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Biomedical subjects

L H Rogler

Publications and source records attributed to L H Rogler.

At least 19 recordsLinked to original sources
PubMed2001

The neglect of response bias in mental health research.

A number of researchers have observed that response biases, defined as when subjects respond to items in research instruments in ways that do not coincide with the intent or content of the instrument, suffuse measurements and assessments of mental disorders. They cautioned that the response bias problem has been neglected in mental health research at the price of substantial error. Have the cautions been heeded? Or does the neglect of response bias continue? Articles published in 1998 in three major psychiatric journals were examined: Archives of General Psychiatry, American Journal of Psychiatry, and the Journal of Nervous and Mental Disease. The articles were examined to determine whether response biases were mentioned and whether systematic efforts were made to attend to their influence on the findings of the study. Each article was assessed twice by independent raters. The examination indicates that a very small minority of the articles reviewed mentioned response bias and that among those mentioning it, a minority attempted to control for bias effects. Cautions offered about response bias have not been heeded. Accordingly, the issue is one of how to incorporate concerns about response bias into the institutional structures that influence the culture of mental health research.

Bias↗
PubMed1999

Methodological sources of cultural insensitivity in mental health research.

The concept of procedural norms, which is taken from the analysis of science as an institutionally structured social process, is used to explain the persistence of cultural insensitivity in research. The concept refers to the canons of research that tell scientists what should be studied and how, and they are taught to successive generations of researchers. An examination of cross-cultural studies in mental health reveals that cultural insensitivity stems from procedural norms in the development of content validity based on experts' rational analysis of concepts, in linguistic translations that try to conform to the exact terms of standardized instruments, and in the uncritical transferring of concepts across cultures. We need a wide-ranging examination of our procedural norms, with the objective of keeping such norms from suppressing, biasing, or deflecting cultural understandings. This article proposes a dialogue on the intricate connections between culture and our customary methodologies.

Cognition↗
PubMed1999

Research on culture-bound syndromes: new directions.

The unprecedented inclusion of culture-bound syndromes in DSM-IV provides the opportunity for highlighting the need to study such syndromes and the occasion for developing a research agenda to study them. The growing ethnic and cultural diversity of the U.S. population presents a challenge to the mental health field to develop truly cross-cultural approaches to mental health research and services. In this article, the authors provide a critique of previous analyses of the relationship between culture-bound syndromes and psychiatric diagnoses. They highlight the problems in previous classificatory exercises, which tend to focus on subsuming the culture-bound syndromes into psychiatric categories and fail to fully investigate these syndromes on their own terms. A detailed research program based on four key questions is presented both to understand culture-bound syndromes within their cultural context and to analyze the relationship between these syndromes and psychiatric disorders. Results of over a decade of research on ataques de nervios, a Latino-Caribbean cultural syndrome, are used to illustrate this research program. The four questions focus on the nature of the phenomenon, the social-cultural location of sufferers, the relationship of culture-bound syndromes to psychiatric disorders, and the social and psychiatric history of the syndrome in the life course of the sufferer.

Cross-Cultural Comparison↗
PubMed1997

Making sense of historical changes in the Diagnostic and statistical manual of mental disorders: five propositions.

From the first to the current fourth edition, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) has grown considerably in size and complexity. The DSM-III (1980) represented a paradigm shift in psychiatric diagnoses and is the main focus of the article's five propositions attempting to make sense of basic historical changes in the manual. The first two propositions concern theoretical changes in the manual; they critically examine the effort to evict unverified etiological assumptions from diagnoses, the adoption of formulations of disorders as discretely constituted, and the role of the multiaxial context in diagnoses. The next two propositions attempt a new development: a set of concepts designating the structural changes in the DSM histories of individual disorders. The fifth proposition examines historical forces supporting the neo-Kraepelinian psychiatrists' efforts to produce the DSM-III. The conclusion brings the propositions together to explain the DSM's growth in size and complexity and to show that the general pattern of the DSM changes are aimed at remedicalizing the profession of psychiatry.

History, 20th Century↗
PubMed1996

Framing research on culture in psychiatric diagnosis: the case of the DSM-IV.

The fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association 1994) treats the concept of culture as directly relevant to the diagnostic task. In contrast, its predecessor, the DSM-III-R, restricted its coverage to two paragraphs of the concept, cautioning that when the manual was used with clients from different cultural groups, cultural factors could interfere with diagnosis. I believe that the adequacy of the cultural insertions in the DSM-IV should be debated but I also believe that the changes will be considered important. The premise of this article is that they are important. The objective is to show that the cultural insertions in DSM-IV can be organized and focused on important issues of research.

Cross-Cultural Comparison↗
PubMed1996

Research on mental health services for Hispanics: targets of convergence.

