Burgeoning global mental health endeavors have renewed debates about cultural applicability of psychiatric
categories. This study's goal is to review strengths and limitations of literature comparing psychiatric categories with cultural
concepts of distress (CCD) such as cultural syndromes, culture-bound syndromes, and idioms of distress.
Systematic Assessment of Quality in Observational Research (SAQOR) was adapted based on cultural psychiatry principles to
develop a Cultural Psychiatry Epidemiology version (SAQOR-CPE), which was used to rate quality of quantitative studies comparing
CCD and psychiatric categories. A meta-analysis was performed for each psychiatric category.
studies met inclusion criteria, with 18 782 unique participants. Primary objectives of the studies included comparing CCD
and psychiatric disorders (51%), assessing risk factors for CCD (18%) and instrument validation (16%). Only 27% of studies
met SAQOR-CPE criteria for medium quality, with the remainder low or very low quality. Only 29% of studies employed representative
samples, 53% used validated outcome measures, 44% included function assessments and 44% controlled for confounding. Meta-analyses
for anxiety, depression, PTSD and somatization revealed high heterogeneity (I2 > 75%). Only general psychological distress
had low heterogeneity (I2 = 8%) with a summary effect odds ratio of 5.39 (95% CI 4.71-6.17). Associations between CCD and
psychiatric disorders were influenced by methodological issues, such as validation designs (β = 16.27, 95%CI 12.75-19.79)
and use of CCD multi-item checklists (β = 6.10, 95%CI 1.89-10.31). Higher quality studies demonstrated weaker associations
of CCD and psychiatric disorders.
Cultural concepts of distress are not inherently unamenable to
epidemiological study. However, poor study quality impedes conceptual advancement and service application. With improved study
design and reporting using guidelines such as the SAQOR-CPE, CCD research can enhance detection of mental health problems,
reduce cultural biases in diagnostic criteria and increase cultural salience of intervention trial outcomes.