SOC363: 10. Comparative Flashcards
The Study of Generalizability
v Most of the research done in North America
v Major questions:
o Do concepts generalize?
The Study of Generalizability
o Do measures generalize?
o Are social patterns the same?
o Does the stress process apply?
The Study of Generalizability
o How does culture intervene?
• Much speculation, little evidence…until recently.
v Mainly questions; few clear answers
Kessler and International Epidemiology
The CIDI has been translated and modified for use in
over 30 countries in Europe, Africa, and Asia.
v Main concerns:
o Meaning of questions
o Differences in symptoms
Kessler and International Epidemiology
o Differences in disorders
v General approach:
Kessler and International Epidemiology
o Use local expert psychiatric teams to translate, change wording, add
questions…. Only when necessary.
o These teams claim most to all of the DSM disorders exist in their countries in some form.
Kessler and International Epidemiology
in diff society, there are differences in symptoms for same disorder and different prevalent disrders
The WHO Initiative: Prevalence in 17 Countries
The joint initiative – Kessler and a cast of millions
Prevalence is current prevalence (but age differences mean not really comparable), and projected lifetime is
projection when everyone is 75.
% under projected lifetime
The WHO Initiative: Prevalence in 17 Countries
strongly in europe, few in africa
many pathways of stress can lead to save disorders and issues
vU.S. the highest rate, but Colombia close (a stressful environment for a different reason)
The WHO Initiative: Prevalence in 17 Countries
-vNorthern / Eastern / Western European countries closer than others (Average LR = 44). big dropoff in LR also survey could have been done poorly if they don’t understand
The WHO Initiative: Prevalence in 17 Countries
vAsian and Southern European countries
lower. (Average LR = 24)
vNigeria lowest overall, China next
Projected Lifetime Risk
Actuarial methods used to project cumulative risk to age 75, to adjust for differences in age distributions and create a common ground for comparison.
vComparative patterns emerge when rates are presented
adjusting for lifetime risk.
Projected Lifetime Risk
Risk-to-prevalence ratios measure the likely result over time of age trends….
o Measured by the ratio of the lifetime risk to the current prevalence: how much will prevalence increase in the future?
o But may reflect special circumstances as well that apply at a point in history
Lifetime Risk in 17 Countries
- Highest risk to prevalence ratios in countries with high levels of continuing sectarian violence (Israel, Nigeria, South Africa.)
- Adjusting for this – no major differences between less and more developed countries
Lifetime Risk in 17 Countries
relative prevalence tend to be anxiety and affect, mood disorders
• But there is real variation across
countries in lifetime risk:
• About half in 6 countries
Lifetime Risk in 17 Countries
• One-third in 6 countries • One quarter in 3 countries • One fifth in 2 countries • But the patterns here do not suggest an explanation – just questions
Generalizations about Prevalence?
vAnxiety disorders most prevalent in 10; mood disorders in all but one of the rest.
vImpulse control disorders least prevalent
vAge of onset shows some consistency as well:
Generalizations about Prevalence?
-o Impulse control disorders occur over a narrow range (e.g., 7-9 for attention deficit, 9-14 for conduct disorder, 13-21 for intermittent explosive)
can’t have huge gaps in onset ages
Generalizations about Prevalence?
-o But some of the most prevalent disorders have a wider range of onset across societies:
• Generalized anxiety, panic, PTSD: median 24-50 is a wide range, though the middle
range of 31-41 is less dispersed.
Generalizations about Prevalence?
-• Mood disorders median onset 29-43. Also varied.
vSuggests differences in causation – but social. Not obviously biological.
Speculation, Hypotheses?
Life in developed Western societies actually more
stressful.: because rates are highest
2. not physical based disorders
vMeaning of mental health problems accepted as a
separate set of illnesses.
Speculation, Hypotheses?
-3. protect from high rates of disorder: Collectivist societies change life expectations and focus on individual functioning is lower priority.
