Etic and emic criteria for non-psychotic mental disorder: a study of the CISR and care provider assessment in Harare.

The paper describes the relationships between the Revised Clinical Interview Schedule (CISR) and the assessment of psychiatric status by primary care providers in Harare. Primary care clinic (PHC) and traditional medical practitioner (TMP) clinic attenders (n = 302) were interviewed with the Shona Symptom Questionnaire, the CISR and the Explanatory Model Interview. The PHC nurses and TMP were interviewed to elicit diagnostic formulation using the WHO Health Staff Rating codes. "Etic" cases were those who scored 12 or more on the CISR and "emic" cases were those whom the care provider had assessed as having a mental disorder. In all, 52% of subjects were classified as etic cases and 59% as emic cases. Overall agreement between the two criteria was 55%. Three-quarters of care provider "false-positives" were accounted for by a failure to take into account the varying reasons for consultation, such as social or spiritual problems. Most of the "false-negative" groups were symptomatic subjects, though with fewer symptoms than those who were "definite cases". One etic concept-phobia-was not considered as a mental disorder and appeared to lack concept validity in this setting.