Developing a generalizable methodology for cross-cultural study of health problems, capable of addressing neglected but vital issues in international psychiatry and minority mental health in the United States, has been the overarching theme of a research agenda supported by an NIMH career development award (RSDA, Level 1). In a cultural study of leprosy and mental health, the research has produced a new instrument that integrates epidemiological and anthropological frameworks, the Explanatory Model Inter-view for-,Classification (EMIC). The EMIC will be adapted to initiate a study of illness beliefs and behavior associated with psychiatric problems of Haitian immigrants. The proposed research """""""" will develop techniques to analyze and compare data from these two samples, each significant in its own right and linked by their role in developing this methodology. Leprosy remains a major tropical disease in many developing countries. As the ultimate metaphor for stigma and despair, it exemplifies health problems for which improving links between psychiatry and medicine may reduce a significant emotional burden and enhance the effectiveness of medical services. This research will clarify psychiatric, sequelae of leprosy and elucidate cultural meanings that may adversely affect compliance with curative treatment that prevents deformities. Building on that experience, the proposed research will demonstrate that the EMIC can be used reliably in conjunction with the SCID and combined Hamilton depression and anxiety rating scales. This research tests the hypothesis that limitations in the utilization and effectiveness of mainstream health services in India, a representative developing country, and among Haitian immigrants in the United States, a significant minority, are related to culturally based illness beliefs and behaviors. Using a coherent framework that builds upon the explanatory model theory of Arthur Kleinman and incorporating advances in diagnostic assessment associated with Spitzer, Endicott, Robins and others, this study will develop techniques to compare relationships between culture, illness beliefs, illness behavior, clinical course and outcome. Experience in the current research will guide plans to study a larger sample and support the development of techniques for the comparative analysis of data derived by similar methods elsewhere.
