Skip to main content Accessibility help
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 1
  • Print publication year: 2007
  • Online publication date: August 2009

6 - Culture, ethnicity and biological psychiatry

from Part I - Theoretical background
    • By Chia-Hui Chen, Division of Mental Health and Substance Abuse Research National Health Research Institutes 5th Floor Second Campus Tapiei City Psychiatric Center 309 Song-De Road Taipei 110 Taiwan, Shi-Kai Liu, Division of Mental Health and Substance Abuse Research National Health Research Institutes, 5th Floor Second Campus, Tapiei City Psychiatric Center 309 Song-De Road Taipei 110 Taiwan, Keh-Ming Lin, Division of Mental Health and Substance Abuse Research National Health Research Institutes 5th Floor, Second Campus Tapiei City Psychiatric Center 309 Song-De Road Taipei 110 Taiwan
  • Edited by Dinesh Bhugra, Institute of Psychiatry, London, Kamaldeep Bhui
  • Publisher: Cambridge University Press
  • DOI:
  • pp 72-80



The differences between universalist and relativist positions related to pharmacological interventions are of great interest to researchers and clinicians alike. The variations in social forces and cultural traditions and attributed similarities are proofs of the universality of the biological processes underlying psychiatric problems. Regional and ethnic variations almost always exist and associated biological and social factors must be considered in managing patients. Chen and colleagues, in this chapter, highlight the interface between biological psychiatry and neurosciences on the one hand and culture and ethnicity on the other. They raise three issues on the subject – those of generalisability, variations in groups and individuals and finally the theoretical implications embedded in cross cultural research is commonly observed and well documented. Beside genetic predispositions, it also stands to reason that influences of culture on biological processes could also lead to disease susceptibility. Biological markers responsible for disease and response to medication have not been studied in all cultural and ethnic groups. Biology is not culture free, and the complex interaction between culture and biology includes genetic vulnerability and resilience related to environmental factors. People with different ethnic and ancestral backgrounds have different genetic profiles, which may indicate differential risks for specific disorders.

Physical and social milieus within which people live are shaped by cultural factors, thus the interaction of biology and culture shapes responses and outcomes in various psychiatric disorders.

