2.3 Cultural influences on depression/therapy Flashcards
Waar gaat artikel Bailey over?
Bailey et al. (2019)
Depression among different racial and ethnic groups
(Degene met clinical bias & cultural relativity bias)
Prevalence differences
Bailey et al. (2019)
- Lifetime prevalence MDD is higher for Caucasians compared to African Americans (AA)
- For AA it’s more chronic + leads to greater functional impairment (don’t seek treatment much)
Discrimination and depression
Bailey et al. (2019)
Major risk factor for developing depression.
Self-perceived racial discrimination was found to be stronly linked to deteriorating mental and physical health.
Protective factor depression
Bailey et al. (2019)
- Strong sense of ethnic identity
- Marriage
- Education
- Higher level of income
Other risk factors
Bailey et al. (2019)
- Socioeconomic status
- Lower annual income
- Poverty status
- Employment
Stressful life events and MDD
Bailey et al. (2019)
Men: stronger link found for Caucasian men compared to AA and Caribbean Black men.
Women: no difference between AA and Caucasian women found.
Undoing hypothesis
Bailey et al. (2019)
Presence of positive affect becomes a buffer to harmful effects of negative affect.
- AA were observed to have more hopefulness, explaining why they are less likely to have depressive symptoms compared to Caucasians.
2 contradictory assumptions behond race difference in psychiatric diagnosis research
Bailey et al. (2019)
- Clinical bias hypothesis: every race shows depressive symptoms similarly, but clinicians misdiagnose by judging each race differently.
- Cultural relativity hypothesis: manifestation of depressive symptoms vary among races in comparison to Caucasians and the clinician midsiagnose due to not considering the difference between ethnis groups.
–> Older studies support the idea of cultural relativity
Barriers of treatment among minority communities
Bailey et al. (2019)
- Lack of health insurance
- Acces to proper resources
- Self-restraint from attending therapy
- AA males were less likely to use mental health services than females and non-AA men (–> belief that psychotherapy is associated with weakness)
Conclusion
Bailey et al. (2019)
- AA and Hispanics of young age, low income level, with comorbid conditions and lower education –> heightened risk of discontinuing mental health services
Could be due to mistrust, historical maltreatment, racial incongruity, social stigmas and cultural perceptions. - MDD is less prevalent in AA, but more chronic and severily debilitating.
- Essential for clinicians to be aware of differences to serve minority communities in need of a more effective way.
Waar gaat artikel Pamplin & Bates over?
Pamplin&Bates (2021)
Black-white depression paradox
Black-white depression paradox
Pamplin&Bates (2021)
Even though Black people experience more major life stressors compared to white people in the US, they have comparable or even lower prevalence of MDD.
Lifetime prevalence is 2-8% lower in Black people in the US compared to white people.
Two different estimates
Pamplin&Bates (2021)
- Invalid estimate: depression among Black Americans is underestimated.
- Valid estimate: there is an actual lower burden of depression for Black Americans
Artefactual mechanisms
Pamplin&Bates (2021)
Paradox is because of invalid estimates.
- Selection bias
- Diagnostic instruments misclassifies
- Somatization
- Clinicians have diagnostic bias
Hierna komen resultaten hierover
Artefactual mechanisms
Selection of studies is based on institutionalized or residential status
Pamplin&Bates (2021)
Homeless people, military camps or people in prison (these groups have higher depression and consist disproportionately of Black people)
This might lead to higher true prevalence if these were included.
–> Studies investigating this found that paradox wasn’t influenced by selection bias
Artefactual mechanisms
The diagnostic instrument misclassifies differentially
Pamplin&Bates (2021)
Black and white Americans respond differently to diagnostic instruments.
–> not the reason for paradox
Artefactual mechanisms
Somatization
Pamplin&Bates (2021)
(Measurement bias)
Black Americans might report more somatic symptoms instead of psychological symptoms.
–> study found: slightly higher somatization, but not support for being explanation for paradox
Artefactual mechanisms
Clinicians have diagnostic bias
Pamplin&Bates (2021)
(Measurement bias)
Clinicians might misdiagnose depression in Black individuals because of biases which could lower the observed prevalence.
–> no proof found that this influenced the paradox
Etiological mechanisms
Pamplin&Bates (2021)
Paradox is because of valid estimates.
1. Racial socialization
2. Social support
3. Environmental affordances (EA) model
Etiological mechanisms
Racial socialization
Pamplin&Bates (2021)
Process where people who belong to different racial groups are primes for realities they might experience resulting from a racialized society.
–> 1 study investigated: found partial support, but study only done on women and racial socialization was not directly measured
Etiological mechanisms
Social support
Pamplin&Bates (2021)
Black individuals may have stronger support systems that might lead to them being able to better cope with frequent life stressors.
