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Vilar-Lluch S. Representing Behavioral Pathology: The Importance of Modality in Medical Descriptions of Conduct, ADHD as Case Study. HEALTH COMMUNICATION 2023; 38:3022-3030. [PMID: 36214362 DOI: 10.1080/10410236.2022.2129649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This paper examines the role of modality resources (e.g. "may," "often") in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in representing behavioral pathology focusing, in particular, on Attention Deficit Hyperactivity Disorder (ADHD). ADHD diagnosis requires reports of non-practitioners (e.g. carers and teachers); an effective understanding of behavioral descriptors by the lay community is thus of paramount importance. The study combines qualitative linguistic discourse analysis and a corpus approach to study the presence and functions of modality, adopting a Systemic Functional perspective toward language. The study argues that in the DSM-5 modality is an important linguistic resource for conveying clinical significance, inferred from graduations of recurrence and probability. However, adopting features of professional discourse in representing behavioral pathology for non-experts, especially when those resources are inherently evaluative, stresses the need of health literacy among the lay social community and accessibility in health communication materials, particularly when non-practitioners are involved in the diagnosis practice.
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Affiliation(s)
- Sara Vilar-Lluch
- School of English, University of Nottingham
- Philosophy, University of Reading
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2
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Lawrence V, McCombie C, Nikolakopoulos G, Morgan C. Navigating the mental health system: Narratives of identity and recovery among people with psychosis across ethnic groups. Soc Sci Med 2021; 279:113981. [PMID: 33991793 DOI: 10.1016/j.socscimed.2021.113981] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
There is consistent evidence that members of the black Caribbean population in the UK are more likely to have coercive relationships with mental health services, typified by high levels of police involvement and compulsory treatment. This research has relied upon a medical epidemiological framework that has enumerated differences in service use but failed to unravel the complex interplay of individual, social, and cultural factors that inform the pathway to care. The purpose of this study was to explore the journey through mental health services from the perspective of individuals from the black Caribbean and majority white British population to help understand variation in the use of mental health services. Individual interviews were conducted with 17 black Caribbean, 15 white British, and 3 non-British white people with psychosis as part of AESOP-10, a 10 year follow up of an ethnically diverse cohort of individuals with first episode psychosis in the UK. Thematic narrative analysis identified three overarching narrative categories: 'losing self within the system' narratives gave primacy to individuals' identity as a chronic psychiatric patient with participants unable to break the cycle of service use; 'steadying self through the system' narratives combined recognition of the value of psychiatry and its limitations with the ability to access psychological therapy and protect valued social roles; 'finding strength beyond the system' narratives challenged negative dominant discourses and emphasised social, interpersonal and intrapersonal factors in recovery. We found variation in narratives across ethnic groups with 'losing self within the system' and 'finding strength beyond the system' narratives most common, though not exclusive to, black Caribbean participants. Distress appeared rooted in social structures that disadvantage black people, and psychiatry appeared to be experienced as a further form of oppression, that initially provoked resistance and fear, and over time, resignation to the identity of psychiatric patient.
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Affiliation(s)
- Vanessa Lawrence
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
| | - Catherine McCombie
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
| | - Georgios Nikolakopoulos
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
| | - Craig Morgan
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
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Shi Y, Song R, Wang L, Qi Y, Zhang H, Zhu J, Zhang X, Tang X, Zhan Q, Zhao Y, Swaab DF, Bao AM, Zhang Z. Identifying Plasma Biomarkers with high specificity for major depressive disorder: A multi-level proteomics study. J Affect Disord 2020; 277:620-630. [PMID: 32905914 DOI: 10.1016/j.jad.2020.08.078] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/08/2020] [Accepted: 08/24/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are currently no objective diagnostic biomarkers for major depressive disorder (MDD) due to the biological complexity of the disorder. The existence of blood-based biomarkers with high specificity would be convenient for the clinical diagnosis of MDD. METHODS A comprehensive plasma proteomic analysis was conducted in a highly homogeneous cohort [7 drug-naïve MDD patients and 7 healthy controls (HCs)], with bioinformatics analysis combined with machine learning used to screen candidate proteins. Verification of reproducibility and specificity was conducted in independent cohorts [60 HCs and 74 MDD, 42 schizophrenia (SZ) and 39 bipolar I disorder (BD-I) drug-naïve patients]. Furthermore, verification of consistency was accomplished by proteomic analysis of postmortem brain tissue from 16 MDD patients and 16 HCs. RESULTS Levels of C-reactive protein (CRP), antithrombin III (ATIII), inter-alpha-trypsin inhibitor heavy chain 4 (ITIH4) and vitamin D-binding protein (VDB) were significantly higher in MDD patients, both in the discovery cohort and independent replication cohort. In comparison with SZ or BD-I patients, two proteins (VDB and ITIH4) were significantly elevated only in MDD patients. In addition, increased VDB and ITIH4 were observed consistently in both plasma and postmortem dorsolateral prefrontal cortex tissues of MDD patients. Furthermore, a panel consisting of all four plasma proteins was able to distinguish MDD patients from HCs or SZ or BD-I patients with the highest accuracy. CONCLUSION Plasma ITIH4 and VDB may be potential plasma biomarkers of MDD with high specificity. The four-protein panel is more suitable as a potential clinical diagnostic marker for MDD.
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Affiliation(s)
- Yachen Shi
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, China
| | - Ruize Song
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, China
| | - Liping Wang
- Nanjing University Aeronaut & Astronaut, Department Math, Nanjing, Jiangsu, 210016, China
| | - Yangjian Qi
- Department of Neurobiology, Key Laboratory of Medical Neurobiology of Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310058, China
| | - Hongxing Zhang
- Department of Psychology, Xinxiang Medical University, Xinxiang, Henan, 453003, China
| | - Jianli Zhu
- Department of Psychology, Xinxiang Medical University, Xinxiang, Henan, 453003, China
| | - Xiaobin Zhang
- Department of Psychiatry, Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu, 225003, China; Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu, 215008, China
| | - Xiaowei Tang
- Department of Psychiatry, Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu, 225003, China
| | - Qiongqiong Zhan
- Department of Psychiatry, Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu, 225003, China
| | - Yang Zhao
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, 211100, China
| | - Dick F Swaab
- Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam 1105 BA, The Netherlands
| | - Ai-Min Bao
- Department of Neurobiology, Key Laboratory of Medical Neurobiology of Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310058, China.
| | - Zhijun Zhang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, China; Department of Psychology, Xinxiang Medical University, Xinxiang, Henan, 453003, China; Mental Health Center Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, China.
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4
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Ostinelli EG, Zangani C, Solmi M. Clozapine for persistent aggressive behaviour or agitation in people with schizophrenia. Hippokratia 2019. [DOI: 10.1002/14651858.cd013493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Edoardo G Ostinelli
- Università degli Studi di Milano; Department of Health Sciences; Via Antonio di Rudinì 8 Milan Italy 20142
| | - Caroline Zangani
- Università degli Studi di Milano; Department of Health Sciences; Via Antonio di Rudinì 8 Milan Italy 20142
| | - Marco Solmi
- University of Padua; Neurosciences Department; Padova PAdova Italy 35100
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Nersessova KS, Jurcik T, Hulsey TL. Differences in beliefs and attitudes toward Depression and Schizophrenia in Russia and the United States. Int J Soc Psychiatry 2019; 65:388-398. [PMID: 31159634 DOI: 10.1177/0020764019850220] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cross-cultural studies find that culture shapes people's understanding of mental illnesses, particularly Depression and Schizophrenia. AIMS To compare individuals' beliefs and attitudes toward Depression and Schizophrenia in Russia and the United States. METHOD Participants (N=607) were presented with vignettes of two diagnostically unlabeled psychiatric case histories and then answered questions regarding mental health literacy (MHL) and attitudes toward the person and the illness. RESULTS Our findings indicate that Depression was most often attributed to psychosocial stress while Schizophrenia was thought to be caused by biological factors. People from both countries considered those suffering from Schizophrenia to be unpredictable and dangerous. US participants were more likely to endorse lay and professional help for both disorders than their Russian counterparts. Russian participants reported being less likely to turn to someone they trust and more likely to deal with problems on their own. Russian participants were also more likely to view those with Depression as 'weak-willed' and leading an 'immoral lifestyle'. CONCLUSION Our findings further inform cultural understandings of these mental illnesses in an often neglected national group. Patterns suggest that both groups may benefit from exposure to corrective information about Depression and Schizophrenia.
