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Chapter 1 - Clinical Epidemiology

Published online by Cambridge University Press:  04 April 2024

By
James B. Kirkbride  and
Annie Jeffery
Edited by
David Kingdon ,
Paul Rowlands  and
George Stein
David Kingdon
Affiliation:
University of Southampton
Paul Rowlands
Affiliation:
Derbyshire Healthcare NHS foundation Trust
George Stein
Affiliation:
Emeritus of the Princess Royal University Hospital
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Summary

This chapter gives an introduction to key concepts in epidemiology for the clinician, student, trainee or early career researcher interested in psychiatry and mental health. Following a brief introduction to the history of epidemiology, we provide a comprehensive, yet accessible introduction to key epidemiological concepts and how these apply to psychiatry and mental health. We introduce the major observational (cohort, case-control, cross-sectional, ecological) and experimental (randomised controlled trial) designs used in epidemiology, their strengths and limitations and specific issues for their use in psychiatry. We also cover measures of disease frequency (incidence, prevalence), measures of effect (risk, rate and odds ratios) and measures of impact (population attributable risk). Our chapter then provides a comprehensive introduction to traditional and contemporary approaches to understanding the critical issue of causation, illustrated via the use of causal diagrams known as Directed Acyclic Graphs. Throughout, we use accessible examples from published research and hypothetical worked examples to consolidate the reader’s knowledge about key methods in psychiatric epidemiology.

Keywords

psychiatric epidemiologyclinical epidemiologymental healthcausal inferencecohort studiescase-control studiesrandomised controlled trialsbiasconfounding
Type
Chapter
Information
Seminars in General Adult Psychiatry , pp. 6 - 29
Publisher: Cambridge University Press
Print publication year: 2024

