Psychiatric outpatients in America and the Netherlands: A transcultural comparison

Abstract

Following a discussion of the methological problems encountered in transcultural research, a systematic comparison of psychiatric patients seen in selected outpatient faoilities in the Netherlands and the United States was undertaken. The purpose of the study was to learn about differences in utilization of the clinics, as well as differences in symptomatology and functioning of the two populations. The American clinics were found to see proportionately fewer male, and fewer older patients, than the Dutch clinics. While American clinics appear to see more than ten times as many patients diagnosed as schizophrenic than do the Dutch clinics, comparisons of symptoms suggest that these differences are due mainly to varying diagnostic habits. It is likely that the higher proportion of cases diagnosed as suffering from hysterical symptoms among Dutch cases also reflect differences in diagnostic habits. Cultural differences in symptom choice were apparent. Depressed Dutch patients more often than American patients showed apathy, guilt feelings and psychomotor retardation, among American patients depression appeared to lead more often to more “violent” symptoms such as agitation or suicidal ideation. Complaints about feelings of inadequacy were marked more among Americans than Dutch patients, and more among younger American men than women. Americans more often than Dutch patients feel lonely and complain about social isolation. Among both clinic populations impairment of functioning at work, marital and social adjustment, were related to extent of psychopathology as measured in terms of selected symptoms of schizophrenia and depression. In both countries patients from the lower socio-economic strata and those unmarried, were unemployed more often than those with higher social status and those married. The data suggest, but because of the relatively small number of cases do not prove, that in the Netherland clinic population level of education is a less important factor in unemployment than in the United States, in contrast symptoms of schizophrenia are associated to a more marked degree with unemployment in the Netherland than in the USA cohort. The data presented in this paper must be considered as suggestive rather than conclusive. Differences in reported symptoms and functioning to an unknown degree may reflect observer bias, or cultural differences in what patients will complain about. For many reasons one cannot generalize from the data reported here about differences in types of mental disorder between countries, among other because there always is the possibility that the observed difference to a more or less large extent reflects differences in referral and admission policies. Because of the importance of the study of the impact of social factors on the prevalence and mode of expression of mental disorders it is hoped that systematic comparison between countries will be forthcoming in the not too distant future.