The Equivalence of the Behavior Problem Index Across U.S. Ethnic Groups

In this study, the authors examine the equivalence of the factor structure of a commonly used symptom checklist of behavioral and emotional problems—the Behavior Problem Index (BPI)—across African American, Hispanic, and White children in the United States. The sample is drawn from the 1998 data file of the Children of the National Longitudinal Survey of Youth, a U.S. data set. The results of the study suggest that the BPI is not equivalent across the three ethnic groups. These findings are consistent when equivalence is tested for a one-factor model, a two-factor model using the internalizing and externalizing dimensions of the BPI, and a six-factor model using the subscales of the BPI. Item-level analyses identify the statistically significant items that are associated with nonequivalence across ethnic groups. The implications of nonequivalent measures for cross-cultural research and practice with families and children are discussed.

Depression: viewed from a transcultural nursing theoretical perspective

Phenomena related to depression are discussed transculturally and examined within the context of Leininger's theory of transcultural diversity and universality of care and health. Mental health and mental illness are viewed within the social structure and world view in order to derive culturally congruent nursing care. Recommendations for future research are suggested.

Two self-rating scales for depression in Hmong refugees: assessment in clinical and nonclinical samples

An exploratory cross-cultural study was undertaken of two widely used self-rating scales: the Zung and the Depression Scale on the 90 Item Symptom Checklist, or SCL-Depression. Both scales were translated into Hmong and tested in two samples of Hmong refugees in the U.S.A. One sample (n = 86) consisted of a field survey of all Hmong people living in Minnesota. Of the 86, 15 sought treatment and were diagnosed as having major depression during the year following their self rating, so that a comparison of patients' scores with nonpatients' scores was possible. The other sample consisted of another 51 Hmong psychiatric patients with major depression. This second group was also assessed by four psychiatric rating scales (i.e. Hamilton Depression Scale, brief Psychiatric Rating Scale, Inpatient Multidimensional Rating Scale, and Nurse's Observation Scale for Inpatient Evaluation) and two measures of treatment intensity (i.e. number of visits, duration of treatment). In the general Hmong population (n = 86), both self-rating scales were highly intercorrelated, and strongly associated with patient status. In the patient sample (n = 51), only the SCL-Depression showed any correlations with psychiatric rating scales or with treatment variables. This is contrary to the anticipated outcome, as it had been expected that the Zung would perform better than the SCL-Depression. In addition, duration of treatment was inversely correlated with the SCL-Depression, also opposite to our prediction. Probable causes for these unexpected results are presented. An item analysis was undertaken, comparing 71 Hmong survey subjects who were not treated for depression with 51 Hmong psychiatric patients who were treated for depression. Most Zung and SCL-Depression items showed significantly higher symptom levels in the depressed patients. However, non-depressed controls unexpectedly reported significantly higher symptom levels on certain items. No significant differences were observed on several Zung and SCL items. These unexpected findings are discussed in light of the refugee's adjustment and experience.

Psychiatric research instruments in the transcultural setting: experiences in India and Brazil

Some of the issues concerned with the application of standardized psychiatric research instruments in settings other than the one in which they are developed are discussed in the light of the authors' experiences in India and Brazil. The authors contend that in spite of the divergent manifestations of mental disorders across cultures, there is an inner core of human suffering which can be reliably detected by suitably modified instruments developed in the West. It is contended that the research worker should be as familiar with the cultural setting where the instrument is to be applied as the language in which the instrument has been developed.

Traditional treatment for mental illness in Africa: a review

The publication of The Quest for Therapy in Lower Zaire (University of California Press) by John M. Janzen (with the collaboration of William Arkinstall), and African Therapeutic Systems (Crossroads Press), edited by Z. A. Ademuwagun, John A. A. Ayoade, Ira E. Harrison and Dennis M. Warren, calls attention to recent research findings which indicate that mentally ill persons, particularly schizophrenics, may recover more rapidly and fully in non-industrialized societies than they do in industrialized ones. The books by Janzen and Ademuwagen et al. will be examined as contributions to a growing body of information on native African therapeutic practices. Evidence relating to the apparently benign course of psychosis in Africa will be examined, and various explanations for this pattern will be evaluated. Finally, some guidelines for future research will be suggested.

Taijin Kyofusho: diagnostic and cultural issues in Japanese psychiatry

Taijin Kyofusho or 'anthrophobia' is a Japanese culture-specific disgnostic label for the presenting problems of various fear reactions in interpersonal situations. The starting point of the present study was accumulating studies on Japanese cases of Taijin Kyofusho and the assertion in Japanese psychiatry that the symptom complex called Taijin kyofusho is Japanese culture-bound. In light of previous works on culture-bound disorders, the present study examines whether or not American mental health professionals could diagnose Japanese case descriptions of Taijin Kyofusho and what kinds of labels they applied to these Japanese cases. The results showed that American judges were able to diagnose Japanese cases nearly as well as American cases. However, there were considerable variability and inconsistency in their judgments of both the Japanese and American cases. The rate of disgnostic agreement dropped considerable as judges were asked to proceed from broad categories to specific categories. American judges grouped the Japanese cases of Taijin Kyofusho into a number of heterogeneous categories using labels such as paranoid schizophrenia, paranoid personality, phobic neurosis, and anxiety neurosis, among others. These results are discussed in terms of psychopathological diagnostic criteria and present conceptualization of culture-bound disorders, value judgments of mental health professionals, and the social contexts in which Taijin Kyofusho reactions occur.