Depression Part 2 Flashcards
1
Q
What is Contemporary Integrative Interpersonal Theory (CIIT)?
A
CIIT is a framework for understanding personality and psychopathology through recurring interpersonal dynamics and interactions, emphasizing agency (dominance–submission) and communion (warmth–aloofness) as core dimensions.
2
Q
What are the six core assumptions of CIIT?
A
- Personality and psychopathology are expressed through interpersonal situations.
- Agency (dominance–submission) and communion (warmth–aloofness) organize interpersonal functioning.
- These dimensions apply across levels of experience (traits, behaviors, motives).
- Interpersonal behavior is driven by satisfying agentic and communal motives.
- The interpersonal transaction cycle predicts patterns of interaction.
- Persistent deviations from expected patterns indicate psychopathology.
3
Q
What is the Interpersonal Circumplex (IPC) in CIIT?
A
The IPC organizes interpersonal behaviors along two axes:
* Agency: Dominance vs. submission.
* Communion: Warmth vs. aloofness.
It describes and predicts interpersonal patterns central to psychological distress.
4
Q
What is the interpersonal transaction cycle in CIIT?
A
Dominant behaviors elicit submissive responses, and warm behaviors elicit warmth in return (complementarity).
Persistent disruptions in these patterns often signal psychopathology.
5
Q
How does CIIT define the interpersonal situation?
A
An interpersonal situation involves the interaction of the self with others, either directly or as internalized representations, affecting agentic and communal motives, anxiety/security, and learning.
Pincus and Ansell (2003): “A pattern of relating self with others, associated with varying levels of anxiety/security, influencing self-concept and social behavior.”
6
Q
How is CIIT applied in psychotherapy?
A
Noncomplementary responding:
* Disrupt maladaptive interpersonal cycles (e.g., responding to hostility with curiosity).
Therapeutic metacommunication:
* Openly discussing interpersonal dynamics to foster insight and behavioral change.
7
Q
How do interpersonal styles affect therapeutic outcomes?
A
Warm and submissive styles: Stronger alliances, faster improvement, and better long-term outcomes.
Hostile and dominant styles: Greater challenges in forming alliances and sustaining treatment progress.
8
Q
How are interpersonal styles linked to diagnoses?
A
Hostile-dominant styles: Common in antisocial personality disorder.
Submissive styles: Linked to major depression, often with chronic symptoms
9
Q
What evidence supports CIIT’s interpersonal processes?
A
Pathological narcissism: Anger in response to perceived dominance.
Borderline personality disorder: Hostility in response to perceived coldness.
Complementary patterns (e.g., warmth eliciting warmth) predict stronger therapeutic alliances and outcomes.
10
Q
What are the therapeutic goals of CIIT?
A
Identify and disrupt maladaptive interpersonal cycles.
Foster new social learning through noncomplementary responses.
Generalize insights to broader relationships, promoting healthier patterns.
11
Q
What is the focus of Cuijpers et al. (2016)?
A
The study reports the effectiveness of Cognitive Behavioral Therapy (CBT) for treating Major Depressive Disorder (MDD) and other anxiety-related disorders, emphasizing MDD.
12
Q
Why are the effects of CBT often overestimated?
A
- Publication bias: Favoring studies with stronger findings.
- Low-quality trials: Limited rigorous evidence.
- Use of waiting list control groups:
- Waiting lists may create nocebo effects, worsening symptoms due to negative expectations.
13
Q
How does the choice of control group affect CBT outcomes?
A
Studies using waiting list controls show larger effect sizes than those using:
* Care as usual (conservative controls).
* Pill placebo.
Waiting list control groups amplify apparent CBT effectiveness due to nocebo effects in controls.
14
Q
What are the conclusions about CBT for MDD?
A
- CBT is “probably effective” for MDD, GAD, PAD, and SAD.
- Effectiveness is greater in studies with waiting list controls.
- Small number of high-quality studies limits certainty of effects.
15
Q
What was the aim of Undurraga et al. (2017)?
A
To compare the effectiveness of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) in treating Major Depressive Disorder (MDD).
16
Q
What were the hypotheses of the study?
