Does Culture Influence Our Response to Depression?
There are myriad influences on the way any individual may respond to psychological distress. Depression is a common response that can have a devastating effect on an individual’s quality of life. The World Health Organization expects disability resulting from depression to be second only to cardiovascular diseases by 2020, while suicide will continue to exact a high toll.1 Nearly 80% of the 450 million people who have mental health problems suffer from depression. However, the lifetime prevalence of depression varies widely between countries, suggesting that culture may be an important issue in the expression of distress.2
Underwriting and claims practice is neutral to culture and ethnicity and both concepts are clearly understood as being distinct. Culture can shape the development of complex and diverse personal feelings in a population and influences the ways people understand and express distress. This affects the language people use to discuss their symptoms and has an impact on the doctor-patient interaction and decisions about treatment.
A dichotomy has been drawn between cultures that focus to a greater extent on the individual and those that have a more "collective" ethos. The higher regard for family and wider society rather than personal happiness may combine with greater social support to decrease the development of depressive disorders in collectivist cultures.3
Distress can be expressed in emotional or in physical terms. DSM-5 highlights changes in mood and decreased interest in activities as the core symptoms of a Major Depressive Episode playing down the physical symptoms that accompany the disorder. Other cultures may mediate their distress to a much greater extend through their bodies, expressing it in terms of physical symptoms such as pain, tiredness or fatigue.
Culture also influences help-seeking behaviour. Few societies encourage the open expression of mental health problems and anti-stigma campaigns have only limited success. Where mental health disorders are associated with high stigma and loss of reputation, people are even less likely to have these recorded in their medical history or acknowledge them on application forms.4
Depression and anxiety are “normal” emotional responses to some life events, but any response is refracted through the culture of the person experiencing those events. Bereavement is a classic example. It is often said that anything beyond six months represents an abnormal grief response but there are cultures where this would be thought of as a disrespectfully short period.5 Depression, as an expression of psychological distress, is the result of a complex interaction between genetic, biological and socio-cultural factors.
Follow our blog series on mental health for more on the complex risk challenges presented by specific disorders and behavioural issues.
- WHO (2014). Preventing Suicide http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/.
- WHO (2015). Fact Sheet Depression. http://www.who.int/mediacentre/factsheets/fs369/en/.
- Nemade, R., Staats Reiss, N., Dombeck, M. (2015). Sociology of Depression – Effects of Culture. https://www.mentalhelp.net/articles/sociology-of-depression-effects-of-culture/.
- Kirmayer, L.J., Rousseau, C., Guzder, J. (2014). Cultural Consultation: Encountering the Other in Mental Health Care. International and Cultural Psychology. Springer: New York.
- Bandini, J. (2015). The medicalization of bereavement: (Ab)normal grief in the DSM-5. Death Studies, 39:6, 347-352.