Assessing Explanatory Models for Common Mental Disorders

Objectives: This article addresses the clinical implications of 3 questions: (1) Can a simple checklist, suitable for use by practitioners, assess all components of explanatory models (EMs) for mental distress? (2) Are perceived causes of mental distress actually related to treatment preferences? (3) Are EMs influenced uniquely by ethnic group, or are they more closely associated with the presence of common mental disorders?

Method: From February 2003 to January 2004, we investigated EMs for mental distress among 79 Bangladeshi, 85 black Caribbean, and 97 white British people who reported difficulties in the preceding month. EMs were assessed by a self-report checklist that inquired about the identity, causes, timeline, consequences, controllability, and preferred treatments for mental distress. Common mental disorders were assessed using the Clinical Interview Schedule (revised).

Results: Independent of ethnic group, people with common mental disorders were more likely to give spiritual causal explanations (odds ratio [OR] = 3.1, 95% CI = 1.9 to 4.9), to report behavioral (OR = 2.2, 95% CI = 1.3 to 3.8) and financial consequences (OR = 3.3, 95% CI = 1.8 to 6), and to prefer complementary treatments (OR = 4.6, 95% CI = 2.3 to 9.1). Compared with black Caribbean and white British subjects, Bangladeshi subjects more often gave spiritual or physical causal explanations. Compared with white British subjects, Bangladeshi and black Caribbean subjects preferred medical and spiritual treatments, whereas white British subjects, as compared with the other 2 ethnic groups, preferred self-management and social treatments. Causal explanations did not always relate to the corresponding treatment preferences.

Conclusions: EMs can be assessed by a simple checklist, show variations by ethnic group, and are associated with common mental disorders. Identifying EMs may strengthen the assessment of common mental disorders.