TEXTBOOK IN PSYCHIATRIC EPIDEMIOLOGY SECOND EDITION TEXTBOOK IN PSYCHIATRIC EPIDEMIOLOGY SECOND EDITION Edited by Ming T Tsuang Department of Epidemiology Harvard School of Public Health and Pediatric Psychopharmacology Unit Psychiatry Service Massachusetts General Hospital Mauricio Tohen Lilly Research Laboratories and Department of Psychiatry McLean Hospital Harvard Medical College Copyright 2002 by John Wiley & Sons, Inc All rights reserved Published by John Wiley & Sons, Inc., Hoboken, New Jersey Published simultaneously in Canada No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-750-4470, or on the web at www.copyright.com Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, Ž201 748-6011, fax Ž201 748-6008, e-mail: permcoordinator@ wiley.com Limit of LiabilityrDisclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose No warranty may be created or extended by sales representatives or written sales materials The advice and strategies contained herein may not be suitable for your situation You should consult with a professional where appropriate Neither the publisher nor author shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages For general information on our other products and services please contact our Customer Care Department within the U.S at 877-762-2974, outside the U.S at 317-572-3993 or fax 317-572-4002 Wiley also publishes its books in a variety of electronic formats Some content that appears in print, however, may not be available in electronic format Library of Congress Cataloging-in-Publication Data is a©ailable ISBN 0-471-40974-X Printed in the United States of America 10 CONTENTS CONTRIBUTORS vii PREFACE xi PART I STUDY DESIGNS AND METHODS Introduction to Epidemiologic Research Methods Jerome A Fleming and Chung-Cheng Hsieh Analysis of Categorized Data: Use of the Odds ratio as a Measure of Association Stephen L Hillis and Robert F Woolson Methods in Psychiatric Genetics Stephen V Faraone, Debby Tsuang, and Ming T Tsuang 35 65 Reliability Patrick E Shrout 131 Validity: Definitions and Applications to Psychiatric Research Jill M Goldstein and John C.Simpson 149 Mental Health Services Research Jack D Burke, Jr 165 The Pharmacoepidemiology of Psychiatric Medications Philip S Wang, Alexander M Walker, and Jerry A®orn 181 Peering into the Future of Psychiatric Epidemiology Ezra Susser, Michaeline Bresnahan, and Bruce Link 195 PART II ASSESSMENT Studying the Natural History of Psychopathology William W Eaton 10 The Developmental Epidemiology of Psychiatric Disorders Mary Cannon, Matti Huttunen, and Robin Murray 213 215 239 v vi CONTENTS 11 Birth and Development of Psychiatric Interviews Lee N Robins 257 12 Symptom Scales and Diagnostic Schedules in Adult Psychiatry Jane M Murphy 273 13 DSM-IV and Psychiatric Epidemiology Michael B First 333 14 The National Comorbidity Survey Ronald C Kessler and Ellen Walters 343 PART III 363 EPIDEMIOLOGY OF MAJOR PSYCHIATRIC DISORDERS 15 Epidemiology of Psychosis with Special Reference to Schizophrenia E®elyn J Bromet, Mary Amanda Dew and William W Eaton 365 16 Epidemiology of Depressive and Anxiety Disorders Ewald Horwath, Rose S Cohen, and Myrna M Weissman 389 17 Epidemiology of Bipolar Disorder Mauricio Tohen and Jules Angst 427 18 The Epidemiology of First-Onset Mania T Lloyd and P B Jones 445 19 The Epidemiology of Alcohol Use, Abuse, and Dependence Nancy L Day and Gregory G Homish 459 20 Epidemiology of Drug Dependence James C Anthony, with John E Helzer 479 21 Personality Disorders: Epidemiological Findings, Methods and Concepts Michael J Lyons and Beth A Jerskey 563 PART IV 601 EPIDEMIOLOGY OF SPECIAL POPULATIONS 22 Epidemiology and Geriatric Psychiatry Celia F Hybels and Dan G Blazer 603 23 The Epidemiology of Child and Adolescent Mental Disorders Stephen L Buka, Michael Monuteaux, and Felton Earls 629 24 Epidemiology of Mood and Anxiety Disorders in Children and Adolescents Kathleen Ries Merikangas and Shelli A®ene®oli 657 Index 705 CONTRIBUTORS Jules Angst, Research Department, Psychiatric University Hospital, P O Box 68, 8029 Zurich, Switzerland James C Anthony, Johns Hopkins University, 624 North Broadway, Room 893, Baltimore, MD 21205 Shelli Avenevoli, Mood and Anxiety Disorder Program, National Institute of Mental Health, 15K North Drive, MSC ࠻2670, Bethesda, MD 20892 Jerry Avorn, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital Medical School, Boston, MA 02115 Dan G Blazer, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 Michaeline Bresnaham, Department of Edpidemiology, Mailman School of Public Health, Columbia University, New York, NY, and New York Psychiatric Institute, New York, NY 10032 Evelyn J Bromet, State University of New York at Stony Brook, Stony Brook, NY 11794 Stephen L Buka, Departments of Maternal and Child Health and Epidemiology, Harvard School of Public Health, Boston, MA 02115 Jack D Burke, Jr., Department of Psychiatry, Harvard Medical School, The Cambridge Hospital, Cambridge, MA 02139 Mary Cannon, Division of Psychological Medicine, Institute of Psychiatry, London, UK SE5 8AF Rose S Cohen, College of Physicians and Surgeons of Columbia University, New York, NY 10032 Nancy L Day, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213-2593 Mary Amanda Dew, Johns Hopkins University, Baltimore, MD 21205 Felton Earls, Harvard School of Public Health, Boston, MA 02115 William W Eaton, Department of Mental Hygiene, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205 Stephen V Faraone, Department of Psychiatry, Massachusetts Mental Health Center, 750 Washington Street, Suite 255, South Eaton, MA 02375 vii viii CONTRIBUTORS Michael B First, New York State Psychiatric Institute, New York, NY 10032 Jerome A Fleming, Harvard Medical School, Department of Psychiatry at Massachusetts Mental Health Center, Harvard Institute of Psychiatric Epidemiology and Genetics, and BrocktonrWest Roxbury Veterans Administration Medical Center, Psychiatry Service, Brockton, MA 02301 Jill M Goldstein, Harvard Medical School at Massachusetts Mental Health Center, Harvard Institute of Psychiatric Epidemiology and Genetics, Massachusetts General Hospital, Massachusetts Mental Health Center, Boston, MA 02115 John E Helzer, Health Behavior Research Center, 54 West Twin Oaks Terrace, Suite 14, South Burlington, VT 05403 Stephen L Hillis, Department of Statistics and Actuarial Science, University of Iowa College of Liberal Arts, Iowa City, IA 52242 Gregory G Homish, Program in Alcohol Epidemiology, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213-2593 Ewald Horwath, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, New York, NY 10032 Chang-Cheng Hsieh, Division of Biostatistics and Epidemiology, University of Massachusetts Cancer Center, Worcester, MA 01605 Matti Huttunen, Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland Celia F Hybels, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 Beth A Jerskey, Department of Psychology, Boston University, Boston, MA 02115 Peter B Jones, Department of Psychiatry, University of Cambridge, Adenbrooke’s Hospital, Cambridge, UK Ronald C Kessler, Department of Health Care Policy, Harvard Medical School, Boston, MA 02115 Bruce Link, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, and New York State Psychiatric Institute, New York, NY 10032 Tuhina Lloyd, University of Nottingham, Duncan Macmillan House, Nottingham, UK Michael J Lyons, Cemter for Clinical Biopsychology, Department of Psychology, Boston