A
- Minimal differences between TCA and SSRI efficacy.
- Trial improvements (e.g., larger participant numbers, longer duration) would not significantly alter efficacy ratings but might show differences in dropout rates.
17
Q
What were the key results of the comparison between TCAs and SSRIs?
A
- Efficacy:
- No significant difference in short-term efficacy.
- Similar depression rating improvements for both drugs.
- Dropout rates:
- Higher dropout rates with TCAs compared to SSRIs.
- SSRIs had better overall tolerability.
18
Q
What factors were unrelated to treatment responses?
A
- Trial size.
- Proportion of women participants.
- Mean drug dose.
- Initial depression ratings.
19
Q
What are the overall conclusions from Undurraga et al. (2017)?
A
TCAs and SSRIs are similarly effective for treating MDD.
SSRIs are better tolerated, with fewer dropouts.
Larger, longer trials reinforce these findings without altering efficacy ratings.
20
Q
What are common factors in psychotherapy?
A
Common factors are elements shared across all therapies, such as:
1. Therapeutic alliance (relationship between therapist and patient).
2. Patient’s understanding of their problem and potential solutions.
3. Credibility of the treatment.
21
Q
What was Rosenzweig’s Dodo Bird Verdict (1936)?
A
Rosenzweig suggested that all therapies are equally effective, sparking ongoing debate about whether differences in therapeutic outcomes are due to specific techniques or common factors.
22
Q
What are Jerome Frank’s four common factors of psychotherapy?
A
- A functional relationship between therapist and patient.
- A credible explanation for the treatment.
- Specific procedures presented in an organized way.
- A therapeutic environment conducive to healing.
23
Q
What is the contextual model of psychotherapy?
A
The most developed common factors model, emphasizing:
1. Real relationship: Authentic connection between therapist and patient.
2. Expectations/hope: Therapy instills hope and provides tools for change.
3. Specific therapeutic elements: These activate expectations and produce tangible benefits (e.g., improved social skills in interpersonal therapy).
24
Q
How do common factors contribute to therapy outcomes?
A
- 30% of change is due to common factors.
- 15% is attributed to specific therapeutic techniques.
25
What are bona fide therapies?
Therapies delivered by trained professionals with a credible theoretical basis.
Non-bona fide therapies are intentionally ineffective and used for comparison with bona fide therapies.
26
What is research allegiance, and how does it affect comparative studies?
Research allegiance refers to the preference of researchers for one therapy over another, influencing study design, interpretation, and results. This can bias comparisons between therapies.
27
What are component studies in psychotherapy research?
1. Dismantling studies: Compare a full therapy with one missing a component.
2. Additive studies: Compare a therapy with and without an added component.
Findings can help determine if specific components drive therapeutic outcomes.
28
What are the main elements of therapy outcomes?
1. Active components: Specific or nonspecific factors responsible for change.
2. Mechanisms of change: Processes explaining how therapies achieve results.
3. Extratherapeutic factors: External influences like life events.
4. Moderators: Characteristics that affect treatment-outcome relationships.
5. Mediators: Explain the relationship between treatment and outcomes.
29
Why is the therapeutic alliance considered crucial in psychotherapy?
It is the strongest predictor of outcomes, consisting of:
1. Relationship between therapist and patient.
2. Agreement on therapy goals.
3. Agreement on therapy tasks.
30
What role do patient expectations play in psychotherapy?
Patient expectations about outcomes and the therapist’s empathy significantly impact therapy success.
31
What does Cuijpers et al. (2019) conclude about specific and common factors?
No conclusive evidence supports the causal role of specific factors or their primacy in CBT effectiveness.
Psychotherapy likely involves an interaction between specific and nonspecific factors, making it a highly complex process.
32
How are therapy outcomes influenced by common and specific factors?
Common factors (e.g., therapeutic alliance) play a significant role in outcomes.
Specific factors contribute to change, but their interaction with nonspecific factors complicates clear attribution.
33
What is Mindfulness-Based Cognitive Therapy (MBCT)?
MBCT is a group intervention designed to prevent relapse in individuals with recurrent Major Depressive Disorder (MDD) in remission. It uses mindfulness exercises (e.g., body scans, yoga, meditation) to help patients manage thoughts, emotions, and bodily sensations.
