Principles of risk, screening, and prevention in psychiatry

Any successful model of prevention in public health must first begin with an epidemiological understanding of the condition in question. When confronted with someone with a mental disorder (or any other health condition), we must first ask ourselves “why did this person get this disease at this time?” In this chapter, we begin by presenting the concepts underlying epidemiological risk and reviewing its mathematical underpinnings. We then describe the idea as it applies within the field of psychiatry through an exploration of mediators and moderators of risk in mental disorders. Next, we discuss the concepts behind psychiatric screening programs in the population and examine the criteria required for the implementation of universal screening programs. We end with a discussion of prevention in psychiatry and give examples of primary, secondary, and tertiary preventive interventions.