Problems in communication in transcultural psychiatry

Kortmann, Frank

doi:10.1111/j.1600-0447.1987.tb02836.x

Cited by 32 publications

(15 citation statements)

References 14 publications

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“…The congruity and comprehensibility of each answer was tested and the intra-rater reliability assessed (test-retest after 15 days): a mean K value for each item which was invariably 1 0.75 was evidentiated. Subsequent to testing, the SRQ proved to be sufficiently comprehensible and reliable, contrary to previous results obtained in some African settings [18], although an excess of affirmative answers was found to 'psychotic' items (33%). This was interpreted as the effect of typical cultural beliefs, such as those regarding thought influence and premonitory voices, more than an indication of substantial psychotic symptoms.…”

Section: Instrumentscontrasting

confidence: 98%

“…No significant difference was found in 'psychosomatic symptoms' (items 1, 2, 7, 19), in items regarding physical energy (13,18,20), core depressive items (9,11,15), psychic anxiety and fear (items 4, 6) or in items regarding cognitive performances (8,9). Positive answers to the item concerning an external attribution of their uneasiness (item 21 modified) were more frequently found in depressed housewives (75 vs. 10% of nondepressed dressmakers, Fisher's exact test p !…”

Section: Resultsmentioning

confidence: 89%

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Depressive Symptoms and Occupational Role among Female Groups: A Research in a South-East African Village

Carta¹,

Carpiniello²,

Dazzan³

et al. 2000

Psychopathology

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Background: Although the relationships between social and cultural factors and African psychopathology have largely been considered from a theoretical point of view, empirical studies are still few and far between. This paper reports the results of a mental health survey conducted in the village of Namwera (Malawi, South-East Africa) to explore the link between social conditions, in particular occupational role, and psychopathology. Methods: A modified version of the Self-Reporting Questionnaire translated into Chichewa language was administered to 161 women (23 dressmakers, 46 nurses, 92 housewives). A Socio-Anamnestic Questionnaire and a Clinical Interview were also applied. Results: Dressmakers and housewives appeared more at risk of psychological suffering than nurses. Psychosomatic symptoms are more frequent among housewives, while dressmakers show more typical depressive symptoms, including suicidal thoughts and self-blame. Conclusions: Data confirm that also in an African context, some social factors are related to depression among female groups.

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Section: Instrumentscontrasting

confidence: 98%

Section: Resultsmentioning

confidence: 89%

Depressive Symptoms and Occupational Role among Female Groups: A Research in a South-East African Village

Carta¹,

Carpiniello²,

Dazzan³

et al. 2000

Psychopathology

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“…Edgerton [26] found that psychosis is not always attributed to witchcraft, and it was often regarded as an illness occurring for no reason or as the ‘natural result of life stress’. In the literature on local aetiological beliefs with regards to psychotic disorders in Africa, a wide range of factors have been described, such as substance misuse [31], nutritional factors [32], diseases of the blood [33], malaria [24] and ‘ worms in the brain’ [26] In this study, most of these factors were mentioned by the respondents, but there was variance between the settings. Among the Luo (arguably the setting that has been least influenced by monotheistic religions), spiritual causes were more prominent.…”

Section: Discussionmentioning

confidence: 90%

Madness or sadness? Local concepts of mental illness in four conflict-affected African communities

et al. 2013

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BackgroundConcepts of ‘what constitutes mental illness’, the presumed aetiology and preferred treatment options, vary considerably from one cultural context to another. Knowledge and understanding of these local conceptualisations is essential to inform public mental health programming and policy.MethodsParticipants from four locations in Burundi, South Sudan and the Democratic Republic of the Congo, were invited to describe ‘problems they knew of that related to thinking, feeling and behaviour?’ Data were collected over 31 focus groups discussions (251 participants) and key informant interviews with traditional healers and health workers.ResultsWhile remarkable similarities occurred across all settings, there were also striking differences. In all areas, participants were able to describe localized syndromes characterized by severe behavioural and cognitive disturbances with considerable resemblance to psychotic disorders. Additionally, respondents throughout all settings described local syndromes that included sadness and social withdrawal as core features. These syndromes had some similarities with nonpsychotic mental disorders, such as major depression or anxiety disorders, but also differed significantly. Aetiological concepts varied a great deal within each setting, and attributed causes varied from supernatural to psychosocial and natural. Local syndromes resembling psychotic disorders were seen as an abnormality in need of treatment, although people did not really know where to go. Local syndromes resembling nonpsychotic mental disorders were not regarded as a ‘medical’ disorder, and were therefore also not seen as a condition for which help should be sought within the biomedical health-care system. Rather, such conditions were expected to improve through social and emotional support from relatives, traditional healers and community members.ConclusionsLocal conceptualizations have significant implications for the planning of mental-health interventions in resource-poor settings recovering from conflict. Treatment options for people suffering from severe mental disorders should be made available to people, preferably within general health care facilities. For people suffering from local syndromes characterized by loss or sadness, the primary aim for public mental health interventions would be to empower existing social support systems already in place at local levels, and to strengthen social cohesion and self-help within communities.

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“…[6,7,15–19] Kortmann [15] had difficulties with the Amharic translation of the Self-Reporting Questionnaire (SRQ) in Ethiopia; more than one in four (26%) of affirmative responses proved invalid due to double-barreled questions, motivational biases, or a lack of conceptual congruity. Two items, “have you noticed any interference or anything else unusual with your thinking?” and “do you ever hear voices without knowing where they are coming from or which other people cannot hear?” are both long and have more than one question embedded within them, which made them difficult for respondents to understand and answer.…”

Section: Resultsmentioning

confidence: 99%

Measuring Depression and Anxiety in Sub-Saharan Africa

2013

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Background Despite being one of the leading causes of disability worldwide, fewer than 10% of depressed individuals in low-resource settings have access to treatment. Mounting evidence suggests that nonspecialist workers are capable of providing counseling and case management at the community level. They often use brief psychiatric screening instruments as clinical tools to identify cases and monitor symptoms over time. In order for such tools to be used in diverse settings, they must demonstrate adequate reliability and validity in addition to cross-cultural relevance. To be used to guide routine care they also need to be flexibly adapted and sensitive to change. The goal of this paper is to assess the cross-cultural validity of brief psychiatric screening instruments in sub-Saharan Africa, identify best practices, and discuss implications for clinical management and scale-up of mental health treatment in resource-poor settings. Method Systematic review of studies assessing the validity of screening instruments for depression, anxiety, and mental distress in sub-Saharan Africa using Medline and PsycINFO. Results Sixty-five studies from 16 countries assessing the validity of brief screening instruments for depression, anxiety, and/or mental distress. Conclusions Despite evidence of underlying universality in the experience of depression and anxiety in sub-Saharan Africa, differences in the salience, manifestation, and expression of symptoms suggest the need for the local adaptation of instruments. Rapid ethnographic assessment has emerged as a promising, low-cost, and efficient strategy for doing so.

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Problems in communication in transcultural psychiatry

Cited by 32 publications

References 14 publications

Depressive Symptoms and Occupational Role among Female Groups: A Research in a South-East African Village

Depressive Symptoms and Occupational Role among Female Groups: A Research in a South-East African Village

Madness or sadness? Local concepts of mental illness in four conflict-affected African communities

Measuring Depression and Anxiety in Sub-Saharan Africa

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