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Determinants and Mechanisms of Prevalence Patterns of Common Mental Disorders in Diverse Populations

NAMHC Concept Clearance

Presenter

Pamela Y. Collins, M.D., M.P.H.
Director, Office for Research on Disparities and Global Mental Health (ORDGMH)
Director, Office of Rural Mental Health Research

Goal

To stimulate research on the determinants and mechanisms over the life course that produce variation in the prevalence of common mental disorders (CMD) across diverse populations.

Rationale

NIMH has supported large-scale descriptive epidemiologic work documenting variation in the prevalence of common mental disorders across diverse populations in the United States. The next generation of studies should seek to elucidate the mechanisms by which variation across diverse populations in psychopathology—particularly CMD—occurs over the life course. Two related lines of inquiry that test novel hypotheses are needed. The first would extend the epidemiologic foundation of the Collaborative Psychiatric Epidemiology Surveys (CPES) to explain how both risk and protective factors, across levels (e.g., individual, family, school, and neighborhood) and over the life course, affect the true prevalence of disorders and the distribution of symptoms within and across diverse populations. A necessary, incremental step in understanding mechanisms is the examination of putative risk and protective factors in the context of development to determine the relevant timing of exposure, through targeted longitudinal research. Understanding what and when risk and protective factors exert their effects on youth could help researchers determine whether and why there are prevalence differences across and within diverse populations in adulthood. Moreover, examining symptom distributions and clusters in addition to Diagnostic and Statistical Manual (DSM)-IV diagnoses would be critical to the expansion of our understanding of population-level variation in psychopathology over the life course.

The second line of inquiry would move beyond the clinical phenotypes of the CPES to examine variation in intermediate phenotypes and endophenotypes across diverse populations. This avenue of research, aligned with the approach of the NIMH Research Domain Criteria project, would promote basic scientific discovery of variation across diverse populations in key domains and constructs across units of analysis (e.g., genes, molecules, cells, circuits, behavior, and self-reports) that might be linked ultimately to clinical phenomena. This line of investigation offers the potential dual advantage of elucidating mechanisms of variation in psychopathology across diverse populations, and of informing the interrelationships among endophenotypes, intermediate phenotypes, and clinical phenomena.

The goal of this initiative is to stimulate research on the mechanisms of variation in CMD across diverse populations by: 1) determining the relevant timing and nature of risk and protective factors for CMD prevalence over the life course; and 2) using genetics and molecular, cellular, and systems neuroscience to understand variation in brain functioning and psychopathology across diverse populations. These key issues should be addressed comprehensively and in concert to enhance our understanding of the prevalence patterns of CMD and distribution of psychopathology across diverse populations, and to identify potential levers for intervention over the life course.

Scientific areas of interest include, but are not limited to:

  • Determination of the nature and relevant timing of biological and social risk factors over the life course (e.g., during childhood, adolescence, and early adulthood) across diverse populations;
  • Examination of variation in symptom patterns and clusters within and across diverse populations; and
  • Examination of variation in key intermediate phenotypes and endophenotypes by using genetics and molecular, cellular, and systems neuroscience to understand brain functioning and psychopathology across diverse populations.

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