34
What is the theoretical basis of MBCT?
Recurrent MDD makes individuals more cognitively sensitive to low moods. This sensitivity triggers negative, ruminative thinking patterns, increasing relapse risk. MBCT teaches mindfulness to break this cycle.
35
What were the key findings of Piet et al. (2011)?
* MBCT is effective for relapse prevention in recurrent MDD.
* Greatest benefit for individuals with 3+ prior episodes, as they are prone to ruminative thinking.
* Less effective for patients with 2 prior episodes when relapse is triggered by stressful life event
36
What are the advantages of MBCT?
* Reduces relapse risk, particularly in those with recurrent MDD.
* Low-cost intervention.
* Effective for addressing ruminative thinking patterns.
37
What are Interpersonal Psychotherapy (IPT) and Cognitive Therapy (CT)?
* IPT: Focuses on improving interpersonal functioning to reduce depressive symptoms.
* CT: Targets the structure, content, and function of negative thoughts and schemas to improve mood.
38
How do IPT and CT compare in terms of efficacy?
* Both IPT and CT significantly reduce depressive symptoms compared to a waitlist.
* No significant differences in effectiveness between IPT and CT.
* Symptom reduction during the 7-month treatment was largely maintained during follow-up.
39
What are the predictors of better treatment outcomes for IPT and CT?
Predictors of lower depression symptoms post-treatment (regardless of intervention):
* Female gender, absence of personality disorder, low anxiety, high quality of life, active employment.
Better response to IPT: Cognitive problems.
Better response to CT:
* Somatic complaints.
* Paranoid symptoms.
* Self-sacrificing interpersonal tendencies.
* Stressful life events.
* Goal-oriented attributional style.
40
How do IPT and CT work differently?
* IPT: Improves interpersonal functioning to reduce symptoms.
* CT: Alters the structure and content of dysfunctional thoughts and schemas.
41
What were the limitations of Lemmens et al. (2020)?
* Lack of empirical evidence supporting the theorized mechanisms of IPT and CT.
* Mechanisms of change for these treatments remain unidentified.
42
How does the presence of comorbid conditions affect IPT and CT outcomes?
* Comorbid anxiety disorders increased dropout rates in both IPT and CT.
* Comorbid personality disorders did not significantly affect outcomes during treatment or follow-up.
43
What are the conclusions about IPT and CT for depression?
* IPT and CT are equally effective for treating MDD.
* They likely work through different mechanisms, though these mechanisms remain unclear.
* Shared factors like therapeutic alliance and motivation may drive treatment success.
44
What was the main goal of Kendler et al. (2014)?
To investigate sex differences in the pathways to Major Depressive Disorder (MDD) using a dizygotic opposite-sex twin design, examining genetic and environmental risk factors.
45
Why is it important to study sex differences in MDD?
Women are at a higher risk for MDD than men. This may be due to a combination of genetic predispositions and environmental exposures, but little research has specifically examined the role of sex in the development of MDD.
46
What are the main risk factors for depression in females?
1. Parental loss.
2. Divorce.
3. Low parental warmth.
4. Lifetime trauma.
5. Low social support.
6. Marital dissatisfaction.
* Strongest effects: Social support and marital satisfaction.
* Moderate effects: Neuroticism and divorce.
* Modest effects: Parental warmth.
47
What are the main risk factors for depression in males?
1. Low self-esteem.
2. Childhood sexual abuse.
3. Conduct disorder.
4. History of major depression.
5. Drug use disorder.
6. Dependent proximal and recent stressful life events.
* Strongest effects: Dependent proximal stressful life events.
* Moderate effects: Conduct and substance use disorders.
* Modest effects: Childhood sexual abuse and past depression.
48
What types of stressful life events had the largest effects on males?
Distal stressful life events (strongest effects):
1. Financial problems.
2. Work problems.
3. Legal problems.
49
What life events had comparable effects on males and females?
Relationship issues and serious illnesses within close social networks had similar effects on both genders.
50
How does the heritability of MDD differ between males and females?
