Culture, Health, Mental health and Interventions Flashcards
Four indicators of health worldwide
- Life expectancy
- Infant mortality
- Obesity
- Subjective well being
Life expectancy
Wealth/resources affect average across and within countries
- ethnic majority –> ethnic minority
Infant mortality
Number of infant deaths per 1000 live births. Differences attributed to resources (good nutrition, health care, and treatment)
Disparities among ethnic groups
Obesity
Body mass index (BMI) > 25 is overweight
BMI > 30 is obese
Subjective well being
Perception of health and well being
higher SWB = better healt
Healthier lifestyle
Large country differences
Predicted by: wealth, autonomy, connection to others
Cultural dimensions and diseases
Individualism versus collectivism –> heart disease
- individualism vs collectivism
- power distance
- uncertainty avoidance
- masculinity-femininity
Higher power distance in diseases
- higher rates of infections and parasitic diseases
- lower rates of malignant neoplasm, circulatory disease, and heart disease
Higher individualism in diseases
- Higher rates of malignant neoplasms and heart disease
- lower rates of infections and parasitic diseases, cerebrovascular disease
Higher uncertainty in deseases
Higher rates of heart disease
Avoidance in disease
Lower rates of cerebrovascular disease and respiratory disease
Higher masculinity in disease
Higher rates of cerebrovascular disease
Biomedical model of health
Views disease as resulting from a specific, identifiable cause, a genetic or developmental abnormality, or physical insult
Biopsychosocial model of health
Views disease as resulting from biological, social and psychological factors
The concept of balance and imbalance
Holistic view
Homeostasis: maintaining steady and stable body functioning during environmental changeso
Body shapes and types
Eating disorders because of body shape ideals and dissatisfaction
- heavier preferred in low SES and skinnier preferred in high SES
Cultural values, beliefs and opinions about wealth, beauty and power impact attitudes toward eating, thinness and obesity
Immigrant paradox
Immigrants doing better on many health measures despite the hardships
- Researchers attribute this to healthy behaviors, social support and immigrant selectivity
Issues with definin abnormality
- absolutist orientation
- universalist perspective
- cultural relativism
Absolutist orientation
Biological models, invariant symptoms across cultures
Universalist perspective
Many disorders actually have identical symptoms
- Alzheimer, Parkinson, Schizophrenia, Autism etc.
Cultural relativism
Disorders can be understood only in the cultural framework within which they occur. Cautions against ethnocentrism
Classification
- assessment issues: reliability/validity and diagnostic categories
- Classification systems: DSM ( CCD and CFI), ICD and CCMD
Classification systems
DSM: Diagnostic and statistical manual of mental disorders
CCD: cultural concepts of distress
CFI: cultural formulation interview
ICD: international classification of diseases
CCMD: chinese classification of mental disorders
Cultural concepts of distress CCD
- cultural syndromes of distress
- cultural idioms of distress
- cultural explanations of distress
Cultural syndromes of distress
Patterns of symptomes that tend to cluster together for individuals in specific cultural groups, communities or contexts
Cultural idioms of distress
Ways that cultural groups and communitires communicate and express their distressing thoughts, behaviours and emotions
Cultural explanations of distress
What cultural groups and communities believe is the cause of the distress, symptoms or illness
Issues in cross-cultural assessment of psychological disorders
- bias and equivalence
- child behavior checklist
- test interpretation
- measuring personality to assess psychopathology
Overpathologizing
Considering behavior as pathological, when behavior is a normal variation for that individual’s culture
- result of failure in addressing issues of assessment
Underpathologizing
Indiscriminately seeing behavior as cultural, when behavior actually reflects abnormal psychological response
- result of failure in adressing issues of assessment
Schizofrenia
International pilot study of schizophrenia
- symptoms: lack of insight, auditory and verbal hallucinations, and ideas of reference
- better recovery in less developed countries
- family and social interactions influence the course of schizophrenia
- hearing voices: culture has an influence on valence, relationship with the voice and category (illness/spirit)
Depression
Physical, motivatoinal, emotional and behavioral changes
- women > men
- crosscultural symptoms: sadness and joylessness, anxiety, tensions and lack of energy and symproms differ due to variations in stress sources and coping mechanisms
Mental health in immigrants
Acculturation issues: depression, anxiety, psychosomatic problems, but there is still the immigrant paradox
Mental health in refugees
Higher posstraumatic stress disorder (PTSD), dpression and axiety caused by trauma with a dose effect
Origins of psychotherapy
Wester origin
- premise: changing our thinking –> changing out behavior
Cognitive behavioral therapy: one of the most common therapies
Cultural assumptions of psychotherapy
Psychotherapy is less effective for people of non-European descent
- different expressions of abnormality
- different notions of self
- ability of therapist related to cultural knowledge, understanding and appreciation
Goal of psychotherapy: to help eople become more functional within their society
Psycotherapy within cultures
Psychologist include cultural elements
- culturally modified psychotherapy is more effective than non-modified psychotherapy
- modifications for minority groups within a cultural setting
Disparities in receiving treatment
Not everyone is equally likely to receive treatment
- between country differences
- within country differences
What are barriers and obstacles in psychotherapy
- language barriers
- stigma and mistrust
- beliefs about health and illness
- social validity
- lack of mental health services
How can we remove therapy barriers
How do barriers interact with racial or ethnic backgrounds, immigration status, and socioeconomic status
- hire bilingual and bicultural staff
- increase outreach
- flexible hours
- reduce stigma
What is the problem and how can we talk about it
- different ways of thinking and expressing thoughts about illness
- language difficulties
- variations in communication patterns
- cultural variations in hierarchy
- differences in treatment expectations
- involvement of extended family
