RESUMO
This paper critically reviews the process and outcome of an effort to enhance the cultural validity of DSM-IV and outlines recommendations to improve future diagnostic systems. An ordered presentation of the antecedents and the main phases of this developmental effort is followed by a content analysis of what was proposed and what was actually incorporated, and a conceptual analysis of underlying biases and their implications. The cultural effort for DSM-IV, spearheaded by a scholarly independent NIMH workgroup, resulted in significant innovations including an introductory cultural statement, cultural considerations for the use of diagnostic categories and criteria, a glossary of culture-bound syndromes and idioms of distress, and an outline for a cultural formulation. However, proposals that challenged universalistic nosological assumptions and argued for the contextualization of illness, diagnosis, and care were minimally incorporated and marginally placed. Although a step forward has been taken to introduce cultural elements in DSM-IV much remains to be done. Further culturally informed research is needed to ensure that future diagnostic systems incorporate a genuinely comprehensive framework, responsive to the complexity of health problems in increasingly multicultural societies.
Assuntos
Cultura , Transtornos Mentais/classificação , Transtornos Mentais/diagnóstico , Terminologia como Assunto , Previsões , Humanos , Manuais como Assunto , Transtornos Mentais/etnologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto , Escalas de Graduação Psiquiátrica/normas , Psicometria/normas , Psicometria/tendências , Reprodutibilidade dos TestesRESUMO
The NIH (National Institutes of Health) Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research requires investigators applying for NIH research funds to develop and, if funded, implement plans for the inclusion of women and minority populations in their research, when that research involves human participants. It is the purpose of this article to help investigators understand (a) the scientific context and rationale behind the NIH Guidelines; (b) the NIH-defined concepts and the specific content of the NIH Guidelines; and (c) how the intent of the NIH Guidelines is related to mental health services research, the most applied area of mental health research. The article also discusses where investigators can find additional information as they work to implement the NIH Guidelines.
