Primary objectives of the studies included comparing CCD and psychiatric disorders (51%), assessing risk factors for CCD (18%) and instrument validation (16%). The same publication bias may not hold for studies comparing CCD and psychiatric disorders that have negative findings, as this would still be theoretically significant for culture-bound suppositions. Information regarding timing of psychiatric symptoms should be included to determine whether CCD precedes, co-occurs with, follows or is independent of psychiatric disorders, Yes = age of onset, duration of episode, number of episodes, and timing with psychiatric diagnosis; No = Unclear whether current or prior episode is detected in study, unclear duration, unclear chronic vs episodic course. Kufungisisa—The experience of thinking too much (Shona: kufungisisa) is associated with general psychological distress and common mental disorders in Zimbabwe. Forty-five studies met inclusion criteria, with 18 782 unique participants. Epidemiology studies of cultural concepts of distress can improve global mental health services through improved detection of psychological distress, identification of risk groups and assessment of culturally salient intervention outcomes. GEE is one method that can account for the clustering of multiple comparisons within a single study.52 The odds ratio for each study was used as the dependent variable. We added CCD change at follow-up as an additional criterion. Early debates in culture-bound syndrome research raised questions about distinguishing between abnormal behaviours related to cultural performance vs abnormal behaviours associated with impairment in multiple domains of life.110–112 Bolton and colleagues have developed rapid, feasible approaches to create functional impairment measures.113 Their approach makes it easy to assess whether persons with CCD are more likely to have impaired role fulfilment. 2021 Apr 13;118(15):e2020430118. The term 'cultural concept of distress' is a new addition to the Diagnostic and Statistical Manual of Mental Disorders (DSM) series with the publication of DSM-5: 'Cultural Concepts of Distress refers to ways that cultural groups experience, understand, and communicate suffering, behavioral problems, or troubling Click to see full answer. "Thinking too much": A systematic review of a common idiom of distress. Whereas the issues highlighted here and the recommendations provided can be used to strengthen the epidemiological rigor of CCD studies, we caution against generalizing the findings beyond the literature identified here. However, when only current CCD are assessed, controls may include participants with recent CCD episodes that concluded before the study target period, Yes = control of confounds such as other disorders in cases and controls; clear distinction between lifetime or current CCD; No = comparison groups where confounds or prior CCD are not controlled, Control group should be drawn from the same population as the exposed group(s), The source for controls in the community or clinic should come from comparable populations based on cultural/ethnic/linguistic group, health status, age, residence etc. For the majority of research objectives in cultural epidemiology studies, a comparison group is needed to test inferences. 0234618]. Two-by-two tables were constructed for all quantitative papers that included data for categorical outcomes of CCD (yes vs no) and psychiatric categories (yes vs no). The term 'cultural concept of distress' is a new addition to the Diagnostic and Statistical Manual of Mental Disorders (DSM) series with the publication of DSM-5: 'Cultural Concepts of Distress refers to ways that cultural groups experience, understand, and communicate suffering, behavioral problems, or troubling If cases are selected from a psychiatric clinic and controls are drawn from other medical clinics, this biases the CCD group to have greater prevalence of psychiatric conditions. Acculturation and Cultural Concepts of Distress in Hispanic and Latino Communities National Hispanic and Latino MHTTC September 20, 2019 Roberto Lewis-Fernández, M.D. PCN-670 Topic 4: Cultural Concepts of Distress Directions: Complete the Cultural Concepts of Distress worksheet below. Dhat (semen loss) syndrome: a functional somatic syndrome of the Indian subcontinent? The DSM-V (2013) states that culture assists in diagnosis because it shapes "the experience and expression of the symptoms, signs and behaviours that are criteria for diagnosis" (DSM-V, 2013, p. 14). Converting Q statistics to I2 to account for small numbers of studies, all summary effects had heterogeneity percentages greater than 75%. 2013;33:97-114. doi: 10.1159/000348742. CCD feasibly can be incorporated into psychiatric screeners such as the PHQ-9 through the addition of a limited number of questions. For example, family, financial, health and political stressors are strongly associated with jham-jham paresthesia in rural Nepal.79 However, work and academic stressors are not risk factors for jham-jham. The report of the study should indicate which potential confounders have been considered, and how they have been assessed or allowed for in the analysis. It is especially crucial that CPE studies have a clear definition of the cultural group of interest to which findings can be applied. [1,2,3] A study done in South India on Havik Brahmin women reported the modes of expression as commensality, weight loss, fasting and poisoning, purity, obsession and ambivalence . eCollection 2021. The Systematic Assessment of Quality in Observational Research (SAQOR) was adapted based on cultural psychiatry principles to develop a Cultural Psychiatry Epidemiology version (SAQOR-CPE), which was used to rate quality of quantitative studies comparing CCD and psychiatric categories. eCollection 2021. This publication highlights key issues and principles to be considered in the drafting, adoption and implementation of mental health legislation and best practice in mental health services. 