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Plausibility Judgments of Atypical Symptoms Across Cultures: an Explorative Study Among Western and Non-Western Experts. PSYCHOLOGICAL INJURY & LAW 2017; 10:274-281. [PMID: 29057031 PMCID: PMC5630653 DOI: 10.1007/s12207-017-9294-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/18/2017] [Indexed: 11/23/2022]
Abstract
Symptom validity tests (SVTs) are predicated on the assumption that overendorsement of atypical symptoms flags symptom exaggeration (i.e., questionable symptom validity). However, few studies have explored how practitioners from different cultural backgrounds evaluate such symptoms. We asked professionals working in Western (n = 56) and non-Western countries (n = 37) to rate the plausibility of uncommon symptoms taken from the Structured Inventory of Malingered Symptomatology (SIMS), dissociative symptoms from the Dissociative Experience Scale (DES-T), and standard symptoms (e.g., anxiety, depression) from the Brief Symptom Inventory-18 (BSI-18). Western and non-Western experts gave similar plausibility ratings to atypical, dissociative, and standard symptoms: both groups judged BSI-18 symptoms as significantly more plausible than either dissociative or atypical symptoms, while the latter two categories did not differ. Our results suggest that the strategy to detect symptom exaggeration by exploring overendorsement of atypical items might work in a non-western context as well.
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Kanagaratnam P, Pain C, McKenzie K, Ratnalingam N, Toner B. Recommendations for Canadian Mental Health Practitioners Working With War-Exposed Immigrants and Refugees. ACTA ACUST UNITED AC 2017. [DOI: 10.7870/cjcmh-2017-010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With the inception of the mental health strategy for Canada, Changing Directions, Changing Lives, the ever increasing ethnic diversity in this country demands re-examination of our approaches to mental wellbeing and illness in the immigrant and refugee population arriving from war-torn countries. Contemporary clinical practice among mental health practitioners is not reflective of the emerging literature in this field, which points towards meaningful and culturally competent care. This article seeks to bridge the gap between existing knowledge and current practice, and provides recommendations for mental health practitioners who work with this population.
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Affiliation(s)
| | - Clare Pain
- University of Toronto
- University of Toronto
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Yasui M, Pottick KJ, Chen Y. Conceptualizing Culturally Infused Engagement and Its Measurement for Ethnic Minority and Immigrant Children and Families. Clin Child Fam Psychol Rev 2017; 20:250-332. [PMID: 28275923 PMCID: PMC5614708 DOI: 10.1007/s10567-017-0229-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite the central role culture plays in racial and ethnic disparities in mental health among ethnic minority and immigrant children and families, existing measures of engagement in mental health services have failed to integrate culturally specific factors that shape these families' engagement with mental health services. To illustrate this gap, the authors systematically review 119 existing instruments that measure the multi-dimensional and developmental process of engagement for ethnic minority and immigrant children and families. The review is anchored in a new integrated conceptualization of engagement, the culturally infused engagement model. The review assesses culturally relevant cognitive, attitudinal, and behavioral mechanisms of engagement from the stages of problem recognition and help seeking to treatment participation that can help illuminate the gaps. Existing measures examined four central domains pertinent to the process of engagement for ethnic minority and immigrant children and families: (a) expressions of mental distress and illness, (b) causal explanations of mental distress and illness, (c) beliefs about mental distress and illness, and (d) beliefs and experiences of seeking help. The findings highlight the variety of tools that are used to measure behavioral and attitudinal dimensions of engagement, showing the limitations of their application for ethnic minority and immigrant children and families. The review proposes directions for promising research methodologies to help intervention scientists and clinicians improve engagement and service delivery and reduce disparities among ethnic minority and immigrant children and families at large, and recommends practical applications for training, program planning, and policymaking.
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Affiliation(s)
- Miwa Yasui
- School of Social Service Administration, University of Chicago, 969 E 60th St, Chicago, IL, 60637, USA.
| | - Kathleen J Pottick
- School of Social Work and Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, 112 Paterson St, New Brunswick, NJ, 08903, USA
| | - Yun Chen
- School of Social Service Administration, University of Chicago, 969 E 60th St, Chicago, IL, 60637, USA
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Tennyson RL, Kemp CG, Rao D. Challenges and strategies for implementing mental health measurement for research in low-resource settings. Int Health 2016; 8:374-380. [PMID: 27799289 DOI: 10.1093/inthealth/ihw043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 07/20/2016] [Accepted: 07/29/2016] [Indexed: 11/13/2022] Open
Abstract
The gap between need and access to mental health care is widest in low-resource settings. Health systems in these contexts devote few resources to expanding mental health care, and it is missing from the agenda of most global health donors. This is partially explained by the paucity of data regarding the nature and extent of the mental health burden in these settings, so accurate and comparable measurement is essential to advocating for, developing, and implementing appropriate policies and services. Inaccurate estimation of mental illness prevalence, and misunderstandings regarding its etiologies and expressions, are associated with unnecessary costs to health systems and people living with mental illness. This paper presents a selective literature review of the challenges associated with mental health measurement in these settings globally, presents several case studies, and suggests three strategies for researchers to improve their assessments: utilize qualitative data, conduct cognitive interviews and train research teams with a focus on inter-rater reliability. These three strategies presented, added to the complement of tools used by mental health researchers in low-resource settings, will enable more researchers to conduct culturally valid work, improve the quality of data available, and assist in narrowing the treatment gap.
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Affiliation(s)
- Robert L Tennyson
- Department of Anthropology, University of Washington, Seattle, WA, USA .,Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
| | | | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
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Conrad MM, Pacquiao DF. Manifestation, Attribution, and Coping With Depression Among Asian Indians From the Perspectives of Health Care Practitioners. J Transcult Nurs 2016; 16:32-40. [PMID: 15608097 DOI: 10.1177/1043659604271239] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The study explores cultural influences on depression and care outcomes among Asian Indians with depression. Data were collected from interviews of 23 multidisciplinary mental health professionals and retrospective review of 20 medical records of patients. Findings revealed a major influence of social and cultural context in expression of symptoms, illness attribution, help-seeking behaviors, and communication patterns. Religious beliefs and social stigma attached to mental illness contributed to prolonged denial of condition, difficulty in sharing emotional problems with professional caregivers, and delayed professional intervention. The traditional family hierarchy rooted in age and gender inequality interfered with help-seeking behaviors and adherence to prescribed regimen as well as heightened some family conflicts and hindered family adaptation after migration to the United States.
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Lomas T. Towards a positive cross-cultural lexicography: Enriching our emotional landscape through 216 ‘untranslatable’ words pertaining to well-being. JOURNAL OF POSITIVE PSYCHOLOGY 2016. [DOI: 10.1080/17439760.2015.1127993] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Okada T, Kubota Y, Sato W, Murai T, Pellion F, Gorog F. Common impairments of emotional facial expression recognition in schizophrenia across French and Japanese cultures. Front Psychol 2015; 6:1018. [PMID: 26257678 PMCID: PMC4511826 DOI: 10.3389/fpsyg.2015.01018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 07/06/2015] [Indexed: 11/13/2022] Open
Abstract
To address whether the recognition of emotional facial expressions is impaired in schizophrenia across different cultures, patients with schizophrenia and age-matched normal controls in France and Japan were tested with a labeling task of emotional facial expressions and a matching task of unfamiliar faces. Schizophrenia patients in both France and Japan were less accurate in labeling fearful facial expressions. There was no correlation between the scores of facial emotion labeling and face matching. These results suggest that the impaired recognition of emotional facial expressions in schizophrenia is common across different cultures.
