Effects of a culturally sensitive assessment on symptom profiles in native Dutch and Moroccan patients with a first psychosis referral

Transcult Psychiatry. 2016 Feb;53(1):45-59. doi: 10.1177/1363461515577288. Epub 2015 Apr 7.


Previous studies have reported a higher incidence of psychosis in Moroccan immigrants in the Netherlands than among native-born residents. However, this disparity was substantially attenuated when cultural differences in symptom presentation were taken into account. To better understand the impact of different diagnostic procedures on incidence rates, we examined the effects of the use of a culturally sensitive diagnostic interview, compared to a standard semi-structured diagnostic interview, on symptom profiles among Moroccan immigrant and native Dutch patients in the Netherlands. A total of 26 Dutch and 26 Moroccan patients referred with a possible first psychosis diagnosis were interviewed twice: once with the standard version and once with a culturally adapted version of the Comprehensive Assessment of Symptoms and History questionnaire (CASH and CASH-CS, respectively). Among native Dutch patients, symptoms profiles based on CASH and CASH-CS interviews were very similar. By contrast, among Moroccan immigrant patients, symptom profiles based on CASH and CASH-CS interviews differed substantially, with more mania symptoms (+30%; p < .05) and fewer delusions (-31%; p < .05) reported when using the CASH-CS. These results suggest that the over-diagnosis of schizophrenia in Moroccan immigrants with a first psychosis referral may be related to a tendency to under-detect mood symptoms and over-detect positive psychotic symptoms when a standard diagnostic procedure is used. This bias may be corrected, at least in part, by the use of a culturally sensitive interview instrument such as the CASH- CS.

Keywords: culturally sensitive; immigrant; psychosis; schizophrenia; standardized diagnosis.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Cross-Cultural Comparison
  • Delusions / ethnology*
  • Depression / ethnology*
  • Emigrants and Immigrants / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Morocco
  • Netherlands / ethnology
  • Psychiatric Status Rating Scales
  • Referral and Consultation / statistics & numerical data*
  • Schizophrenia / ethnology*
  • Young Adult