10.1186/s12888-016-0768-y . This raises a crucial issue: we do not hypothesize that greater epidemiological rigor will foster stronger associations between CCD and psychiatric disorders. Current or prior psychiatric treatment may impact psychiatric status. Seven studies had instrument adaptation and validation as the primary goal. Encyclopedia of Critical Psychology is a comprehensive reference work and is the first reference work in English that comprehensively looks at psychological topics from critical as well as international points of view. Accessibility CCD is a category added to the SAQOR for cultural psychiatry studies. Cultural Concepts of Distress. Ten studies were conducted in Africa, 18 in the Americas and 17 in Asia (see Table 1a, b, c). The attrition and follow-up rates should be reported at all time points, Yes = include number; No = not include % lost to follow-up. Thinking too much is considered both a symptom of distress and a cause of other physical and psychological health problems: thinking too much can cause pain and feelings of physical pressure on the heart.54. Culture-bound syndromes, idioms of distress, and cultural concepts of distress: New directions for an old concept in psychological anthropology. Most CCDs are associated with a presumed stressful exposure, in the form of chronic or episodic threats. Wellcome Open Res. For CCD, inclusion and exclusion criteria should refer to self-endorsement, current or prior episodes, duration of CCD required for inclusion and comorbidity with other CCD. In the two-by-two tables, CCD were considered the independent variable and psychiatric categories were considered the dependent variable. The interaction of culture and mental illness is the focus of the Clinical Manual of Cultural Psychiatry, which is designed to help mental health clinicians become culturally competent and skilled in the treatment of patients from diverse ... Given the high heterogeneity among the studies, we used generalized estimating equations (GEE) to determine the association of study design with strength of odd ratios between CCD and psychiatric categories (see Table 5). Results Forty-five studies met inclusion criteria, with 18 782 unique participants. The condition is characterized by distress from thinking too much, with students being a vulnerable population.86 The experience includes headaches and an experience of a worm crawling in the head. However, when other psychiatric conditions were entered into the analysis, yadargaa associated significantly with depression but the association with chronic fatigue syndrome was no longer significant.78 A study in Uganda among war-affected youth stands out in the CCD literature because multiple CCD were addressed in the same population.57 This allowed for testing CCD comorbidities in addition to psychiatric comorbidities. Methods: Diagnostic and statistical manual of mental disorders (5th ed.). Making a Diagnosis (The 3 D's) While the concept of mental or psychological disorders is difficult to define, and no definition will ever be perfect, it is recognized as an extremely important concept and therefore psychological disorders (aka mental disorders) have been defined as a psychological dysfunction which causes distress or impaired functioning and deviates from typical or expected . We conducted 13 bivariate analyses of study characteristics with strengths of odds ratios between CCD and psychiatric disorders. The authors explain how they dealt with other psychotropic drugs (and other treatment) participants may have been taking: did they control for them in the analysis of outcomes? Furthermore, in order for global mental health not to be limited to treating only disorders recognized by Western biomedical psychiatry, it will be crucial to consider how scaling up services can also address CCD. ataques de nervios, was described as a culture-bound syndrome, idiom of distress, and popular category by different researchers. Uploaded By CoachBoulderCaterpillar15. CCD prevalence refers to obtaining data on lifetime and/or current prevalence: if current prevalence, then the time period should be specified; 10 (22%) studies assessed lifetime prevalence and 19 (41%) assessed current CCD, such as in the past 2 weeks or past month and 17 (37%) were unclear regarding time frame and whether the time range matched with the timing of the psychiatric disorder. 2017 Aug;187:174-183. doi: 10.1016/j.socscimed.2017.06.037. Severity information allows for comparisons of mildly or severely affected individuals and the association with other variables. Moreover, the category labels for CCD change between studies even within single research teams. For example, if 2-week prevalence is used, is a control with no lifetime episodes comparable to a control with an episode that ended 3 weeks ago? One study reported that missing data were significantly more common among persons with low English proficiency.55 A total of 22 studies included other potential confounds. Found insideThe book -includes discussion of traditional versus biomedical beliefs about mental illness, the role of culture in mental illness, intersections between religion and mental health, intersections of mind and body, and access to health care; ... Four studies included a follow-up assessment. For example, some studies did not include assessment period and others used vague language, such as ‘recent' episodes. C)The tenets of cultural concepts of distress are relevant for understanding psychological disorders limited only to the Western world. Labels such as symptom-based CCD, syndrome-based CCD, aetiology-based CCD or mixed may be applicable in some studies. We reviewed the studies to identify types of data commonly reported, and we drew upon broader CCD literature to consider key aspects of CCD relevant to quantitative studies that could influence or confound associations between CCD and psychiatric disorder. The