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Affiliation(s)
- Takashi Okada
- Department of Psychiatry, Nagoya University Graduate School of Medicine Aichi, Japan ; Kouai Hospital Osaka, Japan
| | - Yasutaka Kubota
- Health and Medical Service Center, Shiga University Shiga, Japan ; Centre Hospitalier Sainte Anne Paris, France
| | - Wataru Sato
- Primate Research Institute, Kyoto University Aichi, Japan
| | - Toshiya Murai
- Department of Psychiatry, Kyoto University Graduate School of Medicine Kyoto, Japan
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Kumar M, Ongeri L, Mathai M, Mbwayo A. Translation of EPDS Questionnaire into Kiswahili: Understanding the Cross-Cultural and Translation Issues in Mental Health Research. ACTA ACUST UNITED AC 2015; 2. [PMID: 25893218 DOI: 10.4172/2376-127x.1000134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The need for a suitable tool for assessing postpartum depression in Kenya led to the process of translation of the 10 items Edinburgh Postnatal Scale into Kiswahili. The idea was to seek semantic, conceptual as well as normative equivalence in this translation. The paper discusses issues and the process of translation and provides in depth discussions around translation from the point of view of cross-cultural mental health research and practice. The English version of the EPDS screening tool was finally successfully translated into Kiswahili and the translated version is attached with this paper.
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Affiliation(s)
- Manasi Kumar
- Senior Lecturer, Department of Psychiatry, University of Nairobi, Kenya
| | - Linnet Ongeri
- Research Officer, Centre for Clinical Research, KEMRI, Nairobi, Kenya
| | - Muthoni Mathai
- Senior Lecturer, Department of Psychiatry, University of Nairobi, Kenya
| | - Anne Mbwayo
- Honorary Lecturer, Department of Psychiatry, University of Nairobi, Kenya
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Keith JA, Verdeli H, Vousoura E. Evaluating the Clinical Significance of Depression Treatment. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2014. [DOI: 10.2753/imh0020-7411400301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Kalibatseva Z, Leong FTL, Ham EH. A symptom profile of depression among Asian Americans: is there evidence for differential item functioning of depressive symptoms? Psychol Med 2014; 44:2567-2578. [PMID: 25055174 DOI: 10.1017/s0033291714000130] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Theoretical and clinical publications suggest the existence of cultural differences in the expression and experience of depression. Measurement non-equivalence remains a potential methodological explanation for the lower prevalence of depression among Asian Americans compared to European Americans. METHOD This study compared DSM-IV depressive symptoms among Asian Americans and European Americans using secondary data analysis of the Collaborative Psychiatric Epidemiology Surveys (CPES). The Composite International Diagnostic Interview (CIDI) was used for the assessment of depressive symptoms. Of the entire sample, 310 Asian Americans and 1974 European Americans reported depressive symptoms and were included in the analyses. Measurement variance was examined with an item response theory differential item functioning (IRT DIF) analysis. RESULTS χ2 analyses indicated that, compared to Asian Americans, European American participants more frequently endorsed affective symptoms such as 'feeling depressed', 'feeling discouraged' and 'cried more often'. The IRT analysis detected DIF for four out of the 15 depression symptom items. At equal levels of depression, Asian Americans endorsed feeling worthless and appetite changes more easily than European Americans, and European Americans endorsed feeling nervous and crying more often than Asian Americans. CONCLUSIONS Asian Americans did not seem to over-report somatic symptoms; however, European Americans seemed to report more affective symptoms than Asian Americans. The results suggest that there was measurement variance in a few of the depression items.
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Affiliation(s)
- Z Kalibatseva
- Department of Psychology,Michigan State University,East Lansing, MI,USA
| | - F T L Leong
- Department of Psychology,Michigan State University,East Lansing, MI,USA
| | - E H Ham
- Department of Counseling, Educational Psychology and Special Education,Michigan State University,East Lansing, MI,USA
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McLean D, Thara R, John S, Barrett R, Loa P, McGrath J, Mowry B. DSM-IV "criterion A" schizophrenia symptoms across ethnically different populations: evidence for differing psychotic symptom content or structural organization? Cult Med Psychiatry 2014; 38:408-26. [PMID: 24981830 PMCID: PMC4140994 DOI: 10.1007/s11013-014-9385-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is significant variation in the expression of schizophrenia across ethnically different populations, and the optimal structural and diagnostic representation of schizophrenia are contested. We contrasted both lifetime frequencies of DSM-IV criterion A (the core symptom criterion of the internationally recognized DSM classification system) symptoms and types/content of delusions and hallucinations in transethnic schizophrenia populations from Australia (n = 776), India (n = 504) and Sarawak, Malaysia (n = 259), to elucidate clinical heterogeneity. Differences in both criterion A symptom composition and symptom content were apparent. Indian individuals with schizophrenia reported negative symptoms more frequently than other sites, whereas individuals from Sarawak reported disorganized symptoms more frequently. Delusions of control and thought broadcast, insertion, or withdrawal were less frequent in Sarawak than Australia. Curiously, a subgroup of 20 Indian individuals with schizophrenia reported no lifetime delusions or hallucinations. These findings potentially challenge the long-held view in psychiatry that schizophrenia is fundamentally similar across cultural groups, with differences in only the content of psychotic symptoms, but equivalence in structural form.
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Affiliation(s)
- Duncan McLean
- Queensland Centre for Mental Health Research (Queensland Health), University of Queensland, Brisbane, Queensland, Australia
| | - Rangaswamy Thara
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India Ph: +91 44 2615 3971
| | - Sujit John
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India Ph: +91 44 2615 3971
| | - Robert Barrett
- University of Adelaide, Department of Psychiatry, Royal Adelaide Hospital, Adelaide, South Australia, Australia No contact details as author is deceased
| | - Peter Loa
- Canberra Hospital, Canberra, Australian Capital Territory, Australia Ph: +61 2 6244 2222
| | - John McGrath
- Queensland Brain Institute and Queensland Centre for Mental Health Research (Queensland Health), University of Queensland, Brisbane, Queensland, Australia Ph: +61 7 3346 6372
| | - Bryan Mowry
- Queensland Brain Institute and Queensland Centre for Mental Health Research (Queensland Health), University of Queensland, Brisbane, Queensland, Australia Ph: +61 7 3346 6351
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Burri A, Maercker A. Differences in prevalence rates of PTSD in various European countries explained by war exposure, other trauma and cultural value orientation. BMC Res Notes 2014; 7:407. [PMID: 24972489 PMCID: PMC4114166 DOI: 10.1186/1756-0500-7-407] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 06/23/2014] [Indexed: 11/10/2022] Open
Abstract
Background Guided by previous explorations of historical and cultural influences on the occurrence of PTSD, the aim of the present study was to investigate the contributions of war victimisation (in particular, World War II) and other civil trauma on the prevalence of PTSD, as mediated by cultural value orientation. Secondary data analysis was performed for 12 European countries using data, including PTSD prevalence and number of war victims, crime victims, and natural disaster victims, from different sources. Ten single value orientations, as well as value aggregates for traditional and modern factors, were investigated. Results Whilst differences in PTSD prevalence were strongly associated with war victim rates, associations, albeit weaker, were also found between crime victims and PTSD. When cultural value orientations, such as stimulation and conformity as representatives of modern and traditional values, were included in the multivariate predictions of PTSD prevalence, an average of approximately 80% of PTSD variance could be explained by the model, independent of the type of trauma exposure. Conclusion The results suggest that the aftermath of war contributes to current PTSD prevalence, which may be explained by the high proportion of the older population who directly or indirectly experienced traumatic war experiences. Additional findings for other types of civil trauma point towards an interaction between value orientation and country-specific trauma rates. Particularly, being personally oriented towards stimulation appears to interact with differences in trauma prevalence. Thus, cultural value orientation might be viewed not only as an individual intrinsic process but also as a compensatory strategy after trauma exposure.
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Affiliation(s)
- Andrea Burri
- Department of Psychology, University of Zurich, Zurich, Switzerland.
