STIGMA, DEPRESSION, AND SOMATIZATION IN SOUTH-INDIA

Objective: The relationships of stigma to both depression and somatiza tion were studied in psychiatric patients in South India to test the h ypothesis that stigma is positively related to depressive symptoms and negatively related to somatoform symptoms. Method: Illness experience , symptom prominence, and indicators of stigma for 80 psychiatric outp atients were assessed with the Explanatory Model Interview Catalogue. Stigma scores and ratings of symptoms prominence were derived. The Str uctured Clinical Interview for DSM-III-R and the Hamilton Depression R ating Scale were administered to assess psychiatric diagnoses and symp toms of depression. Clinical narratives were analyzed to clarify the n ature of relationships between stigma and symptom prominence. Results: The mean stigma scores were 18.2 (SD=13.0) for patients with somatofo rm disorders only, 36.0 (SD=19.0) for patients with depressive disorde rs only, and 26.8 (SD=16.0) for those with mixed depressive and somato form disorders. The stigma scores were positively related to depressiv e symptoms, as indicated by Hamilton scale scores and prominence ratin gs for depressive symptoms, but stigma was inversely related to somato form symptoms, as indicated by ratings of symptom prominence. Although both depressive and somatic symptoms were distressing qualitative ana lysis clarified meanings of perceived stigma, showing that depressive symptoms, unlike somatic symptoms, were construed as socially disadvan tageous. Conclusions: The tendency to perceive and report distress in psychological or somatic terms is influenced by various social and cul tural factors, including the degree of stigma associated with particul ar symptoms. This study with the Explanatory Model Interview Catalogue demonstrates how quantitative and qualitative methods can be effectiv ely combined to examine Key issues in cultural psychiatry.