Arango, V., Huang, Y. Y., Underwood, M. D. and Mann, J. J. (2003). Genetics of the serotonergic system in suicidal behavior. Journal of Psychiatric Research, 37(5), 375–386.
Bassett, A. S. and Chow, E. W. (1999). 22q11 deletion syndrome: a genetic subtype of schizophrenia. Biological Psychiatry, 46(7), 882–891.
Behrens, U. J., Worner, T. M., Braly, L. F., Schaffner, F. and Lieber, C. al. (1988). Carbohydratedeficient transferrin, a marker for chronic alcohol consumption in different ethnic populations. Alcohol Clinical Experimental Research, 12(3), 427–432.
Bhugra, D., Leff, J., Mallett, al. (1997). Incidence and outcome of schizophrenia in whites, African-Caribbeans and Asians in London. Psychological Medicine, 27(4), 791–798.
Blaustein, M. P. and Grim, C. E. (1991). The pathogenesis of hypertension: black–white differences. Cardiovascular Clinics, 21(3), 97–114.
Bridge, T. P., Jeste, D. V., Wise, C. al. (1984). Schizophrenic outcome in late life: symptom state and platelet monoamine oxidase activity. Psychiatry Research, 11(2), 91–97.
Carroll, B. J., Feinberg, M., Greden, J. al. (1981). A specific laboratory test for the diagnosis of melancholia. Standardization, validation, and clinical utility. Archives of General Psychiatry, 38(1), 15–22.
Chang, W. H., Chen, T. Y., Lin, S. al. (1990). Plasma catecholamine metabolites in schizophrenics: evidence for the two-subtype concept. Biological Psychiatry, 27(5), 510–518.
Charrow, J. (2004). Ashkenazi Jewish genetic disorders. Familial Cancer, 3(3–4), 201–206.
Coppen, A., Metcalfe, M. and Harwood, J. (1984). WHO collaborative study on the use of the dexamethasone suppression test as a biological indicator of depressive illness. Clinical Neuropharmacology, 7, 226–227.
Crow, T. J. (1980). Molecular pathology of schizophrenia: more than one disease process?' British Medical Journal, 280(6207), 66–68.
DeLisi, L. E., Neckers, L. M., Staub, R. A., Zalcman, S. J. and Wyatt, R. J. (1980). Lymphocyte monoamine oxidase activity and chronic schizophrenia. Psychiatry Research, 2(2), 179–186.
Egan, M. F., Goldberg, T. E., Kolachana, B. al. (2001). Effect of COMT Val108/158 Met genotype on frontal lobe function and risk for schizophrenia. Proceedings of the National Academy of Sciences, USA, 98(12), 6917–6922.
Escobar, J. I., Mendoza, R., Stimmel, al. (1984). The DST in a large outpatient clinic: its diagnostic and predictive significance. Psychopharmacology Bulletin, 20(1), 89–92.
Garver, D. L. (1997). The etiologic heterogeneity of schizophrenia. Harvard Reviews of Psychiatry, 4(6), 317–327.
Giles, D. E., Perlis, M. L., Reynolds, C. F. 3rd and Kupfer, D. J. (1998). EEG sleep in African-American patients with major depression: a historical case control study. Depression and Anxiety, 8(2), 58–64.
Harrison, G., Owens, D., Holton, A., Neilson, D. and Boot, D. (1988). A prospective study of severe mental disorder in Afro-Caribbean patients. Psychological Medicine, 18(3), 643–657.
Hoffman, R. E. and Dobscha, S. K. (1989). Cortical pruning and the development of schizophrenia: a computer model. Schizophrenia Bulletin, 15(3), 477–490.
Hutchison, K. E., Stallings, M., Mc Geary, J. and Bryan, A. (2004). Population stratification in the candidate gene study: fatal threat or red herring?' Psychology Bulletin, 130(1), 66–79.
Huttenlocher, P. R. (1979). Synaptic density in human frontal cortex – developmental changes and effects of aging. Brain Research, 163(2), 195–205.
Hwu, H. G., Chen, T. Y., and Yang, Y. Y., (1985). The clinical diagnostic value of dexamethasone suppression test in depressive illness. Annales of Academic Medicine Singapore, 14(1), 104–109.
Hwu, H. G., Lin, H. N. and Lu, R. B. (1987). Dexamethasone suppression test in psychiatric diagnosis and psychopathology for Chinese patients. Proceedings of the National Science Council of the Republic of China B, 11(2), 164–174.
Jackman, H., Luchins, D., and Meltzer, H. J. (1983). Platelet serotonin levels in schizophrenia: relationship to race and psychopathology. Biological Psychiatry, 18(8), 887–902.
Jilek, W. G. (1995). Emil Kraepelin and comparative sociocultural psychiatry. European Archives of Psychiatry and Clinical Neuroscience, 245(4–5), 231–238.
King, M., Coker, E., Leavey, G., Hoare, A. and Johnson-Sabine, E. (1994). Incidence of psychotic illness in London: comparison of ethnic groups. British Medical Journal, 309(6962), 1115–1119.
King, M., Nazroo, J., Weich, al. (2005). Psychotic symptoms in the general population of England – a comparison of ethnic groups (The EMPIRIC study). Society of Psychiatry and Psychiatric Epidemiology, 40(5), 375–381.
Kleinman, A. M. (1988). Rethinking Psychiatry. New York: Free Press.
Kupfer, D. J. (1995). Sleep research in depressive illness: clinical implications – a tasting menu. Biological Psychiatry 38(6): 391–403.
Lawson, W. B. (1986). Racial and ethnic factors in psychiatric research. Hospital Community Psychiatry, 37(1), 50–54.
Lesch, K. P., Bengel, D., Heils, al. (1996). Association of anxiety-related traits with a polymorphism in the serotonin transporter gene regulatory region. Science, 274(5292), 1527–1531.
