Ecological studies
Ecological studies use aggregated data to infer correlation of exposures with outcomes over time, or by place. One of the first examples of an ecological study was Emile Durkheim’s exploration of country-level factors underlying suicide, first published in 1897. Ecological studies have continued to hold an important place in psychiatry, particularly for developing hypotheses. They can also be used to assess the impact of policies on health outcomes over time. There are important limitations associated with ecological study designs, in particular the ability to make causal inferences at the individual level. Multilevel modelling approaches are an important analytic development in the field, which allow the possibility of using group-level information alongside individual-level attributes in analyses. In the first part of this chapter, some examples of ecological studies and their advantages and disadvantages will be introduced. In the second part of this chapter, multilevel modelling techniques will be briefly introduced and discussed with respect to their use in overcoming some of the limitations of geographical ecological studies.