Tackling dementia globally: the Global Dementia Prevention Program (GloDePP) collaboration

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420http://dx.doi.org/10.7189/jogh.09.0201039pubpub

Tackling dementia globally: the Global Dementia Prevention Program (GloDePP) collaboration

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420http://dx.doi.org/10.7189/jogh.09.0201039pubpub

Neurasthenia spectrum disorders : clinical cultural epidemiology in Pune, India

Background: Persistent and unexplained fatigue and weakness constitute disorders, such as Chronic Fatigue Syndrome (CFS) in USA, fibromyalgia in Europe, and Neurasthenia (NT) in East Asia. Their overlapping diagnostic criteria include essential clinical and additional culture-specific features. They are best regarded as Neurasthenia Spectrum Disorders (NSDs) focusing on essential clinical criteria. Because clinical understanding is limited, public health challenges are more difficult. Psychiatric comorbidity is frequent, e.g. fatigue with depression. NSDs are rarely diagnosed or researched in India. Therefore, we aimed to study clinical cultural epidemiology of NSDs in urban general hospital in Pune, India. Methods: We did a set of cross-sectional studies. Prevalence was estimated by survey of 1,874 consecutive outpatients in clinics of Psychiatry, Medicine, Dermatology, and Ayurved by a brief semi-structured interview. In phase 2, using the same tool, 352 patients were studied in the same clinics with informed consent. A small case-control design compared biomedical markers with controls. SCID-I was used for psychiatric diagnoses. Hamilton scales and SCL-90+ measured dimensional psychopathology. Diagnostic interviews for CFS and NTs (3 definitions: ICD-10, DSM-IV draft, CCMD-2) measured their agreement and sensitivity across the four clinics. EMIC interviews assessed and compared quantitative and qualitative aspects of illness experience (PD), meaning (PC), and help seeking (HS). Appropriate statistical methods were used to compare frequencies, means, and mean prominence; and to test concordance of CFS and NTs. Results: Prevalence of NSD was 5% across four clinics, but higher in Dermatology and Ayurved clinics, and among women (63.8%). Haemoglobin and BMI were similar in patients and controls, but Corrected Arm Muscle Area was lower in patients. Non-specific anxiety and somatoform disorders outnumbered depression (mostly in Psychiatry clinic). Hamilton and SCL scores were highest in Psychiatry and lowest in Ayurved. Pairwise and four-way concordance among four NSDs was very poor (kappa=0.02). EMIC interviews showed weakness more than fatigue, ‘tensions’, future worries, need for support, and diverse and clinic-specific explanatory models with normative stresses. Biological explanatory models were prominent in Medicine, psychological ones in Psychiatry, cultural ones in Dermatology, and multiple ones in Ayurved clinics. Social models and poor health habits, weakness, and sexual-reproductive PCs were common across clinics. Dissatisfied patients sought help from many medical and non-medical sources. Conclusions: High burden and emotional distress, sarcopenia, anxiety and somatization more than depression and ‘weakness with anxiety’ are salient features. NSDs may be explained physiologically and psychologically. Diversity with prominent psychological models is notable. Women’s narratives showed role multiplicity and poor supports. Men’s concerns were the overwork, inadequacy and sexual PCs. Rapid urban development, frustration and demoralization are important cultural contexts. Cultural studies are necessary for clinical and public health purposes

Qualitative analysis of cultural formulation interview: findings and implications for revising the outline for cultural formulation

The DSM-IV Outline for Cultural Formulation (OCF) was a framework for assessment based on principles of cultural psychiatry. The Cultural Formulation Interview (CFI) for DSM-5 provided a tool enabling wider use of cultural formulation in clinical cultural assessment. Validation to justify the inclusion of the CFI in DSM-5 involved quantitative analysis of debriefing interviews of patients and clinicians for feasibility, acceptability and clinical utility. We now further examine qualitative field trial data from the CFI interviews and the debriefing interviews in Pune, India. Administration of the CFI was followed by routine diagnostic assessment of 36 psychiatric outpatients-11 found to have severe mental disorders (SMD) and 25 with common mental disorders (CMD). Domain-wise thematic analyses of the CFI and debriefing interviews identified recurrent themes based on cultural identity, illness explanatory models, stressful and supportive social relationships, and the impact of political, economic, and cultural contexts. A tendency to elaborate accounts, rather than simply name their problem, and more diverse past help-seeking distinguished CMD from SMD groups. Patients valued the CFI more than clinicians did, and most patients did not consider cultural background differences of clinician-patient relationships to be relevant. Qualitative analysis of CFI data and critical analysis of domain mapping of CFI content to the structure of OCF domains indicated the value of revising the dimensional structure of the OCF. A proposed revision (OCF-R) is expected to better facilitate clinical use and research on cultural formulation and use of the CFI