Levav, I., Kohn, R., Golding, J. M. and Weissman, M. M. (1997). Vulnerability of Jews to affective disorders. American Journal of Psychiatry, 154(7), 941–947.
Lin, K. M., Poland, R. E. and Silver, B. (1993). Overview: The Interface between Psychobiology and Ethnicity. Washington, DC: American Psychiatiric Press.
Lu, R. B., Ho, S. L., Huang, H. C. and Lin, Y. T. (1988). The specificity of the dexamethasone suppression test in endogenous depressive patients. Neuropsychopharmacology, 1(2), 157–162.
Luchins, D., Torrey, E. F., Weinberger, D. al. (1980). HLA antigens in schizophrenia:differences between patients with and without evidence of brain atrophy. British Journal of Psychiatry, 136, 243–248.
Marcolin, M. A. (1991). The prognosis of schizophrenia across cultures. Ethnic Disease, 1(1), 99–104.
Marusic, A. (2005). History and geography of suicide: could genetic risk factors account for the variation in suicide rates?' American Journal of Medical Genetics C Seminars in Medical Genetics, 133(1), 43–47.
Mendlewicz, J. and Kerkhofs, M. (1991). Sleep electroencephalography in depressive illness. A collaborative study by the World Health Organization. British Journal of Psychiatry 159: 505–509.
Murphy, H. B. (1982). Comparative Psychiatry: The International and Intercultural Distribution of Mental Illness. Berlin: Springer-Verlag.
O'Leary, D. D., Stanfield, B. B., and Cowan, W. M. (1981). Evidence that the early postnatal restriction of the cells of origin of the callosal projection is due to the elimination of axonal collaterals rather than to the death of neurons. Brain Research, 227(4), 607–617.
Patkar, A. A., Berrettini, W. H., Hoehe, al. (2002). Serotonin transporter polymorphisms and measures of impulsivity, aggression, and sensation seeking among African-American cocaine-dependent individuals. Psychiatry Research, 110(2), 103–115.
Poland, R. E., Rao, U., Lutchmansingh, al. (1999). REM sleep in depression is influenced by ethnicity. Psychiatry Research, 88(2), 95–105.
Polednak, A. (1989). Racial and Ethnic Differences in Disease. New York: Oxford University Press.
Rao, U., Poland, R. E., Lutchmaningh, al. (1999). Relationship between ethnicity and sleep patterns in normal controls: implications for psychopathology and treatment. Journal of Psychiatric Research, 33(5), 419–426.
Richelson, E. (1991). Biological basis of depression and therapeutic relevance. Journal of Clinical Psychiatry, 52 (Suppl), 4–10.
Rivera-Calimlim, L. and Reilly, D. K. (1984). Difference in erythrocyte catechol-O-methyltransferase activity between Orientals and Caucasians: difference in levodopa tolerance. Clinical Pharmacological Therapy, 35(6), 804–809.
Rubin, R. T., Poland, R. E., Lesser, I. M., Winston, R. A. and Blodgett, A. L. (1987). Neuroendocrine aspects of primary endogenous depression. I. Cortisol secretory dynamics in patients and matched controls. Archives of General Psychiatry, 44(4), 328–336.
Rush, A. J., Giles, D. E., Roffwarg, H. P. and Parker, C. R. (1982). Sleep EEG and dexamethasone suppression test findings in outpatients with unipolar major depressive disorders. Biological Psychiatry, 17(3), 327–341.
Sasayama, S. (2004). Optimising outcomes in end-stage heart failure: differences in therapeutic responses between diverse ethnic groups. Drug Safari, 27 (Suppl) 1, 19–24.
Sharpley, M., Hutchinson, G., McKenzie, K. and Murray, R. M. (2001). Understanding the excess of psychosis among the African-Caribbean population in England. Review of current hypotheses. British Journal of Psychiatry, 40 (Suppl), s60–s8.
Smits, K. M., Smits, L. J., Schouten, J. S., et al. (2004). Influence of SERTPR and STin2 in the serotonin transporter gene on the effect of selective serotonin reuptake inhibitors in depression: a systematic review. Molecular Psychiatry, 9(5), 433–441.
Staner, L., Linkowski, P., and Mendlewicz, J. (1994). Biological markers as classifiers for depression: a multivariate study. Progress in Neuropsychopharmacological Biology and Psychiatry, 18(5), 899–914.
Thase, M. E., Simons, A. D., and Reynolds, C. F. 3rd. (1996). Abnormal electroencephalographic sleep profiles in major depression: association with response to cognitive behavior therapy. Archives of General Psychiatry, 53(2), 99–108.
Tsuang, M. T., Lyons, M. J., and Faraone, S. V. (1990). Heterogeneity of schizophrenia. Conceptual models and analytic strategies. British Journal of Psychiatry, 156, 17–26.
UN (2005). Demographic Yearbook 2002, United Nations.
Walker, E. F. and Diforio, D. (1997). Schizophrenia: a neural diathesis-stress model. Psychology Review 104(4), 667–685.
White, H. L., McLeod, M. N., and Davidson, J. R. (1976). Catechol O-methyltransferase in red blood cells of schizophrenic, depressed, and normal human subjects. British Journal of Psychiatry, 128, 184–187.
Zhang, A. Y. and Snowden, L. R. (1999). Ethnic characteristics of mental disorders in five U.S. communities. Cultural Diversity Ethnic Minority Psychology, 5(2), 134–146.