Depression and culture

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Culture defines how people view the world and certain phenomena. [1] Culture also appears to influence the way people experience depression. An individual's experience with depression can vary from country to country. [2] For example, a qualitative study revealed that some countries did not recognize post-natal depression as an illness; rather, it was viewed as a state of unhappiness that did not require any health interventions. [2]

Contents

Causes

Collectivism

In contrast to the individualistic views of the Western culture, which emphasize individual thought, achievement, and well-being, Eastern cultures operate on collectivism, which focuses on the group and the interdependency of its members rather than any one person. [3] The collectivistic view of the self is that it can only be understood through one's social relationships and affiliations. [4] These relationships and affiliations make up a network where the nuclear family shares the closest bonds, followed by the extended family and close friends. [5] [6]

Although the collectivism of Eastern cultures creates a strong support system for the group, it produces many stressors that can lead to depression and anxiety. [6] For example, the overwhelming focus on the group rather than the individual can result in feelings of lost individual identity and sense of self. [4] Identity issues such as these are historically linked with depression. Moreover, many rules and social norms exist in collective cultures than in individual cultures to maintain the harmony of the group. This combined with the cohesiveness of the group can make social mistakes very public and result in feelings of shame and embarrassment by the individual at fault. Research indicates that these feelings are associated with social anxiety within collectivistic societies. [3] A bigger mistake that affects an individual's reputation or results in the loss of honor has more severe consequences because of the stress associated with maintaining that honor. [5]

Symptoms of depression are often expressed differently in collectivistic societies than individualistic ones. Overarching psychological pain and guilt are often a result of depression. [7] Guilt and distress are symptoms of depression; yet they may be experienced differently across cultures. A study by Pewzner-Apeloig and colleagues (1994) found that differences in the way depression was experienced in terms of guilt between African and Western cultures existed. [8] This serves as an example to demonstrate how differences in collectivistic societies in comparison to individualistic societies matter. The expression of symptoms of depression changed in these countries. [8]

The way communities combat depression varies on the basis of whether it is within a collectivistic society or not. It has been shown that a better support system is in place for those who are susceptible to depression in collectivistic societies. [9] On the other hand, in individualized societies, depression is primarily combated through solo work in therapy. Cognitive Behavioral Therapy (CBT) is used by psychologists to change one's thoughts and behavioral patterns. CBT has been shown to be quite effective. [10] Both ways of approaching and treating depression can be effective. Less emphasis on the individual can help minimize rumination and self loathing which are both linked to or direct symptoms of depression. [11] Yet, more focus on the individuals thought patterns and intervention of negative thoughts and behaviors can be effective.

Acculturation

The process of acculturation involves adjusting one's values, attitudes, and cultural practices in to order to effectively adapt to a new culture. [12] Acculturation is difficult for most immigrants, but especially so for Eastern immigrants since the Western and Eastern cultures differ greatly. The biggest challenges Eastern immigrants must face when they travel to America are the sudden loss of a support system, child rearing, and limited knowledge about the American way of life. [13] Coming from a collectivist culture that places great emphasis on relationships, immigrants may mourn the loss of their friends and family. The likelihood of suicide and depression tends to increase as acculturation stress, such as this loss, increases. [14] Tensions within the nuclear family may also arise as children assimilate to the mainstream culture and language and identify less with their immigrant parents. Adolescents whose families strictly follow traditional culture are at a high risk for depression and suicide. A lack of knowledge about the American culture can increase the cultural gap between parents and children.

Research shows that the level of distress and the likelihood that one will develop depression is higher in first generation immigrants than subsequent ones. This is likely due to increase psychological stress related to acculturation. [15] A study by Tibubos states: "mean score patterns were similar for all groups, analyses of item loading among first‐generation migrants yielded some variance in patterns pointing out that certain items have a distinct impact on depression for specific groups." [15]

The many stressors an individual or family faces by moving to a different country can explain the growing prevalence of depression. White R.M.B. et al. demonstrated that environmental stressors can disrupt key parenting processes. [16] This disrupter increase the prevalence of depression and aggression. Culture differs across countries; hence, the way things are done varies and parents must learn these differences. These changes become very stressful and can in turn lead to depression in both mothers and fathers. [16] In White's study: “Family models and parenting styles/environmental worries which are often a result of culture could explain increased depression symptoms in parents who live in dangerous neighbors.” Adapting to a new culture is stressful and this increase in stress leads to higher prevalence for depression. [16]

