During the past 2 decades, there has been enormous growth of interest in and visibility of cultural psychiatry. Much of this is due to the steady increase in migration of the world’s population from low-income to higher-income regions and countries.
In a report by the Population Division of the United Nations in 2007, it was estimated that the total number of immigrants in the world in 2005 numbered 191 million (3% of the world’s population)—an increase from 155 million in 1990. The United States had the largest percentage of the world’s immigrants in 2005, equaling 12.86% of the total US population.
Since 1980, there has been more diversity in race, ethnicity, and religion among people who have immigrated to the United States. The total US population has increased by 29% from 1980 through 2005. During those years, the Asian-Pacific component has grown 219%; the Hispanic component, 174%; the African American component, 37%; and the white component, 9%.
It is these trends in immigration that have compelled the US government to become much more cognizant of the health and social service needs of its increasingly culturally diverse population. As a result, health policy agencies and clinicians need a better understanding of how to clinically assess and treat people of varied backgrounds that come to their facilities for care. There is great variation in the manner and extent that people who feel ill are willing and able to access clinical care. Furthermore, language and conceptual differences often make communication between patients and clinicians problematic. A framework with which to assess the way patients of different backgrounds conceptualize and express feeling unwell, stressed, or ill is needed, as well as an understanding of how those feelings manifest as symptoms and clinical presentations.
One of the most practical applications of cultural psychiatry to clinical practice in all fields of medicine is the open-ended questioning of patients and their families about their personal and family background characteristics. This includes identifying features of race, ethnicity, religion, and socioeconomic class, relevant immigration history, experiences of acculturative stress, and personal and family aspirations. A discussion of these background characteristics can lead naturally to the clinician’s exploration of the presenting clinical symptoms and history. Knowledge of the patient’s background will increase rapport with patients and families and aid the process of collecting a more reliable history. In addition, it will improve the likelihood of treatment adherence.
This process has been described as “cultural case formulation,” and its components are outlined in DSM-IV-TR (2000) and may be expanded in DSM-V. A number of detailed case histories that incorporate the component sections of the cultural case formulation are included in Cultural Assessment in Clinical Psychiatry.1
This Special Report on cross-cultural psychiatry includes 3 articles that apply principles of cultural psychiatry that are of central importance to clinicians: (1) cultural considerations in the assessment and treatment of children and youth; (2) religion, spirituality, and mental health; and (3) cultural and ethnic issues in psychopharmacology. These articles offer the reader an up-to-date overview of clinically applicable principles of cross-cultural psychiatry.
1. Group for the Advancement of Psychiatry. Cultural Assessment in Clinical Psychiatry. Arlington, VA: American Psychiatric Publishing; 2002.