Download Discuss gender and cultural variations in the prevalence of Major

Discuss gender and cultural variations in the prevalence of Major Depressive Disorder
This paper will discuss gender and cultural variations in the prevalence of Major
Depressive Disorder by focusing on various studies and findings. Major depressive disorder is
relatively common, affecting around 15% of people at some time in their life. According to the
Department of Health (1990), during the 1980’s, depression accounted for about one-quarter
of all psychiatric hospital admissions in the UK. Furthermore, depression is much more
common in women than men, having a 1: 10 ratio. Levav (1997) has found the prevalence rate
to be to be above average in Jewish males—and there is no difference in prevalence between
Jewish men and Jewish women. The difference can suggest that some groups are more
vulnerable to depression, but it could also indicate a problem in making reliable diagnosis;
having said that, gender and cultural variations are significant factors when considering the
prevalence of this disorder.
The World Health Organization (1983) has looked at cultural considerations linked to
depression and identified common symptoms of depression in four different countries;
including Iran, Japan, Canada, and Switzerland. These symptoms were feeling of sadness, loss
of enjoyment, anxiety, tension, lack of energy, loss of interest, inability to concentrate, anxiety,
tension, lack of energy, among others. Prince (1968) claimed that there was no depression in
Africa and many regions of Asia, but found that rates of reported depression rose with
westernization in the former colonial countries. Furthermore, Kleinman (1982) showed that in
China, somatization served as a typical channel of expression and as a basic component of
depressive experience. The Chinese rarely complain of feeling sad or depressed; instead, they
refer to these feelings to the body as the medium of distress. Masella (1979) argues that
affective symptoms between (sadness, loneliness, isolatin) are typical of individualist cultures.
In cultures which are collectivist ( for example those that have larger and more stable social
networks to support the individual and where one’s identity is more linked to these groups)
somatic symptoms such as headaches are more common. Lastly, Tahassum et al (2000)
conducted an interview study about etics/emics of depression by interviewing Pakistanis that
lived in the UK. They aimed to answer the question “What are the emics (culturally specific)
and etics (culturally universal) aspects of depression?” based on research from the UK
Pakistani community. They compared emic definitions of depressive symptoms from the
Pakistani community living in the UK with the existing predominant etic (so-called culturally
universal) descriptions used by Western psychiatrists that were treating them. All 79
interviews were conducted in family groups because males typically wouldn’t allow females to
meet with the researchers alone in their home. Combinations of languages were used (English,
Urdu, Punjabi) and only seven of the families allowed the researchers to have the privilege of
recording the interviews. The topics included in the interviews were perception of causes for
mental disorder, help seeking behavior and the community of status of people with mental
disorders. What they found was that 63% viewed aggression as a main symptom of
abnormality. Pakistani culture is a collectivist and emphasizes politeness in their social
behavior, so aggressive displays are views as abnormal more so than anxious or depression
symptoms. However, it is important to keep in mind that this study may have low ecological
validity given that the statistics gathered may not be a representative sample. The majority of
the males thought a doctor should be consulted for treatment, while fewer females identified
a doctor as the first person to consult, but there may be culture barriers to women getting
help from doctors, which included language barriers. Many doctors are males, and that many
Muslim women have difficulty with hospitalization due to shame brought upon the family.
Overall, cross-cultural research has demonstrated that there is a virtually identical core of
symptoms present in depression in many different cultures.
According to statistical evidence, Williams and Hargreaves (1995) found that women are
two to three times more likely to become clinically depressed than men, and are more likely to
experience several episodes of depression. It’s a widely held belief that women are naturally
more emotional than men, and therefore are more vulnerable to emotional upsets because of
hormonal fluctuations. The theory of social factors in depression, which was by Brown and
Harris (1978), a study of the social origins of depression was carried out, who examined the
relationship between social factors and depression in a group of women from Camberwell in
London. They studied women who had received hospital treatment for depression and women
who had visited their doctor seeking help for depression. They also studied a general
population sample of 458 women aged between 18 and 65 years old. They found, that on
average 82% of those who became depressed had recently experienced at least one severe life
event or major difficulty, compared to only 33% of those in non-depressed comparison groups.
They also found evidence of a pronounced social class effect, at least for married women. Of
the working class women in the general population, 23% had been depressed within the past
year, compared to only 3% of the middle class women. Along with the working class women,
those who had one or more young children were at higher risk of becoming depressed than
those who were childless or whose children were older. Women who were currently caring for
three children were particularly likely to have experienced a recent depressive period. There
was a strong association between risk and marital status, which held across all social classes.
Women who were widowed, divorced or separated had relatively high rates of depression.
Although there was a strong overall association between depression and the experience of
stressful life events, only a minority, about 20% of the women who had experienced severe
difficulties became seriously depressed. This suggests that people differ in their vulnerability,
and a number of “vulnerability factors” were identified in the study: lack of confidante, early
loss of mother before the age of 11, and being unemployed. One of the most protecting
factors against depression was found to be the presence of a partner.
A research study by Marco Piccinelli, PhD, and Greg Wilkinson of the British Journal of
Psychiatry, aims to review putative risk factors leading to gender differences in depressive
disorders. Their method was a critical review of the literature, dealing separately with
artefactual and genuine determinants of gender differences in depressive disorders. Their
results were that although artefactual determinants may enhance a female preponderance to
some extent, gender differences in depressive disorders are genuine. At present, adverse
experiences in childhood, depression and anxiety disorders in childhood and adolescence,
sociocultural roles with related adverse experiences, and psychological attributes related to
vulnerability to life events and coping skills are likely to be involved. Genetic and biological
factors and poor social support, however, have few or no effects in the emergence of gender
differences. Their conclusion was that determinants of gender differences in depressive
disorders are far from being established and their combination into integrated aetiological
models continues to be lacking. However, although gender differences may play a role in
coping with depressive disorders, how people cope with stress in terms of social support is
also a factor (from the Bio LOA) and also the importance of individual differences such as
Cognitive Styles of type A personality and hardy personalities affect people and depression.
In conclusion, cultural and gender considerations in the prevalence of major depressive
disorder are important so that the most effective treatments can be developed. As major
depressive disorder are relatively common, and can affect around 15% of everybody from all
cultures and genders at some time in their life. Furthermore, depression is much more
common in women than men, and traditional treatments for men must be adapted to benefit
women as well. The difference can suggest that some groups are more vulnerable to
depression, but it could also indicate a problem in making reliable diagnosis.