Am J Psychiatry 1996; 153:1043-1049
Copyright © 1996 by American Psychiatric Association
Stigma, depression, and somatization in South India
R Raguram, MG Weiss, SM Channabasavanna and GM Devins
Department of Psychiatry, National Institute, of Mental Health and Neuro Sciences, Bangalore, India. raguram@nimhans.ren.nic.in
OBJECTIVE: The relationships of stigma to both depression and somatization
were studied in psychiatric patients in South India to test the hypothesis
that stigma is positively related to depressive symptoms and negatively
related to somatoform symptoms. METHOD: Illness experience, symptom
prominence, and indicators of stigma for 80 psychiatric outpatients were
addressed with the Explanatory Model Interview Catalogue. Stigma scores and
ratings of symptom prominence were derived. The Structured Clinical
Interview for DSM-III-R and the Hamilton Depression Rating Scale were
administered to assess psychiatric diagnoses and symptoms of depression.
Clinical narratives were analyzed to clarify the nature of relationships
between stigma and symptom prominence. RESULTS: The mean stigma scores were
18.2 (SD = 13.0) for patients with somatoform disorders only, 36.0 (SD =
19.0) for patients with depressive disorders only, and 26.8 (SD = 16.0) for
those with mixed depressive and somatoform disorders. The stigma scores
were positively related to depressive symptoms, as indicated by Hamilton
scale scores and prominence ratings for depressive symptoms, but stigma was
inversely related to somatoform symptoms, as indicated by ratings of
symptom prominence. Although both depressive and somatic symptoms were
distressing, qualitative analysis clarified meanings of perceived stigma,
showing that depressive symptoms, unlike somatic symptoms, were construed
as socially disadvantageous. CONCLUSIONS: The tendency to perceive and
report distress in psychological or somatic terms is influenced by various
social and cultural factors, including the degree of stigma associated with
particular symptoms. This study with the Explanatory Model Interview
Catalogue demonstrates how quantitative and qualitative methods can be
effectively combined to examine key issues in cultural psychiatry.
