Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-26T09:21:49.957Z Has data issue: false hasContentIssue false

3 - Multicultural Issues in Clinical Psychological Assessment

from Part I - General Issues in Clinical Assessment and Diagnosis

Published online by Cambridge University Press:  06 December 2019

By
Frederick T. L. Leong ,
P. Priscilla Lui  and
Zornitsa Kalibatseva
Edited by
Martin Sellbom  and
Julie A. Suhr
Martin Sellbom
Affiliation:
University of Otago, New Zealand
Julie A. Suhr
Affiliation:
Ohio University
Get access

Summary

This chapter provides a discussion of multicultural issues in clinical psychological assessment. The first two sections discuss best practice–related issues in assessment in relation to (1) clinical diagnosis and (2) psychological testing and assessment. For example, in terms of clinical diagnosis, the Cultural Formulation approach in DSM-5 represents the current major framework for conducting diagnosis with culturally diverse patients. At the same time, we also highlight the importance of cultural threats to validity. In the third and final section, we discuss the remaining challenges and the future directions related to multicultural issues in clinical psychological assessment. These challenges include the evaluation of cultural validity and measurement invariance of our psychological tests and measures. Future directions for the field involve achieving greater representation and generalizability in light of the WEIRD sample bias, that is, most of the psychological research has been conducted in Western Industrialized Rich Democracies.

Keywords

Multicultural assessmentcultural formulationcultural validitythreats to validity
Type
Chapter
Information
The Cambridge Handbook of Clinical Assessment and Diagnosis , pp. 25 - 37
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adebimpe, V. R. (2004). A second opinion on the White norms in psychiatric diagnosis of Black patients. Psychiatric Annals, 34, 542–551.Google Scholar
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association. (2013a). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association. (2013b). Cultural Formulation Interview. www.multiculturalmentalhealth.ca/wp-content/uploads/2013/10/2013_DSM5_CFI.pdfGoogle Scholar
American Psychiatric Association. (2013c). Supplementary modules to the Core Cultural Formulation Interview (CFI). www.multiculturalmentalhealth.ca/wp-content/uploads/2013/10/CFI-Cultural-Identity.pdfGoogle Scholar
American Psychological Association. (2017). Multicultural guidelines: An ecological approach to context, identity, and intersectionality. www.apa.org/about/policy/multicultural-guidelines.pdfGoogle Scholar
Brown, T. A. (2014). Confirmatory factor analysis for applied research (2nd ed.). New York: Guilford Press.Google Scholar
Burlew, A. K., Feaster, D., Brecht, M., & Hubbard, R. (2014). Measurement and data analysis in research addressing health disparities in substance abuse. Journal of Substance Abuse Treatment, 36, 25–43. https://doi.org/10.1016/j.jsat.2008.04.003Google Scholar
Campbell, D. T., & Stanley, J. C. (1966). Experimental and quasi-experimental designs for research. Chicago: Rand McNally.Google Scholar
Canino, G., & Alegria, M. (2008). Psychiatric diagnosis: Is it universal or relative to culture? Journal of Child Psychology and Psychiatry, 49, 237–250.CrossRefGoogle ScholarPubMed
Chang, E. C. (1996). Evidence for the cultural specificity of pessimism in Asians vs Caucasians: A test of a general negativity hypothesis. Personality and Individual Differences, 21, 819–822.Google Scholar
Cheung, F. M., Cheung, S. F., Zhang, J., Leung, K., Leong, F., & Yeh, K. H. (2008). Relevance of openness as a personality dimension in Chinese culture: Aspects of its cultural relevance. Journal of Cross-Cultural Psychology, 39, 81–108. https://doi.org/10.1177/0022022107311968Google Scholar
Cheung, F. M., Leong, F. T. L., & Ben-Porath, Y. S. (2003). Psychological assessment in Asia: Introduction to the special section. Psychological Assessment, 15, 243-247.Google Scholar
