Bhatnagar K, Frank J
Bradford Community Health NHS Trust, UK.
Int J Geriatr Psychiatry. 1997 Sep;12(9):907-12. doi: 10.1002/(sici)1099-1166(199709)12:9<907::aid-gps661>3.0.co;2-8.
In our community study of the prevalence of psychiatric disorders among elderly South Asian immigrants from the Indian sub-continent (India, Pakistan and Bangladesh) living in Bradford (UK), we found depression in 20%, dementia in 4% and anxiety neurosis in 4%. Subjects were interviewed at their place of residence by a consultant psychiatrist familiar with their culture and language. The Hindi translation of the community version of the Geriatric Mental State schedule (GMS-A) was also administered. Psychiatrist's ICD-9 diagnosis was compared with GMS-AGECAT computerized diagnosis. We found low-level agreement in dementia cases (kappa 0.33) whereas the agreement in subjects with depression was high (kappa 0.81). In many subjects GMS-A made a diagnosis of dementia not diagnosed as cases by the psychiatrist, who had the benefit of additional history information from carers in this population from a different culture and educational background. These findings are discussed along with suggestions and present limitations of GMS-A in the diagnosis of dementia in cross-cultural research. Larger studies are needed in this population (a) to find out prevalence rates in countries of origin and (b) to investigate the author's (KB) observation of low rates of Alzheimer's type dementia in this population, which may have aetiological significance.
在我们针对居住在英国布拉德福德的来自印度次大陆（印度、巴基斯坦和孟加拉国）的南亚老年移民中精神疾病患病率的社区研究中，我们发现抑郁症患病率为20%，痴呆症为4%，焦虑症为4%。由一位熟悉他们文化和语言的精神科顾问医生在他们的住所对研究对象进行访谈。同时还使用了老年精神状态检查表社区版（GMS - A）的印地语译本。将精神科医生依据国际疾病分类第九版（ICD - 9）做出的诊断与GMS - AGECAT计算机化诊断进行比较。我们发现痴呆症病例的一致性较低（卡帕值为0.33），而抑郁症患者的一致性较高（卡帕值为0.81）。在许多研究对象中，GMS - A诊断出了一些精神科医生未诊断为痴呆症的病例，精神科医生在此过程中受益于来自不同文化和教育背景的护理人员提供的额外病史信息。本文将对这些发现进行讨论，并提出相关建议以及指出GMS - A在跨文化研究中诊断痴呆症时目前存在的局限性。在这一人群中需要开展更大规模的研究，（a）以查明其原籍国的患病率，（b）调查作者（KB）观察到的这一人群中阿尔茨海默病型痴呆症低发病率情况，这可能具有病因学意义。
