Procedural validity of the AUDADIS-5 depression, anxiety and post-traumatic stress disorder modules: Substance abusers and others in the general population.

BACKGROUND: Little is known about the procedural validity of lay-administered, fully-structured assessments of depressive, anxiety and post-traumatic stress (PTSD) disorders in the general population as determined by comparison with clinical re-appraisal, and whether this differs between current regular substance abusers and others. We evaluated the procedural validity of the Alcohol Use Disorder and Associated Disabilities Interview Schedule, DSM-5 Version (AUDADIS-5) assessment of these disorders through clinician re-interviews. METHODS: Test-retest design among respondents from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III): (264 current regular substance abusers, 447 others). Clinicians blinded to AUDADIS-5 results administered the semi-structured Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 version (PRISM-5). AUDADIS-5/PRISM-5 concordance was indicated by kappa (κ) for diagnoses and intraclass correlation coefficients (ICC) for dimensional measures (DSM-5 symptom or criterion counts). Results were compared between current regular substance abusers and others. RESULTS: AUDADIS-5 and PRISM-5 concordance for DSM-5 depressive disorders, anxiety disorders and PTSD was generally fair to moderate (κ=0.24-0.59), with concordance on dimensional scales much better (ICC=0.53-0.81). Concordance differed little between regular substance abusers and others. CONCLUSIONS: AUDADIS-5/PRISM-5 concordance indicated procedural validity for the AUDADIS-5 among substance abusers and others, suggesting that AUDADIS-5 diagnoses of DSM-5 depressive, anxiety and PTSD diagnoses are informative measures in both groups in epidemiological studies. The stronger concordance on dimensional measures supports the current movement toward dimensional psychopathology measures, suggesting that such measures provide important information for research in the NESARC-III and other datasets, and possibly for clinical purposes as well.

A theoretical and empirical framework for constructing culture-specific stigma instruments for Chile.

Different cultural contexts contribute to substantial variation in the stigma faced by people with psychosis globally. We propose a new formulation of how culture affects stigma to create psychometrically-validated tools to assess stigma's culture-specific effects. We propose to construct culture-specific stigma measures for the Chilean context via: 1) open-ended administration of 'universal' stigma scales to a sample of individuals with psychosis, relatives, and community respondents; 2) qualitative analyses to identify how culture shapes stigma and to derive initial 'culture-specific' stigma items; 3) construction and pilot-testing of final 'culture-specific' stigma measures; 4) initial psychometric validation among a sample of individuals with psychosis. We identify initial hypotheses for how stigma might threaten the capacities to participate in fundamental activities that 'matter most' in the Chilean context. These include mental illness stigma threatening the man's ability to protect the honor of the family, and the woman's ability to be a 'holy and pure' mother. Mental illness stigma may further endanger the ability of the family to uphold reciprocal obligations within their social network. Developing such measures promises to aid efforts to address culture-specific forms of stigma, and to facilitate implementation of community mental health services, in Chile and other Latin American contexts.

A theoretical and empirical framework for constructing culture-specific stigma instruments for Chile / Uma estrutura teórica e empírica para a construção de instrumentos de estigma específicos para a cultura chilena

Different cultural contexts contribute to substantial variation in the stigma faced by people with psychosis globally. We propose a new formulation of how culture affects stigma to create psychometrically-validated tools to assess stigma's culture-specific effects. We propose to construct culture-specific stigma measures for the Chilean context via: 1) open-ended administration of 'universal' stigma scales to a sample of individuals with psychosis, relatives, and community respondents; 2) qualitative analyses to identify how culture shapes stigma and to derive initial 'culture-specific' stigma items; 3) construction and pilot-testing of final 'culture-specific' stigma measures; 4) initial psychometric validation among a sample of individuals with psychosis. We identify initial hypotheses for how stigma might threaten the capacities to participate in fundamental activities that 'matter most' in the Chilean context. These include mental illness stigma threatening the man's ability to protect the honor of the family, and the woman's ability to be a 'holy and pure' mother. Mental illness stigma may further endanger the ability of the family to uphold reciprocal obligations within their social network. Developing such measures promises to aid efforts to address culture-specific forms of stigma, and to facilitate implementation of community mental health services, in Chile and other Latin American contexts.

Diferentes contextos culturais contribuem para a variação substancial do estigma enfrentado por pessoas com psicose globalmente. Nós propomos uma nova formulação de como a cultura afeta o estigma para criar instrumentos validados psicometricamente a fim de avaliar os efeitos específicos do estigma cultural. Propomos a construção de medidas específicas de estigma cultural no contexto chileno através de: 1) administração aberta de escalas "universais" de estigma em uma amostra de indivíduos com psicose, parentes e entrevistados da comunidade; 2) análise qualitativa para identificar as formas de estigma cultural e extrair itens específicos de stigma cultaral; 3) construção e testes-piloto de medidas finais específicos de estigma cultural; 4) validação psicométrica inicial entre uma amostra de indivíduos com psicose. Identificamos hipóteses iniciais de como o estigma pode ameaçar as capacidades de participar em atividades fundamentais mais importantes no contexto chileno. Estes incluem o estigma de a doença mental ameaçar a capacidade do homem para proteger a honra da família, e da capacidade da mulher para ser uma "santa e pura" mãe. O estigma da doença mental pode comprometer ainda mais a capacidade da família para sustentar as obrigações recíprocas dentro de sua rede social. Desenvolvimento de tais medidas promete ajudar os esforços para abordar formas específicas de estigma cultural, e para facilitar a implementação de serviços comunitários de saúde mental, no Chile e em outros contextos latino-americanos.