Sociocultural validity in the context of DSM comorbidity

DSM 合并症背景下的社会文化有效性

• 批准号: 7091069
• 负责人: JANETTE Louise BEALS
• 金额: $ 39.52万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 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/7091069
• 关键词: Native Americans; alcoholism /alcohol abuse; behavioral /social science research tag; classification; clinical research; comorbidity; culture; diagnosis quality /standard; human data; interview; major depression; mental disorder diagnosis; mental health epidemiology; posttraumatic stress disorder; psychological models; psychometrics; psychopathology; social psychology

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巨大的。 DSM 对精神障碍的定义中对可观察到的和经历过的症状的关注导致了用于基于人群的调查的可靠测量方法的开发。在这些努力中发现的大量合并症迫使人们对这一概念进行深思熟虑的重新考虑。然而，尽管有证据表明精神疾病的社会文化建构的重要性，但社会文化因素在理解此类合并症中可能发挥的作用仍未得到探索。 最近完成的研究强调了文化与合并症相互作用的重要性 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 名部落成员进行 CIDI 管理，并进行文化调整；临床医生使用 SCID 对 335 名参与者进行重新访谈；对 63 名参与者进行进一步的民族志访谈，从参与者的角度探讨痛苦。最常见的 CIDI 诊断是重度抑郁发作 (MDE)、创伤后应激障碍 (PTSD) 和酒精滥用和依赖 (AAD)。这些样本中的 MDE 率远低于我们的预期；然而，MDE 在临床重新评估中更常被诊断出来，AAD 也是如此。人种学访谈表明了创伤和酒精在参与者构建其疾病过程中的重要性。具体目标如下： 1）通过了解非专业访谈中的共病模式，制定诊断中社会文化因素调查的框架。 2）完成对收集了外行、临床和人种学数据的病例的深入分析，并在诊断过程中开发社会文化因素模型。 3）利用外行访谈和临床重新评估来调查方法因素如何影响我们对诊断过程的理解。 4）测试在深入分析过程中开发的社会文化模型，同时考虑方法效果，以了解在共病背景下外行访谈和临床诊断重新评估的不同观点。 当我们迈向 DSM-V 时，这种综合心理测量、临床和人种学工作是及时的。国家美洲印第安人和阿拉斯加原住民心理健康研究中心 (NCAIANMHR) 的工作人员具有从事这项研究的独特资格；该团队由人类学家、临床医生和心理测量学家组成，他们多年来成功地整合了他们的努力。随着我们向 DSM-V 迈进，这项研究对于美洲印第安人群体以及更广泛的人群来说具有重要的公共卫生意义，因为我们寻求改进精神病学诊断过程。