Diagnostic pattern for neuroses in China, Japan, and the United States

A rasch model to test the cross-cultural validity in the positive and negative syndrome scale (PANSS) across six geo-cultural groups

Background

The objective of this study was to examine the cross-cultural differences of the PANSS across six geo-cultural regions. The specific aims are (1) to examine measurement properties of the PANSS; and (2) to examine how each of the 30 items function across geo-cultural regions.

Methods

Data was obtained for 1,169 raters from 6 different regions: Eastern Asia (n = 202), India (n = 185), Northern Europe (n = 126), Russia & Ukraine (n = 197), Southern Europe (n = 162), United States (n = 297). A principle components analysis assessed unidimensionality of the subscales. Rasch rating scale analysis examined cross-cultural differences among each item of the PANSS.

Results

Lower item values reflects items in which raters often showed less variation in the scores; higher item values reflects items with more variation in the scores. Positive Subscale: Most regions found item P5 (Excitement) to be the most difficult item to score. Items varied in severity from −0.93 [item P6. Suspiciousness/persecution (USA) to 0.69 item P4. Excitement (Eastern Asia)]. Item P3 (Hallucinatory Behavior) was the easiest item to score for all geographical regions. Negative Subscale: The most difficult item to score for all regions is N7 (Stereotyped Thinking) with India showing the most difficulty Δ = 0.69, and Northern Europe and the United States showing the least difficulty Δ = 0.21, each. The second most difficult item for raters to score was N1 (Blunted Affect) for most countries including Southern Europe (Δ = 0.30), Eastern Asia (Δ = 0.28), Russia & Ukraine (Δ = 0.22) and India (Δ = 0.10). General Psychopathology: The most difficult item for raters to score for all regions is G4 (Tension) with difficulty levels ranging from Δ = 1.38 (India) to Δ = 0.72.

Conclusions

There were significant differences in response to a number of items on the PANSS, possibly caused by a lack of equivalence between the original and translated versions, cultural differences among interpretation of items or scoring parameters. Knowing which items are problematic for various cultures can help guide PANSS training and make training specialized for specific geographical regions.

Concordance of reports of mental health functioning by adolescents and their caregivers: a comparison of European, African and Latino Americans

The purpose of this study was to examine the concordance of parental and adolescent reports of adolescents having emotional and behavioral problems. Data were collected from youths (age 11-17) and adult caregivers from a community-based sample of households. The sample consisted of 4175 youths and their caregivers (37.8% European, 35.0% African, 25.4% Latino, and 1.8% other American). Indicators of emotional and/or behavioral problems were global indicators: perceived mental health, life satisfaction, happiness, interpersonal problems at home, and problems at school. Overall, parent-child concordance on the indicators of mental health was low, with a mean kappa value of 0.12. In multivariate analyses, European American parent-youth dyads were significantly more likely to be concordant on reports of perceived mental health, problems at home, and problems at school than African American and Latino dyads. Our data suggest that ethnicity is a significant factor in parental labeling and awareness of adolescent mental health problems. Future research should examine whether the extent to which greater lack of concordance on the indicators of mental health by minority parent-child dyads plays a role in entry into and retention in mental health care.

Assessment of psychopathology across and within cultures: issues and findings

Research based information on the impact of culture on psychopathology is reviewed, with particular reference to depression, somatization, schizophrenia, anxiety, and dissociation. A number of worldwide constants in the incidence and mode of expression of psychological disorders are identified, especially in relation to schizophrenia and depression. The scope of variation of psychopathological manifestations across cultures is impressive. Two tasks for future investigations involve the determination of the generic relationship between psychological disturbance and culture and the specification of links between cultural characteristics and psychopathology. To this end, hypotheses are advanced pertaining to the cultural dimensions investigated by Hofstede and their possible reflection in psychiatric symptomatology. It is concluded that the interrelationship of culture and psychopathology should be studied in context and that observer, institution, and community variables should be investigated together with the person's experience of distress and disability.

Multi-cultural study of minor psychiatric disorders in Asia: symptom manifestations

Patients with minor psychiatric disorders, including neuroses, situational adjustment reaction or acute emotional reaction, were investigated using symptom questionnaires at five research sites in Asia including: Chiang-Mai, Thailand; Bali, Indonesia; Kao-Hsiung, Taiwan, China; Shanghai, China; and Tokyo, Japan. The results revealed that the symptom profiles differ significantly among groups of different settings indicating that sociocultural background does contribute to the manifestation of neurotic symptomatology. It was also found that numerous and various subtypes of somatic scales were identified through factor analysis of symptoms for these Asian populations. It demonstrates that the spectrum of neurotic symptoms has a different focus for subjects in different sociocultural settings.

Comparative study of affective disorders in three Asian countries. I. Differences in diagnostic classification

A study aimed at the standardization of symptom evaluation of patients with depression was carried out as the first step in an extensive collaborative study on affective disorders between centers in Nagasaki, Shanghai and Seoul. This study was initiated in order to clarify the factors affecting the low reported prevalence rates of depressive disorders in Asia. No significant difference in evaluation of psychiatric symptoms was observed between the 3 centers. Nevertheless, the diagnoses given by ICD-9 showed very interesting differences. For any given case, Nagasaki tended to make a diagnosis of an affective psychosis depression, while Shanghai made a diagnosis of neurotic disorder. No significant tendency was observed in the Seoul center. These findings are discussed in terms of their importance for future international collaborative studies.