Culturally-sensitive complaints of depressions and anxieties in women

University of Santiago, Chile, CiudadSantiago, Santiago Metropolitan, Chile
Journal of Affective Disorders (Impact Factor: 3.38). 10/2007; 102(1-3):159-76. DOI: 10.1016/j.jad.2006.09.033
Source: PubMed


Current classifications of Mental Disorders are centered on Westernized concepts and constructs. "Cross-cultural sensitivity" emphasizes culturally-appropriate translations of symptoms and questions, assuming that concepts and constructs are applicable.
Groups and individual psychiatrists from various cultures from Asia, Latin America, North Africa and Eastern Europe prepared descriptions of main symptoms and complaints of treatment-seeking women in their cultures, which are interpreted by clinicians as a manifestation of a clinically-relevant dysphoric disorder. They also transliterated the expressions of DSM IV criteria of main dysphoric disorders in their cultures.
In many non-western cultures the symptoms and constructs that are interpreted and treated as dysphoric disorders are mostly somatic and are different from the Western-centered DSM or ICD systems. In many cases the DSM and ICD criteria of depression and anxieties are not even acknowledged by patients.
The descriptive approach reported here is a preliminary step which involved local but Westernized clinicians-investigators following a biomedical thinking. It should be followed by a more systematic-comprehensive surveys in each culture.
Westernized concepts and constructs of mental order and disorders are not necessarily universally applicable. Culturally-sensitive phenomena, treatments and treatment responses may be diversified. Attempts at their cross-cultural harmonization should take into consideration complex interactional multi-dimensional processes.

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    • "Therefore, in these societies, indirect expressions of distress through bodily sensations and other somatic symptoms can be appropriate means of communicating psychological problems (e.g., Kleinman & Kleinman, 1985). Accordingly, somatic symptoms of depression have been frequently reported in some Asian (Ryder et al., 2008), African (Binitie, 1981), Latin American, and Indian populations (Halbreich et al., 2007). Although studies on depression among Somalis are lacking, there is some evidence that Somali refugees commonly express psychological distress through somatic complaints (Bhui et al., 2003; Silveira & Ebrahim, 1995). "
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    ABSTRACT: In this study, we analyzed the manifestation of somatic-affective and cognitive depressive symptoms among older Somali refugees and native Finns. Second, we explored how depressive symptoms, alexithymia, and somatization are associated in the two groups. Finally, we analyzed how two psychosocial factors, sense of coherence (SOC) and social support, are connected to depressive symptoms among Somalis and Finns. The participants were examined with the Beck Depression Inventory (BDI) for depressive symptoms, the Symptom Checklist-90-Revised (SCL-90-R) for somatization, Toronto Alexithymia Scale (TAS-20) for alexithymia, and the Sense of Coherence (SOC-13) concept for SOC. Social support was indicated by help received from social networks and marital status. Results showed that Somalis manifested more somatic-affective symptoms of depression than Finns, whereas Finns manifested more cognitive symptoms than Somalis. The association between depressive symptoms and alexithymia was stronger in the Finnish group, whereas the association between depressive symptoms and somatization was stronger in the Somali group. The association between alexithymia and somatization did not differ between the groups. A weak SOC explained depressive symptoms among Somalis and Finns, but poor social support did not explain depression in either group. The results are discussed in relation to Somali and Finnish cultures, mental health beliefs, and immigrant populations.
    Journal of Cross-Cultural Psychology 08/2014; 45(9). DOI:10.1177/0022022114543519 · 1.42 Impact Factor
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    • "Even despite this issue the recent literature on rs-fMRI in MDD displays a noticeable tendency toward particular Asian as well as North American or European populations. As prevalence and clinical symptomatology differ significantly between cultural contexts (Kirmayer, 2001; Halbreich et al., 2007; Juhasz et al., 2012; Yeung and Chang, 2014) results reported in this meta-analysis may not necessarily be applicable to other populations. "
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    ABSTRACT: Information derived from functional magnetic resonance imaging (fMRI) during wakeful rest has been introduced as a candidate diagnostic biomarker in unipolar major depressive disorder (MDD). Multiple reports of resting state fMRI in MDD describe group effects. Such prior knowledge can be adopted to pre-select potentially discriminating features for diagnostic classification models with the aim to improve diagnostic accuracy. Purpose of this analysis was to consolidate spatial information about alterations of spontaneous brain activity in MDD, primarily to serve as feature selection for multivariate pattern analysis techniques (MVPA). 32 studies were included in final analyses. Coordinates extracted from the original reports were assigned to two categories based on directionality of findings. Meta-analyses were calculated using the non-additive activation likelihood estimation approach with coordinates organized by subject group to account for non-independent samples. Converging evidence revealed a distributed pattern of brain regions with increased or decreased spontaneous activity in MDD. The most distinct finding was hyperactivity/hyperconnectivity presumably reflecting the interaction of cortical midline structures (posterior default mode network components including the precuneus and neighboring posterior cingulate cortices associated with self-referential processing and the subgenual anterior cingulate and neighboring medial frontal cortices) with lateral prefrontal areas related to externally-directed cognition. Other areas of hyperactivity/hyperconnectivity include the left lateral parietal cortex, right hippocampus and right cerebellum whereas hypoactivity/hypoconnectivity was observed mainly in the left temporal cortex, the insula, precuneus, superior frontal gyrus, lentiform nucleus and thalamus. Results are made available in two different data formats to be used as spatial hypotheses in future studies, particularly for diagnostic classification by MVPA.
    Frontiers in Human Neuroscience 08/2014; DOI:10.3389/fnhum.2014.00692 · 3.63 Impact Factor
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    • "dos somáticos (Marsella, 1985). Halbreich et al. (2007) citam que, em culturas não ocidentais, os sintomas que são tratados como distúrbios disfóricos são, sobretudo, somáticos, diferentemente do sistema ocidental centrado nos manuais diagnósticos. Em muitos casos, os critérios destes manuais não são sequer reconhecidos pelos pacientes. Pereira et al. (2007), estudando mulheres de Goa, na Índia, diagnosticadas como deprimidas, identificaram que elas expressam seus problemas de saúde mental especialmente através de uma série de queixas somáticas; localizam a sua angústia na vida através das desvantagens sociais que experimentam em seu dia a dia, e só procuram ajuda médica para queixas somáti"
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    ABSTRACT: O objetivo deste estudo de caráter etnográfico foi analisar o significado da busca de tratamento por mulheres com transtorno depressivo atendidas em um Núcleo de Atenção Psicossocial do município de Santos, São Paulo, Brasil. Foram identificados, neste contexto: o tratamento da depressão no serviço (do encaminhamento ao atendimento), as noções de doença elaboradas pelas mulheres e o consumo de medicamentos. Ficaram evidentes: a banalização da depressão, a importância do psiquiatra e do uso de antidepressivos e ansiolíticos no tratamento. Os padrões encontrados de consumo dos medicamentos pelas mulheres sugerem a ocorrência de uma "toxicomania medicamentosa". O uso de medicamentos, além da ação farmacológica, possui uma ação simbólica, no sentido de conforto e cuidado. O trabalho aponta para a necessidade de se articularem o significado das experiências das mulheres e as abordagens terapêuticas da depressão na construção das políticas públicas de saúde mental.
    Interface - Comunicação Saúde Educação 12/2012; 16(43):885-899. DOI:10.1590/S1414-32832012000400003
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