In reaching to serve the mental health needs of new catchment neighborhoods, the 1963 federally funded Community Mental Health Center (CMHC) program stimulated culturally oriented research on the effectiveness of mental health services for Hispanics. The research, at first scattered and diffuse, has converged on a number of targets. This article examines four of the targets of research and how they can be brought into a unified perspective if they are viewed in temporal order as sequenced disadvantages Hispanics confront in using mental health services. The targets can be arrayed longitudinally: reasons for Hispanics' underutilization of professional mental health services, difficulties in retaining Hispanics in such services, errors in evaluating their mental health, and the problems of adapting treatment modalities to their needs.

Cultural Diversity↗
PubMed1995

Depression among Puerto Ricans in New York City: the Hispanic Health and Nutrition Examination Survey.

This study was conducted to analyze determinants of depression among Puerto Ricans by replicating and expanding earlier studies of depression among Cuban Americans and Mexican Americans. Data from the Hispanic Health and Nutrition Examination Survey, 1982-1984, were employed to examine depression and associated characteristics among Puerto Ricans. We utilized descriptive and multivariate statistics to examine the Center for Epidemiologic Studies Depression Scale (CES-D)-assessed depressive symptomatology and the DSM-III/DIS specification of major depression. The findings indicated that CES-D-assessed depressive symptomatology among Puerto Ricans was associated with female gender, disrupted marital status, poor health, and lower socioeconomic status as indicated by low education, low household income, age, and unemployment. For both 6-month and 1-month DIS major depression, age, disrupted marital status, and income of less than $5,000 were significant risk factors. For 6-month DIS major depression, never married persons had a higher risk for depression. For 1-month diagnoses, writing Spanish better than English was associated with lower risk. In general, our findings for Puerto Ricans were similar to studies of depression among other Hispanic groups. We remained unable to explain the relatively extreme levels of depression among Puerto Ricans in New York, though several probable explanations are elaborated. We emphasized the general need to expand the range of research designs and current risk models in epidemiology in an effort to capture the complexity of psychosocial and cultural processes relevant to psychological distress.

Acculturation↗
PubMed1994

Biculturality among Puerto Rican adults in the United States.

Identified the concept of acculturation as a cornerstone of immigration research, while questioning assumptions about zero-sum cultural change in acculturation scales and in procedures assessing biculturality. Involvements in the host society culture and the culture of origin should be assessed separately in order to reflect the complexities of the cultural interactions immigrants and their offspring experience. To evaluate this prescription, we convened focus groups of Puerto Rican adults to discuss their cultural experiences in Puerto Rico and in the United States. Discussions were content analyzed to develop acculturation items. Factor analysis of the responses of 403 first- and second-generation adults yielded two general factors, involvement in American culture and involvement in Puerto Rican culture, which demonstrated modest reliability, relative independence, and moderate correlations with traditional acculturation scale validators. Results of the study challenge the assumption of mutual cultural exclusivity in acculturative change; enable the measurement of degree of biculturality; and provide future directions for the assessment of acculturation in domains other than language usage. The concept of acculturation is integrated with recent formulations in community psychology which advocate a deeper and more extensive commitment to studying the implications of cultural phenomena and greater focus on the growing cultural diversity in the United States.

Acculturation↗
PubMed1994

International migrations. A framework for directing research.

Current, large-scale, cross-cultural migrations offer promising research targets for the study of human adaptations. The opportunities for such research, however, remain substantially unused in the mainstream of psychology. The purpose here is to provide a framework encompassing components of the migration experience to aid such research. Contextual factors in the sending and receiving societies impinge on the components of the migration experience: social networks, socioeconomic status, and culture. The components, treated as intertwining transitional experiences in migration, should be juxtaposed in research to examine their effects. Gender and age mediate the effects. The framework aims to benefit research that implicates, directly or heuristically, the experiences of persons exposed to rapid sociocultural change and the consequences of such changes in their lives.

Acculturation↗
PubMed1994

The mental health relevance of idioms of distress. Anger and perceptions of injustice among New York Puerto Ricans.

Cultural sensitivity in mental health research is enhanced by examining the collective perceptions of members of ethnic groups about their own idiomatic expressions of distress. Such an examination was conducted with Puerto Ricans living in New York City, beginning with focus group discussions. Their prevailing idioms of distress, based upon themes of anger and injustice, were correlated widely with professionally developed measures of anxiety, depression, and somatization and with utilization of professional mental health care. By examining the relationship between idioms of distress, saliently volunteered by members of the ethnic ingroup, on the one hand, and professional care and assessments of mental health, on the other, we increase our culturally based understanding of mental health in the community.

Adult↗
PubMed1993

Mental health status among Puerto Ricans, Mexican Americans, and non-Hispanic whites: the case of the misbegotten hypothesis.

