, Dr. Antoni Pujadas, 42., 08830 Sant Boi de Llobregat, Barcelona, Spain

Garrett Fitzmaurice

Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA, USA

John R. Geddes

Oxford University, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK

Margo R. Genderson

Department of Psychology, Boston University, Boston, MA 02215, USA

Stephen J. Glatt

Departments of Psychiatry and Behavioral Sciences and Neuroscience and Physiology, Medical Genetics Research Center, SUNY Upstate Medical University, NY, USA

Jill M. Goldstein

Departments of Psychiatry and Medicine at Brigham and Women's Hospital (BWH), Harvard Medical School, Boston MA02115, USA

Felicia Gould

Department of Psychiatry & Behavioral Sciences, Miller School of Medicine, University of Miami, 3225 Aviation Ave., Suite 303, Miami FL 33133, USA

Bridget F. Grant

Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, NIAAA/LEB, 5635 Fishers Lane, Bethesda MD 20892-9304, USA

Josep Maria Haro

Fundacío Sant Joan de Déu Research and Development Unit, Dr. Antoni Pujadas, 42., 08830 Sant Boi de Llobregat, Barcelona, Spain

Deborah S. Hasin

Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York NY 10032, USA

Jari Haukka

National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, P.O. Box 30, FI 00271 Helsinki, Finland

Ralph W. Hingson

Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, NIAAA/LEB, 5635 Fishers Lane, Bethesda MD 20892-9304, USA

Ewald Horwath

Department of Psychiatry, Epidemiology and Public Health, Miller School of Medicine, University of Miami, MHHC, Suite 3100, 1695 NW 9th Ave, Miami FL 33136, USA

James I. Hudson

Psychiatric Epidemiology Research Program, Harvard Medical School/McLean Hospital, 115 Mill Street, Belmont MA 02478, USA

Celia F. Hybels

Department of Psychiatry and Behavioral Sciences, Center for the Study of Aging and Human Development, Duke University Medical Center, Box 3003, Durham NC 27710, USA

Matti Isohanni

Department of Psychiatry, University of Oulu, Finland

Beth A. Jerskey

Instructor of Psychiatry and Human Behavior (Research), Alpert Medical School of Brown University, Providence RI 02912, USA

Peter B. Jones

Department of Psychiatry, University of Cambridge, Box 189, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK

Masayoshi Kawai

Research Centre for Child Mental Development, Hamamatsu University School of Medicine 1-20-1, Handayama, Higashi-Ku, Hamamatsu 431–3192, Japan

Anna Keski-Rahkonen

Academy of Finland, University of Helsinki, Helsinki, Finland

Ronald C. Kessler

Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston MA 02115, USA

Helena Chmura Kraemer

Department of Psychiatry, Stanford University, Palo Alto, Stanford CA 94305, USA

Glyn Lewis

Academic Unit of Psychiatry, University of Bristol, Cotham House, Cotham Hill, Bristol BS6 6JL, UK

Bruce Link

Mailman School of Public Health, Columbia University, Department of Epidemiology, 600 West 168th Street, New York NY 10032, USA

Greg S. Liptak

Center for Development, Behavior and Genetics, SUNY Upstate Medical University, Center for Children's' Health Policy, Syracuse NY 13210, USA

Marsha F. Lopez

Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, 6001 Executive Blvd., MSC 9589, Bethesda, MD 20892-9589, USA

Michael J. Lyons

Department of Psychology, Boston University, Harvard Institute of Psychiatric Epidemiology and Genetics, 64 Cummington Street, Boston MA 02215, USA

Dana March

Mailman School of Public Health, Columbia University, Department of Epidemiology, 600 West 168th Street, New York NY 10032, USA

María Elena Medina-Mora

Ramon de la Fuente National Institute of Psychiatry, Calzada Mexico Xochimilco 101, DF 14370, Mexico

Kathleen R. Merikangas

Genetic Epidemiology Research Branch, Intramural Research Program, NIMH, Porter Neuroscience Research Center, 35 Convent Dr., MSC 3720, Bethesda MD 20892-3720, USA

Jouko Miettunen

Department of Psychiatry, University of Oulu, P.O.Box 5000, FI-90014 Helsinki, Finland

Craig Morgan

Institute of Psychiatry, Psychological Medicine, King's Institute, De Crespigny Park, Denmark Hill, London SE5 8AF, UK

Vera A. Morgan

Neuropsychiatric Epidemiology Research Unit, School of Psychiatry & Clinical Neurosciences, The University of Western Australia, Medical Research Foundation Building, 50 Murray Street, Perth, WA 6000, Australia

Jane M. Murphy

Professor, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Room 215, 5 Longfellow Place, Boston MA 02114, USA

Robin M. Murray

Institute of Psychiatry, Psychological Medicine, King's Institute, De Crespigny Park, Denmark Hill, London SE5 8AF, UK

Erin F. Nakamura

Genetic Epidemiology Research Branch, Intramural Research Program, NIMH, Porter Neuroscience Research Center, 35 Convent Dr., MSC 3720, Bethesda MD 20892-3720, USA

Maria A. Oquendo

Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, NY, USA

Alejandra Pinto-Meza

Fundacío Sant Joan de Déu Research and Development Unit, Dr. Antoni Pujadas, 42., 08830 Sant Boi de Llobregat, Barcelona, Spain

Antoni Pujadas

Fundaci o Sant Joan de Deu Research and Development Unit, Dr. Antoni Pujadas, 42., 08830 Sant Boi de Llobregat, Barcelona, Spain

