Coming to Terms With the Terms of Risk

Abstract

Terms such as risk, risk factors, and especially the term cause are inconsistently and imprecisely used, fostering scientific miscommunication and misleading research and policy. Clarifying such terms is the essential first step. We define risk and a risk factor (protective factor) and their potency, set out the conceptual basis of the methods by which risk factors are identified and potency demonstrated, and propose criteria for establishing the status of a risk factor as a fixed or variable marker or a causal risk factor. All definitions are based on the state of scientific knowledge (empirical documentation), rather than on hypotheses, speculations, or beliefs. We discuss common approaches and pitfalls and give a psychiatric research example. Imprecise reports can impede the search for understanding the cause and course of any disease and also may be a basis of inadequate clinical or policy decision-making. The issues in risk research are much too important to tolerate less than precise terminology or the less than rigorous research reporting that results from imprecise and inconsistent terminology.

Asthma and body weight change: a 20-year prospective community study of young adults

“…It is important, however, to be aware that even a specific temporal order between two conditions may occur in the absence of any causal relationships between them. 34 Moreover, the results of the present study do not exclude the possibility that the association Asthma and body weight change G Hasler et al between asthma and obesity is in part owing to an increased risk of asthma in overweight subjects. Shared pathophysiological mechanisms that may underlie asthma-obesity associations, including dysfunctions of the catecholaminergic system, dysfunctions of the HPA system and systemic inflammation, 5,38 are also critically involved in the pathophysiology of clinical depression.…”

“…The risk factors of disease incidence may considerably differ from risk factors of disease activity. 34 Psychological disturbances in childhood can have longterm profound impact on a child's future health and development. Recent epidemiological studies suggest relatively strong longitudinal associations between depressive symptoms during childhood and adolescence and the development of later obesity in women.…”

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults

“…In the context of suicidal behaviors, risk factors and protective factors interact in complex ways (Kraemer et al 1997). When the clinician is estimating suicide risk and developing a plan to address it, it is helpful to distinguish between nonmodifiable risk factors and modifiable risk factors.…”

Pediatric anxiety disorders: from neuroscience to evidence-based clinical practice

“…68,69,[92][93][94][95][96] In addition, heterogeneity within anxiety disorders is an important factor to consider. Two individuals with similar clinical manifestations may have different dysfunctional processes, and the same dysfunctional process may be Figure 1 Schematic representation of the etiological and pathophysiological process related to anxiety disorders.…”