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Cultural Dimensions of Psychiatric Diagnosis

A Comparison of DSM–III–R and Illness Explanatory Models in South India

Published online by Cambridge University Press:  02 January 2018

Mitchell G. Weiss ,
R. Raguram  and
S. M. Channabasavanna
Mitchell G. Weiss*
Affiliation:
Department of Psychiatry, University of Toronto, and Toronto Hospital
R. Raguram
Affiliation:
National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore
S. M. Channabasavanna
Affiliation:
NIMHANS, Bangalore, India
*
Professor M. G. Weiss, Clark Institute, 250 College Street, Toronto, Canada M5T 1R8
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Abstract

Background

Cross-cultural research to examine the cultural validity of diagnostic categories and underlying concepts requires methods that integrate epidemiological and anthropological frameworks.

Method

The Explanatory Model Interview Catalogue (EMIC) and Structured Clinical Interview for DSM–III–R (SCID) were used to study 80 psychiatric out-patients with depressive neurosis at a clinic in south India.

Results
Summary

kappa values of 0.75 for the EMIC and 0.68 for the SCID confirmed inter-rater reliability. Comparison of patient explanatory models and SCID diagnoses showed that patients emphasised somatic experience while clinicians emphasised depressive diagnoses. More than half the patients (55%) received a non-specific or dual diagnosis.

Conclusions

These findings raise questions about the distinctiveness of depressive, anxiety, and somatoform (DAS) disorders for this population.

Type
Papers
Information
The British Journal of Psychiatry , Volume 166 , Issue 3 , March 1995 , pp. 353 - 359
Copyright
Copyright © 1995 The Royal College of Psychiatrists 

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References

American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Channabasavanna, S. M., Raguram, R. & Weiss, M. G. (1993) Ethnography of psychiatric illness: A pilot study. NIMHANS Journal, 11, 1–10.Google Scholar
Fabrega, H. Jr, Mezzich, J., Jacob, R., et al (1988) Somatoform disorder in a psychiatric setting. Systematic comparisons with depression and anxiety disorders. Journal of Nervous and Mental Disorders, 176, 431–439.CrossRefGoogle Scholar
Flaherty, J. A., Gaviria, F. M., Pathak, D., et al (1988) Developing instruments for cross-cultural psychiatric research. Journal of Nervous and Mental Disorders, 176, 257–263.CrossRefGoogle ScholarPubMed
Goldberg, D. (1992) Common Mental Disorders: A Bio-social Model. London: Tavistock/Routledge.Google Scholar
Kleinman, A. (1980) Patients and Healers in the Context of Culture. Berkeley: University of California Press.CrossRefGoogle Scholar
Littlewood, R. (1992) DSM–IV and culture: is the classification internationally valid? Psychiatric Bulletin, 16, 257–261.CrossRefGoogle Scholar
Robins, E. & Guze, S. B. (1970) Establishment of diagnostic validity in psychiatric illness. American Journal of Psychiatry, 126, 983–987.CrossRefGoogle ScholarPubMed
Robins, L. N. & Barrett, J. E. (eds) (1989) The Validity of Psychiatric Diagnosis. New York: Raven Press.Google Scholar
Rogler, L. H. (1992) The role of culture in mental health diagnosis: The need for programmatic research. Journal of Nervous and Mental Disorders, 180, 745–747.CrossRefGoogle ScholarPubMed
Rosner, B. (1990) Fundamentals of Biostatistics (3rd edn). Boston: PWS-Kent.Google Scholar
Saxena, S., Nepal, M. K. & Mohan, D. (1988) DSM–III axis I diagnoses of Indian psychiatric patients with somatic symptoms. American Journal of Psychiatry, 145, 1023–1024.Google ScholarPubMed
Shweder, R. (1988) Suffering in style. Culture, Medicine and Psychiatry, 12, 479–497.CrossRefGoogle Scholar
Simon, G. & VonKorff, M. (1991) Somatization and psychiatric disorders in the NIMH Epidemiological Catchment Area Study. American Journal of Psychiatry, 148, 1494–1500.Google Scholar
Spitznagel, E. L. & Helzer, J. E. (1985) A proposed solution to the base rate problem in the kappa statistics. Archives of General Psychiatry, 42, 725–728.CrossRefGoogle Scholar
Srinivasan, K., Murthy, R. S. & Janakiramaiah, N. (1986) A nosological study of patients presenting with somatic complaints. Acta Psychiatrica Scandinavica, 73, 1–5.CrossRefGoogle ScholarPubMed
Weiss, M. G. & Kleinman, A. (1988) Depression in cross-cultural perspective: developing a culturally informed model. In Psychology, Culture and Health: Towards Applications (eds Dasen, P., Sartorius, N. & Berry, J.), pp. 179–206. Beverley Hills, CA: Sage.Google Scholar
Weiss, M. G., Doongaji, D. R., Siddhartha, S., et al (1992) The explanatory model interview catalogue (EMIC): contribution to cross-cultural research methods from a study of leprosy and mental health. British Journal of Psychiatry, 160, 819–830.CrossRefGoogle ScholarPubMed
Weiss, M. G., Sharma, S. D., Gaur, R. K., et al (1986) Traditional concepts of mental disorder among Indian psychiatric patients. Social Science and Medicine, 23, 379–386.CrossRefGoogle ScholarPubMed
Williams, J. B., Gibbon, M., First, M. B., et al (1992) The structured clinical interview for DSM–III–R (SCID). II. Multisite test-retest reliability. Archives of General Psychiatry, 49, 630–636.CrossRefGoogle ScholarPubMed
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases (ICD–9). Geneva: WHO.Google Scholar
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