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Eckensberger LH. Integrating the Emic (Indigenous) with the Etic (Universal)-A Case of Squaring the Circle or for Adopting a Culture Inclusive Action Theory Perspective. JOURNAL FOR THE THEORY OF SOCIAL BEHAVIOUR 2014. [DOI: 10.1111/jtsb.12057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lutz H. Eckensberger
- German Institute for International Educational Research (Frankfurt/Berlin)
- Johann Wolfgang Goethe University (Frankfurt)
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Taylor B, Carswell K, Williams ACDC. The interaction of persistent pain and post-traumatic re-experiencing: a qualitative study in torture survivors. J Pain Symptom Manage 2013; 46:546-55. [PMID: 23507129 DOI: 10.1016/j.jpainsymman.2012.10.281] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 10/22/2012] [Accepted: 10/25/2012] [Indexed: 11/29/2022]
Abstract
CONTEXT There are limited studies and few theoretical models addressing the interaction between pain and symptoms of post-traumatic stress disorder, with none concerning this interaction in survivors of torture, who frequently report persistent pain. OBJECTIVES We aimed to explore the relationship between persistent pain and re-experiencing of traumatic events in survivors of torture. METHODS Nine torture survivors were interviewed about their experiences of pain and re-experiencing, and the results analyzed using interpretative phenomenological analysis. Levels of pain and post-traumatic stress were assessed. RESULTS Four superordinate themes emerged, namely "pain is the enemy," "pain and intrusive memories are connected," "changed identity," and "resilience and resources." These themes showed a complex relationship between torture, pain, re-experiencing, and other aspects of individual experience, such as the multiple losses experienced by torture survivors. Both pain and post-traumatic stress disorder symptoms were shown to have profound impacts on the everyday lives of participants. CONCLUSION The results suggest that the relationship between pain and re-experiencing requires a broad model that considers the impact of a range of individual, social, and environmental factors on the interaction between pain and traumatic stress symptoms in survivors of torture. The study has clinical implications, most notably the need to attempt more integrated treatment of pain and traumatic symptoms where they occur together, and to consider the meaning and impact of pain when treating survivors of torture. Further investigation of the relationship between pain and traumatic stress symptoms in torture survivors is needed, as are studies of combined treatment for pain and trauma.
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Affiliation(s)
- Bethany Taylor
- Department of Rehabilitation Psychology, Camden & Islington NHS Foundation Trust, London, United Kingdom.
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Abbo C, Kinyanda E, Kizza RB, Levin J, Ndyanabangi S, Stein DJ. Prevalence, comorbidity and predictors of anxiety disorders in children and adolescents in rural north-eastern Uganda. Child Adolesc Psychiatry Ment Health 2013; 7:21. [PMID: 23841918 PMCID: PMC3710504 DOI: 10.1186/1753-2000-7-21] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 07/08/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Child and adolescent anxiety disorders are the most prevalent form of childhood psychopathology. Research on child and adolescent anxiety disorders has predominantly been done in westernized societies. There is a paucity of data on the prevalence, comorbidity, and predictors of anxiety disorders in children and adolescents in non-western societies including those in sub-Saharan Africa. This paper investigates the prevalence, comorbidity, and predictors of anxiety disorders in children and adolescents in north-eastern Uganda. OBJECTIVE To determine the prevalence of DSM-IV anxiety disorders, as well as comorbidity patterns and predictors in children and adolescents aged 3 to 19 years in north-eastern Uganda. METHODS Four districts (Lira, Tororo, Kaberamaido and Gulu) in rural north-eastern Uganda participated in this study. Using a multi-stage sampling procedure, a sample of 420 households with children aged 3-19 years from each district was enrolled into the study. The MINI International Neuropsychiatric Interview for children and adolescents (MINI KID) was used to assess for psychiatric disorders in 1587 of 1680 respondents. RESULTS The prevalence of anxiety disorders was 26.6%, with rates higher in females (29.7%) than in males (23.1%). The most common disorders in both males and females were specific phobia (15.8%), posttraumatic stress disorder (PTSD) (6.6%) and separation anxiety disorder (5.8%). Children below 5 years of age were significantly more likely to have separation anxiety disorder and specific phobias, while those aged between 14-19 were significantly more likely to have PTSD. Anxiety disorders were more prevalent among respondents with other psychiatric disorders; in respondents with two or more co-morbid psychiatric disorders the prevalence of anxiety disorders was 62.1%. Predictors of anxiety disorders were experience of war trauma (OR = 1.93, p < 0.001) and a higher score on the emotional symptom scale of the SDQ (OR = 2.58, p < 0.001). Significant socio-demograghic associations of anxiety disorders were found for female gender, guardian unemployment, living in permanent housing, living without parents, and having parents without education. CONCLUSION The prevalence of anxiety disorders in children and adolescents in rural north-eastern Uganda is high, but consistent in terms of gender ratio and progression over time with a range of prior work in other contexts. Patterns of comorbidity and predictors of anxiety disorders in this setting are also broadly consistent with previous findings from western community studies. Both psychosocial stressors and exposure to war trauma are significant predictors of anxiety disorders.Prevention and treatment strategies need to be put in place to address the high prevalence rates of anxiety disorders in children and adolescents in Uganda.
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Affiliation(s)
- Catherine Abbo
- Department of Psychiatry, College of Health Sciences, Makerere University, P.O.BOX 7072, Kampala, Uganda
- Division of Child and Adolescent Psychiatry, Red Cross War Memorial Hospital and University of Cape Town, 7700 Rondebosch, Cape Town, South Africa
| | - Eugene Kinyanda
- MRC/UVRI Uganda Reseach Unit on AIDS, P.O.BOX 49, Entebbe, Uganda
| | - Ruth B Kizza
- North Stockholm’s Psychiatric Clinic, Stockholm, Sweden
| | - Jonathan Levin
- MRC/UVRI Uganda Reseach Unit on AIDS, P.O.BOX 49, Entebbe, Uganda
| | | | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Depression and coronary heart disease: Apprehending the elusive black dog. Int J Cardiol 2012; 158:335-6. [DOI: 10.1016/j.ijcard.2011.12.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 12/25/2011] [Indexed: 11/24/2022]
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Commentary on Cultural Diversity Across the Pacific: The Dominance of Western Theories, Models, Research and Practice in Psychology. JOURNAL OF PACIFIC RIM PSYCHOLOGY 2012. [DOI: 10.1017/prp.2012.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The three featured articles in the December 2010 section on cultural diversity across the Pacific address important cultural issues in psychology. Berry (2010) applied these issues to intercultural relations and acculturation, Furnham (2010) to culture shock, and Marsella and Yamada (2010) to psychopathology. The common theme among these articles was the Western-centric dominance of psychology's research, theories, models and practice, in part because of structural discrimination such as ethnocentric curricula, policies and teaching methods within academic institutions. In Aotearoa New Zealand, including mātauranga Māori (Māori knowledge) and kaupapa Māori (Māori philosophy) within curricula for clinical psychology has started to address that Western-centric dominance, but more importantly, resulted in more culturally safe and responsive psychological services being provided to Māori users of those services. The present commentary suggested that including and integrating more cross-cultural and indigenous knowledge into the tertiary curricula of applied psychology fields, such as clinical, industrial-organisational, and coaching psychology would be one way to counter the Western-centric dominance.
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Loo PW, Wong S, Furnham A. Mental health literacy: A cross-cultural study from Britain, Hong Kong and Malaysia. Asia Pac Psychiatry 2012; 4:113-25. [PMID: 26767355 DOI: 10.1111/j.1758-5872.2012.00198.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 01/24/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A cross-cultural study was conducted on the identification of psychiatric problems comparing British, Hong Kong and Malaysian participants. AIMS To investigate the ability to correctly identify different psychiatric problems and recommend strategies for treatment. METHODS A total of 440 participants were shown vignettes of schizophrenia, obsessive compulsive disorder (OCD), social phobia, depression, bipolar disorder, stress, child attention-deficit hyperactivity disorder (ADHD), child depression and child "daily troubles". In each they were asked to say what they thought the person's problem was and how they could be helped as well as give their confidence ratings on both judgments. RESULTS The British were the most adept at correctly identifying the cases of mental disorders in the vignettes followed by the Hong Kong Chinese and Malaysians. Overall, the depression cases were the best identified and social phobia was the least identified. In terms of help recommendation, a higher percentage of British participants endorsed professional help as useful for the person in the vignette compared to Hong Kong and Malaysian participants. DISCUSSION The findings were discussed along with suggestions on how to improve mental health literacy. The ethnocentric nature of applying Western concepts in the East was acknowledged.