University, and Harvard Institute of Psychiatric Epidemiology and Genetics, Boston, MA 02215 Kathleen Ries Merikangas, Mood and Anxiety Disorder Program, National Institute of Mental Health, 15K North Drive, MSC ࠻2670, Bethesda, MD 20892 Michael Monuteaux, Harvard School of Public Health, Boston, MA 02115 CONTRIBUTORS ix Jane M Murphy, Department of Psychiatry, Harvard Medical School, Department of Epidemiology, Harvard School of Public Health, and Psychiatric Epidemiology Unit, Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA 02109 Robin Murray, Division of Psychological Medicine, Institute of Psychiatry, London, UK SE5 8AF Lee N Robins, Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63110 Patrick E Shrout, Department of Psychology, New York University, New York NY 10003 John C, Simpson, Harvard Medical School Department of Psychiatry, Harvard Institute of Psychiatric Epidemiology and Genetics, Massachusetts Mental Health Center, Boston, MA, and VA Boston Healthcare System, Mental Health Careline, Boston, MA 02115 Ezra Susser, Department of Epidemiology, Joseph L Mailman School of Public Health, Columbia University, College of Physcians and Surgeons, and New York State Psychiatric Institute, New York, NY 10032 Mauricio Tohen, Lilly Research Laboratories, Indianapolis, IN, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA 02184 Debby Tsuang, VAPSHCS Ž116 MIRECC, 1660 South Columbian Way, Seattle, WA 98108 Ming T Tsuang, Department of Epidemiology, Harvard School of Public Health and Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, MA 02115 Alexander M Walker, Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115 Ellen Walters, Harvard Medical School, Boston, MA 02115 Philip S Wang, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA 02115 Myrna M Weissman, Department of Epidemiology in Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032 Robert F Woolson, Department of Biostatistics, The University of Iowa, College of Public Health, Iowa City, IA 52242 PREFACE It has been seven years since the publication of our first edition of the Textbook of Psychiatric Epidemiology The field has continued to expand and important new findings have been published The intent of the first edition was to produce a textbook for our students at the Harvard Program in Psychiatric Epidemiology and Biostatistics as well as for students from other training programs across the United States We have received extremely positive feedback about the first edition from students and faculty from training sites across the United States Our expectations were actually surpassed, as general psychiatrists, epidemiologists, and other mental health professionals have been very favorable of the textbook The interest in our textbook, especially from Western Europe, has expanded our geographical boundaries The second edition includes an update of the chapters by the same distinguished faculty We have extended our list of contributors to include our European experts who are contributing as co-authors or, in some cases, with chapters that were not included in the first edition We have also added two chapters on the epidemiology of child mental disorders The textbook is prepared in four separate sections The first focuses on study design and methods, the second on assessment, and the third on epidemiology of major psychiatric disorders The fourth section focuses on the epidemiology of special populations, such as the elderly and children As in our first edition, our objective is to provide a comprehensive, easy to understand overview of research methods for the nonmethodologist Our targeted audience is students of psychiatric epidemiology, psychiatric residents, general psychiatrists, and other mental health professionals We would like to acknowledge three individuals; Alexander Leighton, Gerald Klerman, and Brian MacMahon who were the foundation of the Harvard Program in Psychiatric Epidemiology MING T TSUANG MAURICE TOHEN xi PART I Study Design and Methods Textbook in Psychiatric Epidemiology, Second Edition, Edited by Ming T Tsuang and Mauricio Tohen ISBN 0-471-40974-X ᮊ 2002 John Wiley & Sons, Inc 708 INDEX ŽCIDI Ž Continued bipolar disorder, 433, 434 child and adolescent psychiatry, 645 diagnostic interviews, 263᎐264, 344᎐345 drug dependence, 492, 493, 502᎐505 geriatric psychiatry, 604 major depression, 391᎐392 National Comorbidity Survey, 354 panic disorder, 409 schizophrenia, 367 social phobia, 415 symptom scales and schedules, 294, 295, 296, 298, 299, 301, 303, 306᎐307 validity and reliability, 309 WHO World Mental Health 2000, 355᎐357 Concordance, twin studies, 74 Concurrent validity, criterion validity, 152᎐153 Conduct disorder, comorbidity, mood disorders and, 665 Confounding bias, nonexperimental Žobservational studies, group comparisons in, 28᎐30 Consensus rule, reliability, 137 Consistency of association, internal validity, 159 Construct validity, 156᎐158 application of, 157᎐158 described, 156᎐157 threats to, 158 Content validity: described, 150᎐151 examples of, 151᎐152 Contextual level: individual level combined with, 202᎐203 levels of causation, 200᎐202 Cornell Medical Index ŽCMI., 287, 299, 300, 302 Cornell Selectee Index ŽCSI., 286, 287 Costs See also Health Maintenance Organizations ŽHMOs child and adolescent psychiatry, instrument selection, 635 geriatric psychiatry, 620 mental health services research, 165 mental health services research, analytic studies, 170 psychopharmacoepidemiology, 188 Course of disease, 224᎐228 See also Pathologic process bipolar disorder, 428 drug dependence, 496᎐500 first-onset mania, 454 recurrence, 226᎐228 remission, 224᎐226 schizophrenia, 378᎐379 Criminal justice system, drug dependence, 494, 517 Criterion validity: described, 152᎐153 examples of, 153᎐156 Cronbach’s : content validity, 152 reliability statistics, 143 symptom scales and schedules, 307, 309 Cross-sectional assessments, criterion validity, 152᎐153 Cross-sectional studies, 12᎐16 disease and exposure status measures, 15᎐16 odds ratio, 35᎐36 survey sampling, 13᎐15 Cultural factors: alcohol use and abuse, 459 bipolar disorder, 439 Cumulative incidence, outcome occurrence measures, 56 Cyclothymia, bipolar disorder, 435 Cytogenic abnormalities, psychiatric genetics, 99 Data hierarchies, developmental epidemiology, analytic methods, 243᎐244 Data sources: personality disorders, 585᎐589 psychopharmacoepidemiology, 183᎐185 Dementia praecox, 428, 445 Dementing disorders: comorbidity, 614᎐615 outcome studies, 617᎐619 prevalence, 610᎐611 risk factors, 613᎐614 Demography Žschizophrenia , 370᎐373 See also Risk factors; specific risk factors gender and age, 372᎐373 marital status, 373 race and ethnicity, 371᎐372 social class, 370᎐371 Department Interview, diagnostic interviews, 261᎐262 Dependent personality disorder, prevalence, 578, 580 Depression See also Child and adolescent psychiatry Žmood disorders.; Dysthymic disorder; Major depression developmental epidemiology, 245᎐246 epidemiology of, 389, 418᎐419 geriatric psychiatry, 604᎐605 comorbidity, 614᎐615 depressive disorders, 608᎐609 etiologic studies, 612᎐613 outcome studies, 615᎐617 subsyndromal depression, 609᎐610 Descriptive studies Žmental health services research : institution surveys, 166᎐167 population surveys, 167᎐169 Determinants of Outcome of Severe Mental Disorders ŽDOSMED., 367, 369 Developmental epidemiology, 239᎐255 INDEX analytic methods, 242᎐244 data hierarchies, 243᎐244 growth curve