Heritability of MDD is higher in females compared to males. --> Volgens mij zijn de resultaten voor erfelijkheid tussen mannen en vrouwen inconsistent en kan niet perse gezegd worden of het meer erfelijk is voor mannen of vrouwen.
51
What types of depression are females and males more likely to experience?
Females: Anaclitic depression (lack of supportive connections, unresolved reliance needs).
Males: Introjective depression (inability to fulfill internal expectations for success and value).
52
What are the implications of Kendler et al. (2014) for understanding depression?
Depression pathways differ significantly by sex, with females more affected by social and relational factors and males more by self-esteem and external stressors.
Tailored interventions addressing gender-specific risk factors may improve outcomes for MDD.
53
What was the aim of Martin et al. (2013)?
To investigate gender-based differences in the experience, expression, and response to depression, challenging the validity of DSM-5 criteria and exploring alternative symptoms in men.
54
What is the traditional gender ratio for depression prevalence?
Women are twice as likely as men to be diagnosed with depression, a ratio consistent across both Western and non-Western countries.
55
What are the four conceptual frameworks addressing gender differences in depression?
1. Sex differences framework: Assumes uniform depression but explores sex-specific variations.
* Criticism: Oversimplifies gender by treating male vs. female as binary.
2. Masked depression framework: Suggests men express distress through “depressive equivalents” (e.g., anger, substance use).
* Criticism: Identifying depressive equivalents is difficult.
3. Masculine depression framework: Men face unique depression marked by outward symptoms like anger, self-destructive behavior, and substance use due to traditional masculine norms.
4. Gender response framework: Men’s responses to negative emotions depend on conformity or rejection of traditional masculinity norms.
56
What tools are used to evaluate alternative male depression symptoms?
1. Gotland Male Depression Scale (GMDS): Assesses male-specific depressive symptoms.
2. Masculine Depression Scale (MDS): Evaluates depression influenced by traditional masculine norms.
57
What new measures were developed for evaluating male depression?
1. Male Symptoms Scale (MSS): Focuses on alternative male-type symptoms.
2. Gender Inclusive Depression Scale (GIDS): Combines traditional and alternative symptoms.
58
What were the main results of Martin et al. (2013)?
1. GIDS results: No sex differences in depression prevalence (hypothesis supported).
2. MSS results: Higher male depression prevalence compared to women (hypothesis supported).
3. Symptom patterns: Mixed results on whether men showed more non-traditional symptoms than women.
__________________
Resultaten:
* Mannen tonen vaker externaliserende symptomen van depressie zoals: woedeaanvallen, agressie, middelengebruik en risicovol gedrag.
* Vrouwen tonen vaker symptomen zoals stress, prikkelbaarheid en slaapstoornissen.
* Toevoegen van alternatieve depressiesymptomen leidt tot gelijkere prevalentie van depressie suggereert dat traditionele criteria mogelijk onderdiagnose van depressie bij mannen veroorzaakt.
59
What were the top five symptoms reported by men and women?
1. Depressed mood
2. Irritability
3. Stress
4. Anxiety/uneasiness
5. Anger attacks/aggression
60
What gender-specific behaviors were observed in depression?
More frequent in men: Substance use, risk-taking, irritability, anger, and workaholism.
More frequent in women: Crying, self-blame, and feelings of helplessness.
61
Why might clinicians misdiagnose depression in men?
If clinicians rely solely on traditional symptoms (e.g., sadness), they may overlook men’s non-traditional symptoms, such as irritability, anger, or self-destructive behaviors.
62
What is the main focus of Kuehner’s (2017) study?
To explore gender differences in depression prevalence, symptoms, and risk factors, focusing on the internalizing spectrum of mental disorders where women are overrepresented.
63
How does depression prevalence differ between genders?
* Before puberty: Boys are more likely to meet MDD criteria, but overall prevalence is low.
* After puberty: Depression prevalence rises in girls, becoming twice as high as in boys.
* This gender disparity persists from early adulthood through later life, even after menopause.
64
How do gender differences affect the course of depression?
1. Suicide prevalence: Higher in men.
2. Excess mortality: Depressed men have a higher mortality rate than depressed women.
65
How do depression symptoms differ between men and women?
