Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, Forvie Site, Robinson Way, Cambridge, UK.
Schizophr Bull. 2011 Mar;37(2):262-71. doi: 10.1093/schbul/sbq120. Epub 2010 Oct 25.
The search for the causes of schizophrenia has predominantly originated from 2 research paradigms; genetics and epidemiology. While each approach has made important contributions to etiological understanding, neither has fully resolved the exact milieu of risk factors for schizophrenia, and there is growing recognition that several pathways to the onset of such disorders may exist. Eco-epidemiology offers an integrative framework to study schizophrenia etiology, incorporating multiple, interactive levels of causation, including genetic, epigenetic, individual, familial, community, and societal domains over the life course. In this article, we review the current evidence base, through the lens of eco-epidemiology, to determine whether it warrants the design and implementation of putative prevention strategies for schizophrenia. We argue that while there are potentially large public health gains available, we do not currently have sufficient empirical data to design effective prevention strategies. It will be important for the research community to more fully elucidate the likely multifactorial, multilevel, polygenetic, and eco-epidemiological basis of schizophrenia before we can design useful prevention strategies. We conclude by speculating on the forms effective strategies might take.
遗传学和流行病学。虽然每种方法都对病因理解做出了重要贡献，但都没有完全确定精神分裂症的确切风险因素环境，人们越来越认识到，可能存在多种导致此类疾病的途径。生态流行病学提供了一个综合框架来研究精神分裂症的病因，将遗传、表观遗传、个体、家庭、社区和整个生命周期中的社会等多个相互作用的层面纳入其中。在本文中，我们通过生态流行病学的视角回顾了当前的证据基础，以确定是否需要为精神分裂症设计和实施可能的预防策略。我们认为，虽然可能会带来巨大的公共卫生收益，但我们目前还没有足够的经验数据来设计有效的预防策略。在我们能够设计出有用的预防策略之前，研究界需要更充分地阐明精神分裂症的可能的多因素、多层次、多基因和生态流行病学基础。最后，我们推测了有效策略可能采取的形式。
