Utilization of Standardized Mental Health Assessments in Anthropological Research: Possibilities and Pitfalls.

In the past decade anthropologists working the boundary of culture, medicine, and psychiatry have drawn from ethnographic and epidemiological methods to interdigitate data and provide more depth in understanding critical health problems. But rarely do these studies incorporate psychiatric inventories with ethnographic analysis. This article shows how triangulation of research methods strengthens scholars' ability (1) to draw conclusions from smaller data sets and facilitate comparisons of what suffering means across contexts; (2) to unpack the complexities of ethnographic and narrative data by way of interdigitating narratives with standardized evaluations of psychological distress; and (3) to enhance the translatability of narrative data to interventionists and to make anthropological research more accessible to policymakers. The crux of this argument is based on two discrete case studies, one community sample of Nicaraguan grandmothers in urban Nicaragua, and another clinic-based study of Mexican immigrant women in urban United States, which represent different populations, methodologies, and instruments. Yet, both authors critically examine narrative data and then use the Center for Epidemiologic Studies Depression Scale to further unpack meaning of psychological suffering by analyzing symptomatology. Such integrative methodologies illustrate how incorporating results from standardized mental health assessments can corroborate meaning-making in anthropology while advancing anthropological contributions to mental health treatment and policy.

Barriers to implementing the DSM-5 cultural formulation interview: a qualitative study.

The Outline for Cultural Formulation (OCF) in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) marked an attempt to apply anthropological concepts within psychiatry. The OCF has been criticized for not providing guidelines to clinicians. The DSM-5 Cultural Issues Subgroup has since converted the OCF into the Cultural Formulation Interview (CFI) for use by any clinician with any patient in any clinical setting. This paper presents perceived barriers to CFI implementation in clinical practice reported by patients (n = 32) and clinicians (n = 7) at the New York site within the DSM-5 international field trial. We used an implementation fidelity paradigm to code debriefing interviews after each CFI session through deductive content analysis. The most frequent patient threats were lack of differentiation from other treatments, lack of buy-in, ambiguity of design, over-standardization of the CFI, and severity of illness. The most frequent clinician threats were lack of conceptual relevance between intervention and problem, drift from the format, repetition, severity of patient illness, and lack of clinician buy-in. The Subgroup has revised the CFI based on these barriers for final publication in DSM-5. Our findings expand knowledge on the cultural formulation by reporting the CFI's reception among patients and clinicians.

Culturally sensitive assessment of anxious-depressive distress in the Cambodian population: Avoiding category truncation.

In a large national survey in Cambodia (N = 2689), the present study investigated the prominence of certain culturally salient symptoms and syndromes in the general population and among those with anxious-depressive distress (as determined by the Hopkins Symptom Checklist-25, or HSCL). Using an abbreviated Cambodian Symptom and Syndrome Addendum (CSSA), we found that the CSSA complaints were particularly elevated among those with anxious-depressive distress. Those with anxious-depressive distress had statistically greater mean scores on all the CSSA items as well as severity of endorsement analyzed by percentage: among those with HSCL caseness, 75.3% were bothered "quite a bit" or "extremely" by "thinking a lot" (vs. 27.5% without caseness); 53.8% were bothered by "standing up and feeling dizzy" (vs. 13.8%); and 45.6% by blurry vision (vs. 16.8%). In a logistic regression analysis to predict anxious-depressive distress, 51% of the variance was accounted for by five predictors: "weak heart," "thinking a lot," dizziness, "khyâl hitting up from the stomach," and sleep paralysis. Using ROC analysis, a cut-off score of 1.81 on the CSSA was optimal as a screener to indicate anxious-depressive distress, giving a sensitivity of 0.86. The study results suggest that to avoid category truncation (i.e., the omission of key complaints that are part of an assessed distress domain) when profiling anxious-depressive distress among Cambodia population that items other than those in standard psychopathology measures should be assessed such as "thinking a lot," "weak heart," "blurry vision," and "dizziness upon standing up."

Gulliver's Eggs: Why Methods are not an Issue of Qualitative Research in Cultural Psychology.