Cheung, F. M., Leung, K., Fan, R. M., Song, W.-Z., Zhang, J.-X., & Zhang, J.-P. (1996). Development of the Chinese Personality Assessment Inventory (CPAI). Journal of Cross-Cultural Psychology, 27, 181–199. https://doi.org/10.1177/0022022196272003Google Scholar
Cheung, F. M., van de Vijver, F. J. R., & Leong, F. T. L. (2011). Toward a new approach to the study of personality in culture. American Psychologist, 66, 593–603. https://doi.org/10.1037/a0022389CrossRefGoogle Scholar
Church, A. T. (2001). Personality measurement in cross-cultural perspective. Journal of Personality, 69, 979–1006. https://doi.org/10.1111/1467-6494.696172CrossRefGoogle ScholarPubMed
Constantine, M. G. (2007). Racial microaggressions against African American clients in cross-racial counseling relationships. Journal of Counseling Psychology, 54, 1–16.CrossRefGoogle Scholar
Cross, S. E., Hardin, E. E., & Gercek, B. (2011). The what, how, why and where of self-construal. Personality and Social Psychology, 15, 142–179.Google Scholar
Eap, S., Gobin, R. L., Ng, J., & Nagayama Hall, G. C. (2010). Sociocultural issues in the diagnosis and assessment of psychological disorders. In Maddux, J. E. & Tangney, J. P. (Eds.), Social psychological foundations of clinical psychology (pp. 312–328). New York: Guilford Press.Google Scholar
Enright, J. B., & Jaeckle, W. R. (1963). Psychiatric symptoms and diagnosis in two subcultures. International Journal of Social Psychiatry, 9, 12–17.CrossRefGoogle Scholar
Fernandez, K., Boccaccini, M. T., & Noland, R. M. (2007). Professionally responsible test selection for Spanish-speaking clients: A four-step approach for identifying and selecting translated tests. Professional Psychology: Research and Practice, 38, 363–374. https://doi.org/10.1037/0735-7028.38.4.363Google Scholar
Gamst, G. C., Liang, C. T. H., & Der-Karabetian, A. (2011) Handbook of multicultural measures. Thousand Oaks, CA: Sage Publications.Google Scholar
Garb, H. N. (1997). Race bias, social class bias, and gender bias in clinical judgment. Clinical Psychology: Science and Practice, 4, 99–120.Google Scholar
Garfield, S. (1984). Methodological problems in clinical diagnosis. In Adams, H. E. & Sutker, P. B. (Eds.), Comprehensive handbook of psychopathology (pp. 27–44). New York: Plenum.Google Scholar
Goh, M., Dunnigan, T., & Schuchman, K. M. (2004). Bias in counseling Hmong clients with limited English proficiency. In Chin, J. L. (Ed.), The psychology of prejudice and discrimination: Ethnicity and multiracial identity, Vol. 2 (pp. 109–136). Westport, CT: Praeger and Greenwood Publishing.Google Scholar
Heine, S. J. (2001). Self as a cultural product. An examination of East Asian and North American selves. Journal of Personality, 69, 881–890.Google Scholar
Henrich, J., Heine, S. J., & Norenzayan, A. (2010). The weirdest people in the world? Behavioral and Brain Sciences, 33, 61–135. https://doi.org/10.1017/S0140525X0999152XGoogle Scholar
Hornby, G., & Lafaele, R. (2011). Barriers to parental involvement in education: An explanatory model. Educational Review, 63, 37–52. https://doi.org/10.1080/00131911.2010.488049Google Scholar
Hui, C. H., & Triandis, H. (1986). Individualism-collectivism: A study of cross-cultural researchers. Journal of Cross-Cultural Psychology, 17, 225–248.CrossRefGoogle Scholar
International Test Commission. (2017). The ITC guidelines for translating and adapting tests (2nd ed.). www.intestcom.org/files/guideline_test_adaptation_2ed.pdfGoogle Scholar
Jackson, J. S., Abelson, J. M., Berglund, P. A., Mezuk, B., Torres, M., & Zhang, R. (2011). Ethnicity, immigration, and cultural influences on the nature and distribution of mental disorders: An examination of major depression. In Regier, D., Narrow, W., Kuhl, E., & Kupfer, D. (Eds.), Conceptual evolution of DSM-5 (pp. 267–285). Arlington, VA: American Psychiatric Publishing.Google Scholar
