Skip to main content

Epidemiology on demand: population-based approaches to mental health service commissioning

  • James B. Kirkbride (a1)

One in three people will experience a mental health problem in their lifetime, but the causes and consequences of psychiatric morbidity are socially patterned. Epidemiological studies can provide aetiological clues about the causes of disorder, and when they can provide robust estimates about risk in different strata of the population these can also be used translationally, to provide commissioners and service planners with detailed information about local service need. This approach is illustrated using a newly developed population-level prediction tool for first-episode psychosis, PsyMaptic. Such public mental health prediction tools could be used to improve allocation of finite resources, by integrating evidence-based healthcare, public health and epidemiology together.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Epidemiology on demand: population-based approaches to mental health service commissioning
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Epidemiology on demand: population-based approaches to mental health service commissioning
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Epidemiology on demand: population-based approaches to mental health service commissioning
      Available formats
This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to James Kirkbride (
Hide All

Declaration of interest


Hide All
1 Pedersen, CB, Mors, O, Bertelsen, A, Waltoft, BL, Agerbo, E, McGrath, JJ, et al. A comprehensive nationwide study of the incidence rate and lifetime risk for treated mental disorders. JAMA Psychiatry 2014; 71: 573–81.
2 Bourque, F, van der Ven, E, Malla, A. A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants. Psychol Med 2011; 41: 897910.
3 Kirkbride, JB, Errazuriz, A, Croudace, TJ, Morgan, C, Jackson, D, Boydell, J, et al. Incidence of schizophrenia and other psychoses in England, 1950–2009: a systematic review and meta-analyses. PLoS One 2012; 7: e31660.
4 Veling, W, Selten, JP, Veen, N, Laan, W, Blom, JD, Hoek, HW. Incidence of schizophrenia among ethnic minorities in the Netherlands: a four-year first-contact study. Schizophr Res 2006; 86: 189–93.
5 Kirkbride, JB, Fearon, P, Morgan, C, Dazzan, P, Morgan, K, Tarrant, J, et al. Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP study. Arch Gen Psychiatry 2006; 63: 250–8.
6 Davey Smith, G. Epidemiology, epigenetics and the ‘Gloomy Prospect’: embracing randomness in population health research and practice. Int J Epidemiol 2011; 40: 537–62.
7 Thomsen, AF, Olsbjerg, M, Andersen, PK, Kessing, LV. Cohabitation patterns among patients with severe psychiatric disorders in the entire Danish population. Psychol Med 2013; 43: 1013–21.
8 Kirkbride, JB, Susser, E, Kundakovic, M, Kresovich, JK, Davey Smith, G, Relton, CL. Prenatal nutrition, epigenetics and schizophrenia risk: can we test causal effects? Epigenomics 2012; 4: 303–15.
9 David, AS, Zammit, S, Lewis, G, Dalman, C, Allebeck, P. Impairments in cognition across the spectrum of psychiatric disorders: evidence from a Swedish conscript cohort. Schizophr Bull 2008; 34: 1035–41.
10 Koenen, KC, Moffitt, TE, Roberts, AL, Martin, LT, Kubzansky, L, Harrington, H, et al. Childhood IQ and adult mental disorders: a test of the cognitive reserve hypothesis. Am J Psychiatry 2009; 166: 50–7.
11 Kirkbride, JB. Hitting the floor: understanding migration patterns following the first episode of psychosis. Health Place 2014; 28: 150–2.
12 Jones, PB, Bebbington, P, Foerster, A, Lewis, SW, Murray, RM, Russell, A, et al. Premorbid social underachievement in schizophrenia. Results from the Camberwell Collaborative Psychosis Study. Br J Psychiatry 1993; 162: 6571.
13 Cullen, K, Guimaraes, A, Wozniak, J, Anjum, A, Schulz, S, White, T. Trajectories of social withdrawal and cognitive decline in the schizophrenia prodrome. Clin Schizophr Related Psychoses 2011; 4: 229–38.
14 Leeson, VC, Sharma, P, Harrison, M, Ron, MA, Barnes, TRE, Joyce, EM. IQ trajectory, cognitive reserve, and clinical outcome following a first episode of psychosis: a 3-year longitudinal study. Schizophr Bull 2011; 37: 768–77.
15 Domínguez-Martínez, T, Kwapil, TR, Barrantes-Vidal, N. Subjective quality of life in At-Risk Mental State for psychosis patients: relationship with symptom severity and functional impairment. Early Interv Psychiatry 2013; Dec 3. doi: 10.1111/eip.12111. [Epub ahead of print].