The future of qualitative methods regards the kind of object cultural psychology is interested and the kind of questions it can ask. I propose that the object should be experiencing, understood as a complex whole, consisting of lived-by action and counter-action, that is contextual inter-action with the world in the form of an experiencing subject and otherness. The kind of questions cultural psychology can ask is instead related to the epistemological status attributed to both researcher and participant. Probably few scholars such as Vygotsky, Piaget and Lewin understood to what extent experiencing is always changing, because the relationship between mind, alterity and culture is co-generative. This also implies a relativization and a decentralization of the psychology's perspective. Finally, I provide some examples from the history of psychology and some suggestions to work at the level of such complexity by using methods that can work with complex objects such as products of human activity (e.g., art, literature, architecture, etc.).

Revisiting cultural awareness and cultural relevancy.

Comments on the original article by Christopher et al. (see record 2014-20055-001) regarding critical cultural awareness. The more insights and exploration of the meaning and influence of culture we receive, the better. There is no single treatment of any personal or collective culture(s) that can be inherently complete or totally exhaustive. New hermeneutics and skills are always needed, appreciated, and refreshing.

Beyond the confines of culture: Reflections of two non-American psychologists.

Comments on the original article by Christopher et al. (see record 2014-20055-001) regarding "culturally situated" psychology. In this commentary, the current authors articulate a few points of contention and words of caution to be borne in mind when attempting to cultivate critical cultural awareness.

Cultural humility: The cornerstone of positive contact with culturally different individuals and groups?

Comments on the original article by Christopher et al. (see record 2014-20055-001) regarding cultural and folk psychologies. As noted by Christopher, Wendt, Marecek, and Goodman (2014), "U.S. psychology remains not only overwhelmingly U.S.- centric but also largely unaware of how its cultural roots shape theory and research.

Culture revisited: A reply to comments.

Replies to comments by Winston & Maher (see record 2015-45553-005), Abi-Hashem (see record 2015-45553-006), and Hook & Watkins (see record 2015-45553-007), on the original article by Christopher et al. (see record 2014-20055-001). In this brief response, the authors clarify some elements of their thinking and address some misconceptions put forward by the commentators.

Development and validation of a Haitian Creole screening instrument for depression.

Developing mental health care capacity in postearthquake Haiti is hampered by the lack of assessments that include culturally bound idioms Haitians use when discussing emotional distress. The current paper describes a novel emic-etic approach to developing a depression screening for Partners in Health/Zanmi Lasante. In Study 1 Haitian key informants were asked to classify symptoms and describe categories within a pool of symptoms of common mental disorders. Study 2 tested the symptom set that best approximated depression in a sample of depressed and not depressed Haitians in order to select items for the screening tool. The resulting 13-item instrument produced scores with high internal reliability that were sensitive to culturally informed diagnoses, and interpretations with construct and concurrent validity (vis-à-vis functional impairment). Discussion focuses on the appropriate use of this tool and integrating emic perspectives into developing psychological assessments globally. The screening tool is provided as an Appendix.

Toward a cultural history of the personality disorders.

Psychiatric categories in general, and the personality disorders in particular, remain problematic and contested. This is no where more clearly evident than in the case of the 'antisocial' and 'histrionic' personality disorders. In part, the problem is related to the observation of differences in gender distribution. Men are more likely to be diagnosed 'antisocial' than women, and women are more likely to be diagnosed 'histrionic' than men. Confusion results partly from the suspicion that these categories may be culturally conditioned and therefore spurious as medical labels true in some 'absolute' sense. This paper argues that the antisocial and histrionic disorders have cultural histories, representing (in extreme form) values strongly congruent with familiar cultural stereotypes: the 'independent' male and the 'dependent' female. The process by which these values were delegated to men and women is examined, and then shown to be at least partly determinative of later developments in the formation of psychiatric categories.

Masculinity and gender roles among Puerto Rican men: machismo on the U.S. mainland.

The literature on masculinity and gender roles in American life has mostly over-looked Latino men, or has stereotyped them by means of a distorted concept of machismo. A reconceptualization of masculinity and machismo among Puerto Rican men is presented, based on a multidimensional view of their historical and current sociocultural reality. Relevant clinical and social services for Puerto Rican men are discussed and directions for future research are suggested.

