Sociocultural validity in the context of DSM comorbidity

描述(由申请人提供)：精神病学流行病学取得了巨大的进步。在DSM对精神障碍的定义中，对可观察到的和有经验的症状的关注导致了在基于人口的调查中使用的可靠测量的发展。在这种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，尽管有证据表明社会文化对精神疾病的重要性，但社会文化因素在理解这种合并症方面的可能作用仍未被探索。 在最近完成的一份报告中强调了文化和共病之间的联系的重要性 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的管理，并进行文化调整；临床医生使用SCID重新采访了335名参与者；以及对63名参与者进行了进一步的人种学访谈，从参与者的角度探索痛苦。最常见的CIDI诊断是重度抑郁发作(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，MDE在临床重新评估中被诊断的频率更高，AAD也是如此。民族志访谈表明，创伤和酒精在参与者构建自己的疾病过程中都很重要。具体目标如下：1)通过了解业馀访谈中的共病模式，为调查诊断中的社会文化因素建立一个框架。2)完成对那些收集了生活、临床和人种学数据的病例的深入分析，并建立诊断过程中的社会文化因素模型。3)采用外行访谈和临床再评价的方法，研究方法学因素如何影响我们对诊断过程的理解。4)检验在深入分析过程中建立的社会文化模型，同时考虑方法效应，以了解在共病的背景下，外行访谈和临床诊断重新评估的不同视角。 在我们迈向DSM-V之际，这项综合的心理测量、临床和人种学工作是及时的。美国印第安人和阿拉斯加原住民心理健康研究国家中心(NCAIANMHR)的工作人员是唯一有资格进行这项研究的人；该团队由人类学家、临床医生和心理测量学家组成，他们多年来成功地整合了他们的努力。随着我们迈向DSM-V，这项研究具有重要的公共卫生意义，不仅对美国印第安人，而且对更广泛的，因为我们寻求改善精神病学诊断过程。

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.