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: 7467588
• 负责人: JANETTE Louise BEALS
• 金额: $ 5.44万
• 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/7467588
• 关键词: Accounting; Affect; Alaska Native; Alcohol abuse; Alcohols; American Indians; Behavior; Catchment Area; Classification; Clinical; Comorbidity; Count; Data; Dependence; Depressed mood; Depth; Development; Diagnosis; Diagnostic; Diagnostic and Statistical Manual; Disease; Distress; Epidemiologist; Epidemiology; Ethnography; Facility Construction Funding Category; Genotype; Health Policy; International; Intervention; Interview; Interviewer; Investigation; Knowledge; Life Experience; Measures; Mental Health; Mental disorders; Methods; Modality; Modeling; Participant; Pattern; Policies; Population; Post-Traumatic Stress Disorders; Process; Program Development; Psychiatric Diagnosis; Psychiatrist; Psychiatry; Psychologist; Psychometrics; Public Health; Qualifying; Race; Rate; Reporting; Research; Research Personnel; Risk; Role; Sampling; Services; Source; Standards of Weights and Measures; Structure; Surgeon; Surveys; Symptoms; Testing; Time; Translating; Trauma; Traumatic Stress Disorders; Voice; Work; alcohol misuse; alcohol use disorder; base; concept; design; experience; health disparity; improved; insight; interest; member; service utilization; single episode major depressive disorder; tribal member

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精神障碍定义中对可观察到的和可经历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共病迫使人们对这一概念进行深思熟虑的重新考虑。然而，社会文化因素在理解这种共病中的可能作用仍未被探索，尽管有证据表明一般精神疾病的社会文化建构的重要性。