Motivos de la violencia en el enamoramiento

A breakdown and analysis of GHQ total and sub-scale scores revealed distinct cultural and

sub-group patterns. P respondents tended to score higher than BP and B respondents on

slightly higher than BP respondents on all the sub-scales, apart from on the somatic sub­

scale. In line with this finding, the case identification criteria also implicated a

proportionally greater number o f ? 'probable cases', followed by B and finally BP cases.

H ow ever, w hether these findings on total scores and 'probable cases' can be taken as a

definitive index o f greater psychiatric morbidity in Pakistan is somewhat debatable. There

are a number o f issues that need to be considered before such a conclusion can be drawn.

The issue o f cut-off points and normative uncertainty, which relates to the specificity and

sensitivity o f the GHQ measure in these cultures needs to be considered. K leinman and

Becker (1991) have pointed out that even within W estern psychiatric cultures there is no

agreed cut-off point between normal dysphoria and depression, and dysthymia and

depression. The cultural variation between W estern and South Asian populaitons with

regard to this issue, are indicated by Bandyopadyhyay et al's. (1988) suggestion o f using

higher cut-off scores in these samples in order to reduce the number of false positives.

The possibility of false positives in the P and BP samples cannot easily be dismissed, as

false positives have frequently been associated with somatic symptoms and

misclassification in the GHQ (Finlay-Jones & M urphy , 1979). This clearly bas

repurcussions for the P and BP samples, who in hypothesis Ilb were found to score

particularly high on somatic items. Bearing this in mind the morbidity scores in the P and

BP samples need to be re-considered. The possibility that the GHQ in these samples is

detecting physical illness as opposed to psychological distress can thus not be ruled out.

Finlay-Jones and Murphy, in fact, sugest that somatically presenting individuals or 'false

positives' may be using the GHQ to register a more diverse distress, originating in physical

symptoms, recent adverse life events or loneliness, as opposed to psychiatric morbidity.

Shapiro et al (1987) argued that if this is the case, the benefits to patiets o f diagnosing and

treating non-specific somatic symptoms as mental morbidity must be questioned. This

argument, clearly warrants further investigation as it may undermine the value of

diagnosing disorders like depression in Pakistani patients who present somatically. In

short, the specificity and sensitivity o f the GHQ in P and BP populations needs to be

this study.

Furtherm ore, to ascertain the cross cultural differential levels o f distress in the three

sam ples, the comparability o f the GHQ construct needs to be first established. Factor

analysis results (as discussed in section 4.4.1) suggested that, in the P and B P sam ples, the

GHQ measured a more unitary form o f d i s t r e s s t h a n in the B sample. In contrast the

GHQ factor structure in the B sample appeared to detect distinct aspects o f psychiatric

morbidity. This thus implies that the GHQ is measuring differential constructs in the P /

BP and B samples. Given this limited incomparability in the GHQ construct, caution is

urged in concluding greater morbidity in indigenous Ps. This caution is also supported

by Corser & Phillip (1978) who, on the basis o f their investigation o f newly registered GP

patients, stress the importance o f not taking the GHQ results as definitive evidence of

psychiatric disorder. They echo Kessels (1965) comment that "distress is not the

exclusive province of the mentally ill". Indeed it can be argued that in a developing city

such as Karachi, torn apart by political strife, a high base level o f distress is only to be

expected and may not necessarily indicate a greater morbidity. Clearly, the context the

study was conducted in cannot be divorced from the findings, especially when the context

o f Pakistan and Britain vary so much.

Indeed, it has already been seen that socio cultural factors, such as social desirability and

defensiveness, in response to the GHQ are likely to be effected by the setting in which the

assessment is carried out and the subjects appraisal o f it (Parkes, 1980). The setting in

this study did vary to some extent across all three samples. The P sample, especially

w orking class, were not accustom ed to health surveys and questionnaires, and often

anticipated medical assisstance despite repeated clarification. This may have led them to

more readily report or exaggerate subjective distress. It is therefore possible that there

may be a considerable number o f false positive's in this sample.

This is in line with findings reported in other non-W estern cultures. For example, Shek (1993) also, on the basis o f confirmatory factor analysis using LISREL, reports a higher order factor model, consisting o f a general order factor, as well as, five more distinct factors.

T he BP sample, on the other hand, were members o f a relatively small minority

community and related to the interviewer as a community member. Their responses, in

contrast to the P sample, appeared some-what more defensive. It is tentatively suggested

that this over caution and defensiveness in symptom reporting may have resulted in a

considerable number of false negatives in this sample.

T h e B sample, were the only group which self administered the GHQ (in line with the

m ode o f administration it was originally designed for), which inevitably reduced the

interviewer effect on the s t u d y . T h e GHQ results o f the B sample were in this sense

probably the m ost accurate, as they were less prone to socio-cultural desirability issues

and interviewer effect.

On the basis o f the above considerations (cut off points, false positive's, construct

comparability, context o f administration and subject appraisal), it cannot be safely

concluded that the greater scores of the P sample, followed by the B and BP samples,

reflect absolute cultural differences in psychological distress levels. These confounding issues are to some extent inevitable difficulties which arise from the differential contexts

o f cross cultural research.