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Affiliation(s)
- Phik-Wern Loo
- Department of Psychology, University College London, UK
| | - Sharon Wong
- Department of Psychology, University College London, UK
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McLean D, John S, Barrett R, McGrath J, Loa P, Thara R, Mowry B. Refining clinical phenotypes by contrasting ethnically different populations with schizophrenia from Australia, India and Sarawak. Psychiatry Res 2012; 196:194-200. [PMID: 22401968 DOI: 10.1016/j.psychres.2011.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 12/16/2011] [Accepted: 12/19/2011] [Indexed: 01/02/2023]
Abstract
We contrasted demographic and clinical characteristics in transethnic schizophrenia populations from Australia (n=821), India (n=520) and Sarawak, Malaysia (n=298) and proposed cultural explanations for identified site differences. From these we aimed to identify candidate variables free from significant cultural confounding that are hence suitable for inclusion in genetic analyses. We observed five phenomena: (1) more individuals were living alone in Australia than India or Sarawak; (2) drug use was lower in India than Australia or Sarawak; (3) duration of untreated psychosis (DUP) was longer in India than Australia or Sarawak; (4) the rate of schizoaffective disorder was lower in India than Australia or Sarawak; and (5) age at psychosis onset (AAO) was older in Sarawak than Australia or India. We suggest that site differences for living arrangements, drug use and DUP are culturally confounded. The schizoaffective site difference likely results from measurement bias. The AAO site difference, however, has no obvious cultural or measurement bias explanation. Therefore, this may be an ideal candidate for use in genetic studies, given that genetic variants affecting AAO have already been proposed.
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Affiliation(s)
- Duncan McLean
- Queensland Centre for Mental Health Research, University of Queensland, Brisbane, Queensland, Australia
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Kupper N, Pedersen SS, Höfer S, Saner H, Oldridge N, Denollet J. Cross-cultural analysis of type D (distressed) personality in 6222 patients with ischemic heart disease: a study from the International HeartQoL Project. Int J Cardiol 2011; 166:327-33. [PMID: 22078395 DOI: 10.1016/j.ijcard.2011.10.084] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 10/18/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Type D (distressed) personality, the conjoint effect of negative affectivity (NA) and social inhibition (SI), predicts adverse cardiovascular outcomes, and is assessed with the 14-item Type D Scale (DS14). However, potential cross-cultural differences in Type D have not been examined yet in a direct comparison of countries. AIM To examine the cross-cultural validity of the Type D construct and its relation with cardiovascular risk factors, cardiac symptom severity, and depression/anxiety. METHODS In 22 countries, 6222 patients with ischemic heart disease (angina, 33%; myocardial infarction, 37%; or heart failure, 30%) completed the DS14 as part of the International HeartQoL Project. RESULTS Type D personality was assessed reliably across countries (αNA>.80; αSI>.74; except Russia, which was excluded from further analysis). Cross-cultural measurement equivalence was established for Type D personality at all measurement levels, as the factor-item configuration, factor loadings, and error structure were not different across countries (fit: CFI=.91; NFI=.88; RMSEA=.018), as well as across gender and diagnostic subgroups. Type D personality was more prevalent in Southern (37%) and Eastern (35%) European countries compared to Northern (24%) and Western European and English-speaking (both 27%) countries (p<.001). Type D was not confounded by cardiac symptom severity, but was associated with a higher prevalence of hypertension, smoking, sedentary lifestyle, and depression. CONCLUSION Cross-cultural measurement equivalence was demonstrated for the Type D scale in 21 countries. There is a pan-cultural relationship between Type D personality and some cardiovascular risk factors, supporting the role of Type D personality across countries and cardiac conditions.
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Affiliation(s)
- Nina Kupper
- Tilburg University, Tilburg, The Netherlands.
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George DR, Whitehouse PJ, Ballenger J. The evolving classification of dementia: placing the DSM-V in a meaningful historical and cultural context and pondering the future of "Alzheimer's". Cult Med Psychiatry 2011; 35:417-35. [PMID: 21594753 DOI: 10.1007/s11013-011-9219-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Alzheimer's disease is a 100-year-old concept. As a diagnostic label, it has evolved over the 20th and 21st centuries from a rare diagnosis in younger patients to a worldwide epidemic common in the elderly, said to affect over 35 million people worldwide. In this opinion piece, we use a constructivist approach to review the early history of the terms "Alzheimer's disease" and related concepts such as dementia, as well as the more recent nosological changes that have occurred in the four major editions of the Diagnostic and Statistical Manual since 1952. A critical engagement of the history of Alzheimer's disease and dementia, specifically the evolution of those concepts in the DSM over the past 100 years, raises a number of questions about how those labels and emergent diagnoses, such as Neurocognitive Disorders and Mild Cognitive Impairment, might continue to evolve in the DSM-V, due for release in 2013.
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Affiliation(s)
- Daniel R George
- Department of Humanities, Penn State College of Medicine, Hershey, PA 17033, USA.
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International comparison of clinicians' ability to identify depression in primary care: meta-analysis and meta-regression of predictors. Br J Gen Pract 2011; 61:e72-80. [PMID: 21276327 DOI: 10.3399/bjgp11x556227] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND There are international differences in the epidemiology of depression and the performance of primary care physicians but the factors underlying these national differences are uncertain. AIM To examine the international variability in diagnostic performance of primary care physicians when diagnosing depression in primary care. DESIGN OF STUDY A meta-analysis of unassisted clinical diagnoses against semi-structured interviews. METHOD A systematic literature search, critical appraisal, and pooled analysis were conducted and 25 international studies were identified involving 8917 individuals. A minimum of three independent studies per country were required to aid extrapolation. RESULTS Clinicians in the Netherlands performed best at case finding (the ability to rule in cases of depression with minimal false positives) (AUC+ 0.735) and this was statistically significantly better than the ability of clinicians in Australia (AUC+ 0.622) and the US (AUC+ 0.653), who were the worst performers. Clinicians from Italy had intermediate case-finding abilities. Regarding screening (the ability to rule out cases of no depression with minimal false negatives) there were no strong differences. Looking at overall accuracy, primary care physicians in Italy and the Netherlands were most successful in their diagnoses and physicians from the US and Australia least successful (83.5%, 81.9%, 74.3%, and 67.0%, respectively). GPs in the UK appeared to have the lowest ability to detect depression, as a proportion of all cases of depression (45.6%; 95% CI = 27.7% to 64.2%). Several factors influenced detection accuracy including: collecting data on clinical outcomes; routinely comparing the clinical performance of staff; working in small practices; and having long waits to see a specialist. CONCLUSION Assuming these differences are representative, there appear to be international variations in the ability of primary care physicians to diagnose depression, but little differences in screening success. These might be explained by organisational factors.
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Chakraborty K, Avasthi A, Grover S, Kumar S. Functional somatic complaints in depression: An overview. Asian J Psychiatr 2010; 3:99-107. [PMID: 23051564 DOI: 10.1016/j.ajp.2010.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 06/26/2010] [Accepted: 07/08/2010] [Indexed: 01/01/2023]
Abstract
Depression is a disorder of major public health importance which often manifests through functional somatic complaints. Concept of functional somatic complaints dates back to the time of Wernicke and is later substantiated by various authors. Although considered as an alternative 'idiom of distress' in certain culture, functional somatic complaints are universal. Various international, cross-cultural, inpatient and outpatient based studies have reported that about two-third of subjects of depression present to clinicians with functional somatic complaints which often leads to misrecognition of their illness and in turn leads to increased utilization of health services. These functional somatic complaints can be related to various organ systems but show remarkable homogeneity in their presentation across culture. Various instruments have attempted to tap the functional somatic complaints but are limited by their cross-cultural validity. Among important correlates of functional somatic complaints are female gender, severity of depression, subsyndromal anxiety, alexithymia, somatosensory amplification and hypochondriacal worry are to name a few. Neurobiological understanding implicates neurotransmitters serotonin and norepinephrine, resultantly Serotonin Norepinephrine Reuptake Inhibitors have been found to be effective in treating functional somatic complaints in depression. Future revisions in the nosological systems should consider giving proper importance to some of these symptoms for diagnosing depression.