models, 243 missing values, 244 repeated observations, 243 applications, 244᎐248 affective disorder, 245᎐246 post-traumatic stress disorder ŽPTSD., 246᎐247 schizophrenia, 244᎐245 temperament, adaptation and resilience, 248 violence, 247 defined, 239 developmental psychopathology and, 240 study design strategies, 240᎐242 case-control studies, 241᎐242 cohort studies, 240᎐241 Developmental issues: personality disorders, 567᎐568 psychopathology, developmental epidemiology, 240 Diabetes, schizophrenia and, 374 Diagnostic and Statistical Manual of Mental Disorders Ž DSM : onset, 216 reliability, 131 Diagnostic and Statistical Manual of Mental Disorders Ž DSM-I : personality disorders, 564, 573 perspective of, 334 symptom scales and schedules, 284, 285 Diagnostic and Statistical Manual of Mental Disorders Ž DSM-II , perspective of, 334 Diagnostic and Statistical Manual of Mental Disorders ŽDSM-III.: agoraphobia, 410411, 412, 413, 414 alcoholism, 467, 468, 469᎐471 anxiety disorders, 407 bipolar disorder, 431, 433 child and adolescent psychiatry, 631, 632, 640 diagnostic interviews, 262᎐263, 333, 344 drug dependence, 488, 489, 491, 492, 502᎐505, 513, 514, 530, 531, 540 dysthymic disorder, 404᎐405 first-onset mania, 450, 451 generalized anxiety disorder, 415᎐417 geriatric psychiatry, 605, 609, 610 major depression, 390, 391, 395, 396, 399, 401, 403᎐404 National Comorbidity Survey, 347 obsessive-compulsive disorder, 417᎐418 onset, 220 outcome, 229 panic disorder, 408, 409 personality disorders, 563, 564, 565᎐566, 568, 569, 570᎐581, 584, 588, 590 perspective of, 335, 336 709 population surveys, mental health services research, 168 schizophrenia, 367, 368 social phobia, 414᎐415 symptom scales and schedules, 275, 278, 284, 285, 290, 293, 297, 305, 311, 312 Diagnostic and Statistical Manual of Mental Disorders Ž DSM-III-R : agoraphobia, 410᎐411, 412 alcoholism, 467, 468, 470᎐471 anxiety disorders, 407 bipolar disorder, 433 child and adolescent psychiatry, 631, 632, 633, 634, 641, 642, 648, 675, 678 criterion validity, 154᎐156 drug dependence, 490, 492, 502᎐505, 507 dysthymic disorder, 404᎐405 first-onset mania, 449, 451, 454 generalized anxiety disorder, 415᎐417 geriatric psychiatry, 604, 608, 610 major depression, 390, 391, 395, 396, 403᎐404 National Comorbidity Survey, 346, 348᎐349, 350 panic disorder, 408, 409 personality disorders, 564, 566, 567, 570, 573᎐576, 578, 579, 588 perspective of, 336 population surveys, mental health services research, 168 schizophrenia, 368, 369, 374 social phobia, 414᎐415 symptom scales and schedules, 275, 293, 298, 305 Diagnostic and Statistical Manual of Mental Disorders Ž DSM-IV , 333᎐342 agoraphobia, 412 alcoholism, 467᎐468 bipolar disorder, 428᎐430 child and adolescent psychiatry, 631, 632, 633, 634, 642, 645, 674, 675, 678 diagnostic interviews, 264᎐265 drug dependence, 491, 522 first-onset mania, 446᎐447 future trends, 340᎐341 geriatric psychiatry, 604, 608 historical perspective, 333᎐336 impact of, 336᎐340 clinical significance requirement, 338᎐339 comorbidity, 339᎐340 generally, 336᎐337 specific wording of criteria, 338 symptom counts, 337᎐338 major depression, 395, 398 mood disorders, 658 National Comorbidity Survey, 352 overview, 333 panic disorder, 409 710 INDEX Ž DSM-IV Ž Continued personality disorders, 563᎐564, 567, 576, 580, 582, 584, 587588, 591 schizophrenia, 372 symptom scales and schedules, 275, 290, 293, 305 Diagnostic and Statistical Manual of Mental Disorders Ž DSM-V , 340᎐341 Diagnostic Interview for Children and Adolescents - Revised ŽDICA-R., 675 Diagnostic interviews See Psychiatric interview Diagnostic Interview Schedule ŽDIS., 135 agoraphobia, 413, 414 bipolar disorder, 431, 434 content validity, 151 diagnostic interviews, 262᎐263, 344 drug dependence, 492, 493, 501, 502᎐503, 514 geriatric psychiatry, 604, 605, 609, 610 panic disorder, 409 schizophrenia, 367 symptom scales and schedules, 292, 293, 296, 298, 304, 307 validity and reliability, 309, 310 Diagnostic Interview Schedule for Children ŽDISC., 632᎐633 Differential effects, internal validity, 159 Dimensions, syndromes and, symptom scales and schedules, 275᎐279 Disability Assessment Schedule ŽDAS., 298 Discordant twin studies, family studyrhistory, 72 See also Twin studies Discriminant validity: construct validity, 158 criterion validity, 153 Disease measures, cross-sectional studies, 15᎐16 Dizygotic twins, generenvironment interaction, 74᎐76 See also Twin studies DNA See also Gene location; Psychiatric genetics gene location, 82᎐99 psychiatric genetics, 78 DNA biosensors, gene location, 86 Dopamine, drug dependence, 519᎐520 Drug dependence, 479᎐561 See also Alcohol use and abuse; Substance abuse case ascertainment methods, 492᎐496 clinical features and case definitions, 488᎐492 definitions, 479 determinants of, 508᎐541 adolescence, 534᎐539 adulthood, 539᎐541 age differences, 511᎐516 childhood, 530᎐534 gender differences, 510᎐511 genetics, 518᎐528 prenatal and perinatal influences, 528᎐530 race differences, 516᎐518 future directions, 543᎐545 incidence, 500᎐501 overview, 479᎐483 pathogenesis, natural history, and clinical course, 496᎐500 prevalence, 502᎐508 problem distribution, 483᎐488 treatment, 541᎐542 Duchenne’s muscular dystrophy, psychiatric genetics, 99 Dysthymic disorder, 404᎐407 defined, 404 risk factors, 405᎐406 Ecogenetics, segregation analysis, 113 Economy, mental health services research, 165 See also Costs Ecstasy Ždrug., 481 Education level, alcohol use and abuse, 462, 465, 471 Effectiveness, mental health services research, 165᎐166, 172᎐174 Efficiency, mental health services research, 165 Emergence of symptoms, onset, 218᎐219 Emerging trends See Future directions Environment: child and adolescent psychiatry, 649᎐650 psychiatric genetics, 65᎐66 Environmentrgene interaction: adoption studies, 76᎐78 segregation analysis, 113᎐114 transmission models, 80 twin studies, 74᎐76 Epidemiologic Catchment Area ŽECA Study, 344 agoraphobia, 411, 412, 413, 414 alcoholism, 469, 470, 471, 472 bipolar disorder, 431᎐432, 436, 438, 439 child and adolescent psychiatry, 664 drug dependence, 491᎐492, 493, 501, 502᎐505, 507, 510, 512, 514, 540, 541 dysthymic disorder, 404᎐405 generalized anxiety disorder, 416 geriatric psychiatry, 605᎐607, 613, 616, 618, 619 major depression, 391, 392, 393, 394, 397, 399, 400, 401, 403 panic disorder, 409᎐410 personality disorders, 565, 573, 576, 592 Epidemiologic research methods, 333 See also Psychiatric epidemiologic research methods Epidemiology, defined, See also Psychiatric epidemiologic research methods; Psychopharmacoepidemiology Equity, mental health services research, 165 Established Populations for Epidemiologic Studies of the Elderly ŽEPESE., 608, 610, 611, 612, 613, 615, 618 Estimation, reliability, 133᎐135 INDEX Ethnicity See also Race differences alcohol use and abuse, 462, 463, 464, 469᎐470, 471 child and adolescent psychiatry: anxiety disorders, 680 mood disorders, 667᎐668 major depression, 399 panic disorder, 410 schizophrenia, 371᎐372 Ethnography, drug dependence, 481 Etiology: geriatric psychiatry, 611᎐615 pathologic process and, onset, 216᎐219 Experimental studies: mental health services research, 172᎐174 study designs, 10᎐12 Exposure, psychiatric genetics, 66 Exposure measures, case-control studies, 23᎐24 Exposure status measures, cross-sectional studies, 15᎐16 External validity, described, 160᎐161 Extra-medical drug use, described, 480 Familial disorders, 6673 See also Genetics family study