Cultural dimensions of psychiatric diagnosis. A comparison of DSM-III-R and illness explanatory models in south India.

BACKGROUND Cross-cultural research to examine the cultural validity of diagnostic categories and underlying concepts requires methods that integrate epidemiological and anthropological frameworks. METHOD The Explanatory Model Interview Catalogue (EMIC) and Structured Clinical Interview for DSM-III-R (SCID) were used to study 80 psychiatric out-patients with depressive neurosis at a clinic in south India. RESULTS Summary kappa values of 0.75 for the EMIC and 0.68 for the SCID confirmed interrater reliability. Comparison of patient explanatory models and SCID diagnoses showed that patients emphasised somatic experience while clinicians emphasised depressive diagnoses. More than half the patients (55%) received a non-specific or dual diagnosis. CONCLUSIONS These findings raise questions about the distinctiveness of depressive, anxiety, and somatoform (DAS) disorders for this population.