2.4 cultural influences on depression & therapy Flashcards
3 sets of risk factors for depression
(Bailey et al, 2022)
Racial and ethnic differences in depression: current perspectives
internalizing factors - e.g. genetics
externalizing factors - e.g. medication side effects/secondary to illnesses and substance abuse
adversity due to trauma and psychosocial stressors - e.g. low SES
race and ethnicity disparities in depression
(Bailey et al, 2022)
Racial and ethnic differences in depression: current perspectives
When considering disparities in depression in the context of race and ethnicity it is important to consider:
- the differences in predisposing factors - e.g. genetic factors and adverse childhood events
- the presentation of disease
- the boundaries to sustained and successful treatment
lifetime prevalence:
- among caucasians: 17.9%
- among african americans: 10.4%
- the difference lies in the fact that the chronicity of depression was higher for African Americans (56%) than for caucasians (38.6%)
risk factors for depression in african americans
(Bailey et al, 2022)
Racial and ethnic differences in depression: current perspectives
the role of discrimination: self-perceived racial discrimination has been strongly associated w/worsening mental and physical health, especially in black women
the role of ethnic identity: in contrast, a strong sense of ethnic identity is a protective factor against mental illness
SES and depression
(Bailey et al, 2022)
Racial and ethnic differences in depression: current perspectives
in addition to ethnicity and gender, risk factors such as lower yearly income, SES status, poverty status, and employment are recognized as key factors
household income and unemployment predicted MDD among black ppl
african american males were the only group not to exhibit a net protective effect of education on the development of chronic medical conditions (including depression)
undoing hypothesis
(Bailey et al, 2022)
Racial and ethnic differences in depression: current perspectives
undoing hypothesis: asserts that positive emotions act as a buffer to undo the harmful effects of negative emotions
African Americans are less likely to exhibit depressive symptoms than Caucasians
depressive symptoms are associated with hopelessness in Caucasians more than in African Americans
black ppl with depression have a tendency to maintain positive attitudes in the face of adversity and foster hope
Boundaries to successful treatment
racism in the medical community
(Bailey et al, 2022)
Racial and ethnic differences in depression: current perspectives
many Black ppl have restricted access to adequate care and resources due to racialised framing on the part of the provider
perceived discrimination among Black youth: increased anxiety due to increased negative psychological stress response to discrimination
lack of health insurance and access to proper resources among minorities is a barrier to treatment
treatment discontinuation: black patients are more likely to quit receiving treatment for mental health disorders than other ethnicities
black-white depression paradox
(Pamplin & Bates, 2021)
Evaluating hypothesized explanations for the Black-white depression paradox: A critical review of the extant evidence
Black-White depression paradox = despite greater exposure to major life stressors, Black people in the US relative to white people, experience comparable or lower prevalence of unipolar major depression
valid or invalid estimates?
- invalid estimates: suggest that the burden of depression within Black communities is being systematically underestimated
- valid estimates: if true, then the paradox would be the product of etiological mechanisms producing a true lower burden of depression for Black people
black-white depression paradox
what drives the observed racial patterns
(Pamplin & Bates, 2021)
Evaluating hypothesized explanations for the Black-white depression paradox: A critical review of the extant evidence
inconsistent operationalization of depression - despite having a lower burden of diagnosed depression, Black people often have higher levels of depressive symptoms and non-specific psychological distress
lack of synthesis within the available empirical evidence - it is difficult to draw conclusions about the degree of empirical support for the proposed mechanisms
Artefactual mechanisms
selection based on institutionalised or residential status
(Pamplin & Bates, 2021)
Evaluating hypothesized explanations for the Black-white depression paradox: A critical review of the extant evidence
a form of selection bias
a limitation of the epidemiologic studies is that they are all comprised of samples of non-institutionalized and stably housed populations - implies that the depression paradox could be a product of selection based on institutionalized or residential status
People who are homeless, living on military bases or incarcerated are all absent from community-based studies
Artefactual mechanisms
differential misclassification by diagnostic instrument
(Pamplin & Bates, 2021)
Evaluating hypothesized explanations for the Black-white depression paradox: A critical review of the extant evidence
a form of measurement error
some suggest that the paradox may be produced by differentially performing structured assessment tools
black and white individuals could systematically respond differently to items in structured diagnostic instruments
black ppl w/depression would be misclassified as not having depression, such that the prevalence would be artificially low
Artefactual mechanisms
somatisation
(Pamplin & Bates, 2021)
Evaluating hypothesized explanations for the Black-white depression paradox: A critical review of the extant evidence
a form of measurement error
some evidence suggest that Black people are more likely to report depression in terms of somatic rather than psychological symptoms
this would result in a lower depression prevalence as the DSM is preferentially weighted towards psychological symptoms
Artefactual mechanisms
clinician diagnostic bias
(Pamplin & Bates, 2021)
Evaluating hypothesized explanations for the Black-white depression paradox: A critical review of the extant evidence
when evaluating black patients, clinicians are more likely to misdiagnose depression as a psychotic spectrum disorder than when evaluating white patients
this could lower depression prevalence among Black ppl
not supported by evidence
etiologic mechanisms
racial socialisation
(Pamplin & Bates, 2021)