versus family history, 70᎐73 proband selection, 67᎐70 Family history: child and adolescent psychiatry: anxiety disorders, 680᎐681 mood disorders, 669᎐670 major depression, 402 panic disorder, 410 schizophrenia, 373᎐374 Family-study designs, psychiatric genetics, 107᎐109 Family studyrhistory, psychiatric genetics, 70᎐73 First-onset mania, 445᎐458 age at onset, 450 children and adolescents, 450᎐451 clinical features, 452᎐453 course of disease, 454 diagnosis and definitions, 445᎐447 diagnostic stability, 454᎐455 gender differences, 451 geography and migration, 451᎐452 incidence, 447᎐450 overview, 445 substance abuse, 453᎐454 Fisher’s exact test, tests of association, 40, 41, 42 Fluorescent in situ hybridization ŽFISH., psychiatric genetics, 99 Folie circulaire, 428 See also Bipolar disorder Food and Drug Administration ŽFDA., 182 Forensic psychiatry, drug dependence, 494 Functioning, outcome, 230 Future directions, 195᎐211 711 Diagnostic and Statistical Manual of Mental Disorders Ž DSM-IV , 340᎐341 drug dependence, 543᎐545 historical perspective, 196᎐197 levels of causation, 198᎐206 combining levels, 202᎐203 contextual level, 200᎐202 examples, 203᎐206 individual level, 198᎐200 logic extended, 206᎐207 mood and anxiety disorders, 419᎐420 overview, 195᎐196 personality disorders, 592 possibilities, 207᎐208 psychiatric interview, 270 psychopharmacoepidemiology, 189᎐190 schizophrenia, 380 Gateway association, drug dependence, 498 GEMENI, segregation analysis algorithms, psychiatric genetics, 111 Gender differences: alcohol use and abuse, 461᎐462, 464, 465, 468, 469, 470᎐471 bipolar disorder, 438 child and adolescent psychiatry: anxiety disorders, 679 mood disorders, 666᎐667 drug dependence, 510᎐511 dysthymic disorder, 406 first-onset mania, 451 major depression, 395᎐396 panic disorder, 409 schizophrenia, 372᎐373 Gene chips, gene location, 86 Generenvironment interaction, twin studies, 74᎐76 Gene location, 82᎐99 DNA biosensors and gene chips, 86 linkage analysis, 83᎐86 alternatives to, 95᎐99 background of, 83᎐84 genetic markers for, 84᎐86 statistical methods of, 86᎐94 mode of transmission, psychiatric genetics, 79 General Health Questionnaire ŽGHQ.: diagnostic interviews, 260 reliability and validity, 308᎐309 symptom scales and schedules, 300᎐301, 303, 304, 305, 306 Generalizability theory, reliability estimation, 135 Generalized anxiety disorder, 415᎐417 child and adolescent psychiatry, 674, 675 defined, 415᎐416 rates of, 416᎐417 risk factors, 417 712 INDEX Genetic counseling, psychiatric genetics, 78 Genetic disorders, gene location, 83 Genetic markers, linkage analysis, 84᎐86 Genetics See also Psychiatric genetics alcoholism, 472 bipolar disorder, 440 child and adolescent psychiatry, 646᎐647 anxiety disorders, 680᎐681 mood disorders, 668᎐670 drug dependence, 482, 518᎐528 geriatric psychiatry, 613, 614 levels of causation, 202᎐203 major depression, 402 panic disorder, 410 schizophrenia, 373᎐374 Genome, composition of, 82 Genotype, psychiatric genetics, 66 Geography: drug dependence, 483᎐488, 503 first-onset mania, 451᎐452 Geriatric depression, risk factors, 397᎐398 Geriatric psychiatry, 603᎐628 case definition, 604᎐605 case distribution, 605᎐611 dementing disorders, 610᎐611 depressive disorders, 608᎐609 subsyndromal depression, 609᎐610 etiologic studies, 611᎐615 comorbidity, 614᎐615 dementing disorders, 613᎐614 depression, 612᎐613 health care system, 620 historical perspective, 619᎐620 outcome studies, 615᎐619 dementing disorders, 617᎐619 depressive disorders, 615᎐617 overview, 603᎐604 Goodness of fit, psychiatric genetics, 79 Government databases, psychopharmacoepidemiologic data sources, 183᎐184 Grade of Membership ŽGOM analysis, 309 Great Smoky Mountain Study of Youth, 641᎐642 Group comparisons, nonexperimental Žobservational studies, 26᎐30 Growth curve models, developmental epidemiology, analytic methods, 243 Hamilton Rating Scale, 304 Haplotypes, linkage analysis, 85 Hardy-Weinberg equilibrium, linkage analysis, 90᎐91, 112 Hawthorne effect, experimental study designs, 10᎐11 Health care system, geriatric psychiatry, 620 Health maintenance organizations ŽHMOs See also Costs mental health services research, payments, 171 psychopharmacoepidemiology, data sources, 184 Health Opinion Survey ŽHOS., 288, 289, 290, 291 diagnostic interviews, 260 symptom scales and schedules, 300 Heritability, twin studies, 74᎐75 See also Genetics; Twin studies Heroin, geographic distribution, 484᎐485 Heterozygous gene, linkage analysis, 93 High-risk design, psychiatric genetics, 108᎐109 History effects, internal validity, 159 Histrionic personality disorder, prevalence, 577᎐578 Home Inventory Schedules ŽHIS., prevalence assessment, 259᎐260 Homelessness, bipolar disorder, 439 Homologous chromosomes, linkage analysis, 83᎐84 Homozygous gene, phenylketonuria ŽPKU., 75 Hopkins Symptom Checklist ŽHSCL., 303, 304, 308 Hormonal change, child and adolescent psychiatry, 670 Hospital records, psychiatric epidemiology, 257᎐258 Household informant, psychiatric epidemiology, 258 Hybrid studies, nonexperimental Žobservational studies, 25᎐26 Hypothalamic-pituitary-adrenal ŽHPA system, depression, 246 Ice See Methamphetamine Identity-by-descent method, linkage analysis, 92 Identity-by-state method, linkage analysis, 92 Imipramine, psychopharmacoepidemiology, 181 Incidence: drug dependence, 500᎐501 first-onset mania, 447᎐450 population measures of onset, 22᎐224 Incidence density, outcome occurrence measures, 45 Individual level: contextual level combined with, 202᎐203 levels of causation, 198᎐200 Infectious Disease Era, 196᎐197 Informants, personality disorders, data sources, 586 Information bias, nonexperimental Žobservational studies, group comparisons in, 27᎐28 Inner Borough Study, 639᎐640 Institution surveys, mental health services research, descriptive studies, 166᎐167 Instrumentation effects, internal validity, 159 Intensification of symptoms, onset, 217᎐218 INDEX Internal consistency, reliability estimation, 134᎐135 Internal validity, described, 158᎐160 International Classification of Diseases Ž ICD See also World Health Organization ŽWHO alcoholism, 468 bipolar disorder, 434 child and adolescent psychiatry, 633 diagnostic criteria, 335, 336, 338 drug dependence, 489, 490᎐491 first-onset mania, 446, 447, 449᎐450, 454 geriatric psychiatry, 608, 610 major depression, 392᎐393, 404 National Comorbidity Survey, 353 personality disorders, 569, 588᎐589 symptom scales and schedules, 283, 296, 307 International Personality Disorders Examination ŽIPDE, WHO., 298, 587 Interval prevalence, drug dependence, 506᎐507 Interviews See Psychiatric interview Intraclass correlations, reliability statistics, 138᎐139 Iowa Structured Psychiatric Interview ŽISPI., 292, 296 Iowa 500 Study, 292 IQ, birth weight and, levels of causation, 204᎐205 Isle of WightrInner Borough Study, 639᎐640 Item Response Theory ŽIRT., 277᎐278 Jails, mental health services research, institution surveys, 167 Kaplan-Meier method, psychiatric genetics, 106᎐107 Karyotype, psychiatric genetics, 99 Large sample test of equal proportions, 40 Lay-administered diagnostic schedules, reliability and validity, 309᎐311 Levels of causation, 198᎐206 See also Etiology combining levels, 202᎐203 contextual level, 200᎐202 individual level, 198᎐200 Liability concept, psychiatric genetics, mode of transmission, 80᎐81 Life events: child and adolescent psychiatry Žmood disorders , 671᎐672 risk factors, child and adolescent psychiatry Žanxiety