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Clinicians' Perspectives on Diagnostic Markers for Depression Among Adolescents in India: An Embedded Mixed-Methods Study.

Authors
  • Aggarwal, Pankhuri1
  • Raval, Vaishali V2
  • Chari, Uttara3
  • Raman, Vijaya3
  • Kadnur Sreenivas, Kamalesh3
  • Krishnamurthy, Sanjana3
  • Visweswariah, Ashok Mysore3
  • 1 Department of Psychology, Miami University, 90 N Patterson Ave, Oxford, OH, 45056, USA. [email protected]
  • 2 Department of Psychology, Miami University, 90 N Patterson Ave, Oxford, OH, 45056, USA.
  • 3 Department of Psychiatry, St. John's Medical College, Bengaluru, Karnataka, India. , (India)
Type
Published Article
Journal
Culture Medicine and Psychiatry
Publisher
Springer-Verlag
Publication Date
Jun 01, 2021
Volume
45
Issue
2
Pages
163–192
Identifiers
DOI: 10.1007/s11013-020-09680-8
PMID: 32592142
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Limited research has investigated whether clinicians around the world find diagnostic criteria for depression that were originally developed in the West are useful with diverse populations. Using an embedded mixed-methods design in India, we examined (a) clinicians' and trainees' (n = 143) ratings of the usefulness of the criteria for Major Depressive Disorder (MDD) outlined in two major diagnostic systems (Diagnostic and Statistical Manual of Mental Disorders-5; DSM-5 and International Classification of Mental and Behavioral Disorders-Tenth Edition; ICD-10), and (b) narrative descriptions of clinical cases of adolescent depression and usefulness of diagnostic and screening instruments in day-to-day practice using semi-structured interviews in a subsample of clinicians (n = 24). Qualitative findings demonstrated that Indian clinicians identified markers of depression that were consistent with the current diagnostic manuals (affective, cognitive, somatic symptoms), and the numeric ratings suggested that clinicians found a majority of DSM-5 and ICD-10 criteria for MDD to be useful. However, Indian clinicians also identified additional markers of adolescent depression (i.e., interpersonal conflicts and issues, impairment in school-related functioning, anger-based symptoms, anxiety-based symptoms, additional somatic complaints not included in DSM-5 or ICD-10), highlighting the need to modify existing diagnostic criteria to be more inclusive. The findings suggest the need for culturally informed diagnostic practices that consider a wide range of clinical presentations of depression among adolescents worldwide.

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