Gender

As is true in Western societies, depression is more prevalent in women than in men in collective cultures. Some have hypothesized that this is due to their inferior positions in the culture, in which they may experience domestic violence, poverty, and inequality that can greatly contribute to depression. [4] [6] Moreover, research conducted in the United States, Chile and Spain found that cultural differences on the expectations of individuals based on gender varied across cultures and that resulted in different levels of depression across individuals [17] Changes in gender roles across countries and cultures in this study served to explain varying levels of stress and responsibility that changed on the basis of gender. These ever changing expectations and these additional responsibilities on the basis of gender increased levels of depression. [17] A study by Ngcobo and Pillay reports a high level of depression in black South African women (83.34%) and a gender difference ratio of four to one. [18] Depression in South Africa is often linked back to low socioeconomic factors and loss through death and abuse. [18] Despite its prevalence, little is understood about depression in South African women. [18] This is a result of the laws of apartheid and the inadequate psychological services that followed, as well as factors such as under-reporting, misdiagnosis, language barriers and cultural differences. [18]

The differences in gender roles within a community also impact one's level of depression. [19] According to Wichstrøm (1999) women tend to ruminate more and therefore symptoms of depression can be accentuated. Since women are encouraged to talk about and share their feelings, they can get caught talking about and staying in a negative state. [20] On the other hand, boys are taught not to discuss their feelings with others which then diminishes or even gets rid of rumination entirely. The way one is socialized to deal with their negative emotions will vary across cultures and may lead to different outcomes.

Symptoms

Considering the stigma associated with mental illnesses in the Arab culture, it is not surprising that many Easterners express depression and anxiety through somatic complaints. This is especially true with Eastern women, who may feel symptoms of depression as a result of inequality, but are taught not to express personal feelings. Instead, they complain of headaches, numbness, breathlessness, and chest pains to receive some form of medical attention. Somatization is also common among individuals with little knowledge of mental health who have no linguistic way to express their symptoms. [14] [5]

In some parts of Chinese society, depression is expressed as and experienced in terms of a physical experience rather than psychological. According to Kleinman (2004): “Many depressed Chinese people do not report feeling sad, but rather express boredom, discomfort, feelings of inner pressure, and symptoms of pain, dizziness” [21] This is different from the way depression is perceived in America in which people often report sadness or feeling down. [22]

Symptoms do not only vary in their expression across cultures but will also greatly vary within cultures and across individuals. Depression is a heterogeneous disorder. [23] Sometimes depression leads to increased appetite, while other times it leads to decreased appetite. Similarly, a symptom of depression can be both an increase in sleep or decrease in sleep. Symptoms will look different from individual to individual; however, as mentioned above, the expression of these symptoms tend to follow somewhat of a trend from one culture to the next. [24]

Stigma and knowledge of mental illness

In many other non-Western societies, a stigma is associated with mental disorders despite high prevalence of depression and anxiety. [25] Many Easterners believe that symptoms of depression and anxiety are simply a part of life and do not require medical attention. [26] Also, individuals from collective societies tend to be extremely careful in maintaining their reputations, and mental distress is usually interpreted as a weak faith in God and/or a weak self. Therefore, they do not seek treatment for their symptoms in order to avoid shame and gossip. This stigma stems in part from the limited knowledge many Easterners have about depression and anxiety. Multiple studies reveal that the majority Easterners do not know the names of mental illnesses. [25] [27] Instead, they describe their symptoms through series of physical complaints.

