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.