Psychiatric data are questionable

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7010.947c (Published 07 October 1995) Cite this as: BMJ 1995;311:947
  1. Petrus De Vries
  1. Senior house officer in psychiatry Mental Health Services Addenbrooke's NHS Trust, Fulbourn Hospital, Cambridge CB1 5EF

    EDITOR,--Rajendra Kale's overview of health care in South Africa is a report on a large country sectorised through years of prejudice.1 Epidemiological data (in traditional apartheid style) supply us with an alarming yet not unexpected discrepancy in the health profile of white people compared with black people, which is ascribed to “the best of First World and the worst of Third World medicine.”1 Audit of community psychiatric clinics, however, showed strange figures: “Schizophrenia was diagnosed in 68% of black patients compared with 19% of white patients; mood disorders were diagnosed in 9% of black patients compared with 41% of white patients.”2

    The international pilot study of schizophrenia showed that a reliable diagnosis of schizophrenia was made by local psychiatrists in nine different countries, including India and Nigeria; the prevalence was similar in all countries.3 The large epidemiologic catchment area study of depressive epidemiology in the United States found few differences in the ethnic or racial presentation of mood disorders.4

    I agree that it is difficult to interpret Kale's data. What criteria have been used to make the diagnosis? By whom were the diagnoses made? Could there have been racial prejudice? Did patients always understand questions about “depression” (in most South African languages there is no direct translation for the word)? Is it not a sign of wisdom for rural black people to “hear voices” or “see vision” of their forefathers? And were socioeconomic factors considered?

    One thing is certain: South Africa's mental health urgently needs structured, statistically meaningful epidemiological research. Perhaps then we will know whether Kale has presented us with a fallacy of psychiatry in South Africa or with an internationally unique transcultural phenomenon.


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