Depression and culture

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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]

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

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

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

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.

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