Caitlin Ravichandran

Laboratory for Psychiatric Biostatistics, McLean Hospital, 115 Mill St, Belmont MA 02478, USA

Tania Real

Ramon de la Fuente National Institute of Psychiatry, Calzada Mexico Xochimilco 101, DF 14370, Mexico

Rebeca Robles

Ramon de la Fuente National Institute of Psychiatry, Calzada Mexico Xochimilco 101, DF 14370, Mexico

Sebastian Schneeweiss

Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston MA02115, USA

Antoni Serrano-Blanco

Fundacío Sant Joan de Déu Research and Development Unit, Dr. Antoni Pujadas, 42., 08830 Sant Boi de Llobregat, Barcelona, Spain

Patrick E. Shrout

Department of Psychology, New York University, 6 Washington Place, Rm 455, New York NY 1003, USA

John Simpson

Department of Psychiatry at VA Boston Healthcare System, Harvard Medical School Department of Psychiatry, Boston MA 02215, USA

William S. Stone

Harvard Institute of Psychiatric Epidemiology and Genetics, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

Ezra Susser

Mailman School of Public Health, Columbia University, Department of Epidemiology, 600 West 168th Street, New York NY 10032, USA

Jaana Suvisaari

Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, P.O.Box 30, FI 0027 Helsinki, Finland

Nori Takei

Research Centre of Child Mental Development, Hamamatsu University School of Medicine 1-20-1, Handayama, Higashi-Ku, Hamamatsu 431–3192, Japan

Yonette F. Thomas

Howard University, Office of the Vice President for Research and Compliance (OVPRC), C.B. Powell Building, Suite 137, 525 Bryant Street, N.W., Washington DC 20059, USA

Mauricio Tohen

Division of Mood and Anxiety Disorders, University of Texas Health Science Center at San Antonio, 7526 Louis Pasteur Drive, San Antonio TX 78229-3900, USA

Ming T. Tsuang

Center for Behavioral Genomics, Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92039, USA

Kenji J. Tsuchiya

Research Centre for Child Mental Development, Hamamatsu University School of Medicine 1-20-1, Handayama, Higashi-Ku, Hamamatsu 431–3192, Japan

Christine Ulbricht

Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Blvd, Room 7151, MSC 9629, Bethesda MD 20892-9663, USA

Jim van Os

Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, PO Box 616, Vijverdal, 6200 MD, Maastricht, The Netherlands

Jorge Villatoro

Ramon de la Fuente National Institute of Psychiatry, Calzada Mexico Xochimilco 101, DF 14370, Mexico

Tracey D. Wade

School of Psychology, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia

Philip S. Wang

Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Blvd, Room 7151, MSC 9629, Bethesda, MD 20892-9663, USA

Myrna M. Weissman

Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, New York NY 10032, USA

Chapter 1

Introduction to Epidemiologic Research Methods

Glyn Lewis

Academic Unit of Psychiatry, Cotham House, Cotham Hill, Bristol BS6 6JL, UK

1.1 What is Epidemiology?

Epidemiology, according to Last's Dictionary of Epidemiology, is ‘The study of the distribution and determinants of health-related states or events in specified populations and the application of this study to control of health problems’ [1]. Wikipedia states ‘Epidemiology is the study of factors affecting the health and illness of populations, and serves as the foundation of interventions made in the interest of public health and preventive medicine’. Rothman and Greenland [2] after observing ‘there seem to be more definitions of epidemiology than epidemiologists’ fulfil their own observation by creating a new definition: ‘the ultimate goal of most epidemiologic research is the elaboration of causes that can explain patterns of disease occurrence’ [2], thereby narrowing the focus of the subject on aetiology.

John Snow is usually credited with creating epidemiology as a result of his work in the 1840s associating cholera with contaminated water from the River Thames in London [3]. It was only in the second half of the twentieth century that epidemiological methods began to be consistently applied to the whole range of health problems. Before that time, most of the focus was on infectious disease, though there were exceptions, such as pellagra [4]. Rothman coined the term ‘ modern epidemiology’ [5] to reflect the increasing understanding of population based research after the second world war and the increase in its application. The Framingham Heart Study was started in 1949 and Bradford Hill, amongst his other contributions, conducted the first randomised controlled trial (RCT) in medicine in 1948 [4]. This postwar era is the most important from the perspective of psychiatry. In this period the terms ‘ chronic disease epidemiology’ or ‘ risk factor epidemiology’ have been used to describe the extension of epidemiological methods to non-infectious disease. It is during this period that, in the main, psychiatric epidemiology has developed, often learning from epidemiologists studying heart disease and cancer.

Epidemiologists get involved in studies with a variety of uses [6] including straightforward description, as well as the studies of aetiology that Rothman and Greenland mention in their definition. However, most definitions of epidemiology appear, at least at first sight, to leave out RCTs and systematic reviews yet many epidemiologists also carry out such studies. The use of the term clinical epidemiology [5] reflects this broadening of epidemiological methods into the care of patients, the validity of diagnostic tests and clinical decision making [7]. Epidemiologists have been at the heart of the evidence-based medicine movement [8] and thinking about how research findings are best transferred to clinical practice. And finally, ‘genetic epidemiology’ [6] is the creation of a marriage between epidemiology and genetics. It is designed to exploit molecular genetics and the technological advances that have enabled rapid characterisation of a person's genetic makeup.

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