disorders., 684᎐685 Lifetime prevalence See also Prevalence drug dependence, 502᎐506 National Comorbidity Survey Žbaseline , 345᎐347 713 outcome occurrence measures, 67 Ž See also Developmental epidemiology Lifetime risk, psychiatric genetics, 104 See also Developmental epidemiology Likelihood, psychiatric genetics, mode of transmission, 79 Linkage analysis, 83᎐86 alternatives to, 95᎐99 background of, 83᎐84 genetic markers for, 84᎐86 statistical methods of, 86᎐94 Liver cirrhosis, alcoholism, 469 Lod score method, linkage analysis, 88᎐91 Logistic regression, odds ratio, 58᎐63 Longitudinal Aging Study Amsterdam ŽLASA., 608, 610, 612, 618 Loss to follow-up, cumulative incidence, outcome occurrence measures, Lundby interview, diagnostic interviews, 260᎐261, 262 Major depression, 390᎐404 defined, 390 ECA follow-up, 394 geriatric psychiatry, 609 paradigms of, 394᎐395 rates of, 390᎐393 risk factors, 395᎐403 adolescent depression, 398 attributable risk, 402᎐403 comorbidity, 401᎐402 family history, 402 gender differences, 395᎐396 geriatric depression, 397᎐398 marital status, 401 race and ethnicity, 399 secularrtemporal effects, 396᎐397 socioeconomic status, 399᎐400 urban-rural residence, 400 subtypes, 393 Managed care, geriatric psychiatry, 620 See also Costs; Health Maintenance Organizations ŽHMOs Mania See First-onset mania Manic-depressive illness See Bipolar disorder MANOVA, developmental epidemiology, 243 Mantel-Haenszel test, 49᎐51, 56, 58 Marijuana See Cannabis Marital status: alcohol use and abuse, 462, 464, 470, 471 bipolar disorder, 438᎐439 dysthymic disorder, 406 major depression, 401 schizophrenia, 373 Matched-pairs analysis, odds ratio, 56᎐58 Matching fallacy, psychiatric genetics, 68 714 INDEX Mathematical modeling, psychiatric genetics, mode of transmission, 79᎐80 Maturation, internal validity, 159 Maudsley Personality Inventory ŽMPI., 286, 287, 288, 289 MAXFUN, segregation analysis algorithms, psychiatric genetics, 111 Maximum likelihood estimate ŽMLE., psychiatric genetics, 105 McNemar’s test, 57 Measles, mumps, and rubella ŽMMR immunization, autism and, 199 Medical Outcomes Study ŽMOS., 301 Medication See Psychopharmacoepidemiology; Psychopharmacology Meiosis, linkage analysis, 83᎐84 Mendelian genetic model: linkage analysis, 91 mode of transmission, 79᎐80 Mental health services research, 165᎐179 analytic studies, 169᎐172 costs, 170 payments, 170᎐171 sector interactions, 172 descriptive studies, 166᎐169 institution surveys, 166᎐167 population surveys, 167᎐169 experimental studies, 172᎐174 questions in, 165᎐166 Mental health service utilization, bipolar disorder, 439᎐440 Mental Status Schedule ŽMSS., 304 Methamphetamine, 481 Methylenedioxymethamphetamine ŽMDMA., 481 Midtown Manhattan study, 259, 289, 290, 564 Migration, first-onset mania, 451᎐452 Mini-Mental State Exam ŽMMSE., geriatric psychiatry, 604 Minisatellites, linkage analysis, 85᎐86 Minnesota Multiphasic Personality Inventory ŽMMPI., 258, 259, 286, 289, 302 Minor depression, geriatric psychiatry, 610 Minority groups, mental health services research: institution surveys, 167 population surveys, 167᎐169 Missing values, developmental epidemiology, analytic methods, 244 Mixed model, psychiatric genetics, mode of transmission, 82 Mode of transmission, psychiatric genetics, 78᎐82 Monoamine oxidase A ŽMAOA., drug dependence, 520᎐521 Mono-operations bias, construct validity, 158 Monozygotic twins See also Twin studies family-study designs, 107᎐108 generenvironment interaction, 74᎐76 major depression, 402 psychiatric genetics, 66 schizophrenia, 373 Mood disorders See also Anxiety disorders; Bipolar disorder; Child and adolescent psychiatry Žmood disorders.; Dysthymic disorder; Major depression adoption studies, 77 bipolar disorder, 428᎐430 epidemiology of, 389 future directions, 419᎐420 psychiatric genetics, mode of transmission, 81 twin studies, 75᎐76 Morbidity: incidence density, outcome occurrence measures, 45 risk of, psychiatric genetics, 103᎐106 Mortality: drug dependence, 499, 508᎐509 geriatric psychiatry: dementing disorders, 618᎐619 depression, 615᎐617 incidence density, outcome occurrence measures, 45 outcome, 230 Mortality effects, internal validity, 160 Multifactorial polygenic model, psychiatric genetics, mode of transmission, 80᎐82 Multiple ascertainment, psychiatric genetics, 101 Multistage studies, hybrid studies, 25᎐26 Muscular dystrophy, Duchenne’s, psychiatric genetics, 99 Mutation screening, psychiatric genetics, 98᎐99 Narcissistic personality disorder, prevalence, 578 National Comorbidity Survey ŽNCS., 294᎐296, 298, 310, 343᎐362 agoraphobia, 411, 412 alcoholism, 469, 470, 473 baseline background and design, 344᎐345 baseline results, 345᎐351 age at onset, 347 comorbidity, 347᎐348 lifetime and recent prevalences, 345᎐347 primary and secondary disorders, 348᎐350 primary prevention of secondary disorders, 351 pure and comorbid lifetime disorders, 348 service utilization, 350᎐351 social costs, 350 bipolar disorder, 432᎐433, 436, 438 child and adolescent psychiatry, 641, 645, 659 drug dependence, 492, 493, 502᎐505, 507, 514, 515 dysthymic disorder, 404 generalized anxiety disorder, 416 major depression, 391, 396, 398, 399, 400, 401᎐402 NCS-2, design and rationale, 351᎐352 INDEX NCS-R: Adolescent Survey, 353᎐354 design and rationale, 352᎐353 overview, 343, 357᎐358 personality disorders, 592 schizophrenia, 368 social phobia, 414᎐415 WHO World Mental Health 2000, 355᎐357 calibrating CIDI diagnoses, 357 clinical significant impairment, 356 comparative impairments, 357 recent prevalence and severity, 355᎐356 National Institute of Mental Health ŽNIMH., 335, 336, 632, 642, 658 National Institute of Neurologic, Communicative Diseases and StrokeᎏAlzheimer’s Disease and Related Disorders Association ŽNINCDS-ADRDA., geriatric psychiatry, 604 National Institute on Alcohol Abuse and Alcoholism ŽNIAAA., 336, 507 National Institute on Drug Abuse ŽNIDA., 336 National Longitudinal Alcohol Epidemiology Study ŽNLAES., drug dependence, 492, 502, 527 Natural history of psychopathology, 215᎐238 course of disease, 224᎐228 recurrence, 226᎐228 remission, 224᎐226 drug dependence, 496᎐500 methodology, 231᎐234 attrition, 231᎐232 censoring, 232᎐233 recall bias, 233᎐234 onset, 216᎐224 etiologic and pathologic processes, 216᎐219 population measures, 222᎐224 prodromes and precursors, 219᎐222 outcome, 228᎐230 overview, 215᎐216 Neighborhood factors, child and adolescent psychiatry, 649650 See also Environment Nested case-control studies, developmental epidemiology, 242 Neurobiology: alcoholism, 472 child and adolescent psychiatry Žmood disorders , 670 Neuropsychiatric Screening Adjunct ŽNSA.: prevalence assessment, 259 symptom scales and schedules, 286᎐288, 291, 300, 303 Neurotransmitters, drug dependence, 519᎐520 Nomologic network, construct validity, 156᎐157 Nonaffective acute remitting psychosis, levels of causation, 204 Nonexperimental Žobservational studies, 12᎐30 cohort studies, 16᎐25 715 case-control studies, 19᎐25 prospective, 16᎐17 retrospective, 18᎐19 cross-sectional studies, 12᎐16 disease and exposure status measures, 15᎐16 survey sampling, 13᎐15 group comparisons in, 26᎐30 confounding bias, 28᎐30 information bias, 27᎐28 selection bias, 27 hybrid studies, 25᎐26 Novel populations, reliability, 131᎐132 Nucleotides, linkage analysis, 85 Null hypothesis: chi-squared statistic, tests of association, 37᎐39 Mantel-Haenszel test, 49᎐51 Observational studies See Nonexperimental Žobservational studies