CULTURAL FACTORS IN DEPRESSION AND COMORBID DRINKING

抑郁症和共病饮酒的文化因素

• 批准号: 2890750
• 负责人: THERESA D. O'NELL
• 金额: $ 14.16万
• 依托单位: UNIVERSITY OF OREGON
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-05-01 至 2001-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2890750
• 关键词: Native Americans; alcoholic beverage consumption; alcoholism /alcohol abuse; clinical depression; clinical research; comorbidity; culture; expectancy; human subject; mental disorder diagnosis; mental health epidemiology; racial /ethnic difference; role

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.

借鉴医学人类学的概念和方法，提出 研究调查影响抑郁症的文化和社会因素 以及青少年、成人和老年人的饮酒问题 居住在北部平原保留地的美洲印第安人。 具体来说，该项目的目标包括：1）民族志探索 当地有类似抑郁经历的迹象，有问题的酒精 使用及其共病，特别关注文化习语和 解释模型以及 DSM-IV 标准的文化相关性 每种综合症； 2）亚文化变异的民族志调查 在日常使用的文化习语和解释模型中 按性别和青少年、中年人划分的抑郁症和饮酒问题 成年期和老年期； 3) 影响力评估 病理学对三者症状表现的文化定义 样本——被诊断患有严重疾病的青少年、成人和老年人的样本 根据 DSM-IV 标准的抑郁症，样本构成 并以类似的方式诊断出酒精滥用或依赖，并且 以与合并症类似的方式构成和诊断的样本 既是酒精又是重度抑郁症。 这项研究以人类学和精神病学为基础 对人类疾病的概念化，将产生丰富的、可比较的 一组数据将包括：1）详细说明的民族志报告 当代保留生活； 2）20位治疗师的采访记录 关于 a) 特定于文化的综合症、习语和解释模型 抑郁症和酗酒问题； b) DSM 的文化相关性 抑郁症和酒精障碍的标准； 3）民族志 关于三个年龄段的男性和女性角色期望的报告 以及它们与理解经验和表达的相关性 精神病理学； 4) 关于正常评估的民族志注释 以及日常生活中的异常情绪和饮酒； 5）一套 对大约 30 名未确诊、自我诊断的人进行民族志访谈 选定的受访者； 6) 一组三轮访谈（CIDI、SCID 和 人种学）为 72 名随机选择的受访者中的每一位提供了信息。 通过对文化定义的严格调查 精神病理学，它们与诊断标准的关系，以及 人类苦难的这两种观点之间的相互关系，研究结果将 在实践中为跨文化精神病学领域做出贡献 以及理论上有意义的方法。到本研究完成时， 该领域将准备将这些理解应用于开发 更具文化敏感性的诊断措施和干预措施 作为更好的流行病学和服务利用工具 美国印第安人。此外，文化在精神病理学中的作用是 更好地理解，跨越疾病，跨越生命周期，跨越 文化，我们将能够设计更好的研究 关注精神和情绪障碍的社会本质。