Cross-cultural conceptions of mental illness

DSM-IV: Implications for Hispanic Children and Adolescents

Hispanic children and adolescents are a rapidly growing segment of the general population. The mental health needs of this group of youth are thought to be at least equal to the needs of nonminority children. Culturally appropriate diagnostic, treatment, and evaluation servicesfor this group of Hispanic youth are much needed so that ethical and appropriate mental health and educational services can be provided. This article provides an overview of the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV. Highlighted in this article is a discussion of the validity and reliability of the diagnostic categories included in the DSM-IV. An extensive review of the literature reveals few empirical studies related to the validity and reliability of the DSM when used with Hispanic children and adolescents. This review of the existing literature, as well as the clinical experiences of the authors, provide the basis for some general guidelines in the use of the DSM-IV such that diagnostic errors with Hispanic children and adolescents can be minimized.

The importance of cultural and linguistic issues in the emergency care of children

BACKGROUND

Rapid growth in the diversity of the US population makes it increasingly likely that emergency clinicians will encounter greater numbers of patients from different cultures, but little is known about the importance of culture and language in the emergency care of children.

OBJECTIVE

To conduct a critical review and synthesis of published studies on culture and language in the emergency care of children.

METHODS

PubMed was used to perform a literature search (using 17 search terms) of all articles on culture, language, and the emergency care of children published in English or Spanish from 1966 to 1999.

RESULTS

More than 2000 citations initially were identified; consensus review yielded 400 papers that were photocopied. A final database of 117 articles revealed the following: certain normative cultural values, such as the Navajo hozhooji (the importance of thinking and speaking positively), can have profound effects on informed consent and discussions of medical risk. For limited English proficient children and their families, studies document that medical interpreters frequently are not used, there is a lack of trained interpreters, there are more access barriers, and those who need but do not get interpreters have poor understanding of their diagnosis and treatment. Numerous folk illnesses, such as among Latinos, can affect care, because symptoms often overlap with important biomedical conditions, the first clinical contact may be with folk healers, and certain folk remedies are harmful or even fatal. Certain parent beliefs and practices can result in serious morbidity and fatalities (from lead poisoning, liver failure, and other causes), costly or unnecessary medical evaluations (eg, Fenugreek teas), and clinical findings easily confused with child abuse (eg, coining). Biased provider attitudes and practices can have profound clinical consequences, including ethnic disparities in prescriptions, analgesia, test ordering, sexual history taking, asthma care quality, and diagnostic evaluations.

CONCLUSIONS

Failure to appreciate the importance of culture and language in pediatric emergencies can result in multiple adverse consequences, including difficulties with informed consent, miscommunication, inadequate understanding of diagnoses and treatment by families, dissatisfaction with care, preventable morbidity and mortality, unnecessary child abuse evaluations, lower quality of care, clinician bias, and ethnic disparities in prescriptions, analgesia, test ordering, and diagnostic evaluations.

Perceptions of schizophrenia in multi-cultural Britain

OBJECTIVES

The importance of perceptions of mental health problems from the perspectives of different ethnic populations is especially pertinent within a society such as Britain, which is culturally diverse, but employs a classification of psychopathology which is based upon western models. This study aimed to investigate differences in the lay perceptions of mental health problems, particularly schizophrenia, across different ethnic populations living in Britain. Further it aimed to look at the influence ethnic background had in relation to other variables such as age, gender, religion and contact with people with mental health problems.

DESIGN

190 participants from five broad ethnic groups (Afro-Caribbean, Bangladeshi, Indian, Sub-Saharan African and White British) reported their perceptions of schizophrenia symptoms using the Perceptions of Mental Health Problems Questionnaire.

RESULTS

Differences were found across ethnic groups in participants' perceptions of schizophrenia symptoms. Differences were consistently shown across the specific symptoms of hallucinatory behaviour, suspiciousness, unusual thought content and alogia. In particular, in comparison with the white British group, Bangladeshi participants were less likely to view suspiciousness or hallucinatory behaviour as indicative of mental health problems, and the Afro-Caribbean participants were less likely to view unusual thought content as a symptom. As expected, differences in perceptions were also associated with religion, education, gender and contact with people with mental health problems. However, ethnicity was the best predictor of perceptions of schizophrenia symptoms.

CONCLUSION

Ethnicity was found to be an important factor in influencing perceptions of schizophrenia. The specific differences found across ethnic groups are useful in beginning to understand more fully public perceptions of mental health problems in Britain today. The findings raise interesting discussion in relation to ethnic and cultural factors in planning services for people from ethnic minorities, and considering in more detail issues concerning diagnosis and engagement.

The expression of cognitive vulnerabilities for depression in daily life: a French-American study

This prospective study provided a direct comparison of French and American samples concerning a cognitive diathesis for depression. Using the Experience Sampling Method and identical measures across sites, subjects were signaled five times daily by electronic devices to provide in vivo reports of negative events, attributions, and depressed moods. After controlling for effects associating clinical and demographic variables, and despite differences attributable to national origin, attributional style emerged as a highly significant predictor of the numerous specific attributions made to negative events within the course of daily life. However, consistent with the cognitive mediation hypothesis, attributional style did not directly explain depression levels. The results are discussed in terms of the predictive power of cognitive and personality assessments in understanding the day-to-day experience of depression.