Obsessive-compulsive personality disorder, 417᎐418 defined, 417 prevalence, 581 rates of, 417 risk factors, 417 Obstetric factors, schizophrenia, 375377 See also Prenatal influences Odds ratio, 35᎐63 association measures, 79, 43᎐46 inference for multiple x tables, 49᎐56 inference for single x table, 46᎐49 logistic regression, 58᎐63 matched-pairs analysis, 56᎐58 outcome occurrence measures, 79 overview, 35᎐37 tests of association, 37᎐43 Oldest old, defined, 603 Oligogenic model, psychiatric genetics, mode of transmission, 80 One-way ANOVA analysis, reliability statistics, 139᎐141 Onset, 216224 See also Age at onset etiologic and pathologic processes, 216᎐219 population measures of, 222᎐224 prodromes and precursors, 219᎐222 Ontario Child Health Study, 640 Ontario Mental Health Survey, 298 Opium, geographic distribution, 484᎐485 Outcome, 228᎐230 Outcome occurrence measures, 49 association measures, 79 cumulative incidence, 56 incidence density, 45 prevalence, 67 Outpatients, psychiatric epidemiology, 258 OxyContin, 479, 480᎐481 716 INDEX Pairwise concordance, twin studies, 74 Panel studies, hybrid studies, 26 Panic disorder See also Anxiety disorders agoraphobia and, 412᎐414 child and adolescent psychiatry, 675 defined, 408 rates of, 409 risk factors, 409᎐410 Paranoid personality disorder, prevalence, 570 Parental psychopathology, child and adolescent psychiatry, 647 Path analysis, psychiatric genetics, mode of transmission, 81᎐82 Pathologic process See also Course of disease drug dependence, 496᎐500 etiologic process and, onset, 216᎐219 Patient adherence, psychopharmacoepidemiology, 187᎐188 Patient Health Questionnaire ŽPHQ., 301, 306 Payments, mental health services research, analytic studies, 170᎐171 Pearson correlation, reliability statistics, 145 Penetrance, psychiatric genetics, mode of transmission, 79 Perinatal influences: child and adolescent psychiatry, 648᎐649 child and adolescent psychiatry Žanxiety disorders , 682 drug dependence, 528᎐530 Period prevalence rate, outcome occurrence measures, 67 Persistence: child and adolescent psychiatry Žanxiety disorders , 685᎐686 child and adolescent psychiatry Žmood disorders , 672᎐673 Personal Health Questionnaire ŽPHQ., 301 Personality Assessment Schedule ŽPAS., personality disorders, 566 Personality Diagnostic Questionnaire ŽPDQ., personality disorders, 566, 588 Personality disorders, 563᎐599 comorbidity, 591᎐592 conceptual issues, 581᎐584 developmental issues, 567᎐568 future directions, 592 methodological issues, 584᎐592 overview, 563᎐564 prevalence, 564᎐567 antisocial personality disorder, 573, 576 avoidant personality disorder, 578 borderline personality disorder, 576᎐577 dependent personality disorder, 578, 580 histrionic personality disorder, 577᎐578 narcissistic personality disorder, 578 obsessive-compulsive personality disorder, 581 paranoid personality disorder, 570 schizoid personality disorder, 570 schizotypal personality disorder, 572᎐573 treated prevalence, 569᎐570 Personality traits, defined, 563 Phenocopies, linkage analysis, 91᎐92, 93 Phenothiazines, bipolar disorder and, 428 Phenotype, psychiatric genetics, 66 Phenylketonuria ŽPKU., 583 gene location, 97 segregation analysis, 114 twin studies, 75 Placebo, experimental study designs, 10᎐11 POINTER, segregation analysis algorithms, 109᎐114 Point prevalence, drug dependence, 506᎐507 Polymorphism information, linkage analysis, 85 Population-based studies: alcohol use and abuse, 460 bipolar disorder, 430 child and adolescent psychiatry, 639᎐646 Great Smoky Mountain Study, 641᎐642 Isle of WightrInner Borough Study, 639᎐640 methodology, 642᎐643 National Comorbidity Survey, 641 Ontario Child Health Study, 640 Project on Human Development in Chicago Neighborhoods, 643᎐644 developmental epidemiology, 242 Population measures, of onset, 222᎐224 Population surveys, mental health services research, 167᎐169 Population variance, reliability and, 135 Post-dictive validity, criterion validity, 152 Post-traumatic stress disorder ŽPTSD., developmental epidemiology, 246᎐247 Practice-based networks, psychopharmacoepidemiology, data sources, 185 Precursors, prodromes and, onset, 219᎐222 Predictive validity See Criterion validity Prenatal influences: child and adolescent psychiatry, 648᎐649 drug dependence, 528᎐530 schizophrenia, 375᎐377 Prescription guidelines, psychopharmacoepidemiology, 187 Present State Examination ŽPSE.: bipolar disorder, 434 diagnostic interviews, 260 personality disorders, 566 symptom scales and schedules, 292, 296, 297, 298, 300, 304 Prevalence See also Lifetime prevalence alcohol use and abuse, 461᎐463, 464᎐465, 469᎐471 assessment of, psychiatric interview, 259᎐260 INDEX child and adolescent psychiatry: anxiety disorders, 675᎐678 mood disorders, 658᎐664 drug dependence, 502᎐508 geriatric psychiatry: dementing disorders, 610᎐611 depressive disorders, 608᎐609 subsyndromal depression, 609᎐610 obsessive-compulsive personality disorder, 581 outcome occurrence measures, 67 personality disorders, 564᎐567 antisocial personality disorder, 573, 576 avoidant personality disorder, 578 borderline personality disorder, 576᎐577 dependent personality disorder, 578, 580 histrionic personality disorder, 577᎐578 narcissistic personality disorder, 578 obsessive-compulsive personality disorder, 581 paranoid personality disorder, 570 schizoid personality disorder, 570 schizotypal personality disorder, 57᎐573 treated prevalence, 569᎐570 schizophrenia, 368᎐369 tobacco dependence, 50᎐506 Primary care populations: mental health services research, effectiveness, 173 population surveys, mental health services research, 169 Primary prevention, of secondary disorders, National Comorbidity Survey, 351 Prisons, mental health services research, institution surveys, 167 Probability, odds ratio, 44᎐46 Proband selection: ascertainment bias, 100 familial disorders, 67᎐70 Probandwise concordance, twin studies, 74 Prodromes, precursors and, onset, 219᎐222 Product moment correlation, reliability statistics, 145 Program for Assertive Community Treatment ŽPACT., 174 Project on Human Development in Chicago Neighborhoods, 643᎐644 Prospective cohort studies: described, 16᎐17 developmental epidemiology, 240᎐241 odds ratio, 36᎐37 Protective factors, drug dependence, 483 Psychiatric Epidemiologic Research Instrument ŽPERI., 291, 292 Psychiatric epidemiologic research methods, 333 See also Nonexperimental Žobservational studies outcome occurrence measures, 49 717 association measures, 79 cumulative incidence, 56 incidence density, 45 prevalence, 67 overview, 34 study designs, 926 experimental studies, 10᎐12 generally, 9᎐10 nonexperimental Žobservational studies, 12᎐26 Psychiatric epidemiology See also Developmental epidemiology developmental epidemiology, 239᎐255 future directions in, 195᎐211 Ž See also Future directions psychiatric genetics and, 115 Psychiatric genetics, 65᎐130 See also Genetics familial disorders, 66᎐73 family study versus family history, 70᎐73 proband selection, 67᎐70 generenvironment interaction, 73᎐78 adoption studies, 76᎐78 twin studies, 74᎐76 gene location, 82᎐99 Ž See also Gene location glossary for, 115᎐119 methodology, 99᎐114 ascertainment, 99᎐102 family-study designs, 107᎐109 risk estimation to relatives, 102᎐107 segregation analysis algorithms, 109᎐114 mode of transmission, 78᎐82 mathematical modeling, 79᎐80 model types, 80᎐82 overview, 65᎐66 psychiatric epidemiology and, 115 Psychiatric interview, 257᎐271 See also specific interviews child