Perspectives Of Family Members Participating In Cultural Assessment Of Psychiatric Disorders: Findings From The Dsm-5 International Field Trial

Despite the important roles families play in the lives of many individuals with mental illness across cultures, there is a dearth of data worldwide on how family members perceive the process of cultural assessment as well as to how to best include them. This study addresses this gap in our knowledge through analysis of data collected across six countries as part of a DSM-5 Field Trial of the Cultural Formulation Interview (CFI). At clinician discretion, individuals who accompanied patients to the clinic visit (i.e. patient companions) at the time the CFI was conducted were invited to participate in the cultural assessment and answer questions about their experience. The specific aims of this paper are (1) to describe patterns of participation of patient companions in the CFI across the six countries, and (2) to examine the comparative feasibility, acceptability, and clinical utility of the CFI from companion perspectives through analysis of both quantitative and qualitative data. Among the 321 patient interviews, only 86 (at four of 12 sites) included companions, all of whom were family members or other relatives. The utility, feasibility and acceptability of the CFI were rated favourably by relatives, supported by qualitative analyses of debriefing interviews. Cross-site differences in frequency of accompaniment merit further study

Clinical value of the cultural formulation interview in Pune, India

Context: Development of the cultural formulation interview (CFI) in DSM‑5 required validation for cross‑cultural and global use. Aims: To assess the overall value (OV) of CFI in the domains of feasibility, acceptability, and utility from the vantage points of clinician‑interviewers, patients and accompanying relatives. Settings and Design: We conducted cross‑sectional semi‑structured debriefing interviews in a psychiatric outpatient clinic of a general hospital. Materials and Methods: We debriefed 36 patients, 12 relatives and eight interviewing clinicians following the audio‑recorded CFI. We transformed their Likert scale responses into ordinal values – positive for agreement and negative for disagreement (range +2 to −2). Statistical Analysis: We compared mean ratings of patients, relatives and clinician‑interviewers using nonparametric tests. Clinician‑wise grouping of patients enabled assessment of clinician effects, inasmuch as patients were randomly interviewed by eight clinicians. We assessed the influence of the presence of relatives, clinical diagnosis and interview characteristics by comparing means. Patient and clinician background characteristics were also compared. Results: Patients, relatives and clinicians rated the CFI positively with few differences among them. Patients with serious mental disorders gave lower ratings. Rating of OV was lower for patients and clinicians when relatives were present. Clinician effects were minimal. Clinicians experienced with culturally diverse patients rated the CFI more positively. Narratives clarified the rationale for ratings. Conclusions: Though developed for the American DSM‑5, the CFI was valued by clinicians, patients and relatives in out‑patient psychiatric assessment in urban Pune, India. Though relatives may add information and other value, their presence in the interview may impose additional demands on clinicians. Our findings contribute to cross‑cultural evaluation of the CFI

Stresses and Disability in Depression across Gender

Depression, though generally episodic, results in lasting disability, distress, and burden. Rising prevalence of depression and suicide in the context of epidemiological transition demands more attention to social dimensions like gender related stresses, dysfunction, and their role in outcome of depression. Cross-sectional and follow-up assessment of men and women with depression at a psychiatric tertiary centre was undertaken to compare their illness characteristics including suicidal ideation, stresses, and functioning on GAF, SOFAS, and GARF scales (N=107). We reassessed the patients on HDRS-17 after 6 weeks of treatment. Paired t-test and chi-square test of significance were used to compare the two groups, both before and after treatment. Interpersonal and marital stresses were reported more commonly by women (P<0.001) and financial stresses by men (P<0.001) though relational functioning was equally impaired in both. Women had suffered stresses for significantly longer duration (P=0.0038). Men had more impairment in social and occupational functioning compared to females (P=0.0062). History of suicide attempts was significantly associated with more severe depression and lower levels of functioning in case of females with untreated depression. Significant cross-gender differences in stresses, their duration, and types of dysfunction mandate focusing on these aspects over and above the criterion-based diagnosis