Cross cultural perceptions of depression

Cross cultural perceptions of depression

by Deleted user -
Number of replies: 5

I have always been fascinated by cross-cultural interpretation and incidence of mental illness, and especially depression, and am hoping that this class and your input can help me understand some of the nuances.

 Let me start with a few personal observations based on working as a general practitioner in three different settings: urban Ottawa, remote Chad during the Darfur conflict and a small rural, aboriginal community on the James Bay Coast of Ontario, called Moose Factory. In brief, my experiences suggest that depression was rare during war in the middle of the desert, common in a thriving capital city, and extremely prevalent on a Canadian aboriginal reservation. I found it difficult and confronting to return from serving some of the bravest people I had ever seen in Africa to more routine and occasionally trivial complaints back home (see also http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2278330/pdf/0540255.pdf )

But let’s net have a look and see if any data backs up my impressions.

 As we heard last week, depression is an increasingly important contributor to human DALYs lost, and will actually overtake other chronic diseases that affect the young as much as old by the end of this century (WHO data). Yet upon closer inspection, it is indeed much more important in developed as opposed to developing countries. Now why would this be (assuming the data correct, and that is an assumption—this of all the cross-cultural and linguistic nuances lost during studies and clinical encounters)? And why would it be even more prevalent in a small disadvantaged pocket within a developed country? Could it come down to, once more, inequity? Could people feel worse when surrounded by others seemingly better off? Or could some semblance of maintaining self-sufficiency be crucial to human well being? (I believe that this is why people in the middle of wartime can avoid depression, as they are still using their skills to survive the odds, and why depression becomes more prevalent on a reservation that has been made increasingly dependent on outside help.)

 I hope your reflections and our readings might shed further light on this increasingly prevalent problem.

In reply to Deleted user

Re: Cross cultural perceptions of depression

by Deleted user -

Hi David,

 Your reflections got me thinking about the situation I have observed in central London. I work in Westminster, with a diverse multi-cultural population reflecting various socioeconomic backgrounds. Working in chronic pain, most of the patients who attend clinic have co morbid mental illness particularly, depression irrespective of their socioeconomic status.

Taking the cross cultural perspective, one would expect that different cultures would have different incidence rates of co morbid depression. This doesn’t appear to be the case if we factor in symptom severity as a confounding variable. There is a large migrant population in the borough and some patients reported having no mental of physical illness in their home countries but developed both when they immigrated to the UK. A standard response from Arabic speaking women for example is that they had better social support structures back home than they do here where they are often socially isolated and living in single person households.

Maybe there’s something here as well about the role of self-sufficiency and indeed, having a meaningful role or identity in society. Jackie (temp log in)

In reply to Deleted user

Re: Cross cultural perceptions of depression

by Deleted user -

Fascinating, thanks Jackie. I wonder how you would go about studying this. Probably some kind of narrative analysis.

In reply to Deleted user

Re: Cross cultural perceptions of depression

by Deleted user -

Hi David,


It is very interesting to think about depression like this. I am an intercalating student so probably haven't got widepsread experience like you, and others, on the course do. But I spent a few weeks in Kenya volunteering a couple of years ago - and despite not spending immediate time in a hospital setting or with patients, the stark contrasts between general illness there and illness here was obvious. It was clear that those that have little, celebrate lots and those that have lots, find cause to celebrate little. Maybe depression isn't as widely known in those developing areas so finding a 'name' as such for their feelings leaves individuals to question as to what they are truly feeling and never seek help from it... It would be interesting to see what a psychiatrist in a developing country had as a day to day timetable...

 

Amelia

In reply to Deleted user

Re: Cross cultural perceptions of depression

by Jacqueline Nabuala Walumbe -

Definitely some kind of qualitative analysis which i confess i know little about. There is some work going on around community researchers who conduct interviews in their native language. It'll be good to see what this weeks lecture brings up.

In reply to Deleted user

Re: Cross cultural perceptions of depression

by Obianuju Ezidinma Zoe GB-Dumaka -

Hi David,

I've beem meaning to reply to this post as it's one I've had some inteerst in in the past.  I managed to find a few papers via the British Journal of Psychiatry that I've come across before and they  highlight some of the relevant issues

 

http://bjp.rcpsych.org/content/184/1/10.full

 

http://apt.rcpsych.org/content/10/1/13.short

 

I think it definitely boils down to culture. With growing globalisation, especially when it comes down to ethnic minorities in more devloped countries, it can pose considerable stresses on migrants, and where they do not have the luxury of the social support structures in terms of close knit communities of family and friends they are used to, it is so much easier to fall into depression.

 

I came across an interesting statistic in the past also that said something along the lines of although black women are prone to post natal depression, it is not documeted as being that prevalent amongst them, probably because of cultural norms and the stigma associated with it. Every woman, especially in out culture wants to be seen as capable of coping with the demands of motherhood. Also I read (these quotes tends to stick with me being of AfroCaribbean descent myself lol) that the rates of suicide are the lowest amongst the same group - AfroCaribbean women. It begs the question of why? & I think in the end of definitely boils down to cultures, way of life and support structures, which tend to lack amongst minority and ethnic populations in more developed countries, from what they are used to 'back home'.