Commentary: 'Diseases of the world': from epidemiology to etiology of child and adolescent psychopathology - a commentary on Polanczyk et al. (2015)

摘要

If you are an epidemiologist, professionally interested in patterns of the distribution of disease in time and space, the first question you will be asked is how many?' What is the prevalence rate' of ADHD? How many children have autism? The second question will be are there more nowadays?' Is there an epidemic of childhood depression? Is the rate of conduct disorder increasing? This seems to be the main use that clinicians and clinical researchers make of epidemiology. So epidemiology is seen as important for some purposes but, somehow, not scientifically relevant to the real job of treatment. According to this view, epidemiology's value lies in telling us how bad a problem is (the burden of disease'), how many affected people are getting treatment, and what the likely costs are. All useful stuff, but not getting us any nearer to the holy grail of understanding causes and cures of the diseases of the world'. In their meta-analysis of the worldwide prevalence of mental disorders in children and adolescents', Polanczyk and colleagues (Polanczyk etal., 2015, this issue) demonstrate just how partial and mistaken this view of epidemiology is. Polanczyk etal. have indeed provided a most valuable and thorough review of the descriptive issues that bureaucrats obsess about. But in the process they have illuminated several areas that are of real importance for the etiologic questions that scientists need to have answered if we are to make breakthroughs in the treatment and prevention of child and adolescent psychopathology.