Abstract
Increasingly, the mental health needs of populations are measured using large-sample surveys with standardized measures and methods. Such efforts, however, rarely include sufficient number of smaller, culturally defined populations to draw defensible conclusions about their needs. Furthermore, without some adaptation, the standardized methods and measures may yield invalid results in such populations. Using a recently completed psychiatric epidemiology and services study with American Indian populations as a case example, this paper outlines issues facing epidemiologists working in such culturally diverse contexts. The issues discussed include the following: (1) persuading the scientific community and potential sponsors that work with distinct or culturally defined populations is important; (2) framing research questions and activities to meet the needs of communities; (3) defining a population of inference; (4) balancing the needs for comparability and cultural specificity; (5) maximizing scientific validity in light of the challenges in sample acquisition; and (6) developing and implementing data collection methods that uphold scientific standards but are also realistic given the context. The authors draw on their experiences—most recently in the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP)—to illustrate these issues and suggest ways to address each. A goal of this paper is to challenge those invested in conducting culturally valid epidemiologic work in such populations to better articulate the nature of these efforts.
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REFERENCES
Aderibigbe, Yekeen, and S.K. Adityanjee 1995 Psychiatric Epidemiology in Cross-Cultural Perspective: A Review. European Archives of Psychiatry and Clinical Neuroscience 246(1): 37–46.
Beals, Janette, Spero Manson, Ellen Keane, and Rhonda Dick 1991 Factorial Structure of the Center for Epidemiologic Studies: Depression Scale among American Indian College Students. Psychological Assessment: A Journal of Consulting and Clinical Psychology 3(4): 623–627.
Beals, Janette, Spero Manson, James Shore, Matthew Friedman, Marie Ashcraft, John Fairbank, and William Schlenger 2002a The Prevalence of Posttraumatic Stress Disorder among American Indian Vietnam Veterans: Disparities and Context. Journal of Traumatic Stress 15(2): 89–97.
Beals, Janette, Douglas Novins, Christina Mitchell, James Shore, and Spero Manson 2002b Comorbidity between Alcohol Abuse/Dependence and Psychiatric Disorders: Prevalence, Treatment Implications, and New Directions for Research among American Indian Populations. In Alcohol Use among American Indians and Alaska Natives: Multiple Perspectives on a Complex Problem. Patricia Mail, Suzanne Heurtin-Roberts, Susan Martin, and Jan Howard, eds., pp. 371–410. Bethesda, MD: U.S. Department of Health and Human Services.
Beals, Janette, Joan Piasecki, Scott Nelson, Monica Jones, Ellen Keane, Paul Dauphinais, Roy Red Shirt, William Sack, and Spero Manson 1997 Psychiatric Disorder among American Indian Adolescents: Prevalence in Northern Plains Youth. Journal of the American Academy of Child and Adolescent Psychiatry 36(9): 1252–1259.
Buchwald, Dedra, Janette Beals, and Spero Manson 2000 Use of Traditional Health Practices among Native Americans in a Primary Care Setting. Medical Care 38(12): 1191–1199.
Bureau of Indian Affairs 2000 Indian Entities Recognized and Eligible to Receive Services from the United States Bureau of Indian Affairs. Washington, D.C.: Federal Register.
Burman, William J., Randall Reves, David Cohn, and Robert Schooley 2001 Breaking the Camel's Back: Multicenter Clinical Trials and Local Institutional Review Boards. Annals of Internal Medicine 134(21): 152–157.
Byers, Tim, and John Hubbard 1997 The Navajo Health and Nutrition Survey: Research That Can Make a Difference. Journal of Nutrition 127(10 Suppl): 2075S-2077S
Canino, Glorisa, Hector Bird, Patrick Shrout, Maritza Rubio-Stipec, Milagros Bravo, Ruth Martinez, Myrna Sesman, and Luz Guevara 1987 The Prevalence of Specific Psychiatric Disorders in Puerto Rico. Archives of General Psychiatry 44(8): 727–735.
Cochran, William 1977 Sampling Techniques. New York: Wiley.
Cook, Thomas, and Donald Campbell 1979 Quasi-Experimentation: Design and Analysis Issues for Field Settings. Chicago: Rand McNally.
Dohrenwend, Bruce, ed. 1998 Adversity, Stress, and Psychopathology. New York, NY: Oxford University Press.