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Affiliation(s)
- Kaustav Chakraborty
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Kim G. Measuring Depression in a Multicultural Society: Conceptual Issues and Research Recommendations. ACTA ACUST UNITED AC 2010. [DOI: 10.2190/ha.12.1.c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Snowden A. Classification of schizophrenia. Part 2: The nonsense of mental health illness. ACTA ACUST UNITED AC 2010; 18:1228-32. [PMID: 20081658 DOI: 10.12968/bjon.2009.18.20.45113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The classification of schizophrenia is currently under review in a coordinated worldwide consultation for the Diagnostic and Statistical Manual of Mental Disorders (DSM V) and the International Classification of Diseases (ICD 11)--the standard manuals for psychiatric classification. Classification can seem remote from nurses by appearing to be the antithesis of person-centred approaches to recovery. This should not be the case. Nurses need to critically engage with methods of classification in order to better understand the biological, psychological, social and political assumptions underpinning them. It will be shown that these assumptions often compete, and some common objections to the construct of schizophrenia can be viewed as a function of this. However, it is argued here that a truly holistic approach to care needs to engage with all these factors. The alternative is to simply reject the process as irrelevant to mental health nursing. It will be shown that a corollary of this latter approach is the invention of nonsense terms such as 'mental health illness' as a function of trying to simultaneously deny yet acknowledge the existence of mental illness.
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Affiliation(s)
- Austyn Snowden
- Mental Health Nursing, University of the West of Scotland, Paisley, Scotland
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31
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Balsis S, Segal DL, Donahue C. Revising the personality disorder diagnostic criteria for the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V): consider the later life context. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2009; 79:452-460. [PMID: 20099936 DOI: 10.1037/a0016508] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The categorical measurement approach implemented by the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) personality disorder (PD) diagnostic system is theoretically and pragmatically limited. As a result, many prominent psychologists now advocate for a shift away from this approach in favor of more conceptually sound dimensional measurement. This shift is expected to improve the psychometric properties of the personality disorder (PD) diagnostic system and make it more useful for clinicians and researchers. The current article suggests that despite the probable benefits of such a change, several limitations will remain if the new diagnostic system does not closely consider the context of later life. A failure to address the unique challenges associated with the assessment of personality in older adults likely will result in the continued limited validity, reliability, and utility of the Diagnostic and Statistical Manual of Mental Disorders (DSM) system for this growing population. This article discusses these limitations and their possible implications.
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Affiliation(s)
- Steve Balsis
- Department of Psychology, Texas A&M University, College Station, TX 77843, USA.
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Nock MK, Hwang I, Sampson N, Kessler RC, Angermeyer M, Beautrais A, Borges G, Bromet E, Bruffaerts R, de Girolamo G, de Graaf R, Florescu S, Gureje O, Haro JM, Hu C, Huang Y, Karam EG, Kawakami N, Kovess V, Levinson D, Posada-Villa J, Sagar R, Tomov T, Viana MC, Williams DR. Cross-national analysis of the associations among mental disorders and suicidal behavior: findings from the WHO World Mental Health Surveys. PLoS Med 2009; 6:e1000123. [PMID: 19668361 PMCID: PMC2717212 DOI: 10.1371/journal.pmed.1000123] [Citation(s) in RCA: 511] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 06/25/2009] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suicide is a leading cause of death worldwide. Mental disorders are among the strongest predictors of suicide; however, little is known about which disorders are uniquely predictive of suicidal behavior, the extent to which disorders predict suicide attempts beyond their association with suicidal thoughts, and whether these associations are similar across developed and developing countries. This study was designed to test each of these questions with a focus on nonfatal suicide attempts. METHODS AND FINDINGS Data on the lifetime presence and age-of-onset of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) mental disorders and nonfatal suicidal behaviors were collected via structured face-to-face interviews with 108,664 respondents from 21 countries participating in the WHO World Mental Health Surveys. The results show that each lifetime disorder examined significantly predicts the subsequent first onset of suicide attempt (odds ratios [ORs] = 2.9-8.9). After controlling for comorbidity, these associations decreased substantially (ORs = 1.5-5.6) but remained significant in most cases. Overall, mental disorders were equally predictive in developed and developing countries, with a key difference being that the strongest predictors of suicide attempts in developed countries were mood disorders, whereas in developing countries impulse-control, substance use, and post-traumatic stress disorders were most predictive. Disaggregation of the associations between mental disorders and nonfatal suicide attempts showed that these associations are largely due to disorders predicting the onset of suicidal thoughts rather than predicting progression from thoughts to attempts. In the few instances where mental disorders predicted the transition from suicidal thoughts to attempts, the significant disorders are characterized by anxiety and poor impulse-control. The limitations of this study include the use of retrospective self-reports of lifetime occurrence and age-of-onset of mental disorders and suicidal behaviors, as well as the narrow focus on mental disorders as predictors of nonfatal suicidal behaviors, each of which must be addressed in future studies. CONCLUSIONS This study found that a wide range of mental disorders increased the odds of experiencing suicide ideation. However, after controlling for psychiatric comorbidity, only disorders characterized by anxiety and poor impulse-control predict which people with suicide ideation act on such thoughts. These findings provide a more fine-grained understanding of the associations between mental disorders and subsequent suicidal behavior than previously available and indicate that mental disorders predict suicidal behaviors similarly in both developed and developing countries. Future research is needed to delineate the mechanisms through which people come to think about suicide and subsequently progress from ideation to attempts.
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Affiliation(s)
- Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA.
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Bernert S, Matschinger H, Alonso J, Haro JM, Brugha TS, Angermeyer MC. Is it always the same? Variability of depressive symptoms across six European countries. Psychiatry Res 2009; 168:137-44. [PMID: 19481817 PMCID: PMC3635143 DOI: 10.1016/j.psychres.2008.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Revised: 04/06/2008] [Accepted: 04/10/2008] [Indexed: 11/22/2022]
Abstract
Using common diagnostic systems together with structured interviews to assess mental disorders has made it possible to compare diagnostic groups of mental disorders across countries. The implicit assumption is that the symptomatology of a particular disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) will not vary between different countries. However, it is conceivable that there will be some variability in the symptom patterns. The present study examines if differences in depressive symptom patterns across European countries can be found and if there are different associations between symptoms and the latent construct depression. Data from 4025 individuals of the European Study of the Epidemiology of Mental Disorders (ESEMeD) project were analysed. Individuals were interviewed using the Composite International Diagnostic Interview (CIDI 3.0). Confirmatory factor analysis was used to examine the associations between depressive symptoms and the latent construct of depression in each country. The proportions of endorsed symptoms of depression showed only slight variation across European countries and only minor to moderate differences in the associations between depressive symptoms and the latent construct depression. The results demonstrated that in European countries using a fully structured and standardized interview based on European-American diagnostic concepts leads to similar results with regard to depressive symptom patterns.
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Affiliation(s)
- Sebastian Bernert
- University of Leipzig, Health Economics Research Unit, Department of Psychiatry, Leipzig, Germany.
