Cross-cultural analysis of selected emotional questions from the Cornell Medical Index.

When considering the problems of the crosscultural applicability ofmental health questionnaires, the influence of cultural factors on the results is of central importance. Zola (1966) has suggested that there are at least two ways in which symptoms usually defined as indicating illness in one population may be ignored in others. First, the estimate of the prevalence of a condition may be misleading, for if the corresponding symptoms are common within the population, they might not be considered symptomatic of any illnesses. Secondly, the form taken by the illness may depend on the dominant value-orientations of the culture. Hunt (1959) has concluded that 'studies provide evidence of extensive cultural variability in the expression of mental disorder'. The cultural relativity and dependence on the values of the society may greatly affect the measurement and definition of mental illness in different societies (Wittkower and Fried, 1958; Opler, 1959; HAkanson, 1968). These selective contextual processes, and not aetiological ones, account for many epidemiological differences in the prevalance of mental disorders between societies and subgroups within a society. This has led Zubin and Kietzman (1966) to distinguish culture-dependent and culture-free aspects of mental disorders. The cultural influences can be seen clearly in studies in which ethnic origin has been found to be highly related to the perception and interpretation of symptoms, to the corresponding reaction, and to the content of disorder (Zborowski, 1952 and 1969; Opler and Singer, 1956; Zola, 1966). The cultural dependence of mental disorders restricts the applicability of universal measurement methods in many cultures. The problem of validity in comparing field studies of mental disorder has proved to be difficult (Dohrenwend and Dohrenwend, 1965).