Donovan, John, and Richard Jessor 1985 Structure of Problem Behavior in Adolescence and Young Adulthood. Journal of Consulting and Clinical Psychology 53(6): 890–904.
Driver, Harold 1971 Indians of North America. Chicago: University of Chicago Press.
Eriksen, Eugene 1996 Problems in Sampling Native American and Alaska Native Populations. In Changing Numbers, Changing Needs: American Indian Demography and Public Health. Gary Sandefur, Ronald Rindfuss, and Barney Cohen, eds., pp. 113–129. Washington, D.C.: National Academy Press.
Fleming, Candace 1996 Cultural Formulation of Psychiatric Diagnosis. Case No. 1. An American Indian Woman Suffering from Depression, Alcoholism and Childhood Trauma. Culture, Medicine and Psychiatry 20(2): 145–154.
Foulks, Edward, and Steven Katz 1973 The Mental Health of Alaskan Natives. Acta Psychiatrica Scandavica 49(1): 91–96.
Gurley, Diana, Douglas Novins, Monica Jones, Janette Beals, James Shore, and Spero Manson 2001 Comparative Use of Biomedical Services and Traditional Healing Options by American Indian Veterans. Psychiatric Services 52(1): 68–74.
Henderson, A. Scott 1998 New Methods in Psychiatric Epidemiology. Psychiatry and Clinical Neurosciences 52(Suppl): S261-S264.
Kehoe, Alice 1992 North American Indians: A Comprehensive Account. Englewood Cliffs, NJ: Prentice Hall.
Kessler, Ronald 2000 Psychiatric Epidemiology: Selected Recent Advances and Future Directions. Bulletin of the World Health Organization 78(4): 464–474.
Kessler, Ronald, Katherine McGonagle, Shanyang Zhao, Christopher Nelson, Michael Hughes, Suzann Eshleman, Hans-Ulrich Wittchen, and Kenneth Kendler 1994 Lifetime and 12-Month Prevalence of DSM-III-R Psychiatric Disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry 51(1): 8–19.
Kinzie, J. David, Paul Leung, James Boehnlein, Don Matsunaga, Robert Johnston, Spero Manson, James Shore, John Heinz, and Mary Williams 1992 Psychiatry Epidemiology of an Indian Village: A 19-Year Replication Study. Journal of Nervous and Mental Disease 180(1): 33–39.
Kulka, Richard, William Schlenger, John Fairbank, Richard Hough, B. Kathleen Jordan, Charles Marmar, and Daniel Weiss 1990 Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study. New York: Bruner/Mazel.
Kunitz, Stephen, and Jerrold Levy 1991 Navajo Aging. Tucson, AZ: University of Arizona Press.
Manson, Spero 1994 Culture and Depression: Discovering Variations in the Experience of Illness. In Psychology and Culture. Walter Lonner and Roy Malpass, eds., pp. 285–290. Needham, MA: Allyn and Bacon. Manson, Spero 1996 Culture and DSM-IV: Implications for the Diagnosis of Mood and Anxiety Disorders. In Culture and Psychiatric Diagnosis. Juan Mezzich, Arthur Kleinman, Horacio Fabrega, and Delores Parron, eds. Washington, DC: American Psychiatric Association Press. Manson, Spero 1997 Ethnographic Methods, Cultural Context, and Mental Illness: Bridging Different Ways of Knowing and Experience. Ethos 25(2): 239–258.
Manson, Spero, James Shore, and Joseph Bloom 1985 The Depressive Experience in American Indian Communities: A Challenge for Psychiatric Theory and Diagnosis. Berkeley, CA: University of California Press.
Mitchell, Christina, and Janette Beals 1997 The Structure of Problem and Positive Behavior among American Indian Adolescents: Gender and Community Differences. American Journal of Community Psychology 25(3): 237–288.
Mitchell, Christina, Douglas Novins, and Tamara Holmes 1999 Marijuana Use among American Indian Adolescents: A Growth Curve Analysis from Ages 14 through 20. Journal of the American Academy of Child and Adolescent Psychiatry 38(1): 72–78.
Mitchell, Christina, and Theresa O'Nell 1998 Problem and Conventional Behavior among American Indian Adolescents: Structure and Validity. Journal of Research on Adolescence 8(1): 97–122.
Narrow, William, Donald Rae, Lee Robins, and Darrell Regier 2002 Revised Prevalence Estimates of Mental Disorders in the United States: Using a Clinical Significance Criterion to Reconcile Two Surveys' Estimates. Archives of General Psychiatry 59(2): 115–123.
