Psych Test #3

life expectancy cultural differences

Average number of years a person is expected to live from birth

• Differences in wealth and resources in a country affects its life expectancy rate

• Disparities can vary widely within one country

• Ethnic majority individuals tend to have longer life expectancies than ethnic minority individuals

infant mortality cultural differences

Number of infant deaths per 1,000 live births

• Infant mortality rates in the United States are among the highest in comparison to other industrialized countries

  • Disparities exist among ethnic groups

• Differences can be attributed to resources that ensure access to good nutrition, health care, and treatment

obesity rates cultural differences

Obesity is a public health concern across many countries

• Differences across cultures in food choice, behaviors, and lifestyles contribute to differences in overweight and obesity rates

  • Overweight - Body-mass index (BMI) at or above 25

  • Obesity - BMI at or above 30

• United States has the highest rate of obesity compared to other economically similar countries

• Causes - Diet (consumption of fast food and soft drinks) and lack of exercise

subjective well being (SWB) cultural differences

A person’s perception and self-judgement of their health and wellbeing

• Positively related to physical health

  • People reporting higher SWB have stronger immune systems, fewer heart attacks, and less artery blockage

  • Tend to engage in healthier lifestyles

• Higher SWB is predicted by material wealth, one’s sense of autonomy, and connection to others

environmental effects on health

• social support may buffer against life stress

  • Closer to the equator = hotter climates = collectivistic =foster spread of organisms responsible for infectious and parasitic diseases

• Sanitation systems, water supplies, waste water management systems, hygiene

• Quality and availability of medical and health-care services, delivery systems, and presence and type of health insurance

cultural effects on health

• Individualism vs. collectivism

  • collectivists may be less likely to get care if it’s focused on individual care instead of community care

individual-level influences on health and disease

• View of health in western countries’ is influenced by the:

  • Biomedical model: : Views disease as resulting from a specific, identifiable cause, a genetic or developmental abnormality, or physical insult

  • Biopsychosocial model: Views disease as resulting from biological, social, and psychological factors

• The concept of balance and imbalance is prevalent across certain cultures

  • Homeostasis: Maintaining steady and stable body functioning during environmental changes

Culture and Suicide

• Risks for suicide are complex and culture plays an important role in it

  • Japanese pilots deliberately crashed their planes into enemy targets during World War II to preserve the honor of their country

• Relation between suicide and religion depends on the particular aspect of religion

  • Person’s perception about them being religious plays a role

• Power distance, uncertainty avoidance, and masculinity negatively correlate with suicide

  • Individualism positively correlates with suicide

Health disparities

Differences in health outcomes by groups such as between males and females, African Americans and European Americans, and people of lower and higher socioeconomic status

• genetic predispositions

• perceived racism and discrimination

immigrant paradox

Immigrants doing better on many health measures despite the hardships

• Researchers attribute this to healthy behaviors, social support, and immigrant selectivity

what is “normal”?

• Defined by:

  • Using a statistical approach

  • Applying criteria of impairment or inefficiency, deviance, or subjective distress

• Alternative approach — Applying cultural relativism to abnormality

cultural relativism

view that culture and psychopathology are intertwined

• Disorders can be understood only in the cultural framework within which they occur

bias

a natural inclincation for or against an idea, object, group, or individual

equivalence

the concept of ensuring that psychological measures, tests, and research findings are comparable across different cultures

overpathologizing

considering behavior as pathological, when behavior is a normal variation for that individual’s culture

underpathologizing

indiscriminately seeing behavior as cultural, when behavior actually reflects abnormal psychological response

schizophrenia

• International Pilot Study of Schizophrenia

  • Universal symptoms - Lack of insight, hallucinations, and ideas of reference

  • Course of illness was more positive for patients in developing countries than developed countries

  • Symptom manifestation varies between countries

• Expressed-emotion construct

  • family and social interactions influence the course of schizophrenia

depression

Characterized by physical, motivational, emotional, and behavioral changes

• women more likely to experience than men

• Cross-cultural symptoms

  • sadness and joylessness

  • anxiety, tension, and lack of energy

  • symptom differ across cultures due to variations in stress sources and coping mechanisms

anxiety disorders

• Cultural differences in what elicits anxiety, how and how much to express, and what to do about it when expressed

• Generalized anxiety disorder, panic disorder, and various phobias

• Prevalence rates of anxiety disorders vary depending on the type of disorder and culture

ADHD

• Features - Inattentiveness, impulsivity, and hyperactivity

• Boys are more likely to be diagnosed with ADHD than girls

  • cause and treatment of ADHD differ across countries

• Neurological disorder that is found in all cultures

  • Unrecognized, underdiagnosed, and subsequently, left untreated in many countries

mental health of ethnic minorities, migrants, and refugees

African Americans: Historical context of slavery and exclusion from the social, economic, and educational fronts have influenced their mental health

