Research support for Cultural considerations in diagnosis

1. Research support for Cultural considerations in diagnosis ABNORM – NORMS & DIAGNOSIS #3 PART 2

2. Zhang et al 1998 • Aim: explain differences in Chinese and Western rates of depression • Procedure: survey of 12 Chinese regions in 1993 of 19,223 people • Results: • only 16 claimed to have a Western-style mood disorder sometime in their life • 4/5 of all psychiatric patients had ‘neurasthenia’ defined as ‘weakness of nerves’ and derived from the traditional Chinese explanation for disease of Qi (a energy flow or life force imbalance) Conclusion: Neurasthenia could be a Chinese variation of depression but it doesn’t fit the DSM definition

3. Tseng & Hsu 1970 • The Chinese are very concerned with the body and tend to manifest neurasthenic symptoms (exhaustion, sleep problems, concentration difficulties, etc.) similar to the physical aspects of depression and anxiety

4. Okello and Ekblad (2006) – lay concepts of depression among the Baganda of Uganda • In Uganda depression is seen as “illness of thoughts” and not a biological illness. Therefore, it is believed that depressed do not need medicine, unless the disorder is chronic or recurring.

5. Kleinman (1982) Neurasthenia at a psychiatric hospital in china • Aim: investigate if neurasthenia in China could be similar to depression in the DSM-III • Procedure:interviewed 100 patients • All diagnosed with neurasthenia • Structured interview format • Used DSM-III criteria • Results: • 87% could be considered suffering from depression • 90% had headaches, 78% insomnia, 73% dizziness, 48% other symptoms • Depressed mood given as main complaint only 9% of the cases • Conclusions • Neurasthenia could be a cultural derivation of depression, except the symptoms described are more somatic and less mood-oriented • Clearly this comes from the cultural differences, diagnosticians should take care to account for the cultural differences

6. Le-Repac (1980) : cultural bias of the researcher • Aim: Comparison between Caucasian and Chinese-American Therapists • Procedure: Five white and five Chinese-American therapists were compared in regard to their conceptions of normality, their empathic ability, and their perceptions of the same Chinese and white clients seen on a videotaped interview. • Results: • (1) both therapist groups basically agreed in their conceptions of normality; • (2) white therapists were more accurate in predicting self-descriptive responses of white than of Chinese clients; and • (3) there were significant differences between ratings of the same clients given by white and Chinese-American therapists. • Chinese clients were rated higher on a "Depression/Inhibition" cluster and lower on a "Social Poise/ Interpersonal Capacity" cluster by white therapists than by Chinese-American therapists. • Chinese-American therapists judged the white clients to be more severely disturbed than did the white therapists. • Conclusion : Differences were interpreted as reflections of therapists' biases as well as their own world view.

7. Kirmayer 2001 • DSM IV includes suggestions for cultural interpretation of disorders, but still a Western outlook in psychopathology

8. Bhui 1999 • – diagnostic systems are necessary for cross-cultural comparisons, so definitions of depression must fit psychiatric AND indigenous belief systems

9. Jacobs et al 1998 • Procedure: sample of Indian women in a general practice in London • Findings: doctors were not likely to detect depression if the women did not detect all their symptoms due to cultural differences