National Center for Posttraumatic Stress Disorder and the National Center for American Indian and Alaska Native Mental Health Research 1996 Matsunaga Vietnam Veterans Project. White River Junction, VT: National Center for PTSD.
Norton, Ilena, and Spero Manson 1996 Research in American Indian and Alaska Native Communities: Navigating the Cultural Universe of Values and Process. Journal of Consulting and Clinical Psychology 64(5): 856–860.
Novins, Douglas, Janette Beals, Robert Roberts, and Spero Manson 1999 Factors Associated with Suicide Ideation among American Indian Adolescents: Does Culture Matter? Suicide and Life-Threatening Behavior 29(4): 332–346.
O'Nell, Theresa 1989 Psychiatric Investigations among American Indians and Alaska Natives: A Critical Review. Culture, Medicine and Psychiatry 13(1): 51–87. O'Nell, Theresa 1993 “Feeling Worthless”: An Ethnographic Investigation of the Comorbidity of Depression and Problem Drinking at the Flathead Reservation. Culture, Medicine and Psychiatry 16(4): 447–470. O'Nell, Theresa 1996 Disciplined Hearts: History, Identity, and Depression in an American Indian Community. Berkeley, CA: University of California Press.
O'Nell, Theresa, and Christina Mitchell 1996 Alcohol Use among American Indian Adolescents: The Role of Culture in Pathological Drinking. Social Science and Medicine 42(4): 565–578.
Palinkas, Lawrence, John Russell, Michael Downs, and John Petterson 1992 Ethnic Differences in Stress, Coping, and Depressive Symptoms after the Exxon Valdez Oil Spill. Journal of Nervous and Mental Disease 180(5): 287–295.
Regier, Darrell, Charles Kaelber, Donald Rae, Mary Farmer, Barbel Knauper, Ronald Kessler, and Grayson Norquist 1998 Limitations of Diagnostic Criteria and Assessment Instruments for Mental Disorders: Implications for Research and Policy. Archives of General Psychiatry 55(2): 109–115.
Regier, Darrel, and William Narrow 2002 Defining Clinically Significant Psychopathology with Epidemiologic Data. In Defining Psychopathology in the 21st Century: DSM-V and Beyond. John Helzer and James Hudziak, eds., pp. 19–30. Washington, D.C.: American PsychiatricPublishing, Inc.
Regier, Darrel, William Narrow, Agnes Rupp, Donald Rae, and Charles Kaelber 2000 The Epidemiology of Mental Disorder Treatment Need: Community Estimates of “Medical Necessity.” In Unmet Need in Psychiatry: Problems, Resources, Responses. Gavin Andrews and A. Scott Henderson, eds., pp. 41–58. New York: Cambridge University Press.
Robin, Robert, Barbara Chester, James Rasmussen, James Jaranson, and David Goldman 1997 Prevalence and Characteristics of Trauma and Posttraumatic Stress Disorder in a Southwestern American Indian Community. American Journal of Psychiatry 154(11): 1582–1588.
Robins, Lee, John Helzer, Jack Croughan, and Kathryn Ratliff 1981 National Institute of Mental Health Diagnostic Interview Schedule: History, Characteristics, and Validity. Archives of General Psychiatry 38(4): 381–389.
Robins, Lee, and Darrell Regier 1991 Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: The Free Press.
Robins, Lee, John Wing, Wittchen Hans-Ulrich, John Helzer, Thomas Babor, Jay Burke, Anne Farmer, Assen Jablenski, Roy Rickens, Darrel Regier, Norman Sartorius, and Leland Towle 1988 The Composite Diagnostic Interview: An Epidemiologic Instrument Suitable for Use in Conjunction with Different Diagnostic Systems and in Different Cultures. Archives of General Psychiatry 45(12): 1069–1077.
Rogler, Lloyd 1989 The Meaning of Culturally Sensitive Research in Mental Health. American Journal of Psychiatry 146(3): 296–303.
Shore, James, J. David Kinzie, John Hampson, and E. Mansell Pattison 1973 Psychiatric Epidemiology of an Indian Village. Psychiatry 36(1): 70–81.
Slade, Tim, and Gavin Andrews 2002 Empirical Impact of DSM-IV Diagnostic Criterion for Clinical Significance. Journal of Nervous and Mental Disease. 190(5): 334–337.