Ketterer, H. L., Han, K., Hur, J., & Moon, K. (2010). Development and validation of culture-specific Variable Response Inconsistency and True Response Inconsistency Scales for use with the Korean MMPI-2. Psychological Assessment, 22, 504–519. https://doi.org/10.1037/a0019511Google Scholar
Kleinman, A. (1982). Neurasthenia and depression: A study of somatization and culture in China. Culture, Medicine, and Psychiatry, 6, 117–190.Google Scholar
Kline, R. (2011). Principles and practice of structural equation modeling. New York: Guilford Publications.Google Scholar
Kluckhohn, F. R. (1953). Personality in nature, society, and culture. New York: Alfred A. Knopf.Google Scholar
Lau, A. S., Tsai, W., Shih, J., Liu, L. L., Hwang, W.-C., & Takeuchi, D. T. (2013). The Immigrant Paradox among Asian American Women: Are disparities in the burden of depression and anxiety paradoxical or explicable? Journal of Consulting and Clinical Psychology, 81(5), 901–911. http://doi.org/10.1037/a0032105Google Scholar
Lee, E. (1980). Mental health services for the Asian-Americans: Problems and alternatives. In Chin, L (Ed.), U.S. Commission of Civil Rights, Civil rights issues of Asian and Pacific-Americans: Myths & realities (pp. 676–680). Washington, DC: U.S. Government Printing Office.Google Scholar
Leong, F. T. L. (1996). Towards an integrative model for cross-cultural counseling and psychotherapy. Applied and Preventive Psychology, 5,189–209.CrossRefGoogle Scholar
Leong, F. T. L. (1986). Counseling and psychotherapy with Asian Americans: Review of the literature. Journal of Counseling Psychology, 33, 196–206.Google Scholar
Leong, F. T. L., & Hardin, E. (2002). Career psychology of Asian Americans: Cultural validity and cultural specificity. In Hall, G and Okazaki, S (Eds.), Asian American Psychology: Scientific Innovations for the 21st Century (pp. 131–152). Washington, DC: American Psychological Association.Google Scholar
Leong, F. T. L., & Hartung, P. J. (2003). Cross-cultural career counseling. In Bernal, G, Trimble, J. E, Burlew, A. K, & Leong, F. T. L (Eds.), Handbook of racial and ethnic minority psychology (pp. 504–520). Thousand Oaks, CA: Sage Publications.CrossRefGoogle Scholar
Leong, F. T. L., & Kalibatseva, Z. (2016). Threats to cultural validity in clinical diagnosis and assessment: Illustrated with the case of Asian Americans. In Zane, N., Bernal, G., & Leong, F. T. L. (Eds.), Culturally-informed evidence-based practice in psychology (pp. 57–74). Washington, DC: American Psychological Association.Google Scholar
Leong, F. T. L., Leung, K., & Cheung, F. M. (2010). Integrating cross-cultural research methods into ethnic minority psychology. Cultural Diversity and Ethnic Minority Psychology, 16, 590–597. https://doi.org/10.1037/a0020127Google Scholar
Leong, F. T. L., Okazaki, S., & Tak, J. (2003). Assessment of depression and anxiety in East Asia. Psychological Assessment, 15, 290–305.Google Scholar
Li, Z., & Hicks, M. H.-R. (2010). The CES-D in Chinese American women: Construct validity, diagnostic validity for major depression, and cultural response bias. Psychiatry Research, 175, 227–232. https://doi.org/10.1016/j.psychres.2009.03.007Google Scholar
Li-Repac, D. (1980). Cultural influences on clinical perception: A comparison between Caucasian and Chinese-American therapists. Journal of Cross-Cultural Psychology, 11, 327–342.CrossRefGoogle Scholar
López, S. R., Nelson Hipke, K., Polo, A. J., Jenkins, J. H., Karno, M., Vaughn, C., & Snyder, K. S. (2004). Ethnicity, expressed emotion, attributions, and course of schizophrenia: Family warmth matters. Journal of Abnormal Psychology, 113, 428–439. https://doi.org/10.1037/0021-843X.113.3.428CrossRefGoogle ScholarPubMed
Lui, P. P., & Quezada, L. (2019). Associations between microaggression and adjustment outcomes: A meta-analytic and narrative review. Psychological Bulletin, 145, 45–78. https://doi.org/10.1037/bul0000172Google Scholar
