Lecture 4: Cultural factors Flashcards
Discuss Kraepelin Early studies of culture
Kraepelin:
Visited Java in 1904 and was interested in comparing disorders across-cultures
He, like many physicians of that time, attributed differences in psychiatric disorders to race (like some disorders were considered to be “female”)
Belief that “races” (which included people from other parts of Europe) differed in their “character” or psychological make-up
Seems obsolete, but
We continue to have biases and stereotypes about people from different backgrounds
“laidback” “emotional” “religious
What are the three sources of effects that are hard to separate?
1) Cultural variation in presentation
2) Cultural dislocation and effects of migration
3) Ethnic or cultural variation in risk factors for SZ
Explain the Cultural variation in presentation
1) Different expression of symptoms (Some cultures may express more physical symptoms, rather than “psychological” symptoms, e.g., tired vs depressed; restless vs anxious)
2) People may view and describe psychological experiences and distress differently (People may be reluctant to express distress, or may see distress as normal, e.g., “fate” or “god’s will”)
3) Poor understanding of cultural variations may result in under- or over diagnosis
4) This can affect estimates of prevalence, and assessment of outcomes
Explain Cultural dislocation and SZ – effects of migration
- Immigrants more likely to be diagnosed with and to suffer from psychotic disorders
- This may be mis-diagnosis
- Or, the causes and/or consequences of migration may have negative effects on mental health
Explain Ethnic or cultural variation in risk factors for SZ
Different genetic susceptibility (think cancer, diabetes)
Risk of exposure to infection in home or country of migration
Particular cultures may predispose to certain disorders (i.e Eating disorders in Westernized cultures)
Cultures or societies under stress (war, repression, disaster)
Across all cultures, some people report psychotic-like symptoms. In fact, Isolated psychotic symptoms not uncommon across cultures. What is the lifetime prevalence?
5%
People from cultural and ethnic minorities are ______ more likely to report psychotic-like symptoms
1.5%
Psychotic-like symptoms are linked to ___________ in both Asians and Latinos in the US
acculturative stress
Which ethnic group seen for any psychiatric problem more commonly report psychotic-like symptoms?
Latinos
It is important to assess whether symptoms are ________________________
prodromal SZ or other psychological problems
___________ and ________ can affect prevalence estimates
Reliability and appropriateness of diagnostic tools
Immigrants are at higher risk. Give examples of risk factors.
- Particularly black immigrants to the UK, US, Netherlands and Canada
- Low SES to high SES
- Age at migration
Higher risk persists for ____________
second generation
What are the possible contributors?
Migration stress and biases in diagnosis
Explain further the migration stress.
- Home country (war, poverty, disaster, discrimination)
- New country (stress related to loss of culture, employment, isolation, discrimination)
Give examples for biases in diagnosis.
- Cultural and language barriers
- Racial and ethnic biases in assessment
Symptoms express themselves differently. The content of hallucinations and delusions varies. Give examples for White people, Black people and Latinos.
White: more delusions, grandiosity.
Black: more paranoia, suspiciousness.
Latino: more somatic, religious and family content
Is higher rate of SZ diagnosis in immigrants the result of clinician bias? If so, provide an explanation.
Yes. Longitudinal studies show more variable diagnosis, suggests contribution of bias of individual clinicians.
Expression differences may also contribute to what?
More persecutory content in black people may lead to bias to diagnose psychosis
Poorer access to health care may lead to ______________________________
longer untreated psychosis, leading to more severe symptoms
In regard to genetic variation, SZ risk is related to a __________________
large number of genes
Exposure to ___________ depending on country of origin or migration can increase risk of SZ
prenatal or early childhood infection
The DSM-V Cultural formulation interview is designed to help clinicians address __________
cultural context in diagnostic interviews
The DSM-V Cultural formulation interview encourages people to express ____________
culturally specific views of their issues and views of treatment
What are examples of questions you would ask in a DSM-V Cultural formulation interview?
- Sometimes people have different ways of describing problems to family and friends. How would you describe your problem to them?
- Why do you think this is happening to you?
- What do your family, community think you should do?
However, what is an important caution to remember in regard to the DSM-V Cultural formulation interview?
These are questions good clinicians should ask everyone! Be careful not to marginalize people