Challenged Shrout et al.'s (1992) comparisons of mental health characteristics of island Puerto Ricans to Mexican Americans and non-Hispanic whites from the Los Angeles Epidemiological Catchment Area Study. The hypothesis tested by Shrout et al.--higher symptom counts but lower DSM-III prevalence rates among Puerto Ricans--was misattributed to Rogler (1989). We also question the validity of assessing lifetime prevalence and reaffirm the need for psychiatric epidemiological research to consider the role of culture in diagnostic criteria.

Cross-Cultural Comparison↗
PubMed1993

Culturally sensitizing psychiatric diagnosis. A framework for research.

The convergence between the demystification of psychiatric diagnosis and the increasing professional awareness of a cultural viewpoint offers the opportunity for research to systematically address issues of culturally valid diagnosis. To organize such research, a three-level hierarchical framework is developed which integrates hypotheses about the role of culture, beginning with symptom assessment, then the configuring of symptoms into disorders, and finally the interpersonal situation of the diagnostic interview. An examination of cross-cultural research and research on cultural minorities shows how errors accumulate from the first to the third level because of the neglect of culture or through misconceptions of the concept. The framework is premised upon the need to make programs of research the driving force behind long-range efforts to culturally sensitize psychiatric diagnosis.

Cross-Cultural Comparison↗
PubMed1993

Help-seeking pathways: a unifying concept in mental health care.

The authors argue that the concept of help-seeking pathways, defined generically, oriented toward institutional structures, and put at the forefront of research, can help integrate much of what we know about the use of mental health care and how to make such care more accessible and effective among underserved populations. They focus the concept of help-seeking pathways on current issues and research findings pertinent to the onset of psychological distress, the contacting of mental health care facilities, and treatment in such facilities. Pathways are not random; they are structured by the convergence of psychosocial and cultural factors and have sufficient integrity to be studied directly as unfolding processes.

Adult↗
PubMed1993

Culture in psychiatric diagnosis: an issue of scientific accuracy.

The revised version of the third edition of the American Psychiatric Association's (1987) Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) gives scant attention to the significance of culture. Two paragraphs in the Introduction advising caution when using the Manual in different cultures (pp. xxvi-xxvii) are followed by more than 500 pages in which the relevance of culture remains basically unrecognized. This neglect is problematical: Ethnological research has repeatedly demonstrated the cultural plasticity of human behavior, so much so, in fact, as to controvert the unqualified attribution of psychiatric meaning to symptoms or sets of symptoms (Rogler, 1993). Yet, despite the scant attention given to culture, the DSM-III and its revised version are more widely used cross-nationally in teaching, research, and clinical practice than any other system for classifying mental illnesses (Maser et al. 1991).

Cross-Cultural Comparison↗
PubMed1992

Issues of validity in the Diagnostic Interview Schedule.

The Diagnostic Interview Schedule, the chief instrument in contemporary studies in psychiatric epidemiology, enhances the reliability of psychiatric diagnosis and enables lay interviewers to closely reproduce psychiatric interviews. However, despite frequent references in the literature to the validity of the Diagnostic Interview Schedule, most studies fundamentally represent variations of reliability paradigms to the neglect of criterion-related validity. Mistaken assertions of validity persist in the psychometric language used to describe the Diagnostic Interview Schedule. This article examines the basis for claims and counterclaims of validity in accordance with standard psychometric definition, and identifies sources of erroneous reasoning in attempts to infer validity from reliability. The article presents a general framework organizing the process of diagnostic validation and discusses strategies for research seeking to validate psychiatric diagnoses achieved through the Diagnostic Interview Schedule.

Humans↗
PubMed1992

Evaluation of mental health. Issues of memory in the Diagnostic Interview Schedule.

Research on the Diagnostic Interview Schedule, the chief instrument in contemporary studies in psychiatric epidemiology, has supported its utility in enabling lay interviewers to reproduce psychiatric interviews within an acceptable margin of error. Nonetheless, we propose that the Diagnostic Interview Schedule commits itself to dubious assumptions regarding the accuracy of human memory, shared by other history-taking efforts, by relying on retrospective reports of lifetime DSM-III symptoms and episodic dating of symptom spells. For more than a century, the fallibility of human memory has been the topic of intensive experimental and naturalistic study, a history which is relevant to the construction of instruments like the Diagnostic Interview Schedule. The continuing use of retrospective lifetime symptom reports suggests that this literature has been largely ignored in the development and administration of the Diagnostic Interview Schedule. Prospectively organized research is needed to disclose the limits of human memory for recent psychiatric events and the mediating conditions under which memory for such events can be accurately retrieved and improved.

Adult↗