CULTURAL FACTORS IN DEPRESSION AND COMORBID DRINKING

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Drawing from concepts and methods in medical anthropology, the proposed study examines cultural and social factors affecting depressive disorder and problem drinking among the adolescents, adults, and elderly of an American Indian people living on a Northern Plains reservation. Specifically, the project aims include: 1) an ethnographic exploration of the local signs of depressive-like experiences, problematic alcohol use, and their co-morbidity, with a special focus on cultural idioms and explanatory models, and the cultural relevance of DSM-IV criteria for each syndrome; 2) an ethnographic investigation of subcultural variation in the everyday use of cultural idioms and explanatory models for depression and problem drinking by gender and across youth, middle adulthood and older adulthood; and 3) an appraisal of the influence of cultural definitions of pathology on symptom presentation among three samples -- a sample of youths, adults and elderly diagnosed with major depressive disorder according to DSM-IV criteria, a sample constituted and diagnosed in a similar fashion with alcohol abuse or dependence, and a sample constituted and diagnosed in a similar fashion as comorbid with both an alcohol and a major depressive disorder. This study, anchored in both anthropological and psychiatric conceptualizations of human disorder, will produce a rich and comparative set of data that will include: 1) ethnographic reports detailing contemporary reservation life; 2) interview transcripts with 20 healers about a) culture-specific syndromes, idioms and explanatory models for depression and problem drinking; and b) the cultural relevance of DSM criteria for depressive disorders and alcohol disorders; 3) ethnographic reports about role expectations for men and women across three age-grades and their relevance for understanding the experience and expression of psychopathology; 4) ethnographic notes regarding assessments of normal and abnormal affect and drinking in everyday contexts; 5) a set of ethnographic interviews with approximately 30 non-diagnosed, self- selected respondents; and 6) a set of three interviews (CIDI, SCID, and ethnographic) for each of 72 randomly selected respondents. Through a rigorous investigation of cultural definitions of psychopathology, their relationships to diagnostic criteria, and the interrelation of these two visions of human distress, the findings will contribute to the field of cross-cultural psychiatry in both practically and theoretically significant ways. By the completion of this study, the field will be poised to apply these understandings to the development of more culturally-sensitive diagnostic measures and interventions, as well as better epidemiological and service utilization instruments for American Indians. Moreover, as the role of culture in psychopathology is better understood, across disorders, across the life-span, and across cultures, we will be in the position to design better research that attends to the social nature of mental and emotional disorder.