and adolescent psychiatry, harm to children, 637638 diagnostic interviews, 260᎐264 Center for Epidemiological Studies Depression ŽCESD., 261 Clinical Interview SchedulerGeneral Health Questionnaire ŽCISrGHQ., 260 Composite International Diagnostic Interview ŽCIDI., 263᎐264, 344᎐345 Department Interview, 261᎐262 Diagnostic Interview Schedule ŽDIS., 262᎐263 Health Opinion Survey ŽHOS., 260 Lundby interview, 260᎐261 Present State Examination ŽPSE., 260 psychopharmacoepidemiology, 261 SADS-L, 262 future trends, 270 historical perspective, 257᎐258 personality disorders, 565, 586᎐587 718 INDEX Psychiatric interview Ž Continued prevalence assessment, 259᎐260 Home Inventory Schedules ŽHIS., 259᎐260 Neuropsychiatric Screening Adjunct ŽNSA., 259 psychometric properties, 265᎐270 reliability, 266 validity, 266᎐270 schizophrenia, 367᎐368 stability and innovation in, 264᎐265 Psychiatric medication See Psychopharmacoepidemiology; Psychopharmacology Psychiatric Status Schedule ŽPSS., 304 Psychopathology See Natural history of psychopathology Psychopharmacoepidemiology, 181᎐194 clinical questions, 185᎐189 adverse effects, 185᎐186 cost analysis, 188 optimizing interventions, 188᎐189 patient adherence, 187᎐188 patterns, trends, and predictors, 186 prescription guidelines, 187 unmet needs assessment, 186᎐187 data sources, 183᎐185 government databases, 183᎐184 health maintenance organizations, 184 practice-based networks, 185 surveys, 184᎐185 diagnostic interviews, 261 future directions, 189᎐190 historical perspective, 181᎐182 study advantages, 182᎐183 Psychopharmacology: bipolar disorder, 428 drug dependence, 541᎐542 geriatric psychiatry, 607 Psychosis See also Schizophrenia epidemiology of, 365᎐387 nonaffective acute remitting, levels of causation, 204 Psychotic affective disorder, schizophrenia and, 374 Quasi-experimental studies, internal validity, 159 Questionnaires: psychiatric epidemiology, 258 reliability estimation, 134 Race differences See also Ethnicity alcohol use and abuse, 462, 463, 464, 469᎐470, 471 bipolar disorder, 438 child and adolescent psychiatry: anxiety disorders, 680 mood disorders, 667᎐668 drug dependence, 516᎐518 dysthymic disorder, 406 major depression, 399 panic disorder, 410 schizophrenia, 371᎐372 Randomization, experimental study designs, 10 Randomized clinical trial, experimental study designs, 1112 Random sampling, reliability and, 135 Rating scales, personality disorders, data sources, 589 Recall bias: developmental epidemiology, case-control studies, 242 natural history of psychopathology, 233᎐234 Recessive gene, phenylketonuria ŽPKU., 75 Recombination fraction, linkage analysis, 88᎐91 Record linkage, developmental epidemiology, case-control studies, 242 Recurrence, course of disease, 226᎐228 Regression to mean, internal validity, 160 REGTL, segregation analysis algorithms, psychiatric genetics, 109᎐114 Relapse, recurrence, course of disease, 226᎐228 Relative risk See also Risk association measures, 79 association tests, 44 Reliability, 131᎐147 binary judgments, 137᎐138 defined, 149 drug dependence, 493 estimation, 13᎐135 overview, 131᎐132 personality disorders, 584 population variance effect on, 135 psychiatric interview, 266 reliability coefficient, 132᎐133 statistical remedies for low reliability, 136᎐137 statistics, 138᎐145 ANOVA analysis Žone-way., 139᎐141 ANOVA analysis Žtwo-way., 141᎐143 Cohen’s 6, 144 Cronbach’s , 143 generally, 138᎐139 product moment correlation, 145 symptom scales and schedules, 307᎐311 Reliability coefficient, described, 132᎐133 Religion, alcohol use and abuse, 463, 465 Remission, course of disease, 224᎐226 Repeated cross-sectional survey, hybrid studies, 25 Repeated observations, developmental epidemiology, analytic methods, 243 Replication, reliability estimation, 133 INDEX Research Diagnostic Criteria ŽRDC., 262, 292, 305 major depression, 391, 392 schizophrenia, 367 Research methods See Psychiatric epidemiologic research methods Resilience, developmental epidemiology, 248 Response bias, reliability estimation, 134᎐135 Restriction Fragment Length Polymorphism, linkage analysis, 85 Retrospective cohort studies: described, 18᎐19 developmental epidemiology, 241 odds ratio, 37 Rheumatoid arthritis, schizophrenia and, 374 Risk: association measures, 79 association tests, 44 cumulative incidence, outcome occurrence measures, 56 estimation of, to relatives, 102᎐107 Risk factor epidemiology, historical perspective, 197 Risk factors: bipolar disorder, 437᎐439 child and adolescent psychiatry, 646᎐650 genetics, 646᎐647 neighborhood and social context, 649᎐650 parental psychopathology, 647 prenatal factors, 648᎐649 socioeconomic status, 647᎐648 child and adolescent psychiatry Žanxiety disorders , 679᎐685 age differences, 679᎐680 autonomic and psychophysiologic reactivity, 683᎐684 gender differences, 679 genetics and family history, 680᎐681 life events and stressors, 684᎐685 medical conditions, 682᎐683 perinatal influences, 682 socioeconomic status and ethnicity, 680 temperament and personality, 681᎐682 child and adolescent psychiatry Žmood disorders , 666᎐672 age differences, 667 cognitive factors, 671 gender differences, 666᎐667 genetics, 668᎐670 hormonal change, 670 life events and stressors, 671᎐672 neurobiology, 670 socioeconomic class, race, and ethnicity, 667᎐668 temperament, 670᎐671 drug dependence, 482᎐483 dysthymic disorder, 405᎐406 719 geriatric psychiatry: comorbidity, 614᎐615 dementing disorders, 613᎐614 depression, 397398, 612᎐613 major depression, 395᎐403 adolescent depression, 398 attributable risk, 402᎐403 comorbidity, 401᎐402 family history, 402 gender differences, 395᎐396 marital status, 401 race and ethnicity, 399 secularrtemporal effects, 396᎐397 socioeconomic status, 399᎐400 urban-rural residence, 400 obsessive-compulsive disorder, 417 panic disorder, 409᎐410 social phobia, 415 study designs, Rural place of birth, schizophrenia, 375 See also Urban-rural residence Sampling: psychiatric genetics, 99᎐102 reliability and, 135 survey sampling, cross-sectional studies, 13᎐15 Sanitary Era, 196᎐197 Scales See Symptom scales and schedules Schedule for Affective Disorders and Schizophrenia ŽSADS.: bipolar disorder, 434 child and adolescent psychiatry, 675 content validity, 151 major depression, 391᎐392, 399 personality disorders, 566, 572 reliability and validity, 308, 309 symptom scales and schedules, 292᎐293, 305 Schedule of Affective Disorders and Schizophrenia, Epidemiological Version ŽK-SADS-E., 634 Schedules See Symptom scales and schedules Schedules for Clinical Assessment in Neuropsychiatry ŽSCAN., 297, 298, 307, 310, 311 Schizoaffective disorder, schizophrenia and, 374 Schizoid personality disorder, prevalence, 570 Schizophrenia, 365᎐387 adoption studies, 77 ascertainment bias, 100, 102 bipolar disorder and, 428 course and predictors, 378᎐379 defined, 368 demography, 370᎐373 gender and age, 372᎐373 marital status, 373 720 INDEX Schizophrenia Ž Continued race and ethnicity, 371᎐372 social class, 370᎐371 developmental epidemiology, 244᎐245 diagnosis, 137 familial disorders, 69 future directions, 380 levels of causation, 203᎐204 linkage analysis, 87, 93 mania and, 445, 453 methodology, 366368 outcome investigations, 151 overview, 365 precipitating factors, 37᎐378 predisposing factors, 373᎐377 autoimmune disease, 374 family history and genetics, 373᎐374 obstetric, birth and early childhood factors, 375᎐377 season of birth, 374᎐375 urban versus rural place of birth, 375 psychiatric genetics, mode