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The Clinician's Illusion

Cohen, Patricia·1984·Archives of General Psychiatry

DOI 10.1001/archpsyc.1984.01790230064010

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Abstract

There are several diseases, including schizophrenia, alcoholism, and opiate addiction, for which the long-term prognosis is subject to disagreement between clinicians and researchers and also among researchers. Part of this disagreement may be attributable to a difference in the populations they sample. The clinician samples the population currently suffering from the disease (a "prevalence" or census sample), while research samples tend to more nearly represent the population ever contracting the disease (an "incidence" sample). The clinician's sample is biased toward cases of long duration, since the probability that a case will appear in a prevalence sample is proportional to its duration, hence "the clinician's illusion." The statistical mechanism of this bias is illustrated and its consequences detailed. Other sources of sampling bias in clinical and research samples are briefly described and partial remedies are suggested.

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Authors: Cohen, P.
Affiliations: New York State Psychiatric Institute (US)
Corresponding author: Cohen, Patricia
Venue: Archives of General Psychiatry
Publisher: American Medical Association (AMA)
Published: 1984-12-01
Volume: 41
Issue: 12
Pages: 1178
ISSN: 0003-990X (ISSN-L)
DOI: 10.1001/archpsyc.1984.01790230064010
OpenAlex: W1978848619
Cited by: 607
References: 28
Citations by year: 2026: 6 · 2025: 7 · 2024: 11 · 2023: 10 · 2022: 17 · 2021: 8 · 2020: 30 · 2019: 41 · 2018: 14 · 2017: 23 · 2016: 15 · 2015: 26 · 2014: 35 · 2013: 19 · 2012: 22
FWCI: 4.98
Type: journal article
Language: en
Open access: closed
Locations: Archives of General Psychiatry (publishedVersion)
PubMed (publishedVersion)
Topics: Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Keywords: sampling bias, disease duration, long-term prognosis, schizophrenia, alcoholism, opioid use disorder, sample selection bias
MeSH terms: Alcoholism, Attitude of Health Personnel, Mental Disorders, Cross-Sectional Studies, Epidemiologic Methods, Humans, Probability, Prognosis, Psychiatry, Research, Sampling Studies, Schizophrenia, Substance-Related Disorders

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