Transcultural psychiatry: Some social and epidemiological research issues

Background: Mental Health Research across cultural groups is often criticis ed for using imprecise measures of cultural group and for using outcome mea sures as if they have universal validity. Aims: 1. To Investigate the effect of using different cultural group variab les on the findings of a survey of prevalence of Common Mental Disorders. 2 . To demonstrate that assumptions of validity for outcomes measures can aff ect the interpretation of data from prevalence surveys. Methods: We recruited Punjabi and English subjects to a phase prevalence su rvey that included the Amritsar Depression Inventory and the General Health Questionnaire as screening instruments. The Clinical Interview Schedule wa s the outcome measure. This paper reports on a secondary analysis of the da ta. We used ethnic group, place of birth, religion, first language and lang uage spoken at interview as possible cultural group variables and compared the prevalence estimates. We then considered the limitations of conventiona l methods to assess prevalence, by looking at mean scores on each of the th ree instruments in both cultural groups. Results: Cultural group variables did not influence the prevalence estimate s for Common Mental Disorder. Although conventional scoring methods showed no difference in prevalence across cultures, the mean scores on each instru ment, when compared across cultural groups, differed for the Amritsar Depre ssion Inventory. This instrument showed a higher mean score for the Punjabi s suggesting a higher prevalence. The findings are discussed in the context of value laden 'assumptions' about validity. Conclusions: The findings of prevalence surveys depend on assumptions of va lidity. The 'culture' of psychiatry is a closed system in which validation studies support its basic assumptions.