Diagnosis of Psychiatric Disorders in Epidemiologic Field Studies

For many years, there has been a gap between clinical psychiatry and psychiatric epidemiology.^1-3 Immediately after World War II, a number of community epidemiologic surveys were undertaken in North America in which clinical diagnoses of psychiatric conditions were not directly made. For the most part, these surveys relied heavily on measures of mental impairment rather than clinical diagnoses. The focus on mental impairment was based on theoretical and practical grounds. Theoretically, there was serious questioning of the validity of the concept of mental illness; instead, the concept of a continuum of mental health and mental illness became widely accepted. An indication of this conceptual difference was the congressional decision in 1947 to create the National Institute of Mental Health, rather than a National Institute of Mental Illness. On practical grounds, the low reliability of psychiatric diagnoses and the high cost of clinical interviewers made the use of self-report and