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References

Last, JM. A Dictionary of Epidemiology, 4th ed. Oxford: Oxford University Press; 2001.Google Scholar
Hippocrates. Hippocrates, Volume I: Ancient Medicine, Loeb Classical Library. Cambridge, MA: Harvard University Press; 2022.Google Scholar
Snow, J. On the Mode of the Communication of Cholera, 2nd ed. London: John Churchill, New Burlington Street; 1855 (reprinted New York; 1936).Google Scholar
Cooper, B, Morgan, HG. Epidemiological Psychiatry. Springfield, IL: Charles C Thomas Pub Ltd; 1973.Google ScholarPubMed
Wasserman, D (ed.). Oxford Textbook of Suicidology and Suicide Prevention, 2nd ed. Oxford: Oxford University Press; 2021.CrossRefGoogle Scholar
Hollander, A-C, Pitman, A, Sjöqvist, H, et al. Suicide risk among refugees compared with non-refugee migrants and the Swedish-born majority population. The British Journal of Psychiatry 2020;217(6):686–92. doi.org/10.1192/bjp.2019.220.CrossRefGoogle ScholarPubMed
Harris, S, Dykxhoorn, J, Hollander, A-C, et al. Substance use disorders in refugee and migrant groups in Sweden: a nationwide cohort study of 1.2 million people. PLoS Medicine 2019;16(11):e1002944. doi.org/10.1371/journal.pmed.1002944.CrossRefGoogle ScholarPubMed
Goldberger, J, The cause and prevention of Pellagra on JSTOR. Public Health Report 1914;29(37):2354.CrossRefGoogle Scholar
Hernan, M, Robins, J. Causal Inference: What If. Boca Raton: Chapman & Hall/CRC; 2020.Google Scholar
World Health Organization. International Statistical Classification of Diseases and Related Health Problems (11th ed.). https://icd.who.int/ Geneva: World Health Organization; 2019.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-V), 5th ed. Washington DC: American Psychiatric Association; 2013.Google Scholar
Jongsma, HE, Turner, C, Kirkbride, JB, et al. International incidence of psychotic disorders, 2002–17: a systematic review and meta-analysis. The Lancet Public Health 2019;4(5):e229–e244. doi.org/10.1016/S2468-2667(19)30056-8.CrossRefGoogle ScholarPubMed
Moher, D, Hopewell, S, Schulz, KF, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ 2010;340:869. doi.org/10.1136/BMJ.C869.CrossRefGoogle ScholarPubMed
Lash, TL, VanderWeele, TJ, Haneuse, S, et al. Modern Epidemiology, 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2021.Google Scholar
Lubin, JK, Gail, MH. Biased selection of controls for case-control analyses of cohort studies. Biometrics 1984;40(1):63. doi.org/10.2307/2530744.CrossRefGoogle ScholarPubMed
Helbich, M, de Beurs, D, Kwan, MP, et al. Natural environments and suicide mortality in the Netherlands: a cross-sectional, ecological study. The Lancet Planetary Health 2018;2(3):e134–e139. doi.org/10.1016/S2542-5196(18)30033-0.CrossRefGoogle ScholarPubMed
Keown, P, Weich, S, Bhui, KS, et al. Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988–2008: ecological study. BMJ 2011;343:d3736. doi.org/10.1136/BMJ.D3736.CrossRefGoogle ScholarPubMed
McManus, S, Bebbington, PE, Jenkins, R, et al. Data resource profile: adult psychiatric morbidity survey (APMS). International Journal of Epidemiology 2020;49(2):361–62e. doi.org/10.1093/IJE/DYZ224.CrossRefGoogle ScholarPubMed
Scott, KM, de Jonge, P, Stein, DJ, et al. (eds.). Mental Disorders around the World: Facts and Figures from the WHO World Mental Health Surveys. Cambridge: Cambridge University Press; 2018.CrossRefGoogle Scholar
Wadsworth, M, Kuh, D, Richards, M, et al. Cohort profile: the 1946 national birth cohort (MRC National Survey of Health and Development). International Journal of Epidemiology 2006;35(1):49–54. doi.org/10.1093/IJE/DYI201.CrossRefGoogle ScholarPubMed
Elliott, J, Shepherd, P. Cohort profile: 1970 British Birth Cohort (BCS70). International Journal of Epidemiology 2006;35(4):836–43. doi.org/10.1093/IJE/DYL174.CrossRefGoogle ScholarPubMed
Boyd, A, Golding, J, Macleod, J, et al. Cohort profile: the ‘children of the 90s’—the index offspring of the Avon Longitudinal Study of Parents and Children. International Journal of Epidemiology 2013;42(1):111. doi.org/10.1093/IJE/DYS064.CrossRefGoogle Scholar
Solmi, F, Lewis, G, Zammit, S, et al. Neighborhood characteristics at birth and positive and negative psychotic symptoms in adolescence: findings from the ALSPAC birth cohort. Schizophrenia Bulletin 2020;46(3):581–91. doi.org/10.1093/SCHBUL/SBZ049.CrossRefGoogle ScholarPubMed
Geoffroy, MC, Arseneault, L, Girard, A, et al. Association of childhood bullying victimisation with suicide deaths: findings from a 50-year nationwide cohort study. Psychological Medicine 2022. doi.org/10.1017/S0033291722000836.CrossRefGoogle Scholar
Laugesen, K, Ludvigsson, KF, Schmidt, M, et al. Nordic health registry-based research: a review of health care systems and key registries. Clinical Epidemiology 2021;13:533–4. doi.org/10.2147/CLEP.S314959.CrossRefGoogle ScholarPubMed
Jongsma, HE, Gayer-Anderson, C, Tarricone, I, et al. Social disadvantage, linguistic distance, ethnic minority status and first-episode psychosis: results from the EU-GEI case-control study. Psychological Medicine 2021;51(9):1536–48. doi.org/10.1017/S003329172000029X.CrossRefGoogle ScholarPubMed
Lewis, G, Duffy, L, Ades, A, et al. The clinical effectiveness of sertraline in primary care and the role of depression severity and duration (PANDA): a pragmatic, double-blind, placebo-controlled randomised trial. The Lancet Psychiatry 2019;6(11):903–14. doi.org/10.1016/S2215-0366(19)30366-9.CrossRefGoogle Scholar
Egger, M, Smith, GD, Schneider, M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629–34. doi.org/10.1136/BMJ.315.7109.629.CrossRefGoogle ScholarPubMed
Kandola, A, Lewis, G, Osborn, DPJ, et al. Depressive symptoms and objectively measured physical activity and sedentary behaviour throughout adolescence: a prospective cohort study. The Lancet Psychiatry 2020;7(3):262–71. doi.org/10.1016/S2215-0366(20)30034-1.CrossRefGoogle ScholarPubMed