* Women: More atypical symptoms (e.g., increased appetite, hypersomnia), somatic symptoms (e.g., fatigue, pain).
* Men: More externalizing symptoms and comorbidities (e.g., substance use, antisocial behavior).
66
How do genetic factors contribute to depression risk?
* Depression heritability: 30%-40%.
* Mixed evidence suggests stronger heritability in women.
* Gene-environment (G*E) studies: Short-allele variants of 5-HTT increase susceptibility to depression following stress.
67
How do hormonal fluctuations affect depression in women?
Hormonal changes during:
* Puberty
* Postpartum
* Menstrual cycle
* Menopause
These are linked to increased depression risk in women.
68
How do gender differences in stress response influence depression?
Men: Stronger physiological responses (e.g., HPA-axis activation, higher blood pressure).
Women: Stress sensitivity varies with menstrual cycle, contraceptive use, pregnancy, and menopause.
Men are more reactive to performance challenges; women are more sensitive to social rejection and conflict.
69
How do temperament, personality, and coping styles differ by gender?
Effortful control: Higher in girls, linked to better attention regulation.
Activity/impulsivity: Higher in boys, leading to externalizing behaviors.
Neuroticism: Higher in adolescent girls, linked to negative affect and rumination.
Ruminative coping style: More common in women and predicts depressive symptoms
70
What role do anxiety disorders play in depression risk?
Anxiety-depression comorbidity is higher in women.
Women’s higher lifetime anxiety prevalence contributes to greater depression risk.
71
How does paid employment influence depression risk in men and women?
* Men: Engaging in paid work reduces depression risk.
* Women: Paid work reduces depression risk only if they do not have children.
72
What stressors are more common in men vs. women?
* Women: Stress from interpersonal relationship failures.
* Men: Stress from work, financial, and legal issues.
73
How does childhood abuse and partner violence affect depression risk in women?
Childhood abuse disrupts stress response development and increases depression risk.
Women experiencing partner violence (physical, sexual) are twice as likely to develop depression compared to non-victims.
74
What is the artefact hypothesis about depression prevalence?
Suggests depression rates are equal across genders, but lower treatment utilization and recognition in men falsely elevate women’s prevalence rates. Limited support for this hypothesis exists.
75
How do gender inequalities influence depression prevalence?
Lower gender equality: Correlates with higher depression prevalence in women.
Social inequalities, such as partner violence, exacerbate depression risk.
76
Why is depression more common in women than men?
Depression prevalence in women results from a complex interplay of:
1. Biological factors: Hormonal fluctuations, genetic susceptibility.
2. Psychological factors: Ruminative coping, anxiety disorders.
3. Environmental factors: Interpersonal stress, social inequalities, and partner violence.
77
What was the main goal of DeJong et al. (2010)?
To compare suicide attempters and completers on symptoms of depression, suicide-related variables, and stressful life events to understand differences in risk profiles.
78
What were the main differences between suicide attempters and completers?
1. Lethality: Completers used more lethal methods (e.g., firearms).
2. Demographics: Completers were older and predominantly male.
3. Actions:
* Completers were more likely to leave a suicide note and consume drugs or alcohol.
* Attempters had a history of more attempts and inpatient psychiatric treatment.
4. Stressful life events: Completers experienced more work-related stress and financial problems.
79
What were the similarities between attempters and completers?
Both groups exhibited similar patterns of depressive symptoms.
80
Why is recognizing warning signs important in suicide prevention?
Warning signs (e.g., substance abuse, writing a suicide note, depression) signal immediate risk and require urgent intervention.
81
Why is suicide considered a significant public health issue?
* Suicide rates vary widely by age, gender, geography, and culture.
* Non-fatal suicidal behaviors are more common than completed suicides.
* Suicide rates are highest among middle-aged and elderly men in high-income countries.
82
How do suicide rates differ by gender and age?
Men: Higher suicide completion rates.
Women: Higher rates of ideation and attempts.
Adolescents/young adults: Highest prevalence of suicidal ideation.
83
What are population-level risk factors for suicide?
