clinical key question

Question 1

what is the clinical key question?

Answer 1

How is the diagnosis of mental health disorders affected by cultural differences?

Question 2

what is culture?

Answer 2

the ideas, shared norms and social behaviour which make up the way of life of a particular group

Question 3

diagnosis is affected by…

key question

Answer 3

• Differences in social norms
• Differences in diagnostic manuals (DSM/ICD)
• Differences in language
• Stigma

Question 4

clinical kq - ao1 culture norms

Answer 4

• Different cultures have different norms and values
• This will affect how an individual’s MH behaviour is experienced, labelled and diagnosed

Question 5

clinical kq - ao2 culture norms

Answer 5

Behaviours which are considered normal in one culture can be considered unusual in another so is therefore deviant and potentially a MHD

This is a problem for the individual because diagnosis is not consistent across cultures, leading to inaccurate diagnosis

Question 6

clinical kq - ao3 culture norms

Answer 6

Luhrmann found differences in experiences of auditory hallucinations between cultures
* 70% Americans said their voices told them to hurt people
* 20% Ghanaian’s said their voices told them to kill/ fight but good voices were more powerful.
* Indian people heard family offering guidance and/or scalding them

This suggests differences in cultural norms could affect validity of diagnosis.

Question 7

clinical kq - ao1 diagnostic manuals

Answer 7

• DSM & ICD are biased towards the western experience of MHD
• Inaccurate diagnosis and treatment would be an issue if used in non-western cultures.

Question 8

clinical kq - ao2 diagnostic manuals

Answer 8

• to deal with this, DSM acknowledges cultural differences
• Section 3 ‘cultural concepts of distress’ aims to explain how culture can affect the presentation of symptoms and how they are communicated

Question 9

clinical kq - ao3 diagnostic manuals

Answer 9

• China has it’s own diagnostic manual Chinese Classification of Mental Disorders (CCMD-3) published by the Chinese Society of Psychiatry (CSP)
• Similar to the ICD and DSM, but includes variations on main MHD and around 40 culturally related diagnoses
• This shows culture affects diagnosis of MH and the importance of culturally sensitive diagnostic manuals.

Question 10

clinical kq - ao1 language

Answer 10

Different cultural backgrounds and first languages can make diagnosis difficult because many cultures do not recognise MHD, don’t have words for it or describe symptoms differently

Question 11

clinical kq - ao2 language

Answer 11

ICD is published in different languages so diagnostic errors due to language barriers or misinterpretation can be minimised

Question 12

clinical kq - ao3 language

Answer 12

• Watters (2010) found Chinese, Korean and Iranian cultures report symptoms of depression as ‘tightness in chest’, ‘burning in gut’ and ‘stomach pain’.
• Thus language and cultural differences may lead to inaccurate diagnosis if culturally biased diagnostic tools are used

Question 13

clinical kq - ao1 stigma

Answer 13

Collectivist cultures (China) are less willing to talk about depression because of shame and embarrassment, so it isn’t diagnosed as often. Societies then have to deal with high numbers of severe cases when individuals are left undiagnosed and untreated.

Question 14

clinical kq - ao2 stigma

Answer 14

• Treatments can be adapted to encourage people to access them
• Choi (2012) adapted the western iCBT programme so it would be relevant and more engaging to Chinese-Australians by calling it ‘brighten your mood’
• It carries less stigma and is accessible online, removing the need to make treatment public.

Question 15

clinical kq - ao3 stigma

Answer 15

• Zheng (2017) found improvements to pp’s symptoms of depression up to 6 months after the end of ‘brighten your mood’ treatment.
• This shows culture can affect whether people access treatments so they should be modified to reflect culturally-specific experiences

Question 16

clinical kq - conclusion

Answer 16

Despite mental health being a global experience, culture plays a huge role in how it is experienced and therefore how it is diagnosed.
It is important for clinicians to strike a balance between the use of standardised and culturally sensitive diagnostic tools in order to ensure valid diagnosis and treatment.