Culturally Sensitive Assessment of Anxious-Depressive Distress in Vietnam: Avoiding Category Truncation

Abstract

The present study investigated what complaints are prominent in psychologically distressed Vietnamese in Vietnam beyond standard symptoms assessed by Western diagnostic instruments for anxiety and depression. To form the initial Vietnamese Symptom and Cultural Syndrome Addendum (VN SSA), we reviewed the literature, consulted experts, and conducted focus groups. The preliminary VN SSA was then used in a general survey (N = 1004) of five provinces in Vietnam. We found that the VN SSA items were highly and significantly correlated with a measure of anxious-depressive psychopathology (a composite measure of the General Anxiety Disorder-7; Posttraumatic Diagnostic Scale; and Patient Health Questionnaire-9). The VN SSA item most highly correlated to anxious-depressive psychopathology was "thinking a lot" ( r = .54), reported by 15.8% of the sample. Many other symptoms in the addendum also were prominent, such as orthostatic dizziness (i.e., dizziness upon standing up; r = .41), reported by 22.9% of the sample. By way of comparison, somatic complaints more typically assessed to profile Western anxious-depressive distress, such as palpitations, were less prominent, as evidenced by being less strongly correlated to Western psychiatric symptoms and being less frequent (e.g., palpitations: r = .31, 7.1% of the sample). Study results suggest that to avoid category truncation when profiling anxious-depressive distress among Vietnamese that items other than those in standard psychopathology measures should also be assessed.

The integration of idioms of distress into mental health assessments and interventions: a systematic review

“…Identification of idioms/CCDs was described as being carried out in a number of ways: conducting qualitative interviews as part of the research activity reported in the papers (Patel et al ., 1997; Miller et al ., 2006; Bolton et al ., 2007; Bass et al ., 2008; Fernando, 2008; Kaaya et al ., 2008; Silove et al ., 2009; Betancourt et al ., 2009 a ; Mcmullen et al ., 2012; Rasmussen et al ., 2014; Snodgrass et al ., 2017; Green et al ., 2018); utilising qualitative interview data from other research teams (Rasmussen et al ., 2015); extracting data from clinical case notes (Mumford et al ., 2005; Abeyasinghe et al ., 2012) and combined approaches such as reviewing relevant literature as well as gathering qualitative data (Phan et al ., 2004; Kohrt et al ., 2016); reviewing literature as well as using information from clinical experience (Hinton et al ., 2018); participant observation, observant participation and qualitative interviews (Kaiser et al ., 2013, 2015); and patient chart notes as well as qualitative interviews (Fabian et al ., 2018). Amongst the studies that used qualitative research methods, the most common ways of gathering information on idioms/CCDs were carrying out free-list interviews, focus groups and in-depth interviews with key informants.…”

“…While one paper stated that research was carried out in participants' ‘first language’ (Fernando, 2008), it was not clear whether this was the case with other papers. Research was carried out: with participants who were ‘fluent in’ or ‘spoke the language’ used (Phan et al ., 2004; Abeyasinghe et al ., 2012), in the ‘local language’ (Bass et al ., 2008), in the language of the target ethnic group (Ice & Yogo, 2005; Bolton et al ., 2007; Betancourt et al ., 2009 a ; Mcmullen et al ., 2012); in the preferred language of communication (Hinton et al ., 2011; Weaver & Hadley, 2011; Rasmussen et al ., 2014; Weaver, 2017); the most widely spoken language (Patel et al ., 1997; Kaiser et al ., 2013, 2015; Rasmussen et al ., 2015); the national language (Roberts et al ., 2006; Kaaya et al ., 2008; Hinton et al ., 2012 a , 2013, 2018; Kohrt et al ., 2016; Green et al ., 2018) and the more common language in a multi-lingual context (Mumford et al ., 2005; Miller et al ., 2006; Snodgrass et al ., 2017; Fabian et al ., 2018). In two studies, there was no discussion of what language the research was carried out in (Choi & Lee, 2007; Silove et al ., 2009).…”

“…Sixteen studies discussed incorporating idioms/CCDs into the items of an assessment measure (including measures made up of a range of idioms). Most discussed developing novel assessments for the same cultural group from whom the idiom/CCDs data were gathered (Patel et al ., 1997; Phan et al ., 2004; Ice & Yogo, 2005; Mumford et al ., 2005; Miller et al ., 2006; Bolton et al ., 2007; Fernando, 2008; Betancourt et al ., 2009 a ; Abeyasinghe et al ., 2012; Mcmullen et al ., 2012; Hinton et al ., 2012 a , 2013, 2018; Kaiser et al ., 2013, 2015; Rasmussen et al ., 2014; Rasmussen et al ., 2015; Snodgrass et al ., 2017; Fabian et al ., 2018); while five discussed the use of idioms/CCDs in the adaptation of pre-existing instruments created elsewhere (Bass et al ., 2008; Kaaya et al ., 2008; Silove et al ., 2009; Kohrt et al ., 2016; Green et al ., 2018). Three studies described the development of a checklist or scale for assessing levels of symptoms of a particular idiom/CCD previously identified in the literature: Weaver & Hadley (2011) and Weaver (2017) describe the development of an original checklist within the target population; and Roberts et al .…”

Depression and its associated factors among pregnant women in central Vietnam

“…This study was one of the first studies on depression among pregnant women in the central region of Vietnam. The main strength of this study was that we used a standardized, validated instrument to measure self reported depressive symptoms (Collier et al, 2020;Dreher et al, 2017;Hinton et al, 2018;Nguyen et al, 2016;Vo et al, 2019). Furthermore, data collectors were well-trained midwives which ensured the quality of data collection.…”

Cultural Scripts of Traumatic Stress: Outline, Illustrations, and Research Opportunities

“…In contrast to broader sets of changes within the phenomenological field of a given traumatized individual, descriptions of traumatic stress that appear in the clinical literature are far more succinct (e.g., Terr, 1988; Horowitz, 1997; Somasundaram, 2007; Hinton and Lewis-Fernández, 2010), comprising symptoms that are filtered down from the full phenomenological fields by patients and/or clinicians. Hinton et al (2018) described this discrepancy as a potential “category truncation,” pointing to the need to assess culturally specific sets of symptoms that are representative of local phenomenological fields. Given the complexity of trauma-related changes, it is not surprising that patients filter their own experiences based on a number of considerations, such as what symptoms are attributed to trauma, what hurts the most, what is considered the most problematic or most meaningful, the most appropriate to talk about, and the most likely to elicit support from others.…”