1. Weak social cohesion and lack of shared values.
2. Economic downturns (e.g., unemployment).
3. Media coverage of suicides, which can influence rates.
84
What individual factors increase suicide risk?
1. Heritability: Impulsive aggression may mediate familial risk.
2. Sexual orientation: Higher risk among individuals with same-sex relationships, especially men.
3. Early negative life events: Abuse, neglect, or trauma can increase lifetime risk.
85
How does early trauma influence suicide risk?
* Dysregulation of the HPA axis increases stress response.
* Changes in genetic pathways (e.g., epigenetic modifications).
* Cognitive deficits in memory and problem-solving, contributing to suicidal ideation.
86
What are the three categories of individual suicide risk factors?
1. Distal/predisposing factors: Genetic vulnerabilities, early trauma.
2. Developmental/mediating factors: Mood disorders, substance abuse, cognitive deficits.
3. Proximal/precipitating factors: Recent stressors, hopelessness, psychotic symptoms.
87
How do suicide risk factors change with age?
* Adolescence: Impulsivity, comorbid substance use, cluster B personality disorders.
* Middle age: Depression, high anxiety, substance misuse.
* Old age: Stronger link with psychopathology, especially major depressive disorder.
88
What are the key clinical predictors of suicide?
1. Past suicide attempts (strongest predictor).
2. Psychopathology (e.g., mood disorders).
3. Feelings of hopelessness.
4. Male sex and younger age.
5. Lack of insight into psychiatric conditions.
89
What somatic treatments are effective in reducing suicidal behaviors?
1. Antidepressants: Reduce ideation in individuals over 25.
2. Lithium: Decreases impulsivity and mood disorder episodes.
3. Ketamine: Rapidly decreases suicidal ideation but has side effects.
4. Antipsychotics: (e.g., olanzapine) for psychotic disorders like schizophrenia.
90
What psychotherapeutic interventions help prevent suicide?
1. Dialectical Behavior Therapy (DBT): Focuses on emotional regulation and interpersonal effectiveness.
2. Mentalization-Based Therapy (MBT): Helps individuals understand others’ emotions and thoughts.
3. Cognitive Behavioral Therapy (CBT): Targets maladaptive thinking patterns to reduce risk.
91
What are the main mood disorders associated with suicide?
1. Depressive disorders: Depressed mood, loss of interest, hopelessness, and suicidal ideation are common.
2. Bipolar I disorder: Manic episodes following depressive episodes; includes euphoria and irritability.
3. Bipolar II disorder: Hypomanic episodes linked to depressive episodes, without severe functional impairments.
92
What percentage of depressed patients experience suicidal ideation?
More than 50% of depressed patients report suicidal ideation, often correlating with depression severity.
93
What role do alcohol and drug use play in depression-related suicide risk?
* Alcohol and drug dependence increase suicide risk.
* Depressed individuals with alcohol problems often show lower impulsiveness but higher suicidal intent.
94
Why is hopelessness a critical symptom in suicide prevention?
Hopelessness is the most consistent predictor of suicidal ideation and behavior across mood disorders.
95
How should suicide prevention strategies address mood disorders?
1. Effective depression treatment.
2. Monitoring high-risk groups, including post-discharge psychiatric patients.
3. Prioritizing lithium therapy in bipolar disorder.
4. Identifying and managing comorbidities (e.g., substance use, anxiety).
96
What factors should be considered when examining depression among racial and ethnic groups?
1. Expression of depression.
2. Predisposing factors (e.g., genetics, childhood events).
3. Barriers to therapy initiation and maintenance.
97
How does depression prevalence differ between Caucasians and African Americans?
Caucasians: Higher lifetime prevalence of major depressive disorder (MDD).
African Americans: Lower prevalence but more chronic and functionally impairing
98
What are the key risk and protective factors for depression in African Americans?
Risk factors:
1. Discrimination.
2. Socioeconomic challenges (e.g., poverty, unemployment).
Protective factors:
1. Strong ethnic identity.
2. Marriage and higher education levels.
3. Hopefulness (Undoing Hypothesis).
99
What is the Undoing Hypothesis?
The Undoing Hypothesis suggests that positive affect (e.g., hopefulness) buffers the harmful effects of negative affect, reducing depressive symptoms in African Americans.