Lui, P. P., & Rollock, D. (2018). Greater than the sum of its parts: Development of a measure of collectivism among Asians. Cultural Diversity and Ethnic Minority Psychology, 24(2),242–259. https://doi.org/10.1037/cdp0000163Google Scholar
Lui, P. P., Rollock, D., Chang, E. C., Leong, F. T. L., & Zamboanga, B. L. (2016). Big 5 personality and subjective well-being in Asian Americans: Testing optimism and pessimism as mediators. Asian American Journal of Psychology, 7, 274–286. https://doi.org/10.1037/aap0000054CrossRefGoogle Scholar
Lui, P. P., Vidales, C. A., & Rollock, D. (2018). Personality and the social environment: Contributions to psychological adjustment among Asian and Euro American students. Journal of Social and Clinical Psychology, 37, 659–696. https://doi.org/10.1521/jscp.2018.37.9.659Google Scholar
Lui, P. P., & Zamboanga, B. L. (2018a). Acculturation and alcohol use among Asian Americans: A meta-analytic review. Psychology of Addictive Behavior, 32, 173–186. https://doi.org/10.1037/adb0000340Google Scholar
Lui, P. P., & Zamboanga, B. L. (2018b). A critical review and meta-analysis of the associations between acculturation and alcohol use outcomes among Hispanic Americans. Alcoholism: Clinical and Experimental Research, 42, 1841–1862. https://doi.org/10.1111/acer.13845CrossRefGoogle ScholarPubMed
Malgady, R. G. (1996). The question of cultural bias in assessment and diagnosis of ethnic minority clients: Let’s reject the null hypothesis. Professional Psychology: Research and Practice, 27, 73–77.Google Scholar
Malgady, R. G., Rogler, L. H., & Cortés, D. E. (1996). Cultural expression of psychiatric symptoms: Idioms of anger among Puerto Ricans. Psychological Assessment, 8, 265–268.Google Scholar
Markus, H. R., & Kitayama, S. (1991). Culture and self: Implications for cognition, emotion and motivation. Psychological Review, 98, 224–253.Google Scholar
Marsella, A. J. (2013). All psychologies are indigenous psychologies: Reflections on psychology in a global era. Psychology International, 12. www.apa.org/international/pi/2013/12/reflections.aspxGoogle Scholar
McNeil, D. E., & Binder, R. (1995). Correlates of accuracy in the assessment of psychiatric in-patient’s risk of violence. American Journal of Psychiatry, 152, 901–906.Google Scholar
Meredith, W. (1993). Measurement invariance, factor analysis, and factorial invariance. Psychometrika, 58, 525–543. https://doi.org/10.1007/BF02294825Google Scholar
Nijdam-Jones, A., & Rosenfeld, B. (2017). Cross-cultural feigning assessment: A systematic review of feigning instruments used with linguistically, ethnically, and culturally diverse samples. Psychological Assessment, 29, 1321–1336. https://doi.org/10.1037/pas0000438CrossRefGoogle ScholarPubMed
Okazaki, S., Kallivayalil, D., & Sue, S. (2002). Clinical personality assessment with Asian Americans. In Butcher, J. N. (Ed.), Oxford textbooks in clinical psychology, Vol. 2. Clinical personality assessment: Practical approaches (pp. 135–153). New York: Oxford University Press.Google Scholar
Payne, J. S. (2012). Influence of race and symptom expression on clinicians’ depressive disorder identification in African American men. Journal of the Society for Social Work and Research, 3, 162–177.Google Scholar
Rogers, R., Flores, J., Ustad, K., & Sewell, K. W. (1995). Initial validation of the Personality Assessment Inventory – Spanish version with clients from Mexican American communities. Journal of Personality Assessment, 64, 340–348. https://doi.org/10.1207/s15327752jpa6402_12Google Scholar
Rollock, D., & Lui, P. P. (2016a). Measurement invariance and the five-factor model of personality: Asian international and Euro American cultural groups. Assessment, 23, 571–587. https://doi.org/10.1177/1073191115590854Google Scholar
Rollock, D., & Lui, P. P. (2016b). Do spouses matter? Discrimination, social support, and psychological distress among Asian Americans. Cultural Diversity and Ethnic Minority Psychology, 22, 47–57. https://doi.org/10.1037/cdp0000045Google Scholar
