Psychiatric Comorbidity and Treatment Seeking: Sources of Selection Bias in the Study of Clinical Populations
Abstract
Population studies have shown that the co-occurrence of psychiatric disorders increases the likelihood of treatment seeking. This leads to a biased estimation of the prevalence of comorbidity in clinical samples, and this overestimation can be attributed to two different sources of selection bias. Using data from a population survey of psychiatric disorders, in which 3258 residents of Edmonton, Alberta, Canada, were interviewed with the Diagnostic Interview Schedule, we assessed the extent of each of these two mechanisms. The first source of selection bias is the mathematical bias known as Berkson's bias and arises from the fact that an individual affected with two psychiatric disorders can seek treatment for either one or the other of these disorders. The second source of selection bias is clinical and results from the changed probability of seeking a treatment for a specific disorder because of the existence of a comorbid disorder.
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Studies with treatment-seeking or mentally ill samples, or that oversampled such people, were excluded to prevent clinical selection bias.
“We excluded these studies to avoid clinical selection bias (du Fort, Newman, & Bland, 1993), consistent with meta-analyses on related topics (Brewin et al., 2000; Tolin & Foa, 2006).”
From Sexual assault victimization and psychopathology: A review and meta-analysis (2017) · cites this paper as du Fort, Newman, & Bland, 1993
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Cited by 210
- Authors
- DU FORT, G. G., NEWMAN, S. C., & BLAND, R. C.
- Affiliations
- University of Alberta (CA)
- ORCID
- NEWMAN, STEPHEN C.
- Venue
- The Journal of Nervous and Mental Disease
- Published
- 1993-08
- Volume
- 181
- Issue
- 8
- Pages
- 467-474
- ISSN
- 0022-3018 (ISSN-L)
- OpenAlex
- W2052653553
- Cited by
- 210
- References
- 0
- Citations by year
- 2026: 3 · 2025: 3 · 2023: 2 · 2022: 2 · 2021: 3 · 2020: 4 · 2019: 1 · 2018: 7 · 2017: 7 · 2016: 6 · 2015: 6 · 2014: 4 · 2013: 8 · 2012: 4
- FWCI
- 11.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Nervous and Mental Disease (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- psychiatric comorbidity, treatment seeking, selection bias, prevalence overestimation, Diagnostic Interview Schedule
- MeSH terms
- Alberta, Mental Disorders, Humans, Mathematics, Patient Acceptance of Health Care, Probability, Psychiatric Status Rating Scales, Research Design, Comorbidity, Bias, Prevalence, Odds Ratio
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