100
What are the two hypotheses about race and psychiatric diagnoses?
1. Clinical bias hypothesis: Depression symptoms are similar across races, but clinicians misdiagnose due to biases.
2. Cultural relativity hypothesis: Depressive symptoms manifest differently across races, leading to diagnostic challenges.
101
What is the Black-White Depression Paradox?
Despite experiencing more life stressors, Black Americans have a comparable or lower prevalence of major depressive disorder (MDD) compared to White Americans.
102
What are the two explanations for the Black-White Depression Paradox?
1. Invalid estimates: Depression prevalence in Black Americans is underestimated due to methodological issues.
2. Valid estimates: Black Americans truly have a lower burden of depression.
103
What are the proposed artefactual mechanisms explaining the paradox?
1. Selection bias: Excludes groups like the homeless or incarcerated (disproportionately Black).
2. Diagnostic instrument bias: Tools designed for White individuals misclassify depression in Black Americans.
3. Somatization bias: Black Americans report more somatic than psychological symptoms, missing DSM-5 criteria.
4. Clinical bias: Clinicians misdiagnose depression in Black individuals due to racial biases.
104
Was evidence found to support artefactual mechanisms?
No significant evidence supports these mechanisms. Studies consistently find Black Americans have lower depression rates, even after controlling for these biases.
105
What are the proposed etiological mechanisms explaining the paradox?
1. Racial socialization: Prepares Black individuals for stressors, reducing their impact on mental health.
2. Social support: Stronger support networks help Black individuals cope with life stressors.
3. Environment affordances model (EA): Unhealthy coping behaviors (e.g., substance use) shield Black individuals from mental health consequences but increase physical health risks.
106
What is the social stress theory in relation to the Black-White Depression Paradox?
It posits that members of stigmatized groups, such as racial minorities, face chronic stressors from their marginalized status, which can lead to poorer mental health outcomes.
107
What are common mental health challenges faced by asylum seekers?
1. Lasting psychological and social impacts of emergencies.
2. Post-migration stressors: discrimination, economic difficulties, cultural adjustment, unemployment, and parenting challenges.
108
What are the three themes identified in Slobodin et al. (2018)?
1. Identity Loss: Loss of status, relationships, and self-identity leads to worthlessness and exclusion.
2. Helplessness and Uncertainty: Anxiety, powerlessness, and anger from prolonged asylum procedures.
3. Negative Attitudes Towards Mental Health Problems: Stigma and reluctance to discuss distress, especially among men.
109
How can mental health services reduce stigma for asylum seekers?
Integrate services into inclusive community settings (e.g., schools, prevention programs) to normalize mental health care.
110
What is cultural adaptation in therapy?
Systematic modifications to make therapy compatible with the client’s culture, including values, language, and patterns.
111
What is cultural competence in therapy?
A therapist’s ability to engage effectively with diverse clients, demonstrated through:
1. Cultural knowledge: Understanding communities’ norms and histories.
2. Cultural skills: Adapting methods to meet cultural needs.
3. Cultural awareness: Recognizing cultural influences on both the client and therapist.
112
What factors increased the effectiveness of culturally adapted treatments?
1. Therapy conducted in the client’s preferred language.
2. Incorporation of cultural values and metaphors.
3. Higher levels of cultural adaptation.
4. Homogeneous participant groups (same cultural background).
5. Adults benefitted more than children or adolescents.
113
What should therapists consider when addressing cultural diversity?
1. Assess the client’s cultural background regularly.
2. Adapt therapy based on cultural needs and intersecting identities.
3. Conduct therapy in the client’s preferred language.
4. Avoid assuming their own cultural competence matches the client’s perception.
114
What are Soto et al.’s recommendations for culturally sensitive therapy?
1. Use the client’s preferred language.
2. Align therapy with cultural values and intersecting identities.
3. Incorporate multiple cultural adaptations.
4. Focus on adults for greater effectiveness.
5. Regularly include cultural competence questions in feedback tools.
115
Why should therapists act with cultural humility?
Cultural humility ensures sensitivity to clients’ unique experiences and avoids overestimating one’s competence in diverse settings.
