THE BIOPSYCHOSOCIAL MODEL & THE WEB OF CAUSATION
George Engel promulgated a theoretical model, based on general systems theory, of the etiology of mental disease that remains central to epidemiologic investigations into the twenty-first century. Research demonstrates that unitary explanations are not adequate to explain disease etiology or thus inform appropriate prevention and treatment strategies. Engel suggested an interrelatedness among biological, psychological, and social factors. Biological factors include hereditary, anatomic, and molecular factors and those factors related to gender, age, and ethnicity. Psychological factors include temperament, personality, motivation, emotion, attention, and cognition. According to Engel's theory, social factors included family, society, culture, and environment; other authors would include religious and spiritual as well as economic factors in this group. This model pervades epidemiology, yet recent efforts focus on not simply integrating the different elements but rather moving toward a transdisciplinary approach that breaks down traditional disciplinary barriers. From this perspective, psychiatric epidemiologists explore the frequency, distribution, outcome, and causation of psychiatric disorders.
Identifying a case becomes the first task of the epidemiologist. An essential component of all these uses is the determination of valid denominators to compare the characteristics of populations with and without disease. For example, to determine the prevalence of a case (i.e., the frequency of the case in a given population at a given point in time), one must know the number of persons both with and without the disorder in the population. To determine the incidence of a case (the number of new cases that emerge in the population over a given interval—usually 1 year), one must know the number of people in the population at the beginning of an interval who do not experience the disorder. A list of key terms in epidemiology can be found in Table 2–1.
Table 2–1Key Terms in Epidemiology |Favorite Table|Download (.pdf) Table 2–1 Key Terms in Epidemiology
Prevalence: The frequency of a given disorder in a population at a particular point of time (i.e., it is the ratio of the number of cases of a disorder in the population divided by the number of persons in the population). Although community surveys take time to complete (usually 3 months to 1 year), it is assumed that the results of such studies estimate the frequency of a disorder within a population (usually given as a percentage) on a given day. In some cases, prevalence is measured not as the frequency on a given day but as the frequency of all cases of the disorder that are present during some interval of time, such as 1 month or 1 year.
Denominator: In the prevalence ratio, the denominator is the number of persons in the population. This number becomes important because the prevalence may vary depending on the population from which cases are selected. For example, the denominator may be all persons in a community, all females in a community, ...