Assessing Explanatory Models for Common Mental Disorders
J Clin Psychiatry 2006;67:964-971
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objectives: This article addresses the
clinical implications of 3 questions: (1) Can a
simple checklist, suitable for use by practitioners,
assess all components of explanatory models (EMs)
for mental distress? (2) Are perceived causes of
mental distress actually related to treatment
preferences? (3) Are EMs influenced uniquely by
ethnic group, or are they more closely associated
with the presence of common mental disorders?
Method: From February 2003 to
January 2004, we investigated EMs for mental
distress among 79 Bangladeshi, 85 black Caribbean,
and 97 white British people who reported
difficulties in the preceding month. EMs were assessed by
a self-report checklist that inquired about the
identity, causes, timeline, consequences,
controllability, and preferred treatments for mental
distress. Common mental disorders were assessed
using the Clinical Interview Schedule (revised).
Results: Independent of ethnic group,
people with common mental disorders were more
likely to give spiritual causal explanations (odds
ratio [OR] = 3.1, 95% CI = 1.9 to 4.9), to report
behavioral (OR = 2.2, 95% CI = 1.3 to 3.8) and
financial consequences (OR = 3.3, 95% CI = 1.8 to 6), and
to prefer complementary treatments (OR = 4.6, 95% CI = 2.3 to 9.1). Compared with black
Caribbean and white British subjects, Bangladeshi
subjects more often gave spiritual or physical causal
explanations. Compared with white British
subjects, Bangladeshi and black Caribbean subjects
preferred medical and spiritual treatments,
whereas white British subjects, as compared with the
other 2 ethnic groups, preferred self-management
and social treatments. Causal explanations did not always relate to the corresponding treatment
Conclusions: EMs can be assessed by
a simple checklist, show variations by ethnic
group, and are associated with common mental disorders. Identifying EMs may strengthen the
assessment of common mental disorders.