Kessler R C
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Bull World Health Organ. 2000;78(4):464-74.
Reviewed in this article are selected recent advances and future challenges for psychiatric epidemiology. Major advances in descriptive psychiatric epidemiology in recent years include the development of reliable and valid fully structured diagnostic interviews, the implementation of parallel cross-national surveys of the prevalences and correlates of mental disorders, and the initiation of research in clinical epidemiology. Remaining challenges include the refinement of diagnostic categories and criteria, recognition and evaluation of systematic underreporting bias in surveys of mental disorders, creation and use of accurate assessment tools for studying disorders of children, adolescents, the elderly, and people in less developed countries, and setting up systems to carry out small area estimations for needs assessment and programme planning. Advances in analytical and experimental epidemiology have been more modest. A major challenge is for psychiatric epidemiologists to increase the relevance of their analytical research to their colleagues in preventative psychiatry as well as to social policy analysts. Another challenge is to develop interventions aimed at increasing the proportion of people with mental disorders who receive treatment. Despite encouraging advances, much work still needs to be conducted before psychiatric epidemiology can realize its potential to improve the mental health of populations.
本文回顾了精神疾病流行病学近期的一些进展以及未来面临的挑战。近年来，描述性精神疾病流行病学的主要进展包括开发出可靠且有效的完全结构化诊断访谈、开展平行的跨国精神障碍患病率及相关因素调查以及启动临床流行病学研究。尚存的挑战包括完善诊断类别和标准、识别和评估精神障碍调查中系统性漏报偏差、创建和使用准确的评估工具来研究儿童、青少年、老年人以及欠发达国家人群的精神障碍，以及建立用于需求评估和项目规划的小区域估计系统。分析性和实验性流行病学的进展则较为有限。一个主要挑战是精神疾病流行病学家要提高其分析研究与预防精神病学同事以及社会政策分析师的相关性。另一个挑战是开发旨在提高接受治疗的精神障碍患者比例的干预措施。尽管取得了令人鼓舞的进展，但在精神疾病流行病学发挥其改善人群心理健康的潜力之前，仍有许多工作要做。
