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The Clinician's Illusion
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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“However, clinical samples have the disadvantage of initial referral biases that limit inference about adult outcomes(7-10).”
From Is adult ADHD a childhood-onset neurodevelopmental disorder? Evidence from a four-decade longitudinal cohort study (2015) · cites this paper as [8]
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Metadata
- 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)
- 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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