Chowdhury A N, Sanyal D, Bhattacharya A, Dutta S K, De R, Banerjee S, Bhattacharya K, Palit S, Bhattacharya P, Mondal R K, Weiss M G
Department of Psychiatry, Institute of Postgraduate Medical Education and Research, Calcutta.
J Indian Med Assoc. 2001 Jan;99(1):20-3.
A pilot study of 29 patients for research on clinical depression employed the framework of cultural epidemiology to examine illness-related experience, meaning, behaviour with a Bengali version of the explanatory Model Interview Catalogue (EMIC). This report examined patterns of distress and stigma with reference to the most troubling patient-specified symptom. All subjects were psychiatric outpatients in the Institute of Psychiatry, Calcutta, and met Diagnostic and Statistical Manual (DSM)-IV criteria for a major depressive episode. Only 5 patients (17.2%) identified sadness as the most troubling problem, and 48.3% specified pains and other somatic symptoms instead. An internally consistent stigma scale with Cronbach's alpha of .67, comprised 13 items, was used to assess stigma. In addition to the scale score for each subject, the contribution of each item was reported and compared. A suggestive, though not significantly lower value of the stigma score for patients reporting somatic symptoms as most troubling, compared with sadness, was consistent with findings from prior studies showing a positive relationship between the magnitude of depression and stigma. These findings are discussed with reference to their impact on recognition and help seeking among patients, and recognition and management of depression by general practitioner. Culturally distinctive presentations and social contexts of depression and other mental illnesses should be addressed in professional training and public health communications.
一项针对29名临床抑郁症患者的试点研究采用文化流行病学框架，使用孟加拉语版的解释模型访谈目录（EMIC）来研究与疾病相关的经历、意义和行为。本报告参照患者指定的最困扰症状，研究了痛苦和耻辱的模式。所有受试者均为加尔各答精神病学研究所的精神科门诊患者，符合《精神疾病诊断与统计手册》（DSM）-IV中重度抑郁发作的标准。只有5名患者（17.2%）将悲伤视为最困扰的问题，而48.3%的患者则指出疼痛和其他躯体症状。使用了一个内部一致性的耻辱感量表来评估耻辱感，该量表由13个项目组成，Cronbach's alpha系数为0.67。除了报告每个受试者的量表得分外，还报告并比较了每个项目的贡献。与悲伤相比，将躯体症状报告为最困扰的患者的耻辱感得分虽无显著降低，但具有提示性，这与先前研究结果一致，即抑郁程度与耻辱感之间存在正相关。讨论了这些发现对患者识别和求助的影响，以及全科医生对抑郁症的识别和管理。在专业培训和公共卫生宣传中，应关注抑郁症和其他精神疾病在文化上的独特表现及社会背景。
