A Psychosocial Perspective on the Past and Future of Psychiatric Epidemiology

Since the turn of the century and continuing at least until 1980, there were what Barbara Dohrenwend and I described (1) as two generations of epidemiologic studies that were designed to investigate the occurrence and distribution of psychiatric disorders in the general population. The first generation comprised 16 studies, all of which were carried out before World War II; the second was made up of more than 60 studies that were conducted mostly following World War II in various parts of the world. Despite the serious methodological problems of identifying and classifying disorders independently of treatment status, these first and second generation studies made important contributions. Concentrating for the most part on current prevalence (i.e., the presence of disorder during a period of several months to 1 year prior to interview), first and second generation investigators found that prevalence rates of various types of psychiatric disorders varied consistently by gender, socioeconomic status (SES), and locale (urban vs. rural) (1); and they showed that only minorities of persons identified as having cases of most types of psychiatric disorder had ever been treated by a mental health professional (2). By and large, these results have been confirmed by more recent research (3, 4), and the findings from first and second generation studies continue to raise important theoretical and policy questions (5). The transition from the first generation to the second generation of studies was stimulated by dramatic changes in psychiatric nomenclature, reflecting the experience of psychiatrists and clinical psychologists with Selective Service screening and with psychiatric casualties incurred in combat during World War II (1).