Child psychiatric epidemiology: stars and hypes

Abstract

Usually, epidemiologists stay away from trying to forecast the future at the individual level. One of today's most influential epidemiologists, George Davy Smith, emphasizes the neglected role of chance events that contributes a stochastic element to all occurrences and hampers meaningful prediction of any specific negative or positive outcome [3]. In this editorial, we take the liberty, admittedly with some pleasure, to violate his advice and attempt to predict the future of child psychiatric epidemiology. We hope the reader will appreciate that we briefly look ahead and try to identify those epidemiological activities and study opportunities that, to our opinion, are exciting and deemed successful, as well as those that may well lead to dead-ends.Studies need to look for innovative opportunities to test hypotheses rather than put their ambition in unrealistic large size only. A recent dramatic example of how an epidemiological study can fail is the dismantling of the National Children's Study (NCS) in December 2014. This study aimed to follow the health of 100,000 U.S. children from before birth to age 21 and investigate a range of hypotheses developed by hundreds of scientists on the influences of countless factors, from chemical to psychosocial exposures, on child development and health outcomes. This study cost more than $1.2 billion, but because of its scientific and managerial flaws it was discontinued after only some pilot inclusions. This contrasts with studies of less ambitious size that are equally or more innovative and suited to test specific hypotheses. Examples are studies carried out in third world countries, where exposure to poverty is much greater than in Western countries, or studies in Scandinavian countries, where the use of registers with data on millions of individuals enables researchers to perform prospective etiological studies of disorders with relatively low frequencies such as autism.Epidemiological studies have been essential for the development of child psychiatry over the last half-century, especially in describing the frequency and course of child psychiatric problems, and in demonstrating strong crossculturally consistent associations between social disadvantage or child neglect with child psychopathology. Traditionally, epidemiological studies also attempt to tackle questions of causality of child mental health problems. For obvious ethical and practical reasons, the experimental design to answer causal questions is often not feasible, and observational approaches, more than ever, have been crucial for a better understanding of the role of risk factors in the development of psychopathology. Perhaps the most outstanding contribution of recent epidemiological science has been to show the many reasons why observed associations do not reflect environmentally mediated causal effects. For example, the association between prenatal smoking and later child problem behaviours can largely be explained by inherited factors transmitted from mother to child [1].So far so good, and surely th...

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