16 Garety, PA, Craig, TK, Dunn, G, Fornells-Ambrojo, M, Colbert, S, Rahaman, N, et al. Specialised care for early psychosis: symptoms, social functioning and patient satisfaction: randomised controlled trial. Br J Psychiatry 2006; 188: 3745.
17 Ngamini Ngui, A, Cohen, AA, Courteau, J, Lesage, A, Fleury, MJ, Grégoire, JP, et al. Does elapsed time between first diagnosis of schizophrenia and migration between health territories vary by place of residence? A survival analysis approach. Health Place 2013; 20: 6674.
18 Weiser, M, van Os, J, Reichenberg, A, Rabinowitz, J, Nahon, D, Kravitz, E, et al. Social and cognitive functioning, urbanicity and risk for schizophrenia. Br J Psychiatry 2007; 191: 320–4.
19 McGrath, J, Saha, S, Welham, J, El Saadi, O, MacCauley, C, Chant, D. A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Medicine 2004; 2: 122.
20 Department of Health. Mental Health Policy Implementation Guide. National Health Service, 2001.
21 Craig, TJ, Bromet, EJ, Fennig, S, Tanenberg-Karant, M, Lavelle, J, Galambos, N. Is there an association between duration of untreated psychosis and 24-month clinical outcome in a first-admission series? Am J Psychiatry 2000; 157: 60–6.
22 Marshall, M, Lewis, S, Lockwood, A, Drake, R, Jones, P, Croudace, T. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 2005; 62: 975–83.
23 Perkins, DO, Gu, H, Boteva, K, Lieberman, JA. Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry 2005; 162: 1785–804.
24 McGlashan, TH, Johannessen, JO. Early detection and intervention with schizophrenia: rationale. Schizophr Bull 1996; 22: 201–22.
25 McGorry, PD, Edwards, J, Mihalopoulos, C, Harrigan, SM, Jackson, HJ. EPPIC: an evolving system of early detection and optimal management. Schizophr Bull 1996; 22: 305–26.
26 Cannon, TD, Cadenhead, K, Cornblatt, B, Woods, SW, Addington, J, Walker, E, et al. Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Arch Gen Psychiatry 2008; 65: 2837.
27 Yung, AR, Yuen, HP, McGorry, PD, Phillips, LJ, Kelly, D, Dell'Olio, M, et al. Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States. Aust N Z J Psychiatry 2005; 39: 964–71.
28 Fusar-Poli, P, Borgwardt, S, Bechdolf, A, Addington, J, Riecher-Rössler, A, Schultze-Lutter, F, et al. The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry 2013; 70: 107–20.
29 Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Øhlenschlaeger, J, le Quach, P, et al. Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Arch Gen Psychiatry 2008; 65: 762–71.
30 Craig, TKJ, Garety, P, Power, P, Rahaman, N, Colbert, S, Fornells-Ambiojo, M, et al. The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. BMJ 2004; 329: 1067.
31 Nordentoft, M, Rasmussen, JO, Melau, M, Hjorthoj, CR, Thorup, AA. How successful are first episode programs? A review of the evidence for specialized assertive early intervention. Curr Opin Psychiatry 2014; 27: 167–72.
32 Lester, H, Marshall, M, Jones, P, Fowler, D, Amos, T, Khan, N, et al. Views of young people in early intervention services for first-episode psychosis in England. Psychiatr Serv 2011; 62: 882–7.
33 Melle, I, Johannesen, JO, Friis, S, Haahr, U, Joa, I, Larsen, TK, et al. Early detection of the first episode of schizophrenia and suicidal behavior. Am J Psychiatry 2006; 163: 800–4.
34 Rethink. Lost Generation: Why Young People with Psychosis are Being Left Behind, and What Needs to Change. Rethink, 2014.
35 Andrew, A, Knapp, M, McCrone, , Parsonage, M, Trachtenberg, M. Effective Interventions in Schizophrenia: The Economic Case. London School of Economics and Political Science Personal Social Services Research Unit (PSSRU), 2012.
36 National Institute for Health and Care Excellence. Costing Statement: Psychosis and Schizophrenia in Adults: Treatment and Management. Implementing the NICE Guideline on Psychosis and Schizophrenia in Adults (Clinical Guideline 178). NICE, 2014.
37 McCrone, P, Park, A-L, Knapp, M. Early Intervention for Psychosis. Department of Health, 2011.
38 Mihalopoulos, C, Harris, M, Henry, L, Harrigan, S, McGorry, P. Is early intervention in psychosis cost-effective over the long term? Schizophr Bull 2009; 35: 909–18.
39 Valmaggia, LR, McCrone, P, Knapp, M, Woolley, JB, Broome, MR, Tabraham, P, et al. Economic impact of early intervention in people at high risk of psychosis. Psychol Med 2009; 39: 1617–26.
40 Park, AL, McCrone, P, Knapp, M. Early intervention for first-episode psychosis: broadening the scope of economic estimates. Early Interv Psychiatry 2014 Apr 17. doi: 10.1111/eip.12149. [Epub ahead of print].
41 Hafner, H, Maurer, K, Loffler, W, Riecher-Rossler, A. The influence of age and sex on the onset and early course of schizophrenia. Br J Psychiatry 1993; 162: 80–6.
