Making an accurate diagnosis of a psychological disorder like depression or PTSD is very important. However, it’s not always easy and culture is one factor that can influence the validity and reliability of diagnosis.
Culture and Reporting Symptoms
One factor that may affect diagnosis is culture. In particular, people from different cultures may report their symptoms differently. For example, a lot of research has shown that Chinese patients focus less on psychological symptoms and more on somatic (physical) symptoms when meeting with a clinician. These differences in reporting symptoms can be shown in Parker et al.’s study (see below).
How does this affect diagnosis? Well a diagnosis is made depending on the symptoms presented to the clinician (person making the diagnosis). A Western clinician would probably be expecting symptoms of depression to be associated with cognition (thinking) and emotions, so may not recognize physical symptoms as being a result of depression, and vice-versa if the clinician is Asian. This can cause problems with diagnosis if the clinician and patient do not share the same culture (an increasing occurrence in today’s multicultural societies).
Key Study: A cross-cultural comparison of reporting symptoms of depression (Parker et al. 2001)
This study was conducted in Malaysia and compared how depression was reported in two distinct groups: Malaysian-Chinese and white Australians. The researchers gathered data on the major symptom the patient identified as why they sought help and the patients also filled out questionnaires on their symptoms. The results showed that even though all patients were diagnosed with depression, 60% of Malaysian-Chinese outpatients identified a somatic (physical) symptom as their major reason for seeking help, compared with only 13% of the Australian participants. One conclusion to draw from this study is that culture can affect how symptoms are reported which in turn can affect the diagnosis of a disorder. More evidence of this can be seen in Kleinman’s landmark study (see below).
Culture and Somatization
One explanation for the differences in reporting symptoms is that the symptoms of a disorder may actually be different for people from different cultures. The way culture affects the presentation of symptoms (i.e. reporting of symptoms to a clinician) is a major factor that can affect diagnosis. For example, it is common that people from Asian cultures experience depression more physically (i.e. more physical symptoms) than people from Western cultures. This was tested by Kleinman et al.
Key Study: The DSM III and somatic symptoms in Chinese patients (Kleinman, 1982)
In this study, Kleinman analyzed 100 Chinese patients who had been diagnosed with neurasthenia. This is a disorder that is characterized by somatic symptoms, such as fatigue, insomnia, headaches, anxiety and a general low mood. While it is similar to depression, it is a separate diagnosis. As part of the study, Kleinman re-diagnosed the patients using the newly released DSM-III. As a result, 87% of the patients met the criteria for Major Depressive Disorder (MDD, i.e. depression). The initial diagnosis of neurasthenia could be because of differences in how symptoms of depression are reported by the Chinese patients. After taking anti-depressant medication, 70% of patients experienced a major improvement in symptoms. This study highlights a couple of factors; firstly, culture can affect how patients report their symptoms which can affect the accuracy of diagnosis. Secondly, an accurate diagnosis is essential in getting the right treatment.
Critical Thinking Considerations
- What are some limitations in the above studies? What are some reasons why generalizability might be an issue? For example, Kleinman and Parker focus on depression. Can this be generalized to other disorders?
- What are the ethical considerations associated with the above studies?
- Are there other reasons why psychiatrists might consciously or unconsciously make a false diagnosis? For example, how might they have an economic incentive to make a diagnosis of a disorder?
The material in this post could be used to answer a question on:
- Factors influencing diagnosis
- Sociocultural approach in relation to factors influencing diagnosis
- Normality and abnormality
- Classification systems
- Validity and reliability of diagnosis
The material in this post has been developed and adapted from our textbook and our revision textbooks – both available from our online store (here).