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Nicholl C, Thompson A. The psychological treatment of Post Traumatic Stress Disorder (PTSD) in adult refugees: A review of the current state of psychological therapies. J Ment Health 2009. [DOI: 10.1080/09638230410001729807] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kellezi B, Reicher S, Cassidy C. Surviving the Kosovo Conflict: A Study of Social Identity, Appraisal of Extreme Events, and Mental Well‐Being. APPLIED PSYCHOLOGY-AN INTERNATIONAL REVIEW-PSYCHOLOGIE APPLIQUEE-REVUE INTERNATIONALE 2008. [DOI: 10.1111/j.1464-0597.2008.00382.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bastos CL. Tempo e psicopatologia cultural das experiências traumáticas. REVISTA LATINOAMERICANA DE PSICOPATOLOGIA FUNDAMENTAL 2008. [DOI: 10.1590/s1415-47142008000200002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Relacionamos aqui dois aspectos fundamentais das intuições culturais sobre a passagem do tempo - a temporalidade cíclica e a contínua - com a psicopatologia e a terapêutica médica, psicológica e religiosa dos estados de estresse pós-traumáticos. Nas concepções culturais cíclicas do tempo, vida e morte são indissociáveis do movimento eterno do cosmos. A severidade e a persistência do trauma mental não são diretamente proporcionais à magnitude da catástrofe, mas associadas às características imaginárias e aos papéis que representam na mente. A cultura moderna tende a produzir indivíduos preparados para um mundo altamente complexo, sob pressão constante em um ritmo frenético. Quase todos os eventos devem ser antecipados, planejados ou controlados e os traços anancásticos de personalidade são bem aceitos pelas sociedades modernas. Todavia, face a eventos catastróficos, imprevisíveis, quando nada resta a fazer, esses indivíduos metódicos e organizados podem apresentar fragilidade e desespero. Nas comunidades tradicionais as vítimas parecem capazes de suportar níveis muito altos de agressão ou sofrimento - em situações traumáticas - sem mostrar sinais proporcionais de estresse mental. Enquanto que nos estratos superiores das comunidades modernas um ato de violência, como um assalto ou um estupro, pode ter conseqüências muito sérias e duradouras, na prática diária, nos hospitais públicos, encontramos pessoas que sofreram eventos potencialmente traumáticos sem qualquer dos esperados efeitos devastadores na sua vida mental. Os rituais dissociativos periódicos podem ter algum papel na sua resiliência.
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Affiliation(s)
- Claudio Lyra Bastos
- Universidade Federal Fluminense, Brasil; Instituto Fluminense de Saúde Mental, Brasil
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Lee B, Kaaya SF, Mbwambo JK, Smith-Fawzi MC, Leshabari MT. Detecting depressive disorder with the Hopkins Symptom Checklist-25 in Tanzania. Int J Soc Psychiatry 2008; 54:7-20. [PMID: 18309755 DOI: 10.1177/0020764006074995] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Assessment of the growing prevalence of depression in developing countries is hampered by a lack of valid diagnostic instruments for the local settings. AIM AND METHOD This study attempted to examine the validity of the 25-item Hopkins Symptom Checklist (HSCL-25) in a special primary care population in Dar es Salaam, Tanzania. RESULTS 787 antenatal participants were recruited, and their responses revealed good internal consistency, interrater reliability, and test-retest reliability, and the scale was validated using content, construct, and discriminant validation methods. Factor analysis of the depression subscale, however, confirmed the need for a locally developed scale. CONCLUSIONS Integrating universalist and relativist approaches, through the validation and modification of scales, may help in the detection of depression in cross-cultural settings.
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Affiliation(s)
- Bandy Lee
- Yale University School of Medicine, Division of Law and Psychiatry, New Haven, CT 06519, USA.
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Shoeb M, Weinstein H, Mollica R. The Harvard trauma questionnaire: adapting a cross-cultural instrument for measuring torture, trauma and posttraumatic stress disorder in Iraqi refugees. Int J Soc Psychiatry 2007; 53:447-63. [PMID: 18018666 DOI: 10.1177/0020764007078362] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mental health assessments in post-conflict zones have relied heavily on Western psychiatric scales. Yet, a strict dependence on the paradigms of Western psychiatry risks inappropriately prioritizing syndromes, such as PTSD, which, however important, are eclipsed by local concerns. MATERIAL AND DISCUSSION In Dearborn, Michigan, home to the largest population of Iraqi refugees in the United States, 60 Iraqi refugee life stories were collected in order to adapt the Harvard Trauma Questionnaire (HTQ) to the Iraqi context. CONCLUSION The methodology described proved to be a useful approach to developing a trauma measure that is culturally grounded in a multi-dimensional model of mental health.
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Affiliation(s)
- Marwa Shoeb
- University of California, San Francisco School of Medicine, 94143, USA.
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Higgins L, Dey-Ghatak P, Davey G. Mental health nurses' experiences of schizophrenia rehabilitation in China and India: a preliminary study. Int J Ment Health Nurs 2007; 16:22-7. [PMID: 17229271 DOI: 10.1111/j.1447-0349.2006.00440.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Nursing methods based on Western models may not be culturally relevant to patients from ethnic minority groups or other countries. In order to meet the needs of all patients, more research is needed to understand the cultural and social factors that influence nursing approaches. This paper reports preliminary open-ended discussions with mental health nurses in China and India in order to gain insights into the cultural and social issues that surround social rehabilitation of patients with schizophrenia. Rehabilitation methods included cognitive behavioural therapy, psychosocial methods, and employment/vocational training. Several cultural and social issues drive the rehabilitation process in both countries, including the use of traditional medicine and healers, emphasis on family involvement, stigma, gender inequality, and lack of resources. Participants in both countries were working hard to tackle some of these issues, but also expressed need for improved resources. The study provides an insight into the cultural and social factors that shape schizophrenia rehabilitation in China and India, and serves as a baseline for further research about nursing across cultures. The study also highlights the marked differences in attitudes, values, and behaviours across cultural groups that need to be considered by nursing professionals to ensure that services are culturally competent.
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Affiliation(s)
- Louise Higgins
- Department of Psychology, University of Chester, Chester, UK.
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Kosmidis MH, Bozikas VP, Giannakou M, Anezoulaki D, Fantie BD, Karavatos A. Impaired emotion perception in schizophrenia: a differential deficit. Psychiatry Res 2007; 149:279-84. [PMID: 17161465 DOI: 10.1016/j.psychres.2004.09.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2003] [Revised: 09/17/2004] [Accepted: 09/17/2004] [Indexed: 10/23/2022]
Abstract
We investigated previously reported contradictory findings regarding the nature of deficits in emotion perception among patients with schizophrenia. Some studies have concluded that such deficits are due to a generalized impairment in visual processing of faces, while others have found it to be restricted to facial emotional expressions. We examined 37 patients and 32 healthy controls, matched on age and education, using three computerized tests: matching facial identity, matching facial emotional expressions, and discrimination of subtle differences in the valence of facial emotional expressions. Our results showed impaired matching of emotions in patients with schizophrenia. This impairment did not manifest on tasks that depended on perceiving the identity of faces or cues of the relative valence of facial emotional expressions. Our findings support the differential deficit hypothesis of emotion perception in schizophrenia.
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Affiliation(s)
- Mary H Kosmidis
- Department of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
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Widmer C. Depression is associated with nonspecific physical symptoms in Asian TMD patients. J Evid Based Dent Pract 2006; 5:168-9. [PMID: 17138366 DOI: 10.1016/j.jebdp.2005.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Charles Widmer
- University of Florida, Department of Orthodontics, Gainesville, Florida, USA
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Møllersen S, Sexton HC, Holte A. Ethnic variations in the initial phase of mental health treatment: A study of Sami and non-Sami clients and therapists in northern Norway. Scand J Psychol 2005; 46:447-57. [PMID: 16179027 DOI: 10.1111/j.1467-9450.2005.00476.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Several studies indicate that mental health and mental health service vary with ethnicity. Ethnically linked social differences affect these results. We examined the multiethnic population in northern Norway where social inequalities between the Sami and the non-Sami population are not prominent. Clients (N=347) and therapists (N=32) in outpatient treatments reported demographics, ethnicity and the therapeutic alliance. Clients also reported pretreatment psychosocial status, service utilization and the type of help requested. Therapist recorded clinical and diagnostic assessments and treatment plans. The Sami and non-Sami client groups were similar in demographics and pretreatment psychosocial characteristics. However, the therapists prescribed more sessions and more socially focused interventions when clients were Sami. Verbal therapy was more often used by the non-Sami therapists. Alliance ratings were positively correlated only between Sami therapists and their clients, and Sami therapists rated the largest initial clinical improvement. Clinics located in the high Sami density areas offered their clients more therapy sessions, than in clinics in the high non-Sami density areas. Ethnic similarity between client and therapist were associated with more frequent use of medication and less frequent use of verbal therapy.
