Problems in studying the prevalence of psychiatric disorder.

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Abstract
Should community mental health centers engage in prevalence studies to determine the magnitude of the mental health problem in their designated areas? The answer must be in the negative. Until the criteria for diagnosis are freed from bias or whim and are standardized, the validity of the rates for psychiatric disorder will remain questionable. Prevalence studies under these circumstances have little value as a guide to the planning of services. Additionally, rates which include a large proportion of equivocal or mild cases, or actually nonsick individuals, may even have the deleterious effect of encouraging the deployment of the limited mental health forces for the treatment of those who are least sick and have the best prognosis. There is, furthermore, no particular need for prevalence studies. They are of no value in uncovering possible etiologic relationships. Their utility is dubious from a practical point of view the community mental health centers will have difficulty for many years to come in saturating their "catchment" areas with enough services to meet the needs of those with more severe mental illness. The main contribution of epidemiology is not in discovering the prevalence of disease. It lies in the search for the cause of disease. For this search, the main tool is the incidence rate. To determine the incidence of psychiatric disorder, to relate the incidence to environmental and biological characteristics, to use inferences from these relationships as clues to etiology, and thereby to lay the basis for the prevention and control of disease[long dash]these are the tasks of epidemiologic research in mental disorder. The 1st step along this road is to develop uniform criteria for the definition of a case.

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