"Somatization" and "comorbidity":: A study of jhum-jhum and depression in rural Nepal
"Somatization" and "comorbidity":: A study of jhum-jhum and depression in rural Nepal
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DOI：
10.1525/eth.2005.33.1.125
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发表时间：
2005-03-01
期刊：
影响因子：
0.6
通讯作者：
Nepal, MK
中科院分区：
文献类型：
--
作者：
Kohrt, BA;Kunz, RD;Nepal, MK
在非西方环境中对抑郁症的研究集中在“躯体化”上，定义为有心理困扰的人经常性的身体不适。这些研究经常记录到非西方群体中的躯体化比率高于西方环境，从而引发了对精神疾病身体表现的跨文化差异的猜测。然而，这些研究中很少有在诊断为躯体化之前严格考虑可能的身体解释。例如，身体不适可能是由共病的非精神性生理疾病引起的，而不仅仅是心理困扰。本研究采用生物文化的框架，探讨共病的生理和心理疾病与躯体化的力量，影响身体投诉。这项研究探讨了尼泊尔农村的抑郁症，重点是jhum-jhum，感觉异常的一种形式（主观麻木或刺痛），从文化的角度来解释其主位和其发病机制的医学模型。这项研究确定了42%的jum-jhum患病率（N = 316），报告jum-jhum的组比非jum-jhum组更抑郁。如果没有进一步的身体诊断，那些患有jum-jum的抑郁个体可能被诊断为躯体化者。然而，在一个具有jhum-jhum和高抑郁评分的个体的子样本（N = 65）中，身体病理学与三分之二的jhum-jhum病例相关。考虑到生理相关性后，躯体化的估计患病率并不高于西方环境中观察到的患病率。这些研究结果表明，因此，索赔的跨文化差异的躯体化应进行检查，注意当地的负担，身体疾病，使用适当的生物和文化的方法来评估comorbidity。
Research on depression in non-Western settings has focused on "somatization," defined as recurrent bodily complaints among persons with psychological distress. Such studies have often recorded higher rates of somatization in non-Western groups compared to Western settings, fueling speculation about cross-cultural differences in the physical manifestation of psychiatric disorders. However, few of these studies have rigorously considered possible physical explanations before diagnosing cases as somatization. For example, bodily complaints may result from comorbid nonpsychiatric physiological illness as opposed to psychological distress exclusively. The present study employs a biocultural framework to investigate the power of comorbid physiological and psychological illness versus somatization to influence bodily complaints. This' study examines depression in rural Nepal, focusing on jhum-jhum, a form of paresthesia (subjective numbness or tingling), from a cultural standpoint of its emic explanation and a medical model of its pathogenesis. This study identified a 42 percent prevalence of jhum-jhum (N = 316), with the group reporting jhum-jhum being more depressed than the non-jhum-jhum group. Without further physical diagnosis, those depressed individuals with jhum-jhum might be diagnosed as somatizers. However, in a subsample of individuals (N = 65) with jhum-jhum and high depression scores, physical pathology associated with two-thirds of jhum-jhum cases. After accounting for physiological associations, the estimated prevalence of somatization is no higher than observed in Western settings. These findings suggest, therefore, that claims of cross-cultural differences in somatization should be examined, with attention to the local burden of physical disease using adequate biological and cultural methods for assessing comorbidity.