–> inconsistent findings, more studies finding no supprt
Might help to refine theory, because social support is a complex construct
Etiological mechanisms
Environmental affordances (EA) model
Pamplin&Bates (2021)
Black people more exposed to major life stressors –> engaging in unhealthy coping behaviours like substance use.
These coping mechanisms might lead to protecting them from nega mental health consequences.
–> Studies were not able to replicate this model, this explanation is overstates and should not get more attention.
Discussion
Pamplin&Bates (2021)
- No support for artifictual mechanisms.
- Modest support for racial socialization theory.
- No support for EA and social support model
None of the proposed mechanisms show strong support.
Other mechanisms for future studies:
- Self-esteem
- Religiosity
- Social stress theory (minorities likely to experience poor mental health outcomes due to their marginalized status and heightened exposure to stressors)
Waar gaat artikel Slobodin over?
Slobodin et al. (2018)
Mental health in asylum seekers in Nederland
Three themes in results emerged:
Slobodin et al. (2018)
- Identity loss
- Helplessness and uncertainty
- Negative attitudes towards mental health problems
Identity loss
Slobodin et al. (2018)
- Like education, profession, relationship, social belonging, and status
Leads to feelings of loss of unique existence, feelings of worthlessnesss and negative self-esteem.
People feel like a number and excluded from society they live in.
Helplessness and uncertainty
Slobodin et al. (2018)
- Lack of control over situation, passively waiting, worrying
Uncertainty= due to whether they would see the rest of family again, if they can get a residence permit or what would happen if application is rejected.
- Powerlessness/vague future –> anger and anxiety
- The longer the duration, the higher the levels of anxiety and depression
Negative attitudes towards mental health problems
Slobodin et al. (2018)
- Mental health problems= negatively stigmatized, men in particular avoid expressing mental struggle.
- Individuals experience disconnection from traumatic past and isolation, they think that their pain is beyond understanding or support.
- Conflict between wanting to decrease distress in therapeutic setting and not wanting to talk about it.
Conclusion
Slobodin et al. (2018)
Integrating asylum seekers into inclusive settings like schools, primary prevention or case management programs can reduce stigma with mental health services.
Waar gaat artikel Soto over?
Soto et al. (2018)
Patient therapist alliance and cultural background of client
Cultural adaptation
Soto et al. (2018)
Culturally adapted therapy takes into account several factors that are typically addressed in psychotherapy and modifies them taking the culture of the client into account.
VB: considering the culture and language of the client in a way that is compatible with the values and cultural patterns of the client
Cultural competence
Soto et al. (2018)
Ability of therapist to engage and work with diverse clients.
This is shown through: awareness, knowledge and skills of therapist.
Some subpoints:
- Cultural knowledge
- Cultural skills
- Cultural awareness
Cultural knowledge
Soto et al. (2018)
Therapist’s understanding of distinct cultural communities, their norms, unique experiences, colonialism etc.
Cultural skills
Soto et al. (2018)
Therapist shows cultural skills when they are able to engage with diverse clients and modify their methods to be able to regard the cultural need of the client better.
Cultural awareness
Soto et al. (2018)
Describes the ability of the therapist to recognize the cultural background of their client but also themselves.
Meta analysis of cultural adaptation of treatments
Treatment characteristic
Soto et al. (2018)
- Having treatment in preferred language had larger effects
- Written assignments in preferred language also larger effect
- When goals were explicitely based on cultural values effect sizes were higher.
- Using cultural metaphors in treatment also higher effect sizes
- Treatment adapted to culture les to higher effect sizes
- The more treatment was culturally adapted, the higher the effect sizes were.
Meta analysis of cultural adaptation of treatments
Participant characteristics
Soto et al. (2018)
- Gender did not moderate effect size.
- Studies with participant with same race had higher effect sizes than when clients from different cultures had the same culturally adapted therapy.
- Clinical sample had more benefits from treatment compared to community and high at risk samples
- Age moderated effect size. Adults older than 40 showed higher effect sizes, whereas children and adolescents had smaller effect sizes.
Meta analysis investigating competence of therapist
Soto et al. (2018)
- Client rating of cultural competence of therapist correlated strongly with the outcome of therapy.
- Self-rated cultural competence of therapist did not correlate strongly.
Therapeutic practices
Soto et al. (2018)
The author urge people to take into account:
1. Therapists should regularly assess background of client
2. Psychological treatment should be aligned with cultural background of client
3. Several cultural adaptations should be incorperated.
4. Doing this is especially important for adults
5. Therapists should take age into account.
6. Therapy should be done in preferred language of client
7. Therapies should be adapted to specific cultural groups, not mixed groups.
8. Therapists should always act in a sensitive and humble way
9. Therapists own cultural competence rating might not be in line with how client would rate them.
10. Questions about cultural competens should be added to routinely administered questionnaires