Sociocultural validity in the context of DSM comorbidity

DSM 合并症背景下的社会文化有效性

基本信息

批准号：
7232715
负责人：
JANETTE Louise BEALS
金额：
$ 47.2万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2006
资助国家：
美国
起止时间：
2006-07-01 至 2009-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7232715
关键词：
Accounting Affect Alaska Native Alcohol abuse Alcohols American Indians Behavior Catchment Area Classification Clinical Comorbidity Count Data Dependence Depressed mood Depth Development Diagnosis Diagnostic Diagnostic and Statistical Manual Disease Distress Epidemiologist Epidemiology Ethnography Facility Construction Funding Category Genotype Health Policy International Intervention Interview Interviewer Investigation Knowledge Life Experience Measures Mental Health Mental disorders Methods Modality Modeling Participant Pattern Policies Population Post-Traumatic Stress Disorders Process Program Development Psychiatric Diagnosis Psychiatrist Psychiatry Psychologist Psychometrics Public Health Qualifying Race Rate Reporting Research Research Personnel Risk Role Sampling Services Source Standards of Weights and Measures Structure Surgeon Surveys Symptoms Testing Time Translating Trauma Traumatic Stress Disorders Voice Work alcohol misuse alcohol use disorder base concept design experience health disparity improved insight interest member service utilization single episode major depressive disorder tribal member

项目摘要

DESCRIPTION (provided by applicant): Progress in psychiatric epidemiology has been dramatic. The focus on observable and experienced symptoms in the DSM definitions of mental disorder led to the development of reliable measures for use in population-based surveys. The substantial levels of comorbidity found in such efforts have forced thoughtful reconsideration of this concept. The probable role of sociocultural factors in understanding such comorbidity, however, has remained unexplored, despite evidence of the importance of the sociocultural construction of mental illness in general. The importance of the interface of culture and comorbidity was highlighted in the recently completed American Indian Service Utilization, Psychiatry Epidemiology, Risk and Protective Factors Project (Al- SUPERPFP), which included the administration of the CIDI, with cultural adaptations, to 3,084 tribal members; re-interviews of 335 participants by clinicians using the SCID; and further ethnographic interviews of 63 participants exploring distress from participants' perspectives. The most common CIDI diagnoses were Major Depressive Episode (MDE), Posttraumatic Stress Disorder (PTSD), and Alcohol Abuse and Dependence (AAD). Rates of MDE in these samples were much lower than we anticipated; however MDE was diagnosed more often in the clinical reappraisal, as was AAD. The ethnographic interviews suggested the importance of both trauma and alcohol in participants' construction of their illnesses. The specific aims are as follows: 1) To develop a framework for the investigation of sociocultural factors in diagnosis by understanding the patterns of comorbidity within the lay interview. 2) To complete in-depth analyses of those cases for which lay, clinical, and ethnographic data were collected and to develop models of sociocultural factors in the diagnostic process. 3) To use the lay interviews and clinical reappraisals to investigate how methodological factors inform our understandings of diagnostic processes. 4) To test the sociocultural models developed during the in-depth analyses, simultaneously accounting for method effects, to understand the differing perspectives of the lay interviews and clinical reappraisals of diagnosis in the context of comorbidity. This integrated psychometric, clinical, and ethnographic work is timely as we move toward DSM-V. The staff of the National Center for American Indian and Alaska Native Mental Health Research (NCAIANMHR) is uniquely qualified for this research; the team consists of anthropologists, clinicians, and psychometricians who have successfully integrated their efforts for many years. This study has important public health implications as we move towards DSM-V, both for American Indian populations but also more generally, as we seek to improve the psychiatric diagnostic process.

描述（由申请人提供）：精神病流行病学的进展是戏剧性的。在心理障碍的DSM定义中，关注可观察和经历的症状，导致开发了可靠的措施，以在基于人群的调查中使用。在这种努力中发现的合并症的大量合并症迫使人们重新考虑了这一概念。然而，尽管有证据表明社会文化建设一般而言，但社会文化因素在理解这种合并症中的可能作用仍未开发。最近完成的文化和合并症界面的重要性突出了美洲印第安人服务利用，精神病学流行病学，风险和保护因素项目（AL-SUPERPFP），其中包括对3,084个部落成员进行文化适应的CIDI的管理；使用SCID对335名参与者进行335名参与者的审视；以及63名参与者的人种志访谈，从参与者的角度探索困扰。最常见的CIDI诊断是主要抑郁发作（MDE），创伤后应激障碍（PTSD）以及酗酒和依赖性（AAD）。这些样品中的MDE速率远低于我们预期的。然而，在临床重新评估中，MDE经常被诊断出来，就像AAD一样。民族志访谈表明，创伤和酒精在参与者的疾病中的重要性。具体目的如下：1）通过了解外行访谈中合并症的模式来开发诊断中社会文化因素的框架。 2）完成收集临床，临床和民族志数据的情况的深入分析，并在诊断过程中开发社会文化因素的模型。 3）使用外行访谈和临床重新评估来研究方法论因素如何为我们对诊断过程的理解提供理解。 4）测试在深入分析过程中开发的社会文化模型，同时考虑方法效应，以了解合并症的背景下的外行访谈和临床重新评估诊断的不同观点。当我们迈向DSM-V时，这种综合的心理测量，临床和人种学工作是及时的。美国国家印第安人和阿拉斯加本地心理健康研究中心（NCAIANMHR）的工作人员具有独特的资格；该团队由人类学家，临床医生和心理医生组成，他们多年来成功整合了他们的努力。这项研究在我们朝着DSM-V方向发展时具有重要的公共卫生影响，无论是在美洲印第安人的人群而言，而且更普遍地，我们试图改善精神病诊断过程。