Rosenberger, E., & Hayes, J. (2002). Therapist as subject: A review of the empirical countertransference literature. Journal of Counseling and Development, 80, 264–270.CrossRefGoogle Scholar
Ryder, A. G., Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S., et al. (2008). The cultural shaping of depression: Somatic symptoms in China, psychological symptoms in North America? Journal of Abnormal Psychology, 117, 300–313.Google Scholar
Sabin, J. E. (1975). Translating despair. American Journal of Psychiatry, 132, 197–199.Google Scholar
Sadler, J. Z. (2005). Values and psychiatric diagnosis. Oxford: Oxford University Press.Google Scholar
Schmitt, N., & Kuljanin, G. (2008). Measurement invariance: Review of practice and implications. Human Resource Management Review, 18, 210–222. https://doi.org/10.1016/j.hrmr.2008.03.003Google Scholar
Shou, Y., Sellbom, M., Xu, J., Chen, T., & Sui, A. (2017). Elaborating on the construct validity of Triarchic Psychopathy Measure in Chinese clinical and nonclinical samples. Psychological Assessment, 29(9), 1071–1081. http://dx.doi.org/10.1037/pas0000398Google Scholar
Shuy, R. W. (1983). Three types of interference to an effective exchange of information in the medical interview. In Fisher, S. & Todd, A. D. (Eds.), The social organization of doctor-patient communication (pp. 189–202). Washington, DC: Center for Applied Linguistics.Google Scholar
Sinha, D. (1997). Indigenizing psychology. In Berry, J. W., Poortinga, Y. H., & Pandey, J. (Eds.), Handbook of cross-cultural psychology, Vol.1 (2nd ed., pp. 129–169). Boston: Allyn & Bacon.Google Scholar
Solano-Flores, G., & Nelson-Barber, S. (2001). On the cultural validity of science assessments. Journal of Research in Science Teaching, 38, 553–573.Google Scholar
Spector, R. (2001). Is there racial bias in clinicians’ perceptions of the dangerousness of psychiatric patients? A review of the literature. Journal of Mental Health, 10, 5–15.Google Scholar
Sue, D. W. (1981). Counseling the culturally different: Theory and practice. New York: John Wiley & Sons.Google Scholar
Sue, D. W., & Sue, D. (2012). Counseling the culturally diverse: Theory and practice (6th ed.). New York: John Wiley & Sons.Google Scholar
Sue, S., & Morishima, J. K. (1982). The mental health of Asian Americans. San Francisco: Jossey-Bass.Google Scholar
Takeuchi, D. T., Kuo, H., Kim, K., & Leaf, P. J. (1989). Psychiatric symptom dimensions among Asian Americans and Native Hawaiians: An analysis of the symptom checklist. Journal of Community Psychology, 17, 319–329.Google Scholar
Triandis, H. C. (1997). Cross-cultural perspectives on personality. In Hogan, R., Johnson, J., & Briggs, S. (Eds.), Handbook of personality psychology (pp. 439–464). San Diego: Academic Press.CrossRefGoogle Scholar
Wakabayashi, A. (2014). A sixth personality domain that is independent of the big five domains: The psychometric properties of the HEXACO personality inventory in a Japanese sample. Japanese Psychological Research, 56, 211–223. https://doi.org/10.1111/jpr.12045Google Scholar
Westermeyer, J. (1985). Psychiatric diagnosis across cultural boundaries. American Journal of Psychiatry, 142, 798–805.Google Scholar
Whaley, A. L. (1997). Ethnicity/race, paranoia, and psychiatric diagnoses: Clinical bias versus sociocultural differences. Journal of Psychopathology and Behavioral Assessment, 19, 1–20.Google Scholar
Whaley, A. L., & Hall, B. N. (2009). Effects of cultural themes in psychotic symptoms on the diagnosis of schizophrenia in African Americans. Mental Health, Religion and Culture, 12, 457–471.Google Scholar
Yakushko, O. (2010). Clinical work with limited English proficiency clients: A phenomenological study. Professional Psychology: Research and Practice, 41, 449–455.CrossRefGoogle Scholar
Yang, K.-S. (2000). Monocultural and cross-cultural indigenous approaches: The royal road to the development of a balanced global psychology. Asian Journal of Social Psychology, 3, 241–263.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×