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）：精神病学的进展是戏剧性的。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在基于人口的调查中使用的可靠措施的发展。在这些努力中发现的大量科摩罗人迫使人们对这一概念进行深思熟虑的重新思考。社会文化因素在理解这种并发症的可能作用，然而，仍然没有探索，尽管有证据表明，一般精神疾病的社会文化建设的重要性。 最近完成的一项关于文化和共同体之间的相互作用的研究强调了这一点。 美国印第安人服务利用、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，并进行文化适应;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人种学访谈，从参与者的角度探讨痛苦。最常见的CIDI诊断是严重抑郁发作（MDE），创伤后应激障碍（PTSD）和酒精滥用和依赖（AAD）。这些样本中MDE的发生率远低于我们的预期;然而，在临床再评价中，MDE的诊断率更高，AAD也是如此。人种学访谈表明创伤和酒精在参与者构建疾病中的重要性。具体目标如下：（1）通过了解非专业人员访谈中的共病模式，建立一个调查诊断中社会文化因素的框架。2)完成对收集了平信徒、临床和人种学数据的病例的深入分析，并在诊断过程中建立社会文化因素模型。3)使用外行访谈和临床再评估来调查方法学因素如何告知我们对诊断过程的理解。4)为了测试在深入分析过程中开发的社会文化模型，同时考虑方法的影响，以了解在合并症的背景下，外行访谈和诊断的临床重新评估的不同观点。 这种综合的心理测量，临床和人种学的工作是及时的，因为我们走向DSM-V的美国印第安人和阿拉斯加原住民心理健康研究（NCAIANMHR）的国家中心的工作人员是唯一有资格进行这项研究;该团队由人类学家，临床医生和心理测量学家谁已经成功地整合了他们的努力多年。这项研究具有重要的公共卫生意义，因为我们走向DSM-V，无论是对美国印第安人群体，但也更普遍，因为我们寻求改善精神病诊断过程。