An appraisal of the NIMH Epidemiologic Catchment Area Program

The Epidemiologic Catchment Area Program was a massive United States community survey of psychiatric illness, dwarfing all prior similar surveys. It has been described as a 'landmark in the development of American contributions to the psychiatric knowledge base'. The results pose a number of challenges to psychiatry. This paper briefly describes the program and appraises it, raising considerable doubts regarding the validity and usefulness of the Diagnostic Interview Schedule as a measuring instrument for the diagnosis of psychiatric illness, especially in the elderly; the use of lay interviewers to measure psychiatric illness; whether it is possible to measure lifetime prevalence of psychiatric illness; some of the reported prevalence rates, especially of phobia; the failure to include generalised anxiety among the 15 psychiatric diagnoses measured; and the failure to compare the results with those reported elsewhere in the literature.