bolton

Question 1

Focus

Answer 1

Cross-cultural validity

Question 2

Aim

Answer 2

To investigate if Western diagnosis of depression or PTSD is accepted by the local community as a valid description of their response to trauma (Rwandan genocide)

Question 3

results

Answer 3

• participants described the diagnostic symptoms of depression and PTSD as results of the genocide and also described associated “local” symptoms not included in the established diagnostic criteria
• after the questionnaire was established, 93 people were identified as having mental health issues in the community
• some were diagnosed by local healers as showing the symptoms of agahinda gakabije. When given the newly standardized questionnaire, 30 of those then tested positive for signs of depression.

Question 3

Participants

Answer 3

Two rural areas in Rwanda

Question 4

procedure

Answer 4

Three interviews:

• free listing -> a list of local terms for mental symptoms and disorders.
• key informant interviews -> when mental health issues were identified, participants were asked for the names of people in the community who were knowledgeable of these problems; they were traditional healers and local leaders.
• pile sorts -> a set of cards was created which included the mental health symptoms that were identified in the initial interview as well as the symptoms that identify depression as outlined in the DSM. The healers were asked to sort the cards based on similarity .

After that, they used these local symptoms as part of their questionnaire which they developed to determine prevalence levels of depression in the community

Question 5

evaluation

Answer 5

STRENGHTS

• emic approach -> By adopting this approach, clinicians consider how the various components of culture have shaped an individual’s health and help to determine appropriate treatment.
• data triangulation -> strengthen the credibility of the findings.

LIMITATIONS

• reliant on determining which Western disorder most resembles the locally defined problems -> there is no outside verifiability of an actual diagnosis of depression - except by drawing comparisons to diagnoses in the West, which may also be flawed.
• limited generalizability -> Emic approaches are limited to the community that is studied.
• fails to recognize that cultures are dynamic, complex social constructs that defy easy definition or measurement