Reliability of Diagnosis
1) Pontizovsky 2006 - Short term
D> Looked at agreement on diagnosis of type of depression on admission and a year later on release in Islamic psychiatric hospitals in 2003.
F> There was an 83 PPV rate (83% stayed them same.) Therefore 2/10 diagnoses changed.
S> Low reliability in short term diagnosis
E> -Problem could have actually changed
-High ecological validity- natural observation.
2) Baca-Garcia 2007 - Long term
D> Looked at 2322 patients assessed at a spanish psychiatric hospital between 1992-2004. Each patient was assessed atleast 10 times.
F> 54 PPV (54% stayed the same)
S> Even lower rates of reliability over long term assessments.
E> Large sample size and meta-analysis, so generalisable.
Issues of Validity of Diagnosis
D> Gave the diagnostic criteria for depression from the DSM-IV to 62 people who had already been diagnosed as depression and to 42 people without a diagnosis.
F> 74% with a diagnosis were correctly identified as depressed
81% without a diagnosis were confirmed as not depressed
S> Low validity of diagnosis of depression
Doctors often get it wrong
E> -Situation may have actually changed
-Small sample size
Cultural Issues in Diagnosis- Attitudes
Cinnerella and Loewenthal 1999
D> Interviewed a range of people of different cultures living in Britain in their own home, about depression and schizophrenia
F> All cultures agreed that depression was a result of life events and environmental conditions
-All cultures except Catholics had a fear of being misunderstood by a medical professional
-Black Christians and Muslim groups both felt that these conditions were shameful
S> Valid and reliable diagnoses can be difficult as many groups are unwilling to share
Cultural Issues in Diagnosis- Vunerability
Levav et al 1997
D> Compared the frequency of alcholism and depression in American Jews, Catholics and Protestants.
F> -Much higher rate of depression and lower rate of alcholism in Jews
-Jewish Men are twice as likely to be diagnosed as women
S> Some aspect of Jewish culture makes the men find it easier to deal with times of adversity with depression rather than alcoholism.
Could be a genetic predisposition but most likely to be social influences of the culture.
Cultural Issues in Diagnosis- Racism
Littlewood and Lipsedge 1997- Case Study
D> Reviewed the assessment given of 'Calvin', a Jamaican man who got arrested under suspicion of stealing.
F> Instances of institutional racism.
-Said he had a straggly goatee- Doesn't shave for religion.
-Called him arrogant- Had just been arrested.
S> How bias in the system can affect diagnosis given.
Issues of Labelling someone with Depression
Lamy 1996 STIGMA
Found that mothers would prefer to leave their children with a person who had been convicted of a crime and sent to jail than somebody labelled as a mental patient.
Farina et al 1971
D> Studied patients who had formerly been treated for depression by setting them up for an interview with prospective employers.
Split into 2 groups:
1) The employer knew they had a history of depression and participants knew this
2) The employer knew they were previously medical patients and participants knew they didn't know about their depression
-They then had to complete the interview and rate their feelings
F> -When the interviewer knew of their depression they felt unappreciated and performed worse on the tasks
-When the interviewer knew of their past they were rated as tense and anxious.
S> Self- fulfilling prophecy and stigma of psychiatrists affect behaviour.