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Cultural Factors in Depression and Co-Morbid Drinking

Cultural Factors in Depression and Co-Morbid Drinking (O’Nell First Award)


1996 – 2001

Theresa O’Nell, Ph.D.

Theresa O’Nell, Ph.D..; Ilena Norton, MD; Spero Manson, Ph.D.; Jan Beals, Ph.D; Christina Mitchell, Ph.D.



The proposed study examines cultural and social factors affecting depressive disorder and problem drinking among the adolescents, adults, and elderly of an American Indian people living on a Northern Plains reservation.   Specifically, this study has 3 Specific Aims:

  1. An ethnographic exploration of the local signs of depressive-like experiences, problematic alcohol use, and their co-morbidity, with a special focus on the cultural relevance of DSM-IV criteria for each syndrome;
  2. an ethnographic investigation of subcultural variation in the everyday use of cultural idioms and explanatory models for depression and problem drinking by gender and across the age categories of youth, middle adulthood and older adulthood; and
  3. an appraisal of the influence of cultural definitions of pathology on symptom presentation among three samples – a sample of youths, adults and elderly diagnosed with major depressive disorder according to DSM-IV criteria, a sample constituted and diagnosed in a similar fashion with alcohol abuse or dependence, and a sample constituted and diagnosed in a similar fashion as comorbid with both an alcohol and a major depressive disorder.



This study will produce a comparative set of data:

  1. Ethnographic reports detailing contemporary reservation life;
  2. interview transcripts with 20 healers about a) culture-specific syndromes, idioms and EM’s for depression and problem drinking; and b) the cultural relevance of DSM criteria for depressive disorders and alcohol disorders;
  3. ethnographic reports about role expectations for men and women across three age-grades;
  4. ethnographic notes regarding assessments of normal and abnormal affect and drinking in everyday contexts; and
  5. a set of three interviews (CIDI, SCID, and ethnographic) for each of 72 randomly selected respondents.   Through the cultural analyses of cultural definitions of psychopathology, their relationships to psychiatric criteria, and the interrelation of these two visions of human distress, the findings will contribute to the field of cross-cultural psychiatry in both practically and theoretically significant ways.


The Year-3 interview sample of 36 respondents randomly selected from the AI-SUPERPFP project will consist of 12 youths (ages 15-25), 12 middle-aged adults (ages 26-55), and elders (ages 56 and up), with respondents in each age group to be divided equally between males and females.   Within each of the subgroups based on age-grade and gender, the respondents will be equally divided among the following diagnoses: depressive disorder; alcohol disorder; comorbid depressive and alcohol disorders.  The Year 4 interview sample of 36 respondents will repeat the Year 3 structure, and will bring the total sample to 72.



O'Nell, T. D. (1996). Disciplined hearts: History, identity and depression in an American Indian community. Berkeley, CA: University of California Press.

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