Latino Americans: variations in rates of mental illness among different Latino groups

• factors that influence mental health:

  • Reception and history of immigration, varying SES and experiences with discrimination

Asian Americans: Model minority stereotype masks the fact that Asian Americans could be at risk for poor mental health

Native Americans: Higher prevalence of depression, other mood and anxiety disorders, and rates of alcohol use and suicide

Immigrants: Immigrants adapting to a new cultural environment are faced with acculturation issues

• May cause depression, anxiety, and psychosomatic problems

Refugees: Show higher rates of posttraumatic stress disorder (PTSD), depression, and anxiety

psychotherapy

method of healing that emphasizes an explicit focus on the self

• traditional psychotherapy

  • Sigmund Freud - Father of psychoanalysis

  • Developed the psychoanalytic model

  • Carl Rogers - Developed the client-centered approach

  • Emphasized the client's self-propelled growth

cultural assumptions of psychotherapy

Psychotherapy is less effective for people of non-European descent

• Expressions of abnormality vary based on cultures

• Cultures differ on notions of self

• Ability of the therapist to assess is related to their knowledge, understanding, and appreciation of cultural context

• Goal of psychotherapy - To help people become more functional within their society

  • Functionality is culturally determined

Disparities in receiving treatment

• Not all people are equally likely to receive treatment

  • Those in lower income countries are less likely to receive treatment than those in countries with more economic resources

  • Disparities for receiving treatment exist within one country

• Mental health utilization and length of treatment differ by racial or ethnic group

barriers to seeking treatment

• language barriers

  • Study reviewing mental health services in 16 European countries showed that difficulty with mainstream language was the most important barrier to seeking mental health services

  • United States - strong evidence that those with limited English proficiency are less likely to use mental health services

  • Language assistance measures may help but did not have a lasting effect

• stigma and mistrust

  • Greater stigma attached to seeking mental health services:

  • Asian Americans – feelings of shame and loss of face

  • Mexican Americans – shame, weakness of character, and disgrace

  • Arab Americans – could damage marriageability for women

• beliefs about health and illness

  • Cultural groups may hold beliefs about health and illness that lead to less reliance on formal treatment:

  • “Tough out”, depend on own willpower, “hardy” personality

  • Native Americans – cultural beliefs that sickness comes from disharmony with one’s community, nature, and spiritual world

  • Religion – may be more inclined to seek help from religious and folk healers

• social validity

  • perception of the social importance and acceptability of an intervention by a specific cultural group

  • In addition to stigma, some communities may be mistrustful of mental health professionals

  • Mistrust among African Americans may stem from history of segregation, racism, and discrimination

  • Tuskegee experiment

• social structures and policies

  • Lack of availability of mental health services (esp. in rural areas)

  • Health insurance coverage (financial barriers and ethnic minorities more likely to be uninsured)

  • culturally competent services

cultural challenges around conceptualization and communication

Challenges faced when the clinician and patient differ with respect to cultural backgrounds

• Different ways of thinking and expressing thoughts about illness

• Language difficulties

• Variations in communication patterns of ethnic groups

• Cultural variations in the importance of hierarchy in interpersonal relationships

• Differences in treatment expectations

• Recognition and involvement of members of the extended family

expectations about roles, treatment modalities, and outcomes

Different cultures may have different expectations about different aspects of treatment:

• Therapists are authority figures

• Directive and strategic interventions vs. client-centered or reflective therapy

• Active, direct, pragmatic approaches vs. inactive or indirect approaches that include “talk” therapy

• Goal: improve productive life roles vs. gain better insight about oneself in order to feel better

face

refers to claims about one’s social character, integrity, reputation, public appearance, or social image

• concerned with “loss of face’

• Self-disclosure, sharing private thoughts and feelings with a stranger

the role of extended families in mental health treatment

Recognizing and involving family members may be useful and present a more familiar approach to problem-solving

culturally-informed services

Involves understanding and respecting the histories, traditions, and value systems of the various cultural groups

• Acculturation status and ethnic identity are determinants of client responses to treatment

Matching: Attempt to provide more effective services by examining the cultural, ethnic, or racial match between therapists and clients

• Ethnic matching did not predict better overall functioning, dropout rate, or number of treatment sessions

Indigenous healing: Therapeutic beliefs and practices rooted within a given culture

• Commonalities: reliance on family and communicty, incorporation of traditional, spiritual, and religious beliefs, use of shamans in treatment

Traditional medicine: Treatments that have a long history within a culture and that are indigenous to that culture

Complementary medicine: Treatments that do not originate within that culture