Godlee, F, Smith, J, Marcovitch, H. Wakefield’s article linking MMR vaccine and autism was fraudulent. BMJ 2011;342:64–6. doi.org/10.1136/BMJ.C7452.Google ScholarPubMed
Wakefield, AJ, Murch, SH, Anthony, A, et al. Retracted: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998;351(9103):637–41. doi.org/10.1016/S0140-6736(97)11096-0.CrossRefGoogle ScholarPubMed
Napier, G, Lee, D, Robertson, C, et al. A model to estimate the impact of changes in MMR vaccine uptake on inequalities in measles susceptibility in Scotland. Statistical Methods in Medical Research 2016;25(4):1185–200. doi.org/10.1177/0962280216660420.CrossRefGoogle Scholar
Motta, M, Stecula, D. Quantifying the effect of Wakefield et al. (1998) on skepticism about MMR vaccine safety in the U.S. PLoS ONE 2021;16(8):e0256395. doi.org/10.1371/JOURNAL.PONE.0256395.CrossRefGoogle ScholarPubMed
Hill, AB. The Environment and Disease: Association or Causation? Proceedings of the Royal Society of Medicine 1965;58(5):295–300.CrossRefGoogle ScholarPubMed
van Dyck, CH, Swanson, CJ, Aisen, P, et al. Lecanemab in early Alzheimer’s disease. The New England Journal of Medicine 2023;388(1):9–21. doi.org/10.1056/nejmoa2212948.CrossRefGoogle ScholarPubMed
Lawlor, DA, Tilling, K, Smith, GD. Triangulation in aetiological epidemiology. International Journal of Epidemiology 2016;45(6):1866–86. doi.org/10.1093/IJE/DYW314.Google ScholarPubMed
Munafò, MR, Higgins, JPT, Smith, GD. Triangulating evidence through the inclusion of genetically informed designs. Cold Spring Harbor Perspectives in Medicine 2020;1:11. doi.org/10.1101/CSHPERSPECT.A040659.Google Scholar
Rothman, KJ, Greenland, S. Causation and causal inference in epidemiology. American Journal of Public Health 2005;95:S144–S150. doi.org/10.2105/AJPH.2004.059204.CrossRefGoogle ScholarPubMed
Tennant, PWG, Murray, EJ, Arnold, KF, et al. Use of directed acyclic graphs (DAGs) to identify confounders in applied health research: review and recommendations. International Journal of Epidemiology 2021;50(2):620–32. doi.org/10.1093/IJE/DYAA213.CrossRefGoogle Scholar
Pearce, N. Analysis of matched case-control studies. BMJ 2016;352:i969. doi.org/10.1136/bmj.i969.CrossRefGoogle ScholarPubMed
Henssler, J, Brandt, L, Müller, M, et al. Migration and schizophrenia: meta-analysis and explanatory framework. European Archives of Psychiatry and Clinical Neuroscience 2020;270:325–35. doi.org/10.1007/S00406-019-01028-7.Google ScholarPubMed
Pardiñas, AF, Holmans, P, Pocklington, AJ, et al. Common schizophrenia alleles are enriched in mutation-intolerant genes and in regions under strong background selection. Nature Genetics 2018;50:381–9. doi.org/10.1038/s41588-018-0059-2.CrossRefGoogle ScholarPubMed
Martin, J, Tilling, K, Hubbard, L, et al. Association of genetic risk for schizophrenia with nonparticipation over time in a population-based cohort study. American Journal of Epidemiology 2016;183(12):1149–58. doi.org/10.1093/aje/kww009.CrossRefGoogle Scholar
Kirkbride, JB, Hameed, Y, Ankireddypalli, G, et al. The epidemiology of first-episode psychosis in early intervention in psychosis services: findings from the social epidemiology of psychoses in East Anglia [SEPEA] study. American Journal of Psychiatry 2017;174(2):143–53. doi.org/10.1176/appi.ajp.2016.16010103.CrossRefGoogle ScholarPubMed
Bennett, C, Miller, M, Wolford, G. Neural correlates of interspecies perspective taking in the post-mortem Atlantic Salmon: an argument for multiple comparisons correction. NeuroImage 2009;47:S125. doi.org/10.1016/S1053-8119(09)71202-9.CrossRefGoogle Scholar
Faris, R, Dunham, H. Mental Disorders in Urban Areas: An Ecological Study of Schizophrenia and Other Psychoses. Chicago/London: The University of Chicago Press; 1939.Google Scholar
Lewis, G, Dykxhoorn, J, Karlsson, H, et al. Assessment of the role of IQ in associations between population density and deprivation and nonaffective psychosis. JAMA Psychiatry 2020;77(7):729–36. doi.org/10.1001/jamapsychiatry.2020.0103.CrossRefGoogle ScholarPubMed
Lewis, G, David, A, Andreasson, S, et al. Schizophrenia and city life. Lancet 1992;340(8812):137–40. doi.org/10.1016/0140-6736(92)93213-7.CrossRefGoogle ScholarPubMed
Colodro-Conde, L, Couvy-Duchesne, B, Whitfield, JB, et al. Association between population density and genetic risk for schizophrenia. JAMA Psychiatry 2018;75(9):901–10. doi.org/10.1001/jamapsychiatry.2018.1581.CrossRefGoogle ScholarPubMed
Solmi, F, Lewis, G, Zammit, S, et al. Neighborhood characteristics at birth and positive and negative psychotic symptoms in adolescence: findings from the ALSPAC birth cohort. Schizophrenia Bulletin 2020;46(3):581–91. doi.org/10.1093/SCHBUL/SBZ049.CrossRefGoogle ScholarPubMed
Paksarian, D, Trabjerg, BB, Merikangas, KR, et al. The role of genetic liability in the association of urbanicity at birth and during upbringing with schizophrenia in Denmark. Psychological Medicine 2018;48(2):305–14. doi.org/10.1017/S0033291717001696.CrossRefGoogle ScholarPubMed
Greenland, S, Senn, SJ, Rothman, KJ, et al. Statistical tests, P values, confidence intervals, and power: a guide to misinterpretations. European Journal of Epidemiology 2016;31:337–50. doi.org/10.1007/S10654-016-0149-3.CrossRefGoogle Scholar
Ford, I, Norrie, J. Pragmatic trials. New England Journal of Medicine 2016;375:454–63. www.nejm.org/doi/10.1056/NEJMra1510059.CrossRefGoogle ScholarPubMed
Hotopf, M, Churchill, R, Lewis, G. Pragmatic randomised controlled trials in psychiatry. The British Journal of Psychiatry 1999;175(3):217–23. doi.org/10.1192/BJP.175.3.217.CrossRefGoogle ScholarPubMed

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