Jacob K S, Bhugra D, Lloyd K R, Mann A H
Institute of Psychiatry, Denmark Hill, London, UK.
J R Soc Med. 1998 Feb;91(2):66-71. doi: 10.1177/014107689809100204.
Women of Indian origin are said to have a lower rate of recognized common mental disorders and a higher frequency of consultation in primary care than white British. The aim of this study was to evaluate factors, including explanatory models (patient perspectives) of illness, associated with common mental disorders and with frequency of consultation among women of Indian origin in primary care. The investigation was conducted in a general practice in West London with a large Indian population. Consecutive woman attenders of Indian descent were screened with the General Health Questionnaire-12 to identify probable cases of psychiatric morbidity. 100 patients were interviewed with the Revised Clinical Interview Schedule (CIS-R), a specific tool for the diagnosis of common mental disorders, and the Short Explanatory Model Interview, which elicits the individual's conceptualization of his or her illness. Those patients who satisfied CIS-R criteria were classified as 'cases', the others as 'controls'. Common mental disorders were documented in 30% of patients. The general practitioner's diagnosis of common mental disorders had a sensitivity of 17% and a specificity of 91%. Individuals with common mental disorders had a higher frequency of consultation (P = 0.017), were less likely to see depression as an indication for medical intervention and were more likely to withhold some of their concerns from the general practitioner. Incorrect diagnosis by the GP was most likely to occur when patients did not disclose all their complaints. These associations were all statistically significant after adjustment for possible confounders by multiple linear and logistic regression. Women of Indian origin in this sample had rates of common mental disorders similar to those in other UK populations. Differing conceptualizations of common mental disorders may contribute to their underrecognition in women of Indian origin.
据说，与英国白人相比，印度裔女性被诊断出患有常见精神障碍的比例较低，且在初级保健机构就诊的频率较高。本研究的目的是评估与常见精神障碍以及印度裔女性在初级保健机构就诊频率相关的因素，包括疾病的解释模型（患者观点）。调查在伦敦西部一个印度人口众多的普通诊所进行。连续就诊的印度裔女性接受了一般健康问卷-12的筛查，以确定可能患有精神疾病的病例。100名患者接受了修订版临床访谈量表（CIS-R）和简短解释模型访谈，CIS-R是诊断常见精神障碍的特定工具，简短解释模型访谈用于引出个体对自身疾病的概念化理解。那些符合CIS-R标准的患者被归类为“病例”，其他患者为“对照”。30%的患者被记录患有常见精神障碍。全科医生对常见精神障碍的诊断敏感性为17%，特异性为91%。患有常见精神障碍的个体就诊频率更高（P = 0.017），将抑郁症视为医疗干预指征的可能性更小，并且更有可能对全科医生隐瞒一些担忧。当患者未透露所有症状时，全科医生最有可能做出错误诊断。在通过多元线性和逻辑回归对可能的混杂因素进行调整后，所有这些关联在统计学上均具有显著性。本样本中的印度裔女性常见精神障碍的发生率与英国其他人群相似。对常见精神障碍的不同概念化理解可能导致其在印度裔女性中未被充分认识。