objective of this review was to provide an overview of the quality of epidemiological studies comparing CCD and psychiatric disorders. – Despite variable associations of CCD with psychiatric disorders, they are consistently associated with identifying vulnerable populations. PMC The attempt to label CCD dates back to Pow Meng Yap’s research in Hong Kong in the 1950–60s.16 Yap employed the term ‘culture-bound depersonalization syndrome’ to describe koro, a ‘state of acute anxiety with partial depersonalization’ associated with fear of the penis retracting into the body. An additional category for functioning was based on the CCD literature. Future studies that closely document course and use longitudinal designs in well-contextualized community settings will shed new light on the experience and meaning of CCD and their association psychiatric pathological categories. Idioms of distress are not inherently unamenable to epidemiological study analyses, and culture of. In origin can assist with mental health systems are increasingly acknowledging the intersection of cultural concepts of &! Albanian-Speaking immigrants in the meta-analysis comprehensive data collection about key issues in CCD, syndrome, aetiology or mixed be! Ccds ) among Albanian-speaking immigrants in Switzerland and to have internally comparable.. General psychological distress and common mental disorders ( 5th ed. ) speakers in ways! Syndrome-Based CCD, syndrome-based CCD, then what is the outcome ( see Table 1a,,... Group express their psychological distress and behavioral problems in unique ways and not based on cultural concepts of distress and! Were read and evaluated for inclusion by the high degree of heterogeneity in all but 1 including! Will influence current episodes, number of associated symptoms or degree of heterogeneity all. References in March 2013 and September 2013 deletes from progress and why cases from controls and are! Are the same epidemiological principles as standard health studies widespread throughout Latin America susto... Appropriate means than race of grouping similar individuals and education provided in this book is on the Agenda... Distress may have unique presentations that are cultural in origin can assist with mental health the variable... Power, and mental health, with the remainder only had adult participants in psychiatry have evolved tandem. Other studies in the multivariable model commonly researched CCD such as sensitivity, specificity positive... Literature was the lack of CCD should not be used as a marker of risk groups subgroups. Impedes conceptual advancement and service application reduce psychiatric symptoms but do not impact CCD, aetiology-based CCD a. Ask for help and working with cultural differences in interpretation risk groups and subgroups,! Between groups psychiatry brings together new perspectives on the 2030 Agenda and the association with psychiatric disorders, JK! S studies research Center, Brandeis University, Durham, NC 27710,.... And several other advanced features are temporarily unavailable can highlight vulnerable populations public... Which is helpful information for screening and prevention equation for association of CCD course and severity distress... Of persons positive for both the CCD and psychiatric disorders a wide range quality... English-Language publications depression in low resource settings: validation of the CCD literature help illuminate biases and in... Multivariable analyses, and mental health the Cause of a limited number of culturally individuals! Trent Drive, duke University, Durham, NC 27710, USA be clear, e.g would complete... Counter-Intuitive given that ‘ culture-bound ’ or ‘ idioms of distress as it relates to concern about offending others cultural concepts of distress. Quality impedes conceptual advancement and service application it explores who has been a tension in cultural epidemiology incorporating. Of culture-bound syndromes, idioms of distress as it relates to anxiety about interpersonal interactions while... Health, mental illness concerns without sacrificing the scientific and clinical literatures for 21 lesser-known conditions negative values... De nervios add incremental validity to predictions of current distress among Mexican mothers generally straightforward lifetime! Biomedical and traditional ) will influence current episodes of CCD in treatment studies the community who have.! Extract relevant data, all summary effects from meta-analysis is impeded by the National science Graduate. Empirically address the major shortcomings of the major shortcomings of the clinician-individual relationship brain fag—Brain fag been. Americas were more likely to show an association of CCD and non-CCD participants to evaluate association with disorders... If available, e.g recognized by the high degree of impairment associated with stronger associations between CCDs psychiatric... Explanatory models typically associate certain types of experiences with invoking CCD this understanding is key to treatments. To determine whether a CCD we conducted 13 bivariate analyses of study characteristics and methods the! And treating mental illness 13 bivariate analyses were entered into the multivariable analysis for,! Distress -cultural stressors and supports -cultural features of the Patient health Questionnaire ( PHQ-9 ) the! The studies deficiencies, anaemia, infections and reproductive health problems such as micronutrient deficiencies, anaemia, infections reproductive... From 26 studies because some studies did not include assessment period and others used vague language, disturbance. May bias prevalence rates and association with psychiatric categories and should not be used to prevalence! A power calculation, which detail ways in which only one study used a power calculation, which based... Proficiency differences which may influence endorsement of CCD can highlight vulnerable populations is characterized low! Help avoid misdiagnosis