2.3 Cultural influences on depression/therapy

Question 1

Waar gaat artikel Bailey over?

Bailey et al. (2019)

Answer 1

Depression among different racial and ethnic groups
(Degene met clinical bias & cultural relativity bias)

Question 2

Prevalence differences

Bailey et al. (2019)

Answer 2

• 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)

Question 3

Discrimination and depression

Bailey et al. (2019)

Answer 3

Major risk factor for developing depression.

Self-perceived racial discrimination was found to be stronly linked to deteriorating mental and physical health.

Question 4

Protective factor depression

Bailey et al. (2019)

Answer 4

• Strong sense of ethnic identity
• Marriage
• Education
• Higher level of income

Question 5

Other risk factors

Bailey et al. (2019)

Answer 5

1. Socioeconomic status
2. Lower annual income
3. Poverty status
4. Employment

Question 6

Stressful life events and MDD

Bailey et al. (2019)

Answer 6

Men: stronger link found for Caucasian men compared to AA and Caribbean Black men.

Women: no difference between AA and Caucasian women found.

Question 7

Undoing hypothesis

Bailey et al. (2019)

Answer 7

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.

Question 8

2 contradictory assumptions behond race difference in psychiatric diagnosis research

Bailey et al. (2019)

Answer 8

1. Clinical bias hypothesis: every race shows depressive symptoms similarly, but clinicians misdiagnose by judging each race differently.
2. 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

Question 9

Barriers of treatment among minority communities

Bailey et al. (2019)

Answer 9

1. Lack of health insurance
2. Acces to proper resources
3. Self-restraint from attending therapy
4. AA males were less likely to use mental health services than females and non-AA men (–> belief that psychotherapy is associated with weakness)

Question 10

Conclusion

Bailey et al. (2019)

Answer 10

1. 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.
2. MDD is less prevalent in AA, but more chronic and severily debilitating.
3. Essential for clinicians to be aware of differences to serve minority communities in need of a more effective way.

Question 11

Waar gaat artikel Pamplin & Bates over?

Pamplin&Bates (2021)

Answer 11

Black-white depression paradox

Question 12

Black-white depression paradox

Pamplin&Bates (2021)

Answer 12

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.

Question 13

Two different estimates

Pamplin&Bates (2021)

Answer 13

1. Invalid estimate: depression among Black Americans is underestimated.
2. Valid estimate: there is an actual lower burden of depression for Black Americans

Question 14

Artefactual mechanisms

Pamplin&Bates (2021)

Answer 14

Paradox is because of invalid estimates.

1. Selection bias
2. Diagnostic instruments misclassifies
3. Somatization
4. Clinicians have diagnostic bias

Hierna komen resultaten hierover

Question 15

Artefactual mechanisms

Selection of studies is based on institutionalized or residential status

Pamplin&Bates (2021)

Answer 15

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

Question 16

Artefactual mechanisms

The diagnostic instrument misclassifies differentially

Pamplin&Bates (2021)

Answer 16

Black and white Americans respond differently to diagnostic instruments.

–> not the reason for paradox

Question 17

Artefactual mechanisms

Somatization

Pamplin&Bates (2021)

Answer 17

(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

Question 18

Artefactual mechanisms

Clinicians have diagnostic bias

Pamplin&Bates (2021)

Answer 18

(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

Question 19

Etiological mechanisms

Pamplin&Bates (2021)

Answer 19

Paradox is because of valid estimates.
1. Racial socialization
2. Social support
3. Environmental affordances (EA) model

Question 20

Etiological mechanisms

Racial socialization

Pamplin&Bates (2021)

Answer 20

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

Question 21

Etiological mechanisms

Social support

Pamplin&Bates (2021)

Answer 21

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

Question 22

Etiological mechanisms

Environmental affordances (EA) model

Pamplin&Bates (2021)

Answer 22

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.

Question 23

Discussion

Pamplin&Bates (2021)

Answer 23

• 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)

Question 24

Waar gaat artikel Slobodin over?

Slobodin et al. (2018)

Answer 24

Mental health in asylum seekers in Nederland

Question 25

Three themes in results emerged: | Slobodin et al. (2018)

Answer 25

1. Identity loss 2. Helplessness and uncertainty 3. Negative attitudes towards mental health problems

Question 26

Identity loss | Slobodin et al. (2018)

Answer 26

- 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.

Question 27

Helplessness and uncertainty | Slobodin et al. (2018)

Answer 27

- 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

Question 28

Negative attitudes towards mental health problems | Slobodin et al. (2018)

Answer 28

- 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.

Question 29

Conclusion | Slobodin et al. (2018)

Answer 29

Integrating asylum seekers into inclusive settings like schools, primary prevention or case management programs can reduce stigma with mental health services.

Question 30

Waar gaat artikel Soto over? | Soto et al. (2018)

Answer 30

Patient therapist alliance and cultural background of client

Question 31

Cultural adaptation | Soto et al. (2018)

Answer 31

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*

Question 32

Cultural competence | Soto et al. (2018)

Answer 32

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

Question 33

Cultural knowledge | Soto et al. (2018)

Answer 33

Therapist's understanding of distinct cultural communities, their norms, unique experiences, colonialism etc.

Question 34

Cultural skills | Soto et al. (2018)

Answer 34

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.

Question 35

Cultural awareness | Soto et al. (2018)

Answer 35

Describes the ability of the therapist to recognize the cultural background of their client but also themselves.

Question 36

# Meta analysis of cultural adaptation of treatments Treatment characteristic | Soto et al. (2018)

Answer 36

1. Having treatment in **preferred language** had larger effects 2. Written assignments in preferred language also larger effect 3. When goals were **explicitely based on cultural values** effect sizes were higher. 4. Using **cultural metaphors** in treatment also higher effect sizes 5. Treatment **adapted to culture** les to higher effect sizes 6. The more treatment was culturally adapted, the higher the effect sizes were.

Question 37

# Meta analysis of cultural adaptation of treatments Participant characteristics | Soto et al. (2018)

Answer 37

1. Gender did **not** moderate effect size. 2. Studies with participant with **same race** had higher effect sizes than when clients from different cultures had the same culturally adapted therapy. 3. Clinical sample had more benefits from treatment compared to community and high at risk samples 4. **Age** moderated effect size. Adults older than 40 showed higher effect sizes, whereas children and adolescents had smaller effect sizes.

Question 38

Meta analysis investigating competence of therapist | Soto et al. (2018)

Answer 38

- Client rating of **cultural competence** of therapist correlated **strongly** with the outcome of therapy. - **Self-rated** cultural competence of therapist **did not** correlate strongly.

Question 39

Therapeutic practices | Soto et al. (2018)

Answer 39

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