Evaluating hypothesized explanations for the Black-white depression paradox: A critical review of the extant evidence
racial socialisation: the process in which people of diff racial groups are primed for the realities that they will face as a result of their place society
for black ppl: this is hypothesised to lessen the impact of adverse life events on mental health and depression
etiologic mechanisms
social support
(Pamplin & Bates, 2021)
Evaluating hypothesized explanations for the Black-white depression paradox: A critical review of the extant evidence
theorised greater social support in black communities
greater social support serves as a protective factor against mood disorders in general, and among Black Americans specifically
evidence - no support
etiologic mechanisms
environmental affordances model
(Pamplin & Bates, 2021)
Evaluating hypothesized explanations for the Black-white depression paradox: A critical review of the extant evidence
posits that Black ppl in response to heightened exposure to major life stressors and discrimination, engage in unhealthy coping behaviors
these simultaneously protect them from negative mental health consequences while increasing their risk for chronic physical illness
this would explain the higher presence of somatic symptoms
discussion
(Pamplin & Bates, 2021)
Evaluating hypothesized explanations for the Black-white depression paradox: A critical review of the extant evidence
artefactual mechanism: out of the 4 artifactual mechanisms, for 3 of them the available evidence consisted of only one study each
etiological mechanisms: moderate support for the EA Model and the Racial socialization hypothesis; however, the evidence comes from studies with considerable limitations
ultimately none of the proposed mechanisms included in this review are strongly supported by the available evidence
method
(Slobodin et al, 2018)
Developing a culturally sensitive mental health intervention for asylum seekers in the Netherlands: a pilot study
participants were residents of a certain asylum-seekers centre in the Netherlands, with most of them from the Middle East crisis
needs and expectations were identified using therapy expectations questionnaire and two focus groups
results
expectations from therapy questionnaires
(Slobodin et al, 2018)
Developing a culturally sensitive mental health intervention for asylum seekers in the Netherlands: a pilot study
most desired outcome was that the therapist will help them to ease their distress and get active
most participants expected that the therapist will assist them in solving everyday problems and organise their daily lives
seeking a safe place were they could explore their difficulties
most patients appreciated help focusing on symptoms associated w/their adverse past
results
focus group - 3 themes
(Slobodin et al, 2018)
Developing a culturally sensitive mental health intervention for asylum seekers in the Netherlands: a pilot study
loss of identity:
- a loss of self-resources and assets that once constituted their sense of identity, including relationships, education, profession, belongings and social status
- this identity crisis was associated w/negative self-esteem and feelings of worthlessness
feelings of uncertainty and helplessness:
- described their daily lives as empty from activities and full of waiting, thinking and worrying
- experience of being passive and the lack of control were often described as a major source of psychological distress
- their vague future combined w/the absolute powerlessness in the decision were associated w/feelings of anxiety and anger
negative attitudes towards mental health issues:
- sharing mental health problems was associated with heavy stigmatisation and shame
- psychological distress is associated w/abnormal behaviour and people are overburdened w/their own problems, hence they refuse to help others who are experiencing psychological distress
discussion
key finding
(Slobodin et al, 2018)
Developing a culturally sensitive mental health intervention for asylum seekers in the Netherlands: a pilot study
- mental health problems were more frequently associated with post-migration stressors than with past traumatic experiences
- mental health problems and the use of mental health services were silenced among refugees due to shame guilt, anxiety and the fear of negative stigma
- participants expressed their readiness to process adverse experiences in therapy
- individuals and communities were limited in their ability to support those suffering from psycho distress due to the heavy stigma of such issues and the burden of multiple stressors
discussion
risk factors
(Slobodin et al, 2018)
Developing a culturally sensitive mental health intervention for asylum seekers in the Netherlands: a pilot study
duration of the asylum procedure: those who stayed longer than 2yrs in the asylum-seekers centre suffered from higher anxiety, depression and somatoform disorders
stigma and discriminations: stigma hinders help-seeking behaviour and results in social-isolation, low self-esteem and limited opportunity in employment and education
cultural adaptations of mental health treatments
(Soto et al, 2018)
Cultural adaptations and therapist multicultural competence: Two meta‐analytic reviews
involve systematic modifications to consider language, culture, and context in such a way that it is compatible w/the client’s cultural patterns, meanings and values
culturally adapted therapy considers multiple factors not typically addressed in traditional psychotherapy
Meta-analysis of cultural adaptations to treatments
results
(Soto et al, 2018)
Cultural adaptations and therapist multicultural competence: Two meta‐analytic reviews
overall results:
- moderately strong effect of cultural adaptations to treatment on treatment gains
- high heterogeneity indicating that the results were inconsistent across studies
publication bias:
- the distribution strongly suggest presence of publication bias in the available literature
- after accounting for publication bias the effect size was decreased
overall, the more cultural adaptations reported in the study, the larger the effect size
Meta-analysis of therapist multicultural competence
results
(Soto et al, 2018)
Cultural adaptations and therapist multicultural competence: Two meta‐analytic reviews
high heterogeneity of findings - the relation between therapist multicultural competence and client experiences in treatment was highly variable across studies
publication bias: the gap between statistically significant and nonsignificant studies suggested ‘missing studies’
