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March 2000

Controversies in Community-Based Psychiatric Epidemiology: Let the Data Speak for Themselves

Arch Gen Psychiatry. 2000;57(3):227-228. doi:10.1001/archpsyc.57.3.227

RECENT brushfires have emerged from the decades-old controversy regarding "caseness" in community-based epidemiological studies of psychiatric disorders.1-3 Three studies4-6 in this issue of the ARCHIVES speak to this controversy not so much through the opinions of the investigators but rather through a fresh look at the data from 2 large longitudinal surveys. As noted by Regier et al,1 the research field of psychiatric epidemiology has been most productive during the past 20 years, due in large part to 2 surveys—the Epidemiologic Catchment Area (ECA) Study7 and the National Comorbidity Survey (NCS).8 Yet prior to that time, major community-based studies were fielded, the best now being the Stirling County Study9 and the Midtown Manhattan Study.10 Unlike earlier studies, the ECA Study and NCS were fielded in large part to bring community-based studies into concert with clinical studies primarily through applying DSM-III11 (and its successors') criteria to community samples. Unfortunately, the basic conflict between community and clinical evaluation—whether the reported symptoms by community residents approximate a recognized clinical syndrome and whether the symptoms are "clinically significant"—has not been resolved.

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