Critical cultural awareness: contributions to a globalizing psychology.

The number of psychologists whose work crosses cultural boundaries is increasing. Without a critical awareness of their own cultural grounding, they risk imposing the assumptions, concepts, practices, and values of U.S.-centered psychology on societies where they do not fit, as a brief example from the 2004 Indian Ocean tsunami shows. Hermeneutic thinkers offer theoretical resources for gaining cultural awareness. Culture, in the hermeneutic view, is the constellation of meanings that constitutes a way of life. Such cultural meanings-especially in the form of folk psychologies and moral visions-inevitably shape every psychology, including U.S. psychology. The insights of hermeneutics, as well as its conceptual resources and research approaches, open the way for psychological knowledge and practice that are more culturally situated.

International epidemiology of child and adolescent psychopathology I: diagnoses, dimensions, and conceptual issues.

OBJECTIVES: To review international findings on the prevalence of diagnosed disorders, generalizability of dimensional scales, and distributions of dimensional scores for school-age children and to address the conceptual and clinical issues raised by the findings. METHOD: A review of findings for interviews (Development and Well-Being Assessment, Diagnostic Interview Schedule for Children) and dimensional rating instruments (Conners Rating Scales, Strengths and Difficulties Questionnaire [SDQ]) that have been used to assess general population samples of at least 300 children in at least five societies. RESULTS: Prevalence estimates for diagnosed disorders varied greatly, owing at least in part to methodologic variations. A Goodman five-dimension model for the SDQ received some support, whereas a three-dimension internalizing-externalizing-prosocial model for the SDQ was supported for epidemiologic studies. The SDQ total difficulties scores varied less than the prevalence estimates for diagnoses, but population-specific norms may be needed. CONCLUSIONS: Numerous studies have shown the feasibility of assessing children in diverse societies with diagnostic interviews and dimensional ratings. However, the findings disclose challenges to be met to help clinicians take account of the similarities and differences found for psychopathology in different societies.

International epidemiology of child and adolescent psychopathology ii: integration and applications of dimensional findings from 44 societies.

OBJECTIVE: To build on Achenbach, Rescorla, and Ivanova (2012) by (a) reporting new international findings for parent, teacher, and self-ratings on the Child Behavior Checklist, Youth Self-Report, and Teacher's Report Form; (b) testing the fit of syndrome models to new data from 17 societies, including previously underrepresented regions; (c) testing effects of society, gender, and age in 44 societies by integrating new and previous data; (d) testing cross-society correlations between mean item ratings; (e) describing the construction of multisociety norms; (f) illustrating clinical applications. METHOD: Confirmatory factor analyses (CFAs) of parent, teacher, and self-ratings, performed separately for each society; tests of societal, gender, and age effects on dimensional syndrome scales, DSM-oriented scales, Internalizing, Externalizing, and Total Problems scales; tests of agreement between low, medium, and high ratings of problem items across societies. RESULTS: CFAs supported the tested syndrome models in all societies according to the primary fit index (Root Mean Square Error of Approximation [RMSEA]), but less consistently according to other indices; effect sizes were small-to-medium for societal differences in scale scores, but very small for gender, age, and interactions with society; items received similarly low, medium, or high ratings in different societies; problem scores from 44 societies fit three sets of multisociety norms. CONCLUSIONS: Statistically derived syndrome models fit parent, teacher, and self-ratings when tested individually in all 44 societies according to RMSEAs (but less consistently according to other indices). Small to medium differences in scale scores among societies supported the use of low-, medium-, and high-scoring norms in clinical assessment of individual children.

Psychiatrists in times of ethnonationalism.

OBJECTIVE: My goal was to determine the function served by ethnopsychological writings of prominent Croatian and Serbian psychiatrists, published between 1990 and 1998, when fierce interethnic strife between their communities occurred. METHOD: These writings, which deal with the national character of the Croats and Serbs, were analysed. RESULTS: The writings have served the function of detachment. CONCLUSION: Croatian and Serbian psychiatrists have been affected by ethnonationalist sentiments that have prevailed in their communities, and have shown bias in stereotyping each others' population.