Beals Janette, Manson Spero M, Mitchell Christina M, Spicer Paul
American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Mail Stop F800, PO Box 6508, Aurora, CO 80045-0508, USA.
Cult Med Psychiatry. 2003 Sep;27(3):259-89. doi: 10.1023/a:1025347130953.
Increasingly, the mental health needs of populations are measured using large-sample surveys with standardized measures and methods. Such efforts, however, rarely include sufficient number of smaller, culturally defined populations to draw defensible conclusions about their needs. Furthermore, without some adaptation, the standardized methods and measures may yield invalid results in such populations. Using a recently completed psychiatric epidemiology and services study with American Indian populations as a case example, this paper outlines issues facing epidemiologists working in such culturally diverse contexts. The issues discussed include the following: (1) persuading the scientific community and potential sponsors that work with distinct or culturally defined populations is important; (2) framing research questions and activities to meet the needs of communities; (3) defining a population of inference; (4) balancing the needs for comparability and cultural specificity; (5) maximizing scientific validity in light of the challenges in sample acquisition; and (6) developing and implementing data collection methods that uphold scientific standards but are also realistic given the context. The authors draw on their experiences--most recently in the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP)--to illustrate these issues and suggest ways to address each. A goal of this paper is to challenge those invested in conducting culturally valid epidemiologic work in such populations to better articulate the nature of these efforts.
越来越多的人使用标准化的测量方法和手段，通过大样本调查来衡量人群的心理健康需求。然而，这些调查很少纳入足够数量的规模较小、具有文化界定的人群，以便就他们的需求得出可靠的结论。此外，如果不做一些调整，标准化的方法和测量手段可能在这些人群中得出无效的结果。本文以最近完成的一项针对美国印第安人群体的精神病流行病学和服务研究为例，概述了在这种文化背景多样的环境中工作的流行病学家所面临的问题。所讨论的问题包括：（1）说服科学界和潜在赞助商，开展针对独特或具有文化界定的人群的研究很重要；（2）设计研究问题和活动以满足社区需求；（3）界定推断人群；（4）平衡可比性需求和文化特异性需求；（5）鉴于样本获取方面的挑战，最大限度地提高科学有效性；（6）开发和实施既符合科学标准又考虑到实际情况的数据收集方法。作者借鉴他们的经验——最近是在美国印第安人服务利用、精神病流行病学、风险与保护因素项目（AI-SUPERPFP）中的经验——来说明这些问题，并提出应对每个问题的方法。本文的一个目标是促使那些致力于在这些人群中开展具有文化效度的流行病学研究的人，更好地阐明这些工作的性质。