42 Pelosi, AJ, Birchwood, M. Is early intervention for psychosis a waste of valuable resources? Br J Psychiatry 2003; 182: 196–8.
43 McGorry, P, Johanessen, JO, Lewis, S, et al. Early intervention in psychosis: keeping faith with evidence-based health care. Psychol Med 2010; 40: 399404.
44 Marshall, M, Rathbone, J. Early intervention for psychosis. Schizophr Bull 2011; 37: 1111–4.
45 Bosanac, P, Patton, GC, Castle, DJ. Early intervention in psychotic disorders: faith before facts? Psychol Med 2010; 40: 353–8.
46 Kelly, M, O'Meara Howard, A, Smith, J. Early intervention in psychosis: a rural perspective. J Psychiatr Men Health Nurs 2007; 14: 203–8.
47 Tiffin, PA, Glover, G. From commitment to reality: early intervention in psychosis services in England. Early Interv Psychiatry 2007; 1: 104–7.
48 Mahmmood, MA, Fisher, H. The incidence of first episode psychosis in inner London: findings from the Lambeth early onset (LEO) service. Schizophr Res 2006; 86: 0548.
49 von Reventlow, HG, Krüger-Özgürdal, S, Ruhrmann, S, Schultze-Lutter, F, Heinz, A, Patterson, P, et al. Pathways to care in subjects at high risk for psychotic disorders – A European perspective. Schizophr Res 2014; 152: 400–7.
50 Birchwood, M, Connor, C, Lester, H, Patterson, P, Freemantle, N, Marshall, M, et al. Reducing duration of untreated psychosis: care pathways to early intervention in psychosis services. Br J Psychiatry 2013; 203: 5864.
51 McDaid, D, Knapp, M. Black-skies planning? Prioritising mental health services in times of austerity. Br J Psychiatry 2010; 196: 423–4.
52 National Institute for Health and Care Excellence. Psychosis and Schizophrenia in Adults: Treatment and Management (Clinical Guideline 178). NICE, 2014.
53 National Collaboration for Integrated Care and Support. Integrated Care and Support: Our Shared Commitment. Department of Health, 2013.
54 Birchwood, M, Lester, H, McCarthy, L, Jones, P, Fowler, D, Amos, T, et al. The UK national evaluation of the development and impact of Early Intervention Services (the National EDEN studies): study rationale, design and baseline characteristics. Early Interv Psychiatry 2014; 8: 5967.
55 Mental Health Foundation. Crossing Boundaries: Improving Integrated Care for People with Mental Health Problems. Mental Health Foundation, 2013.
56 Joint Commissioning Panel for Mental Health. Guidance for Commissioning Public Mental Health Services. Joint Commissioning Panel for Mental Health, 2012.
57 McManus, S, Meltzer, H, Brugha, T, Bebbington, P, Jenkins, R. Adult Psychiatric Morbidity in England, 2007. The NHS Information Centre for Health and Social Care, 2007.
58 Campion, J. Public mental health: the local tangibles. Psychiatrist 2013; 37: 238–43.
59 Coid, JW, Kirkbride, JB, Barker, D, Cowden, F, Stamps, R, Yang, M, et al. Raised incidence rates of all psychoses among migrant groups: findings from the East London first episode psychosis study. Arch Gen Psychiatry 2008; 65: 1250–8.
60 Kirkbride, JB, Jackson, D, Perez, J, Fowler, D, Winton, F, Coid, JW, et al. A population-level prediction tool for the incidence of first-episode psychosis: translational epidemiology based on cross-sectional data. BMJ Open 2013; 3: e001998.
61 Kirkbride, JB, Jones, PB, Ullrich, S, Coid, JW. Social deprivation, inequality, and the neighbourhood-level incidence of psychotic syndromes in East London. Schizophr Bull 2014; 40: 169–80.
62 Fusar-Poli, P, Yung, AR, McGorry, P, van Os, J. Lessons learned from the psychosis high-risk state: towards a general staging model of prodromal intervention. Psychol Med 2014; 44: 1724.
63 McGorry, PD, Killackey, E, Yung, A. Early intervention in psychosis: concepts, evidence and future directions. World Psychiatry 2008; 7: 148–56.
64 Kirkbride, JB, Jones, PB. Parity of esteem begins at home: translating empirical psychiatric research into effective public mental health. Psychol Med 2014; 44: 1569–76.
65 North East Public Health Observatory. Community Mental Health Profiles. North East Public Health Observatory, 2011 (
66 Campion, J. UCLPartners Mental Health Informatics Platform. UCLPartners (
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 2056-4694
  • EISSN: 2056-4708
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 1
Total number of PDF views: 22 *
Loading metrics...

Abstract views

Total abstract views: 64 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 18th July 2018. This data will be updated every 24 hours.

Epidemiology on demand: population-based approaches to mental health service commissioning

  • James B. Kirkbride (a1)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *