Book Review

Psychiatric Epidemiology: Assessment Concepts and Methods

N Engl J Med 1994; 331:1317November 10, 1994

Article

Psychiatric Epidemiology: Assessment Concepts and Methods
(The Johns Hopkins Series in Psychiatry and Neuroscience.) Edited by Juan E. Mezzich, Miguel R. Jorge, and Ihsan M. Salloum. 612 pp. Baltimore, Johns Hopkins University Press, 1994. $65. ISBN: 0-8018-4615-3

Americans enjoy big novels, biographies, and textbooks. Now they have a big book on psychiatric epidemiology. The title may represent a limitation, since with the present tendency for psychiatry to cuddle up to the neurosciences it would be more au courant to speak of neuroepidemiology. Perhaps this is a selling point. This is a big book, but is it really a book at all? It is a collection of published pieces, with commentaries and short summaries of other articles. It is not the proceedings of a conference, or a Festschrift, or the invited views of experts on a fixed topic. The book is unusual, because all the material has been successfully peer-reviewed and published elsewhere. So where does that leave the reviewer? Given that I am cited, along with friends and colleagues, what can I justifiably say?

The editors state that the development of the book “started with the preparation of a course on assessment in psychiatric epidemiology at the Graduate School of Public Health of the University of Pittsburgh.” Fine, but at what level, and for teachers and students alike? Are these articles preparation for lectures and seminars, or are they background reading? They are full of detail and unlikely to hold the beginner's attention. Those who do psychiatric epidemiology, such as the people who attend the biennial conference of the World Psychiatric Association, for example, will recognize names and substance. But they are an in-group, not the wider world. They may even question the choice of material, since the articles are familiar but not necessarily classic.

So, apart from the students in Pittsburgh, who will read and benefit from this book? It's hard to say, especially since the book concentrates on assessment, concepts, and methods rather than findings. It cannot compare, for example, with Psychiatric Disorders in America: The Epidemiologic Catchment Area Study (Lee N. Robins and Darrel A. Regier, eds. New York: Free Press, 1991), which recounted the Epidemiologic Catchment Area studies instigated by Rosalynn Carter. For many, that book, showing that mental illness was widespread and more common than many other well-known diseases, was a revelation. It was exciting stuff, leading to greater public awareness and improved treatment. Obviously, though, without the improved reliability and validity measurements of psychiatric phenomena over the past few decades, the Epidemiologic Catchment Area studies would not have come about. Measuring these phenomena has been a success story, probably not well understood even by the rest of medicine, and certainly not by society in general.

Epidemiology has been a popular scientific pursuit of psychiatrists because it involves what they do clinically writ large. The result has been a better description and classification of symptoms, syndromes, and disorders. This in itself should lead to more effective and efficient treatment. This book, therefore, deserves to be well received as a tribute to all the work devoted to methodology. The obvious caveat, however, is that the unaware will find the detail tedious and the expert will know it already. Finally, whoever attends that course in Pittsburgh would gain from the inclusion of more on the history of the topic and less discussion of individual questionnaires.

M.R. Eastwood, M.D.
Clarke Institute of Psychiatry, Toronto, ON M5T 1R8, Canada