of transmission, 82 rates, 368᎐370 incidence, 369᎐370 prevalence, 368᎐369 twin studies, 66, 76 Schizotypal personality disorder: prevalence, 572᎐573 schizophrenia and, 374 Season of birth, schizophrenia, 374᎐375 Sector interactions, mental health services research, analytic studies, 172 Secularrtemporal effects, major depression, 396᎐397 Sedative-hypnotics, adverse effects, psychopharmacoepidemiology, 185᎐186 Segregation analysis, mode of transmission, psychiatric genetics, 78 Segregation analysis algorithms, psychiatric genetics, 109᎐114 Selection bias: developmental epidemiology, case-control studies, 242 nonexperimental Žobservational studies, group comparisons in, 27 Selection-drift hypothesis, schizophrenia, 371 Selection effects, internal validity, 160 Selective serotonin reuptake inhibitors ŽSSRIs., adverse effects, psychopharmacoepidemiology, 186 Self-report instruments, criterion validity, 153 Self-report questionnaire, personality disorders, data sources, 588᎐589 Services, child and adolescent psychiatry, 629᎐630 Service use estimates, population surveys, mental health services research, 169 Service utilization, National Comorbidity Survey, baseline results, 350᎐351 SIMLINK Žsoftware program., linkage analysis, 94 Simple random sampling, survey sampling, 14᎐15 Single ascertainment, psychiatric genetics, 101 Single nucleotide polymorphisms, linkage analysis, 86 Single stranded conformational polymorphisms, psychiatric genetics, 98᎐99 Skin cancer, segregation analysis, 114 Social Adjustment Interview Schedule, content validity, 151 Social costs: child and adolescent psychiatry, 630 National Comorbidity Survey, baseline results, 350 Social phobia, 414᎐415 defined, 414 rates of, 414᎐415 risk factors, 415 Socioeconomic status: alcohol use and abuse, 462, 463 bipolar disorder, 438 child and adolescent psychiatry, 647᎐648 anxiety disorders, 680 mood disorders, 667᎐668 major depression, 399᎐400 schizophrenia, 370᎐371 Sociological model, clinical model and, alcohol use and abuse, 465᎐466 Spearman-Brown formula, statistical remedies for low reliability, 136, 137, 143 Specificity, internal validity, 159 Speed of remission, defined, 226 Standardized Psychiatric Examination ŽSPE., personality disorders, 565 Statistical regression artifacts, internal validity, 159᎐160 Statistical remedies, for low reliability, 136᎐137 Steppingstone association, drug dependence, 498 Stirling Study, 290 Stress: child and adolescent psychiatry Žanxiety disorders , 684᎐685 child and adolescent psychiatry Žmood disorders , 671᎐672 schizophrenia, 377 Structured interview, personality disorders, data sources, 587᎐588 Study designs, 926 developmental epidemiology, 240᎐242 Ž See also Developmental epidemiology experimental studies, 10᎐12 generally, 9᎐10 nonexperimental Žobservational studies, 12᎐26 Ž See also Nonexperimental Žobservational studies Substance abuse See also Alcohol use and abuse; Drug dependence INDEX first-onset mania, 453᎐454 schizophrenia, 377᎐378 Subsyndromal depression, geriatric psychiatry, 609᎐610 Suicide: child and adolescent psychiatry Žmood disorders , 673 geriatric psychiatry, 619 Surveys, psychopharmacoepidemiology, data sources, 184᎐185 Survey sampling, cross-sectional studies, 13᎐15 Survival, cumulative incidence, outcome occurrence measures, 56 Symptom Checklist 90-items ŽSCL-90., 304 Symptom scales and schedules, 273᎐332 dimensions and syndromes, 275᎐279 scales, 275᎐278 schedules, 278᎐279 instrument selection, 279᎐281 interdisciplinary collaboration, 315 landmarks and trends, 283᎐307, 318 clinical instruments Žprimary care settings., 299᎐302 clinical instruments ŽU.K and WHO., 296᎐298 clinical instruments ŽU.S , 302᎐306 epidemiologic instruments ŽU.K , 306᎐307 epidemiologic instruments ŽU.S and Canada., 288᎐296 epidemiologic instruments ŽWHO., 298᎐299 generally, 283᎐286 World War II, 286᎐288 measurements, 311᎐314, 315᎐316 overview, 273᎐274, 281᎐283 reliability and validity, 307᎐311, 316᎐318 clinician-administered structured interviews, 311 lay-administered diagnostic schedules, 309᎐311 symptom scales, 307᎐309 technical developments, 281 Syndromes, dimensions and, symptom scales and schedules, 275᎐279 Temperament: child and adolescent psychiatry: anxiety disorders, 681᎐682 mood disorders, 670᎐671 developmental epidemiology, 248 Testing effects, internal validity, 159 Test-retest design, reliability estimation, 133᎐134 Tests of association, sampling methods, 37᎐43 Thalidomide, psychopharmacoepidemiology, 182 Time sequence, internal validity, 159 721 Tobacco dependence: prevalence, 505᎐506 twin studies, 525 Tolerance, alcoholism, 466 Tourette’s syndrome, psychiatric genetics, mode of transmission, 82 Transmission test for linkage, psychiatric genetics, 97᎐98 Tridimensional Personality Questionnaire ŽTPQ., content validity, 151᎐152 Truncate ascertainment, psychiatric genetics, 100 Tuberculosis, psychiatric genetics, mode of transmission, 82 Twenty-Two Item Scale Ž22IS., symptom scales and schedules, 300 Twin studies: bipolar disorder, 440 child and adolescent psychiatry, 646᎐647 anxiety disorders, 681, 684 mood disorders, 669 drug dependence, 522᎐526 family-study designs, 107᎐108 family studyrhistory, 72 generenvironment interaction, 74᎐76 major depression, 402 personality disorders, 566᎐567 psychiatric genetics, 66 schizophrenia, 373 Two-way ANOVA analysis, reliability statistics, 141᎐143 Unipolar mania See First-onset mania U.S Food and Drug Administration ŽFDA., 182 Urban-rural residence: bipolar disorder, 437᎐438 dysthymic disorder, 406 major depression, 400 schizophrenia, 375 Validity, 149᎐163 of construct, 149᎐158 construct validity, 156᎐158 content validity, 150᎐152 criterion validity, 152᎐156 defined, 149᎐150 developmental epidemiology, case-control studies, 242 drug dependence, 493᎐495 generalizability theory, 135 overview, 149 personality disorders, 584 psychiatric interview, 266᎐270 relationships between variables, 158᎐161 reliability and, 131 symptom scales and schedules, 307᎐311 722 INDEX Variable number of tandem repeats ŽVNTRs., linkage analysis, 85 Variables, relationships between, validity of, 158᎐161 Violence: alcoholism, 467 developmental epidemiology, 247 drug dependence, 499 mental illness and, levels of causation, 205᎐206 Viral infection, schizophrenia, 376 Withdrawal, drug dependence, 489 World Health Organization ŽWHO See also Composite International Diagnostic Interview ŽCIDI.; International Classification of Diseases ŽICD alcoholism, 469 comorbidity, 343, 344᎐345 diagnostic criteria, 335, 338 diagnostic interviews, 263᎐264 drug dependence, 483 major depression, 394 schizophrenia, 367, 369, 379 symptom scales and schedules, 281, 282, 283, 285᎐286, 294, 297, 298᎐299 World Mental Health 2000 Project, 299, 307, 343, 350, 355᎐357 World War II, symptom scales and schedules, 286᎐288 Zung Depression Scale, 304 ... popularity in psychiatric epidemiology for a number of reasons A population survey allows investigators to gather information on all cases of disorder occurring in a defined area, including syndromes in. .. the Harvard Program in Psychiatric Epidemiology MING T TSUANG MAURICE TOHEN xi PART I Study Design and Methods Textbook in Psychiatric Epidemiology, Second Edition, Edited by Ming T Tsuang and Mauricio... Epidemiology, Second Edition, Edited by Ming T Tsuang and Mauricio Tohen ISBN 0-471-40974-X ᮊ 2002 John Wiley & Sons, Inc INTRODUCTION TO EPIDEMIOLOGIC RESEARCH METHODS Experimental methods used in medicine