Social Psychiatry

Bruce Dohrenwend, Ph.D., Chief of Psychiatric Research
Yuval Neria, Ph.D., Research Scientist VI

The Department of Social Psychiatry develops and sustains a program of research on important substantive and methodological issues in psychiatric epidemiology. The focus of the substantive research is on questions about the role of adversity and stress in the onset and course of psychiatric disorders that are inversely related to socioeconomic status (SES) -- especially schizophrenia, major depression, antisocial personality, alcoholism, substance use disorders, and post-traumatic stress disorder (PTSD). The methodological issues center on how to conceptualize and measure stressful life events as risk factors for the development of disorders that are inversely related to SES.

Two main research projects are underway in the Department. One is a three-year study of post-traumatic stress disorder (PTSD) in U.S. veterans of the war in Vietnam funded by the U.S. National Institute of Mental Health (NIMH) and an anonymous private foundation. The other is study of the conceptualization and measurement of major stressful events over the life course that is supported by a five-year grant from NIMH. Dr. Dohrenwend is Principal Investigator on both studies which involve interdisciplinary collaboration with colleagues from the Department of Psychiatry and the School of Public Health at Columbia University.

Vietnam Study
The purpose of the Vietnam study is to investigate hypotheses about differences in pre-war vulnerability/protective factors and exposure to war-zone stressors that may lead to different rates of PTSD onset, and differences in post-war experiences that may contribute to differences in PTSD persistence and recurrence in groups of Vietnam veterans defined by gender, ethnic/racial status, and socioeconomic background. The data come from the National Vietnam Veterans Readjustment Study (NVVRS) conducted by the Research Triangle Institute (RTI) with funds from the Veterans Administration.

The main focus of the present research is on an intensively studied subsample consisting of 343 veterans who served in Vietnam (Theater veterans) and 93 veterans who served at the same time outside Vietnam (Era veterans). All 436 members of the subsample were interviewed as part of the National Survey of the Vietnam Generation (NSVG) which included the entire Theater sample (1632) and Era sample (716). In addition to participating in the detailed NSVG interview, the 436 subsample members were interviewed and psychiatrically diagnosed by doctoral level clinicians; the diagnostic interviews were tape-recorded. Independent diagnoses based on reviews of over 50 of these tape recordings by psychiatrists and clinical psychologists on our study team agree well with the original diagnoses of PTSD and most of the co-morbid disorders.

A major new initiative during the past year has been in the development of measures of exposure to war-zone stressors that are based on military records and are, therefore, independent of respondent reports and free of recall biases. These are based on military occupational specialties, the overall casualty rates during the months the veteran served in Vietnam, the casualty rates of the units in which the veteran served, and the casualty rates during major battles in which the unit of the veteran took part during the months he was in Vietnam. The resulting record based and historical measures will be compared with measures constructed from narratives of the veterans’ experiences with war-zone stressors in Vietnam. Six papers are well underway reporting results of this research, and findings from them will be summarized in next year’s annual report.

The Conceptualization and Measurement of Major Stressful Events over the Life Course
Powerful research designs and statistical methods for studying the roles of heredity and environment in the etiology of psychiatric disorders have outstripped our ability to measure the relevant variables. The conceptualization and measurement of major stressful life events as important environmental variables is a case in point. This project addresses problems with even the best of the self-report checklist approaches and with the more labor-intensive interview and rating approaches. It involves review and analysis of the literature on case studies of individual events varying from those in extreme situations, such as exposure to combat and to human-made and natural disasters, to more usual events such as spousal bereavement, divorce, unemployment, child abuse and neglect, and rape. The resulting measures will be tested on already existing event narratives collected in five case/control studies of various types of disorder, including schizophrenia, major depression, and PTSD.