Managing Depression Among Ethnic Communities: A Qualitative Study

John Furler; Renata Kokanovic; Christopher Dowrick; Danielle Newton; Jane Gunn; Carl May

doi:10.1370/afm.1091

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The ethnic interpretation of Depression
Evan Bichara

Published on: 24 May 2010
Cross-cultural care of patients with depression - additional perspectives and resources
Robert C. Like

Published on: 20 May 2010

Published on: (24 May 2010)
Page navigation anchor for The ethnic interpretation of Depression
The ethnic interpretation of Depression
Evan Bichara, Fitzroy, Victoria, Australia
In response to this most important article outlining the Concepts of depression within our ethnic Communities is very interesting, though very true.
To visualize Depression under the two sub headings:
• independent of time, place and culture
• dependent of time, place and culture (socially constructed).
I may comment that the ethnic people may benefit the most from...
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In response to this most important article outlining the Concepts of depression within our ethnic Communities is very interesting, though very true.
To visualize Depression under the two sub headings:
• independent of time, place and culture
• dependent of time, place and culture (socially constructed).
I may comment that the ethnic people may benefit the most from public education forums, where they are invited to comment on their experiences of sadness, worry or stress that may impact on them greatly to not function well in the Community.
Even the dialogue formation with the practitioner can also be of great value: this is greatly seen as therapeutical, more so than rehabilitational programs can offer. The actual talking with someone is most theraupuetical in overcoming sadness, worry or stress.
Conversation is usually led by the patient and lets them affirm their lives: where they wish to go and how they will attain it. One just becomes a facilitator to the process. It is a way that ethnic people respond to the "suffering" induced over the sadness, the worry or the stress.
Depression as an illness is unheard of in many ethnic cultures of today, and if it is mentioned it is not taken as serious enough to assist the person to overcome it. Simplify the condition by simplier terms such as 'sad', 'worry', or 'stress', then it becomes easier to work with, manage, or overcome. It is an illness not placed on the individual, but rather something which had been triggered from a source outside of the individual; for example: the Community, the family, work, or the outer environment of the individual; a problem associated with something a person engaged in.
Ethnic people in general do have very diverse views on Depression but the Practitioner needs to work very carefully with these diverse views and be selective with the proper treatment that he/she will administer. Sometimes medication is given in the instance where communication is limited; and this is true for most newly arrived ethnic people - they do not know the language that well.
But I do see that the best form of treatment is the dialogue: the process of the dialogue exchange and negotiation, the laughter generated, the happiness in giving someone an opportunity to voice themselves and arrive at a solution to their sad state, their worriness, or their state of bewildeness. Talking things out does affirm their self belief in therapy as well.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (20 May 2010)
Page navigation anchor for Cross-cultural care of patients with depression - additional perspectives and resources
Cross-cultural care of patients with depression - additional perspectives and resources
Robert C. Like, New Brunswick, New Jersey USA
The article by Furler and his colleagues is an important contribution to the literature about the cross-cultural management of depression by family physicians working with diverse ethnic minority communities in different countries. Fortunately, we are seeing a growing recognition of the need to address the role of culture in psychiatric diagnosis and treatment, and the implications for the development of DSM-V and its use...
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The article by Furler and his colleagues is an important contribution to the literature about the cross-cultural management of depression by family physicians working with diverse ethnic minority communities in different countries. Fortunately, we are seeing a growing recognition of the need to address the role of culture in psychiatric diagnosis and treatment, and the implications for the development of DSM-V and its use globally,(1) as well as the importance of integrating socio-cultural perspectives in the education and training of primary care physicians, psychiatrists, and other health and mental health professionals.(2)
Readers of the Annals of Family Medicine should find the following new online continuing education resources to be of particular interest:
a) Initiative for Decreasing Disparities in Depression http://www.i-3d.org
b) Improving Outcomes for Adult Depression in Ethnically and Racially Diverse Patients (authors: Annelle B. Primm, MD, MPH; Richard A. Levy, PhD; Debra Cohen, MBA; Alison Bondurant, MA, Medscape and UMDNJ Center for Continuing Outreach and Education http://cme.medscape.com/viewarticle/702891 (registration is free)
c) Initiative for Decreasing Disparities in Depression CME: Provider Self-Assessment CME Model Incorporating Cultural and Linguistic Competence in the Diagnosis and Treatment of Depression http://nccc.georgetown.edu/projects/cme.html
Hron (3) has recently powerfully discussed the relevance of employing literary/narrative analysis in understanding the variety of ways in which physical and psychological pain and suffering are expressed in multicultural communities in relation to immigrant psychology, historical, ethnographic, and socio-political studies.
In this regard, we also need to move away from solely employing “deficit models” in understanding illness and disease, and examine the “assets, strengths, and resilience” that many refugees bring during the migration process to their new host countries. The evocative documentary – If We Knew Their Stories – produced as part of the “Medicine Box Project” by Free Country Media is well worth viewing. http://www.youtube.com/watch?v=woM0s0HmCd0 http://www.minnesotamovie.com/ifweknew.html
Hopefully, multi-method research will continue to be carried out that studies the provision, effectiveness, quality, and outcomes of culturally responsive and effective care to patients with depression around the world.
References:

Alarcón RD, Becker AE, Lewis-Fernández R, Like, RC, Desai P, Foulks E, Gonzales J, Hansen H, Kopelowicz A, Lu F, Oquendo MA, Primm A, for the Cultural Psychiatry Committee of the Group for the Advancement of Psychiatry. Issues for DSM-V: The Role of Culture in Psychiatric Diagnosis. The Journal of Nervous and Mental Disease 2009; 197(8):559-660.

Overstreet KM, Moore DE, Kristofco RE, Like RC. Addressing Disparities in Diagnosing and Treating Depression: A Promising Role for Continuing Medical Education. The Journal of Continuing Education in the Health Professions. 2007 Supplement 1, Fall 2007; S5-S8.

Hron M. Translating Pain: Immigrant Suffering in Literature and Culture. Toronto: University of Toronto Press, 2009.

Competing interests: Dr. Like received fees for serving as consulting medical education director for program a, content reviewer for program b, and a grant reviewer for program c.
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Competing Interests: None declared.