Supplementary procedures (Fig.
6.1) can be used to obtain acomprehensive assessment of social,
cultural and other contextualfactors influencing the occurrence,
presentation, course ortreatment of clinical disorders. They may also be
useful formeasuring social and occupational functioning and participation,
social support, family adjustment, life events and quality oflife. In these,
as in all clinical assessments, the culturalframework should be
systematically considered.
The purposes of these supplementary assessments are:
to document areas and degrees of impairment in social and occupational
functioning for the purposes of comprehensive diagnosis, prognosis,care
planning and disability compensation;
to describe patients'social support systems or networks, personaland
environmentalresources, and recent and remote stressfullife events for the
purposes of diagnosis and treatment;
to assess the family'sperceptions of the patient's problems,their impact
on thepatient, and their consequences for familyfunctioning;
toassess quality of life for a broad assessment of well-beingand to
ensure that attention is paid to what is most meaningfulto the patient (e.g.
family supports, religious beliefs).
Various types of supplementary assessment procedures shouldbe considered
for use in evaluating these domains, includingclinician-rated, self-rated and
family-rated scales, checklists,and semi-structured interview methods.
Choice of a supplementary assessment procedure should be basedon a
consideration of the purpose intended (e.g. to aid indetermining level of
treatment needed, to identify particulartargets of treatment); the breadth or
specificity desired (e.g.global assessment of functioning v.
specific measure of socialfunctioning); the kind of patient, or setting of
evaluation(e.g. adults with schizophrenia, married couples, people in
institutional care); and the resources available (e.g. trainedinterviewer, or
clerical scorer of self-report questionnaire).
Global assessment instruments provide an overall rating of clinicalstate
or functioning. A trained clinician is usually neededto make the assessment.
The rating is usually made on a singlecontinuous scale and can be used to
monitor clinical improvementover time.
Detailed measures of social functioning should be used to assessclinical
state and health status and to determine level ofcare (e.g. in-patient,
out-patient or long-term residentialtreatment). The most important areas to
assess are interpersonalfunctioning, occupational functioning, self-care and
broadersocial participation, keeping in mind that their relative importance
varies across cultures.
Important areas of social context to be assessed include socio-economic
status (for example through head of household's occupation andeducation),
social supports and stressors, and access to care(including financial,
insurance, geographical, transportationand cultural barriers).
It is often important, particularly in multicultural societies,to assess
the cultural framework of the experience of illnessexplanations and
help-seeking behaviours. Consideration ofthe patient's explanatory models can
be valuable for both validdiagnosis and effective care planning.
The need to broaden the information base of health status assessmenthas
led to the development of quality-of-life measures. Theserefer predominantly
to the individual's subjective perceptionof satisfaction with and position in
life in relation to thatindividual's goals, expectations, standards and
aspirations.
Goldman, H. H., Skodol, A. E. & Love, T. R.
(1992) Revising Axis V for DSMIV: a review of measures
of social functioning. American Journal of Psychiatry,
149,
1148-1156.[Abstract] Kabanov, M. M. (1985)Reabilitatsiya
Psikhicheski Bolnykh [The Rehabilitation of the Mentally III]
(2nd edn). Leningrad: Medicine. Katschnig, H., Freeman, H. & Sartorius, N.
(1999)Quality of Life in Mental
Disorders. Chichester: John Wiley & Sons. Also available from
the publisher in Italian, Japanese and Spanish translations. Weiss, M. G., Raguram, M. & Channabasavanna, S. M.
(1995) Cultural dimensions of psychiatric diagnosis. A
comparison of DSMIIIR and illness explanatory models in south
India. British Journal of Psychiatry,
166,
353-359.[Abstract] World Health Organization (1999)International Classification of Functioning, Disability and Health
(ICF). Geneva: WHO.