Academic journal article Bulletin of the World Health Organization

Psychiatric Epidemiology: Selected Recent Advances and Future Directions

Academic journal article Bulletin of the World Health Organization

Psychiatric Epidemiology: Selected Recent Advances and Future Directions

Article excerpt

Voir page 471 le resume en francais. En la pagina 472 figura un resumen en espanol.


Epidemiology is concerned with understanding and controlling disease epidemics by investigating empirically the associations between variation in exposure to disease-causing agents external to the individual, variation in the resistance of individuals exposed to the disease-causing agents, and variation in resistance resources in the environments of exposed individuals (1). These investigations are initially carried out by examining natural variations. Hypotheses based on these analyses are then, usually, tested provisionally in naturalistic quasi-experimental situations with matching or statistical controls used to approximate the conditions of an experiment. If the hypotheses stand up to these preliminary, tests, they are evaluated in interventions aimed at preventing the onset or altering the course of the disorders.

Psychiatric epidemiology traditionally lags behind other branches of epidemiology because of difficulties encountered in conceptualizing and measuring mental disorders. As a result, much contemporary psychiatric epidemiology continues to be descriptive, focusing on the estimation of disorder prevalences and subtypes (2) at a time when other branches of epidemiology are making progress in documenting risk factors and developing preventive interventions (3). To the extent that psychiatric epidemiologists study risk, they tend to focus on broad nonspecific risk markers, such as gender and social class, rather than on modifiable risk factors, hence limiting the possibilities for intervention. However, this situation is changing as descriptive issues are being resolved, more analytical questions are being addressed, and preventive interventions are being implemented.

Descriptive psychiatric epidemiology

Adult community epidemiological surveys

Descriptive psychiatric epidemiology has gone through an unprecedented period of growth over the past twenty years. Starting with the Epidemiologic Catchment Area (ECA) study in the USA (2), large surveys of adult mental disorders in the general population have been carried out in numerous countries throughout the world. An important innovation of the ECA was the use of a fully structured research diagnostic interview known as the Diagnostic Interview Schedule (DIS, 4). Methodological studies demonstrated that the DIS yields reliable and valid diagnoses (5), a result that was yew important in promoting the ECA-DIS methodology in subsequent general population surveys.

The first expansion of the ECA-DIS methodology was carried out by WHO in collaboration with the US Alcohol, Drug, and Mental Health Administration to include International Statistical Classification of Diseases (ICD) criteria for research and to produce versions of the instrument in many different languages. The resulting instrument, the Composite International Diagnostic Interview (CIDI, 6), first became available in 1990. WHO technical support led to an unprecedented number of major epidemiologic surveys using the CIDI in countries as diverse as Brazil (7), Canada (8), Germany (9), Mexico (10), the Netherlands (11), and Turkey (12).

In 1997, WHO created the International Consortium in Psychiatric Epidemiology (ICPE) to coordinate the comparative analysis of these data (13). ICPE also provides technical assistance to researchers planning new CIDI surveys. The WHO World Mental Health 2000 (WMH2000) initiative has grown out of these technical assistance activities. WMH2000 will coordinate general population CIDI surveys in 20 countries in the year 2000, distributed globally in North America (Canada, USA), Latin America (Brazil, Colombia, Mexico, Peru), Europe (Belgium, France, Germany, Italy, the Netherlands, Spain, the Ukraine), the Middle East (Israel), Africa (South Africa), Asia (China, India, Japan) and the Pacific (Indonesia, New Zealand). …

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