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Tijdschrift voor Psychiatrie 45 (2003) 4, 203 - 210

New research

Cultural bias in diagnosing negative symptoms?

J.P.A.M. Bogers, A.W. Goedhart, P.J. Hermans

background  The DSM-IV warns diagnosticians to be aware of the possible effects of cultural differences when attempting to diagnose a patient from a different ethnic background. This warning becomes more relevant when there is some evidence about which diagnostic observations may be influenced by which cultural differences.
aim  To identify diagnostic observations of negative symptoms of schizophrenia that are susceptible to cultural bias.
method  Descriptions given by Dutch psychiatrists concerning the negative symptoms in 33 files and by Surinamese psychiatrists in 31 files of Surinamese patients with schizophrenia were compared. results  Dutch psychiatrists noted more often symptoms such as poverty of content of speech, affective responsivity, work inattentiveness and sexual interest and activity, whereas Surinamese psychiatrists listed symptoms such as lack of facial expression and on average passed more severe
judgements on inadequate affect. No differences were found between the mean scores for the negative symptoms as a whole.
conclusion  The differences in the descriptions can be attributed to cultural differences in the style of communication and suggest that a cultural divide can have a negative effect on the way in which emotional experiences are perceived and thus on the interactions. However, no evidence was found of cultural bias in the total assessment of the severity of the symptoms.

keywords cultural bias, diagnosis, negative symptoms, schizophrenia, Surinam