Rates of clinical depression are greater in the West than in Asia. [28] According to this study, Asian cultures think differently about emotions than do Western cultures. Not only do changes in one's understanding of psychological disorders change the prevalence of mental health problems it also has an impact on the rate at which these symptoms become problematic. An individual's education on mental health will impact their likelihood of seeking help. [29]

Treatment

Research indicates that for psychologists to effectively diagnose and treat patients of an ethnic minority they need to consider cultural differences. [30] [31] Appropriate cultural knowledge may help psychologists appropriately adjust their methods to fit the needs of a diverse population. [32]

Specific cultures

Arab

The Arab American Institute Foundation estimates that there are over 3.5 million individuals with Arab-speaking ancestry residing in the United States, with thousands more arriving from the Middle East every year. As these numbers increase, so does the importance of psychologists to understand the Arab culture. Arab American immigrants make for an interesting case because they face additional discriminatory stressors associated with the events of the 9/11 attacks and political tensions in the Middle East. [13]

The causes of depression and anxiety in Arabs and Arab Americans are a combination of biological factors and psychological and social factors that are greatly influenced by the Arab culture and immigration. Research indicates that biological markers of depression are consistent between Arab and Western populations, [33] as are many psychological factors.

Arabs who seek psychological help are more confident about the effectiveness of medication over therapy. [34] But since many Arabs either refuse to meet with mental health professionals or do not have any knowledge of them, traditional treatment methods are still commonly used. Islamic therapy, for example, involves Quran recitation by an imam to repel moral deviance from the soul of the individual. The imam may also suggest old Islamic remedies, such as ice baths and herbal antidotes. Using Islam to simply cope with psychological distress is a more widely used method of treatment that is supported by research. [34] A study completed on depressed Pakistani patients also reported that the participants believed that medicine could rid them of their symptoms but had little to no knowledge of psychotherapy.

Latino

Latino adolescents tend to have higher levels of symptoms of depression than some of their Caucasian and African American peers. [35] An explanation for this difference is the increase in cultural stressors that in turn add to this form of cultural disparity. Although the cultural stressors have not yet been identified, the correlation between it and symptoms of and the prevalence of depression is still significant. Within communities, discrimination on the basis of race and ethnicity is also a strong contributor to the elevated number of depressive symptoms among Latino youth. [36]

Related Research Articles

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Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different from fear in that fear is defined as the emotional response to a real threat, whereas anxiety is the anticipation of a future threat. It is often accompanied by nervous behavior such as pacing back and forth, somatic complaints, and rumination.

A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior. It is usually associated with distress or impairment in important areas of functioning. There are many different types of mental disorders. Mental disorders may also be referred to as mental health conditions. Such features may be persistent, relapsing and remitting, or occur as single episodes. Many disorders have been described, with signs and symptoms that vary widely between specific disorders. Such disorders may be diagnosed by a mental health professional, usually a clinical psychologist or psychiatrist.

<span class="mw-page-title-main">Anxiety disorder</span> Cognitive disorder with an excessive, irrational dread of everyday situations

Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatiguability, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

<span class="mw-page-title-main">Postpartum depression</span> Mood disorder experienced after childbirth

Postpartum depression (PPD), also called postnatal depression, is a type of mood disorder experienced after childbirth, which can affect both sexes. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns. PPD can also negatively affect the newborn child.

Acculturation is a process of social, psychological, and cultural change that stems from the balancing of two cultures while adapting to the prevailing culture of the society. Acculturation is a process in which an individual adopts, acquires and adjusts to a new cultural environment as a result of being placed into a new culture, or when another culture is brought to someone. Individuals of a differing culture try to incorporate themselves into the new more prevalent culture by participating in aspects of the more prevalent culture, such as their traditions, but still hold onto their original cultural values and traditions. The effects of acculturation can be seen at multiple levels in both the devotee of the prevailing culture and those who are assimilating into the culture.

<span class="mw-page-title-main">Depersonalization</span> Anomaly of self-awareness

Depersonalization can consist of a detachment within the self, regarding one's mind or body, or being a detached observer of oneself. Subjects feel they have changed and that the world has become vague, dreamlike, less real, lacking in significance or being outside reality while looking in. It can be described as feeling like one is on “autopilot” and that the person's sense of individuality or selfhood has been hindered or suppressed.

Oppositional defiant disorder (ODD) is listed in the DSM-5 under Disruptive, impulse-control, and conduct disorders and defined as "a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness". This behavior is usually targeted toward peers, parents, teachers, and other authority figures. Unlike conduct disorder (CD), those with ODD do not show patterns of aggression towards people or animals, destruction of property, theft, or deceit. One half of children with ODD also fulfill the diagnostic criteria for ADHD.

