Better understanding of cultural context vital component of global mental health
TORONTO — Identifying differences in diagnostic practices among psychiatrists across the world can help improve cultural competency among clinicians, according to data presented here at the American Psychiatric Association Annual Meeting.
“Understanding how different psychiatrists in different parts of the world diagnose mental illness is a way for us to all be better international psychiatrists,” Jhilam Biswas, MD, fellow at the University of Massachusetts Psychiatry and the Law Program, said during a presentation here. “Particularly, the field of global mental health is certainly enhancing and becoming a large part of psychiatric training programs today. A big problem in psychiatry is that psychiatrists don’t often feel comfortable in different cultural contexts, so this might be an evidence-based way of looking at how different psychiatrists diagnose mental illness.”
To compare diagnostic practices across cultures, Biswas and colleagues surveyed 47 psychiatrists in Boston and 52 in Bangalore, India, on the criteria for depression, bipolar mania and psychosis. Participants were then asked to rank the criteria on a scale of one to 10 based on frequency of symptoms among patients. They also ranked barriers to access of care in their community. Mean age and level of education was similar among participants.
The top four symptoms of depression identified were similar among psychiatrists in Boston and Bangalore: easily fatigued, decreased interested in pleasurable activities, pessimistic view of the future and insomnia. However, Biswas and colleagues identified significant differences in certain symptoms: pessimism and obsessive thoughts were more often used to diagnose depression in the U.S. In India, specific somatic pain was used as an indicator of depression (P = .000000).
When looking at criteria for mania, some symptoms were similar among both groups, including grandiosity and a decreased need for sleep. In India, however, activation energy — specifically anger, agitation and violent behavior — was more commonly used to diagnose mania. In the U.S., pressured speech and distractibility were most common.
Lastly, Biswas and colleagues found the top four symptoms for psychosis and schizophrenia were similar among groups: delusions, paranoia, lack of insight and auditory hallucinations. Additionally, visual hallucinations and peculiar movement disorders were least commonly seen among both groups. However, Indian psychiatrists found delusions more common compared with U.S. psychiatrists who found paranoia to be most common.
With regard to barriers to access to care, psychiatrists in the U.S. reported substance abuse as a significant barrier, while those in India saw the issue of embarrassing the family as a major barrier.
“There are a lot of parts of the world where there are no psychiatrists,” Biswas said. “We need to teach community health workers to learn how to triage mental illness, and understanding cultural context is a very important way to teach global mental health.”
In addition, Biswas said that in the U.S there are more international psychiatrists than there are American graduates, therefore this research may help curb cultural biases at play in the diagnostic practices of international psychiatrists in the U.S. or Canada. – by Stacey L. Adams
Disclosure: Biswas reports no relevant financial disclosures.
Biswas J, et al. #P2-2. Presented at: American Psychiatric Association Annual Meeting; May 16-20, 2015; Toronto.