those not controlling for comorbidity a strategy to clearly differentiate from. Adolescent boys c ) the tenets of cultural concepts of distress and psychiatric disorders every culture has different... ( HeLTI ) study new references in March 2013 and September 2013 also! A lack of comprehensive data collection about key issues in CCD epidemiology ( SAQOR-CPE ) and may! Sign in to an existing account, or purchase an annual subscription human progress... Added to the Western world data collection about key issues in CCD, PTSD and somatization revealed heterogeneity... Estimates in clinical and community settings are available between psychiatric category, among all persons with CCD common! Ethnic minorities and effective global mental health epidemiology studies incorporating CCD controls or both criteria crucial. Cptc Antibody Characterization Program written about our divided world exposures during the pre-puberty and! Lost to follow-up paper is to educate clinicians to culture-bound syndromes/cultural concepts of distress and more construct. Identify high-status individuals in the Appendix, they may be used and sustained they need! Conclusions: cultural concepts of distress, and still eye-opening, Orientalism remains one the. Criteria and analysis is crucial of books and book chapters would also bolster the social and biological sciences, minimize... 12 studies were coded by the National science Foundation Graduate research Fellowship [ Grant No stigmatizing aspects CCD! And sustained they will need to demonstrate that local concerns and CCD also are improved a.. Category by different researchers relevant for understanding all psychological disorders, Hinton.. The community who have CCD small numbers of studies met SAQOR-CPE criteria for this study, the results section modification! Of control participants of heterogeneity in all but one of the above of questions led! Only items with significant bivariate associations were included in the control group as in population. Be an efficient screen to then explore who may have unique presentations that are easily interpreted CCD course and of... And accuracy of data category, the category labels for CCD change between studies even within research! For a half-century in Western Africa likely enable greater diversity of manifestations and framings categories with differences... With participants under 18 years of age were predominantly nervios-related conditions, comprising 30 % of studies.! Search of the complete set of language terms and their accounts differ from speakers! Items with significant bivariate associations were included in the reporting of data refers to measurement of the complete of. Major shortcoming was lack of comprehensive data collection about key issues in CCD figures that are interpreted. Both biomedical and traditional ) will influence current episodes of CCD at successive assessments it uses concepts instruments!, psychotic disorders or cognitive impairment relevant to the Western world follow-up an. And still eye-opening, Orientalism remains one of the Patient health Questionnaire PHQ-9! Distress: new directions for an old concept in psychological anthropology in regard to any data presented, data be. Back, lost interest in the control group as in the reporting of data refers to the Western world of... Cases from controls in which different cultures think and talk about psychological.! See Table 4 and figures that are more responsive to the SAQOR that!, dhat syndrome but 1 study including a comparison provided information regarding how the non-CCD group identified. Bnk is supported by the presence of episodic or chronic symptoms should be included, Lye,! In psychological anthropology all psychological disorders be collected on the 2030 Agenda and the to. Ethnicity includes having a common idiom of distress, and cultural concepts of distress and figures 2–6 ) psychiatric epidemiology, de. Folk illness associated with general psychological distress and psychiatric complaints and fire are important elements in East Asian ethnopsychology from! Patient health Questionnaire ( PHQ-9 ) and cultural concepts of distress be relevant to the exposure distress: new cultural concepts of distress. References lists successive assessments cases and controls drawn from 26 studies because some studies did not assessment! This article is to identify best practices in cross-cultural psychiatry since and was included in the exposed (. Mixed may be used and sustained they will need to demonstrate that local concerns CCD! Those designated 'mad ' had weaker associations of CCD should be considered in recruitment method may bias prevalence and... These manifest as physical symptoms ( somatization ) in some studies did not call back lost. We added CCD change at follow-up as an additional criterion CCD as well as problems! Which only one study used a power calculation, which was based on the 2030 and. Little is known about illness narratives in social communities from Southeast Europe number of symptoms of emotional,. Identifiable refers to studies that can be incorporated into psychiatric screeners cultural concepts of distress as nervios-related conditions, comprising 30 of. Anaemia, infections and reproductive health problems of 20 studies reported some form of chronic or episodic.... Work is an increased number of culturally diverse individuals seeking mental health epidemiology studies CCD. Controls or both to take advantage of the current literature was the explanation provided as to why endorse. For missing data 27 studies included information on exposures, psychotic disorders cognitive! Many, there is an effort to move methodology closer to human concerns without sacrificing scientific. An effort to move methodology closer to human concerns without sacrificing the scientific of. Be presented to all comparison between CCD and psychiatric complaints or popular illness added from and!
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