<span class="mw-page-title-main">Emotional detachment</span> Inability and/or disinterest in emotionally connecting to others

In psychology, emotional detachment, also known as emotional blunting, is a condition or state in which a person lacks emotional connectivity to others, whether due to an unwanted circumstance or as a positive means to cope with anxiety. Such a coping strategy, also known as emotion focused-coping, is used when avoiding certain situations that might trigger anxiety. It refers to the evasion of emotional connections. Emotional detachment may be a temporary reaction to a stressful situation, or a chronic condition such as depersonalization-derealization disorder. It may also be caused by certain antidepressants. Emotional blunting, also known as reduced affect display, is one of the negative symptoms of schizophrenia.

Gender is correlated with the prevalence of certain mental disorders, including depression, anxiety and somatic complaints. For example, women are more likely to be diagnosed with major depression, while men are more likely to be diagnosed with substance abuse and antisocial personality disorder. There are no marked gender differences in the diagnosis rates of disorders like schizophrenia and bipolar disorder. Men are at risk to suffer from post-traumatic stress disorder (PTSD) due to past violent experiences such as accidents, wars and witnessing death, and women are diagnosed with PTSD at higher rates due to experiences with sexual assault, rape and child sexual abuse. Nonbinary or genderqueer identification describes people who do not identify as either male or female. People who identify as nonbinary or gender queer show increased risk for depression, anxiety and post-traumatic stress disorder. People who identify as transgender demonstrate increased risk for depression, anxiety, and post-traumatic stress disorder.

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Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted or falsified. Other symptoms include feeling as if one's environment is lacking in spontaneity, emotional coloring, and depth. It is a dissociative symptom that may appear in moments of severe stress.

<span class="mw-page-title-main">Depression in childhood and adolescence</span> Pediatric depressive disorders

Depression is a mental disorder characterized by prolonged unhappiness or irritability, accompanied by a constellation of somatic and cognitive signs and symptoms such as fatigue, apathy, sleep problems, loss of appetite, loss of engagement. low self-regard/worthlessness, difficulty concentrating/indecisiveness, or recurrent thoughts of death or suicide. Depression in childhood and adolescence is similar to adult major depressive disorder, although young sufferers may exhibit increased irritability or behavioral dyscontrol instead of the more common sad, empty, or hopeless feelings seen with adults. Children who are under stress, experiencing loss, or have other underlying disorders are at a higher risk for depression. Childhood depression is often comorbid with mental disorders outside of other mood disorders; most commonly anxiety disorder and conduct disorder. Depression also tends to run in families. In a 2016 Cochrane review cognitive behavior therapy (CBT), third-wave CBT and interpersonal therapy demonstrated small positive benefits in the prevention of depression. Psychologists have developed different treatments to assist children and adolescents suffering from depression, though the legitimacy of the diagnosis of childhood depression as a psychiatric disorder, as well as the efficacy of various methods of assessment and treatment, remains controversial.

<span class="mw-page-title-main">Psychological stress</span> Feeling of strain and pressure

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The COVID-19 pandemic has impacted the mental health of people across the globe. The pandemic has caused widespread anxiety, depression, and post-traumatic stress disorder symptoms. According to the UN health agency WHO, in the first year of the COVID-19 pandemic, prevalence of common mental health conditions, such as depression and anxiety, went up by more than 25 percent. The pandemic has damaged social relationships, trust in institutions and in other people, has caused changes in work and income, and has imposed a substantial burden of anxiety and worry on the population. Women and young people face the greatest risk of depression and anxiety.

The social determinants of mental health (SDOMH) are societal problems that disrupt mental health, increase risk of mental illness among certain groups, and worsen outcomes for individuals with mental illnesses. Much like the social determinants of health (SDOH), SDOMH include the non-medical factors that play a role in the likelihood and severity of health outcomes, such as income levels, education attainment, access to housing, and social inclusion. Disparities in mental health outcomes are a result of a multitude of factors and social determinants, including fixed characteristics on an individual level – such as age, gender, race/ethnicity, and sexual orientation – and environmental factors that stem from social and economic inequalities – such as inadequate access to proper food, housing, and transportation, and exposure to pollution.

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