Limitations of a structured psychiatric diagnostic instrument in assessing somatization among Latino patients in primary care.
BACKGROUND
The Composite International Diagnostic Interview (CIDI) has been developed as a state-of-the-art, structured diagnostic instrument, designed to diagnose psychiatric disorders across cultures and languages. Partly because it has been validated in a number of countries and cultural settings, the CIDI has become widely accepted as a diagnostic instrument in epidemiologic and clinical research.


OBJECTIVE
As part of a larger study of psychiatric disorders in a multi-ethnic, primary care setting, we tried to clarify the limitations of the CIDI in diagnosing somatoform symptoms among Latino patients.


METHODS
Relevant sections of the CIDI were administered in English or Spanish to new patients seeking primary care services at an inner-city, university-affiliated community clinic. Interviews were tape recorded and pertinent passages were transcribed for qualitative analysis.


METHODS
One thousand, four hundred and fifty six new patients, comprising 4 ethnic groups: Central American; Mexican; Chicano; and non-Latino White.


METHODS
The CIDI's diagnostic algorithms for somatization were examined in relation to the transcriptions of interviews for Latino patients whom the CIDI diagnosed as somatizers.


RESULTS
The CIDI led to the inaccurate identification of somatoform symptoms resulting from such issues as financial barriers to healthcare access, cultural syndromes that were not recognized by Western medicine, and language differences between patients and physicians. Like other structured instruments, the CIDI also forced a range of complex experience into a fixed-choice interview format.


CONCLUSIONS
Despite the advantages of such structured instruments as the CIDI, their capacity to reach accurate psychiatric diagnoses in some cultural groups and clinical settings requires clarification. These findings also call into question the relatively high rates of somatization among Latino patients reported in previous studies that have used structured psychiatric diagnostic instruments.
Villaseñor
Y
Y
Center for Health Policy Research, University of California, Irvine, USA.
Waitzkin
H
H
D000465:Algorithms; D001294:Attitude to Health / Q000208:ethnology; D003431:Cross-Cultural Comparison; D004641:Emigration and Immigration; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D007406:Interview, Psychological / Q000379:methods*; D008297:Male; D011320:Primary Health Care; D015203:Reproducibility of Results; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000208:ethnology*; D013313:Stress Disorders, Post-Traumatic / Q000150:complications; D014481:United States; D014857:Warfare; D044465:White People / Q000523:psychology