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Epidemiology in community psychiatric research: common uses and methodological issues

Published online by Cambridge University Press:  11 October 2011

Summary

Objective – Epidemiological principles underpin much medical research particularly that concerned with the planning and evaluation of health services, including research in community and social psychiatry. The aim of this paper is to review some of the common uses of epidemiology in community psychiatric research and to discuss some methodological issues that arise frequently in epidemiological research in community settings. Methods – This is a review of the relevant literature and of the work currently in progress in the department of psychological medicine of the university of Wales College of Medicine. Results – Among the many uses of epidemiology in health care, four are especially relevant in community psychiatric settings: the assessment of the mental health needs of the population (four approaches are described: the collection of routine data, surveys of existing patients, surveys of the general population and statistical modelling), the identification of risk factors of disease, the contribution to prevention and the assessment of the clinical effectiveness of health care interventions. The most important methodological issues include causal inference which in epidemiology takes the form of explaining the association between an exposure and disease (chance, bias, confounding, reverse causality and causality), the issue of confounding and how to adjust for it and issues arising in the context of specific study designs. Conclusion – Epidemiology has become a set of methods used to investigate a wide range of clinical questions. Population based research is an essential part of clinical research but epidemiological knowledge is also needed by clinicians in order to critically appraise and interpret the scientific literature.

Riassunto

Scopo – I principi epidemiologici sono alia base di molte ricerche mediche, in particolare di quelle concernenti la pianificazione e la valutazione dei servizi sanitari, comprese le ricerche di psichiatria sociale e di comunità. Scopo di questo lavoro è quello di effettuare una revisione relativa ad alcune comuni utilizzazioni dell'epidemiologia nelle ricerche di psichiatria di comunità e di discutere alcune questioni metodologiche che si presentano frequentemente nelle ricerche epidemiologiche relative ai setting comunitari. Metodo – Questa è una review della letteratura rilevante e delle ricerche in corso nel Dipartimento di Psicologia Medica dell'Università del Galles, Facoltà di Medicina. Risultati – Tra le varie utilizzazioni dell'epidemiologia nella sanità, quattro sono particolarmente rilevanti nei setting comunitari: l'accertamento dei bisogni di salute mentale della popolazione (vengono descritti quattro approcci: la raccolta di dati di routine, rilevamento dei pazienti esistenti, il rilevamento nella popolazione generale ed i modelli statistici), l'identificazione dei fattori di rischio della malattia, il contributo della prevenzione e la valutazione dell'efficacia clinica degli interventi di cura. Le questioni metodologiche più importanti includono l'inferenza di tipo causale, che in epidemiologia comporta la spiegazione dell'associazione tra esposizione e malattia (caso, bias, fattori confondenti, causalità inversa e causalità), la questione dei fattori confondenti e come tener conto di essi e questioni che sorgono nel contesto di specifici disegni di studio. Conclusioni – L'epidemiologia à divenuta un insieme di metodi utilizzati per rispondere ad un ampio settore di domande cliniche. La ricerca basata sulla popolazione è una parte senziale della ricerca clinica, ma le conoscenze epidemiologiche sono necessarie ai clinici per valutare e interpretare la letteratura scientifica.

Type
Invited paper
Copyright
Copyright © Cambridge University Press 2001

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