Snipp, C. Matthew 1996 The Size and Distribution of the American Indian Population: Fertility, Mortality, Migration, and Residence. In Changing Numbers, Changing Needs: American Indian Demography and Public Health. Gary Sandefur, Ronald Rindfuss, and Barney Cohen, eds., pp. 17–52. Washington, D.C.: National Academy Press.
Spicer, Edward 1962 Cycles of Conquest. Tucson, AZ: University of Arizona Press.
Spicer, Paul 2002 Les méthodes ethnographiques, la psychoanalyse, et la récherche sur les interventions précoces. Devenir 14: 389–399.
Spicer, Paul, Jon Korffmacher, Terry Hudgens, and Robert Emde 2002 Joining Communities: The Value of an Ethnographic Perspective in Early Childhood Intervention Research. National Head State Association Dialog 5(2 and 3): 340–355.
Spitzer, Robert, Janet Williams, and Miriam Gibbon 1987 Structured Clinical Interview for DSM-III-R, Version NP. New York: New York Psychiatric Institute, Biometrics Research Department.
Sue, Stanley, Derald Sue, Leslie Sue, and David Takeuchi 1995 Psychopathology among Asian Americans: A Model Minority. Cultural Diversity and Mental Health 1(1): 39–51.
Takeuchi, David, Rita Chung, Keh-Ming Lin, Haikang Shen, Karen Kurasaki, Chi-Ah Chun, and Stanley Sue 1998 Lifetime and Twelve-Month Prevalence Rates of Major Depressive Episodes and Dysthymia among Chinese Americans in Los Angeles. American Journal of Psychiatry 155(10): 1407–1414.
Thoits, Peggy 1982 Life Stress, Social Support, and Psychological Vulnerability: Epidemiological Considerations. Journal of Community Psychology 10(4): 341–362.
Trimble, Joseph 1990 Ethnic Specification, Validation Prospects, and the Future of Drug Use Research. International Journal of the Addictions 25(2A): 149–168.
U.S. Department of Commerce and Bureau of the Census 1991 A 1990 Census Profile of American Indian, Eskimo, or Aleut Population. Washington, DC: U.S. Department of Commerce.
U.S. Department of Commerce and Bureau of the Census 2002 The American Indian and Alaska Native Population: 2000. Washington, DC: U.S. Census Bureau.
U.S. Department of Health and Human Services 2001a Mental Health: Culture, Race, and Ethnicity. Rockville, MD: Public Health Service, Office of the Surgeon General.
U.S. Department of Health and Human Services 2001b Trends in Indian Health 1998–1999. Rockville, MD: Department of Health and Human Services.
Vega, William, Bohdan Kolody, Sergio Aguilar-Gaxiola, Ethel Alderete, Ralph Catalano, and Jorge Caraveo-Anduaga 1998 Lifetime Prevalence of DSM-III-R Psychiatric Disorders among Urban and Rural Mexican Americans in California. Archives of General Psychiatry 55(9): 771–788.
Wakefield, Jerome, and Robert Spitzer 2002 Why Requiring Clinical Significance Does Not Solve Epidemiology's and DSM's Validity Problem: Response to Regier and Narrow. In Defining Psychopathology in the 21st Century: DSM-V and Beyond. John Helzer and James Hudziak, eds., pp. 31–40. Washington, DC: American Psychiatric Publishing, Inc.
Weissman, Myrna 1995 The Epidemiology of Psychiatric Disorders: Past, Present, and Future Generations. International Journal of Methods in Psychiatric Research 5(2): 69–78.
WHO International Consortium in Psychiatric Epidemiology 2000 Cross-National Comparisons of the Prevalences and Correlates of Mental Disorders. Bulletin of the World Health Organization 78(4): 413–426.
Wittchen, Hans-Ulrich, and Ronald Kessler 1994 Modifications of the CIDI in the National Comorbidity Survey: The Development of the UM-CIDI. In NCS Working Papers. Ann Arbor, MI: Institute for Social Research.
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Beals, J., Manson, S.M., Mitchell, C.M. et al. Cultural Specificity and Comparison in Psychiatric Epidemiology: Walking the Tightrope in American Indian Research. Cult Med Psychiatry 27, 259–289 (2003). https://doi.org/10.1023/A:1025347130953
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DOI: https://doi.org/10.1023/A:1025347130953