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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
Centre for Women's Mental Health, 3rd Floor East, Jean McFarlane Bdg, University of Manchester, Oxford Road, Manchester M13 9PL, UK
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
Carrer del Doctor Aiguader, 88, Edifici PRBB, E-08003 Barcelona, Spain
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
Ramon de la Fuente National Institute of Psychiatry, Calzada Mexico Xochimilco 101, DF 14370, Mexico
Mailman School of Public Health, Columbia University, Department of Epidemiology, 600 West 168th Street, New York NY 10032, USA
Dept of Psychiatry, SUNY Stony Brook University, PutnamHall—South Campus, Stony Brook NY 11794-8790, USA
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston MA 02115, USA
Institute of Psychiatry, Psychological Medicine, King's Institute, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
National Health Research Institutes, Institute of Population Health Sciences, Division of Mental Health and Addiction Medicine, Taiwan
Departments of Psychiatry and Medicine at Brigham and Women's Hospital (BWH), Harvard Medical School, Boston, MA, USA
Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, 6001 Executive Blvd., MSC 9589, Bethesda MD 20892-9589, USA
Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, 6001 Executive Blvd., MSC 9589, Bethesda MD 20892-9589, USA
Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY 10032, USA
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
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
Center for NeuroPsychiatric Genetics, SUNY Upstate Medical University, Weiskotten Hall 3285, Syracuse NY 13210, USA
New York State Psychiatric Institute 1051 Riverside Drive, New York, NY 10032, USA
Fundacío Sant Joan de Déu Research and Development Unit, Dr. Antoni Pujadas, 42., 08830 Sant Boi de Llobregat, Barcelona, Spain
Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA, USA
Oxford University, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK
Department of Psychology, Boston University, Boston, MA 02215, USA
Departments of Psychiatry and Behavioral Sciences and Neuroscience and Physiology, Medical Genetics Research Center, SUNY Upstate Medical University, NY, USA
Departments of Psychiatry and Medicine at Brigham and Women's Hospital (BWH), Harvard Medical School, Boston MA02115, USA
Department of Psychiatry & Behavioral Sciences, Miller School of Medicine, University of Miami, 3225 Aviation Ave., Suite 303, Miami FL 33133, USA
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
Fundacío Sant Joan de Déu Research and Development Unit, Dr. Antoni Pujadas, 42., 08830 Sant Boi de Llobregat, Barcelona, Spain
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York NY 10032, USA
National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, P.O. Box 30, FI 00271 Helsinki, Finland
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
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
Psychiatric Epidemiology Research Program, Harvard Medical School/McLean Hospital, 115 Mill Street, Belmont MA 02478, USA
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
Department of Psychiatry, University of Oulu, Finland
Instructor of Psychiatry and Human Behavior (Research), Alpert Medical School of Brown University, Providence RI 02912, USA
Department of Psychiatry, University of Cambridge, Box 189, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK
Research Centre for Child Mental Development, Hamamatsu University School of Medicine 1-20-1, Handayama, Higashi-Ku, Hamamatsu 431–3192, Japan
Academy of Finland, University of Helsinki, Helsinki, Finland
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston MA 02115, USA
Department of Psychiatry, Stanford University, Palo Alto, Stanford CA 94305, USA
Academic Unit of Psychiatry, University of Bristol, Cotham House, Cotham Hill, Bristol BS6 6JL, UK
Mailman School of Public Health, Columbia University, Department of Epidemiology, 600 West 168th Street, New York NY 10032, USA
Center for Development, Behavior and Genetics, SUNY Upstate Medical University, Center for Children's' Health Policy, Syracuse NY 13210, USA
Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, 6001 Executive Blvd., MSC 9589, Bethesda, MD 20892-9589, USA
Department of Psychology, Boston University, Harvard Institute of Psychiatric Epidemiology and Genetics, 64 Cummington Street, Boston MA 02215, USA
Mailman School of Public Health, Columbia University, Department of Epidemiology, 600 West 168th Street, New York NY 10032, USA
Ramon de la Fuente National Institute of Psychiatry, Calzada Mexico Xochimilco 101, DF 14370, Mexico
Genetic Epidemiology Research Branch, Intramural Research Program, NIMH, Porter Neuroscience Research Center, 35 Convent Dr., MSC 3720, Bethesda MD 20892-3720, USA
Department of Psychiatry, University of Oulu, P.O.Box 5000, FI-90014 Helsinki, Finland
Institute of Psychiatry, Psychological Medicine, King's Institute, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
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
Professor, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Room 215, 5 Longfellow Place, Boston MA 02114, USA
Institute of Psychiatry, Psychological Medicine, King's Institute, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
Genetic Epidemiology Research Branch, Intramural Research Program, NIMH, Porter Neuroscience Research Center, 35 Convent Dr., MSC 3720, Bethesda MD 20892-3720, USA
Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, NY, USA
Fundacío Sant Joan de Déu Research and Development Unit, Dr. Antoni Pujadas, 42., 08830 Sant Boi de Llobregat, Barcelona, Spain
Fundaci o Sant Joan de Deu Research and Development Unit, Dr. Antoni Pujadas, 42., 08830 Sant Boi de Llobregat, Barcelona, Spain
Laboratory for Psychiatric Biostatistics, McLean Hospital, 115 Mill St, Belmont MA 02478, USA
Ramon de la Fuente National Institute of Psychiatry, Calzada Mexico Xochimilco 101, DF 14370, Mexico
Ramon de la Fuente National Institute of Psychiatry, Calzada Mexico Xochimilco 101, DF 14370, Mexico
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston MA02115, USA
Fundacío Sant Joan de Déu Research and Development Unit, Dr. Antoni Pujadas, 42., 08830 Sant Boi de Llobregat, Barcelona, Spain
Department of Psychology, New York University, 6 Washington Place, Rm 455, New York NY 1003, USA
Department of Psychiatry at VA Boston Healthcare System, Harvard Medical School Department of Psychiatry, Boston MA 02215, USA
Harvard Institute of Psychiatric Epidemiology and Genetics, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
Mailman School of Public Health, Columbia University, Department of Epidemiology, 600 West 168th Street, New York NY 10032, USA
Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, P.O.Box 30, FI 0027 Helsinki, Finland
Research Centre of Child Mental Development, Hamamatsu University School of Medicine 1-20-1, Handayama, Higashi-Ku, Hamamatsu 431–3192, Japan
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
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
Center for Behavioral Genomics, Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92039, USA
Research Centre for Child Mental Development, Hamamatsu University School of Medicine 1-20-1, Handayama, Higashi-Ku, Hamamatsu 431–3192, Japan
Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Blvd, Room 7151, MSC 9629, Bethesda MD 20892-9663, USA
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
Ramon de la Fuente National Institute of Psychiatry, Calzada Mexico Xochimilco 101, DF 14370, Mexico
School of Psychology, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia
Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Blvd, Room 7151, MSC 9629, Bethesda, MD 20892-9663, USA
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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Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!
Lesen Sie weiter in der vollständigen Ausgabe!