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Affiliation(s)
- Snefrid Møllersen
- Psychiatric Centre of Eastern Finnmark, Finnmark Health Department, Norway.
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Ritsher JB. Association of Rorschach and MMPI Psychosis Indicators and Schizophrenia Spectrum Diagnoses in a Russian Clinical Sample. J Pers Assess 2004; 83:46-63. [PMID: 15271595 DOI: 10.1207/s15327752jpa8301_05] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In this study, I investigated the relationships among psychological test variables and schizophrenia spectrum diagnoses in a Russian sample of 180 psychiatric patients. Schizophrenia is understood somewhat differently in Russia than in the West. Analyses compared Rorschach (SCZI, PTI; Exner, 2001) and MMPI (Berezin, Mitroshinkov, & Sokolova, 1994) psychosis indicators (Sc, Sc3, Sc6, and BIZ) and 3 diagnostic systems: (a) Russian traditional, (b) the Russian-modified International Classification of Diseases (9th ed. [ICD-9]; Ministerstvo Zdravokhraneniya SSSR, 1982), and (c) the nonmodified ICD-10 (World Health Organization, 1992; comparable to the Diagnostic and Statistical Manual of Mental Disorders [4th ed.], American Psychiatric Association, 1994). Results showed modest support for the SCZI and PTI but not the MMPI indicators. While the field awaits further evidence, psychologists should proceed with caution when using the Rorschach and MMPI to assess for psychosis among Russians.
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Affiliation(s)
- Jennifer Boyd Ritsher
- Department of Psychiatry, University of California-San Francisco, VA Medical Center (116A), 4150 Clement Street, San Francisco, CA 94121, USA.
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Abstract
BACKGROUND Globalisation is the process by which traditional boundaries of cultures are changing. Industrialisation, urbanisation and influence of the media are influencing idioms of distress across cultures. AIMS To discuss the role of globalisation, using the epidemiology, diagnosis, clinical presentation and treatment of depression across various cultures as an example. METHOD Recent studies focusing on transcultural aspects of depression were reviewed and summarised. RESULTS Cultural, social and religious mores account for variations in the presentation of depression across cultures. Somatic symptoms are common presenting features throughout the world and may serve as cultural idioms of distress, but psychological symptoms can usually be found when probed. Feelings of guilt and suicide rates vary across cultures and depression may be underdiagnosed. CONCLUSIONS Training packages could enhance clinicians'cultural competency in multicultural settings. However, globalisation is likely to influence idioms of distress and pathways to care in ways that are difficult to predict.
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Draguns JG, Tanaka-Matsumi J. Assessment of psychopathology across and within cultures: issues and findings. Behav Res Ther 2003; 41:755-76. [PMID: 12781244 DOI: 10.1016/s0005-7967(02)00190-0] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Research based information on the impact of culture on psychopathology is reviewed, with particular reference to depression, somatization, schizophrenia, anxiety, and dissociation. A number of worldwide constants in the incidence and mode of expression of psychological disorders are identified, especially in relation to schizophrenia and depression. The scope of variation of psychopathological manifestations across cultures is impressive. Two tasks for future investigations involve the determination of the generic relationship between psychological disturbance and culture and the specification of links between cultural characteristics and psychopathology. To this end, hypotheses are advanced pertaining to the cultural dimensions investigated by Hofstede and their possible reflection in psychiatric symptomatology. It is concluded that the interrelationship of culture and psychopathology should be studied in context and that observer, institution, and community variables should be investigated together with the person's experience of distress and disability.
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Affiliation(s)
- Juris G Draguns
- Department of Psychology, The Pennsylvania State University, 410 Moore Building, University Park, PA 16802, USA.
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Kim MT. Measuring depression in Korean Americans: development of the Kim Depression Scale for Korean Americans. J Transcult Nurs 2002; 13:109-17. [PMID: 11951713 DOI: 10.1177/104365960201300203] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This article discusses issues related to measuring depression in linguistic and cultural minority groups, using Korean Americans as an example. The article details the process of developing and evaluating a depression-screening tool for Korean Americans. A series of focus groups was conducted in the development stage of the study. In the evaluation phase, 154 first-generation Korean Americans participated in the assessment of the psychometric properties of the newly developed depression scale, the Kim Depression Scale for Korean Americans (KDSKA). The KDSKA showed adequate reliability, validity, and potentially high sensitivity as a depression-screening tool for Korean Americans.
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Affiliation(s)
- Miyong T Kim
- Johns Hopkins University School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205-2110, USA.
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Abstract
This study examined the longitudinal trajectory of a sociocentric construct among African-Americans, Latinos, and nonminorities. Participants were 163 individuals diagnosed with schizophrenia who were admitted to community-based psychosocial programs. Previous research had established empathy and social competence as sociocentric cultural mediators of a benign symptom profile for ethnic minorities. Data on sociocentric indicators were collected every 6 months for over 3 years. Growth curve methodology was used to examine the empathy and social competence outcomes over time and across ethnic groups. The results revealed a dynamic course for both sociocentric mediators. However, the dynamic growth curve for empathy was related to ethnicity; for social competence it was not. Empathy levels for African-Americans decreased and then attenuated, whereas empathy levels for Latinos decreased over the entire study. Nonminorities showed very little change overall. The nature of sociocentric phenomena is dynamic and complex. These qualities can apparently be cultivated or diminished over time.
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Affiliation(s)
- C Barrio
- School of Social Work, San Diego State University, California 92182-4119, USA
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Sharpley M, Hutchinson G, McKenzie K, Murray RM. Understanding the excess of psychosis among the African-Caribbean population in England. Review of current hypotheses. Br J Psychiatry Suppl 2001; 40:s60-8. [PMID: 11315227 DOI: 10.1192/bjp.178.40.s60] [Citation(s) in RCA: 206] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Increased rates of schizophrenia continue to be reported among the African-Caribbean population in England. AIMS To evaluate the competing biological, psychological and social explanations that have been proposed. METHOD Literature review. RESULTS The African-Caribbean population in England is at increased risk of both schizophrenia and mania; the higher rates remain when operational diagnostic criteria are used. The excess of the two psychotic disorders are probably linked: African-Caribbean patients with schizophrenia show more affective symptoms, and a more relapsing course with greater social disruption but fewer chronic negative symptoms, than White patients. No simple hypothesis explains these findings. CONCLUSIONS More complex hypotheses are needed. One such links cultural variation in symptom reporting, the use of phenomenological constructs by psychiatrists and social disadvantage.
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Affiliation(s)
- M Sharpley
- Department of Psychiatry, Institute of Psychiatry, King's College London, UK
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Habel U, Gur RC, Mandal MK, Salloum JB, Gur RE, Schneider F. Emotional processing in schizophrenia across cultures: standardized measures of discrimination and experience. Schizophr Res 2000; 42:57-66. [PMID: 10706986 DOI: 10.1016/s0920-9964(99)00093-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Schizophrenia appears quite similar across a range of cultures. However, variability has been noted, and understanding the variant and invariant features of the disorder is necessary for elucidating its biological and environmental basis. Evidence of prominent emotion processing deficits in schizophrenia, including perceptual and experiential aspects, led us to extend the paradigm of standardized measures cross-culturally. We assessed performance of American, German, and Indian patients with schizophrenia and healthy controls on standardized emotion discrimination and experience (mood induction) procedures using happy, sad, and neutral facial expressions of Caucasian actors. Participants were 80 Americans (40 patients; 40 controls), 48 Germans (24 patients; 24 controls), and 58 Indians (29 patients; 29 controls). Face discrimination performance was impaired across patient groups, but was most impaired in those of Indian origin. Lower performance was also found in Indian controls, relative to their American and German counterparts. Mood induction produced weaker effects in all patient groups relative to their respective controls. The results supported the feasibility of cross-cultural comparisons and also emphasized the importance of poser ethnic background for facial affect identification, while poser ethnicity was less consequential for mood induction effects. Emotion processing deficits in schizophrenia may add to the clinical burden, and merit further examination.
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Affiliation(s)
- U Habel
- Department of Psychiatry, Heinrich-Heine-University Düsseldorf, Bergische Landstrasse 2, 40629, Düsseldorf, Germany.
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