Speculation, Hypotheses?
–4. The role of social “safety nets”?: social safety nets: Strong norms and relative homogeneity of culture and religion ..help?
Speculation, Hypotheses?
-5. Coping, history, and culture……: history of culture hom mental health responds to mental health
Mental health a “white” North American / Eurocentric
problem?
Other Countries,
Other Countries, Same Method: Lebanon
Karam et al., 2008.
lower overall rate despite history of war
3x rate of anxiety and higher mood than males
but also higher rate of impulse in males
Other Countries, Same Method: Lebanon
substance abuse significantly lower than NA and so low for males
20% for 8-34 vs 10.6% for 65+
more exposure to stressful circumstances
Other Countries, Same Method: Lebanon
vLower overall rate is obvious – despite war exposure in
the background of many of the respondents.
thus overall rates is much higher for females because substance abuse is missing for males
Other Countries, Same Method: Lebanon
vHighest relative single prevalence for depression, but
highest prevalence for class of disorders is for anxiety – similar to the U.S.
if we didn’t look at substance abuse, discussion on gender differences would be different
Main Similarities and Differences with U.S
-vGender differences similar for mood and anxiety
disorders..
v but low rate of substance use affects overall balance – thus higher rates overall among females.-
Main Similarities and Differences with U.S
–thus overall rates is much higher for females because substance abuse is missing for males
if we didn’t look at substance abuse, discussion on gender differences would be different
Main Similarities and Differences with U.S
-v Cohort shifts or war exposure??
vWar exposure does affect risk…..
Main Similarities and Differences with U.S
Odds mostly above 1..
Mostly 5 to 15 times the risk
all at least 5-10 OR
creates higher risk for disorder
Speculation, Hypotheses?
vLife in developed Western societies actually more
stressful.
vMeaning of mental health problems accepted as a
separate set of illnesses.
vCollectivist societies change life expectations and focus
on individual functioning is lower priority.
vStrong norms and relative homogeneity of culture and
religion ..help?
Speculation, Hypotheses?
-vThe role of social “safety nets”? vCoping, history, and culture…… vMental health a “white” North American / Eurocentric problem? 9 9 Other Countries,
Speculation, Hypotheses?
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Speculation, Hypotheses?
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Speculation, Hypotheses?
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Speculation, Hypotheses?
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Speculation, Hypotheses?
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Other Countries, Same Method: Lebanon
vKaram et al., 2008.
Other Countries, Same Method: Lebanon
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Other Countries, Same Method: Lebanon
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Other Countries, Same Method: Lebanon
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Other Countries, Same Method: Lebanon
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Main Similarities and Differences with U.S
vLower overall rate is obvious – despite war exposure in
the background of many of the respondents.
vHighest relative single prevalence for depression, but
highest prevalence for class of disorders is for anxiety – similar to the U.S.
Main Similarities and Differences with U.S
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Main Similarities and Differences with U.S
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Main Similarities and Differences with U.S
vGender differences similar for mood and anxiety
disorders..
v but low rate of substance use affects overall balance – thus higher rates overall among females.
v Cohort shifts or war exposure??
vWar exposure does affect risk…..
Main Similarities and Differences with U.S
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Main Similarities and Differences with U.S
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Main Similarities and Differences with U.S
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Odds Ratios due to “war events” in Lebanon
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Odds Ratios due to “war events” in Lebanon
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Odds Ratios due to “war events” in Lebanon
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Other Countries, Same Method: China
vLee et al. (2007) –Beijing and Shanghai vTaken at face value, the rates of all of these problems is much lower in China. vBut note the two most prevalent similar to U.S. – depression and alcohol abuse. v Reporting problem or difference in meaning?
Other Countries, Same Method: China
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Other Countries, Same Method: China
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Other Countries, Same Method: China
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Other Countries, Same Method: China
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Cohort Change in Metropolitan China
Sharp drop in rates beyond youngest cohort…
