The validity of the BDHI translated into Papiamento in pre-trial defendants in Curaçao.

The Buss-Durkee Hostility Inventory (BDHI) is an important assessment scale of hostility in forensic psychiatry. We analyzed the validity and reliability of a Papiamento translation of the BDHI in 134 pre-trial defendants in Curaçao using Exploratory Structural Equation Modeling (ESEM). The reliability of the Direct and Indirect Hostility BHDI-P subscales were good and the reliability of the Social Desirability poor. There was a negative correlation between Direct Hostility and Agreeableness and a positive correlation between Indirect Hostility and Anxiety. We conclude that the BDHI-P has an acceptable measurement quality when used in defendants.

[Depressive disorders in ethnic minorities in the doctor's office]. / Depressie bij allochtonen in de spreekkamer.

Doctors often find the diagnosis and treatment of psychiatric disorders in non-Western ethnic minorities difficult. Not only do language and culture form barriers to understanding, the symptoms of these disorders can be expressed in unfamiliar ways. We describe three cases that illustrate how the clinical presentation of depression in ethnic minorities living in the Netherlands can differ from that of Dutch patients. While the core symptoms of depressive disorder are similar, ethnic minority patients exhibit somatic symptoms more frequently. On average, they also have more severe symptoms, more psychiatric comorbidity such as anxiety and psychosis; the illness is also more often complicated by a multitude of social problems. Improving the diagnosis and treatment of depression in ethnic minorities requires knowledge and the exploration of potential differences in symptom presentation and the patient's explanatory models of mental illness. Patients and physicians also need to discuss their mutual expectations, in order to reach a consensus about treatment goals.

Pre-trial psychiatric evaluations and ethnicity in the Netherlands.

OBJECTIVE: Black and ethnic minorities (BME) are disproportionally represented in western prisons and forensic psychiatric facilities. The authors wished to determine whether patient-related or services-related factors account for this overrepresentation. This study examined the relationship among the assessments of psychological accountability for a crime, treatment recommendations, and ethnicity among persons accused of a crime and suspected of having a mental disorder. METHOD: We examined all 21,857 pre-trial psychiatric reports requested by Dutch courts between 2000 and 2006. Ethnicity was classified as Dutch native (n=15,004), Black and minority ethnic (BME) groups (n=6202), and Whites from other western countries (n=638). Accountability assessments and treatment recommendations were compared using chi-square tests and logistic regression models, adjusted for demographic, psychiatric, and judiciary characteristics. RESULTS: Among BME and Whites from other western countries, accountability for the crimes committed was more often judged to be at the extreme ends of the spectrum, that is, "fully responsible" or "not responsible." Compulsory admission to a psychiatric hospital was more frequently recommended for BME persons (OR: 1.38, 95% CI: 1.16-1.64) and Whites from other western countries (OR: 1.54, 95% CI: 1.05-2.27), but not admission to a penitentiary hospital or use of medication. The compulsory admission findings are largely explained by a higher prevalence of psychotic disorders in BME persons (19.8%) and Whites from other western countries (19.3%) as compared to Dutch natives (9.2%). Outpatient treatment was less often recommended for BME persons (OR: 0.81, 95% CI: 0.76-0.87) and Whites from other western countries (OR: 0.83, 95% CI: 0.70-0.99) than for Dutch natives. CONCLUSION: Both patient-related and services-related factors play a role in the increased admission of BME groups and Whites from other western countries to psychiatric hospitals.