Culturally sensitive assessment of anxious-depressive distress in the Cambodian population: Avoiding category truncation

Abstract

In a large national survey in Cambodia (N = 2689), the present study investigated the prominence of certain culturally salient symptoms and syndromes in the general population and among those with anxious-depressive distress (as determined by the Hopkins Symptom Checklist-25, or HSCL). Using an abbreviated Cambodian Symptom and Syndrome Addendum (CSSA), we found that the CSSA complaints were particularly elevated among those with anxious-depressive distress. Those with anxious-depressive distress had statistically greater mean scores on all the CSSA items as well as severity of endorsement analyzed by percentage: among those with HSCL caseness, 75.3% were bothered “quite a bit” or “extremely” by “thinking a lot” (vs. 27.5% without caseness); 53.8% were bothered by “standing up and feeling dizzy” (vs. 13.8%); and 45.6% by blurry vision (vs. 16.8%). In a logistic regression analysis to predict anxious-depressive distress, 51% of the variance was accounted for by five predictors: “weak heart,” “thinking a lot,” dizziness, “ khyâl hitting up from the stomach,” and sleep paralysis. Using ROC analysis, a cut-off score of 1.81 on the CSSA was optimal as a screener to indicate anxious-depressive distress, giving a sensitivity of 0.86. The study results suggest that to avoid category truncation (i.e., the omission of key complaints that are part of an assessed distress domain) when profiling anxious-depressive distress among Cambodia population that items other than those in standard psychopathology measures should be assessed such as “thinking a lot,” “weak heart,” “blurry vision,” and “dizziness upon standing up.”

Adaptive Functioning Behaviors for Trauma-Affected Children in the Cambodian Context

“…Religio-cultural practices, teachings, and ceremonies permeate child and caregiver responses in the current sample, including how children conceptualize, express, and cope with adverse life experiences and distress. This fits within a large body of cultural research in Cambodia and with Cambodian refugees that highlight religio-cultural belief systems as central to how Khmer people understand and express mental health problems (Bertrand, 2005; Chhim, 2013; Figge et al, 2020a; Hinton et al, 2002, 2005, 2019). For older populations, the reinstitution of Khmer Buddhist practices and beliefs is critical for shared healing following elimination of Buddhism and widespread violations of Buddhist rituals during the Khmer Rouge era (Kent, 2006), which is reflected in the various roles children in the current sample play in religio-cultural ceremonies and practices.…”

Cultural concepts of distress and psychiatric disorders: Understanding symptom experience and expression in context

“…Together, these CCDs accounted for 51% of the variance in predicting anxious-depressive distress after adjusting for several covariates. The authors also list 12 types of clinical utility from CCDs, including enhancing treatment processes like engagement, cognitive restructuring of catastrophic cognitions, and therapeutic alliance, which Hinton and his colleagues have illustrated in other publications (Hinton et al, 2019). Also in this issue, Gibson, Haslam and Kaplan note how the use of prevalent CCDs in Tuvalu that are closely related to anxiety, grief, and depressive disorders can increase the cultural validity of measures of distress in these communities and enhance ''clinical and public health communication and participation in psychosocial interventions'' (p. 685).…”

Prevalence and correlates of somatization in anxious individuals in a Chinese online crisis intervention during COVID-19 epidemic

“…Moreover, the genetic correlation between musculoskeletal pain and fatigue was particularly strong ( Vassend et al 2018 ). Fourth, anxiety-related dizziness is also common in the general population ( Hinton et al 2019 ; Lempert et al 2009 ).…”