Social determinants of diagnostic labels in depression.
Social determinants of diagnostic labels in depression.
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抑郁症诊断标签的社会决定因素。
DOI：
10.1016/j.socscimed.2005.05.021
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发表时间：
2006
影响因子：
5.4
通讯作者：
D. Armstrong
中科院分区：
文献类型：
--
作者：
S. McPherson;D. Armstrong
诊断标签在医学中的作用通常是将疾病标记为一种交流手段。对医学标签过程的控制通常是通过医学院、教科书、教育或诊断手册来实施的。诊断标签通常会随着潜在病理的新发现而改变，例如“消费”被重新标记为“结核病”或“癌症”。广泛的诊断标签的亚型也经常从这些发现中出现，例如“肺癌”或“咽喉癌”。在心理健康领域，潜在的病理学一直是争论的主题，争论涉及的观点包括大脑是一个有缺陷的器官、有缺陷的基因和环境问题。随着对病理学的争论而来的是对标签的争论，标签不仅可以用于交流，还可以作为社会和职业控制的工具，产生于社会过程。本研究探讨了“抑郁症”诊断标签的编纂，该标签出现在20世纪，并在过去40年里以众多亚型激增。其目的是检查其社会决定因素和背景。Medline用作专业标签使用的数据源。确定了专业使用的抑郁症亚型标签的范围。这个练习揭示了许多专业用语中的官方和“非官方”术语。然后对这些洼地亚型标签生成按年的引文率图。不同标签的兴衰与社会决定因素和背景有关，包括诊断手册DSM和ICD的出版，精神病学的权力转移，精神药物的发现以及从住院病人到社区护理的转变。以这种方式探索官方和非官方标签的使用随时间的变化，为20世纪后期抑郁症的概念提供了一个新的历史视角。
The role of diagnostic labels in medicine is usually that of labelling an illness as a means of communication. Control over labelling processes in medicine is ordinarily imposed via medical schools, textbooks, education or by diagnostic manuals. Diagnostic labels often change following new discoveries in underlying pathology such as ‘consumption’ being relabelled as ‘TB’ or ‘cancer’. Sub-types of broad diagnostic labels also often emerge from such discoveries e.g. ‘lung cancer’ or ‘throat cancer’. In mental health, underlying pathology is the subject of ongoing debate spanning ideas including the brain as a faulty organ, faulty genetics and environmental problems. With controversy over pathology comes controversy over labels and the idea that labels may be used not just for communication, but as devices of social and professional control, arising out of a social process. This study explores the codification of the diagnostic label ‘depression’ which emerged in the twentieth-century and has proliferated with numerous sub-types over the last 40years. The aim is to examine its social determinants and context. Medline is used as a data source for professional label usage. A range of depression sub-type labels in professional use was identified. This exercise revealed many official and ‘unofficial’ terms in professional use. Citation rate plots by year were then generated for these depression sub-type labels. The rise and fall of different labels are examined in relation to social determinants and context, including publication of diagnostic manuals DSM and ICD, power shifts in psychiatry, the discovery of psychiatric drugs and the shift from inpatient to community care. Exploring the changing use of official and unofficial labels over time in this way provides a novel historical perspective on the concept of depression in the late twentieth-century.