The Bradford Somatic Inventory

it is not known whether such symptoms are generally experienced more often by patients in non-Western societies than among patients in the Western world. We are not aware of any multicultural study that has set out specifically to compare the prevalence of somatic symptoms in different ethnic groups using a comprehensive inventory of such symptoms. Many well established psychological scales such as the Hamilton Rating Scale for Anxiety (Hamilton, 1959), the Hamilton Rating Scale for Depression (Hamilton, 1967), the Beck Depression Inventory (Beck et a!, 1961) and the General Health Questionnaire (GHQ; Goldberg, 1972) contain a limited range of items concerning somatic symptoms found in anxiety and depression. The Cornell Medical Index Health Questionnaire (Brodman eta!, 1949) has a list of 195 symptoms occurring in both physical and mental disorders, but makes no distinction between †̃¿ functional' and †̃¿ organic' somatic symptoms. Some recent instruments have been careful to exclude somatic symptoms that could have increased the likelihood of false positive responses in the presence of coexisting physical disease (e.g. the Hospital Anxiety and Depression Scale (HAD); Zigmond & Snaith, 1983). The 30-item version of the GHQ has been devised to place more emphasis on psycho logical than somatic symptoms (Goldberg, 1978). All these instruments have been developed for use with Western patients. Many have been translated and used in the non-Western world, but doubts have been expressed about the cultural validity of this procedure (Draguns, 1982; Marsella et a!, 1985; Obeysekere, 1985; Beiser & Fleming, 1986; Mumford Patients from India and Pakistan suffering from anxiety or depressive disorders frequently present to the doctor in Britain with somatic complaints (Rack, 1982;Bavington & Majid, 1986;Bal, 1987).Difficulties with the English language may prevent a clear history of mood change being elicited. When questioned in their own language, such patients are usually able to describe the psychological symptoms of a mood disturbance (Bavington & Majid, 1986; Rao, 1986). Indigenous British patients who present to doctors complaining of depression or anxiety also describe a variety of somatic symptoms (Hamilton, 1989). In addition, many British patients attend their general practitioner or hospital out-patient clinic with somatic symptoms for which no physical cause is found (Shepherd et a!, 1966; Katon et a!, 1984; Goldberg & Bridges, 1988). It has often been asserted that patients from developing countries †̃¿ somatise' their depression, whereas patients in the Western world †̃¿ psychologise' depression (Tseng, 1975; Katon et a!, 1982; Leff, 1988; Goldberg & Bridges, 1988). Kleinman (1987) refers to the “¿ widespread finding―that “¿ somatic symptoms in depression and anxiety disorders play a more central role in the experience and expression of disorder in non-Western societies and among ethnic groups in the West―. Numerous psychiatric studies from India, China and Africa have confirmed the high rate of somatic presentation among non-Western patients (Tseng, 1975; Binitie, 1975;Carstairs & Kapur, 1976; Jegede, 1978; Ndetei & Muhangi, 1979; Janakiramaiah & Subbakrishna, 1980;Kleinman, 1982;Srinivasan eta!, 1986; Keegstra, 1986; Saxena eta!, 1988). However, The Bradford Somatic Inventory