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Lesson Module - 9 - Mental Health - Part 1 (1)

Mental Health

Universal Mental Health Syndromes

  • Psychological disorders are found across all cultures but their manifestation and prevalence vary.

  • This variation suggests that disorders are not solely due to innate biological causes.

Major Depressive Disorder (MDD)

  • Characterized by prolonged depressed mood.

  • DSM-V Criteria:

    • A change in mood from baseline impacts social, occupational, and educational functioning for two or more weeks.

    • Diagnosis requires at least five of the following nine symptoms:

      • Depressed mood

      • Inability to feel pleasure

      • Change in weight or appetite

      • Sleep problems

      • Psychomotor change

      • Fatigue or loss of energy

      • Feelings of worthlessness or guilt

      • Poor concentration or indecisiveness

      • Suicidality

Cultural Variation in Prevalence of MDD

  • MDD occurs globally, though prevalence rates differ:

    • United States: Lifetime prevalence is between 4.9% - 17.9%.

    • China: Lifetime prevalence is about 1/5 of US rates.

    • Nigeria: Lifetime prevalence about 4 times that of the US.

Cultural Variation in Manifestation of MDD

Neurasthenia

  • Described as “exhaustion of the nervous system,” with symptoms like:

    • Exhaustion

    • Poor appetite

    • Headaches

    • Insomnia

  • Initially considered common in 19th-century America but fell out of favor.

Arthur Kleinmann Study

  • Assessed psychiatric patients in Hunan, China:

    • 87% diagnosed with clinical depression.

    • Primary complaints were physical:

      • Headaches: 90%

      • Insomnia: 78%

      • Dizziness: 73%

      • Physical pains: 49%

      • Only 9% reported depressed mood as a key issue.

Cultural Shaping of Depression (Ryder et al. 2008)

  • Different presentations of depression symptoms:

    • Chinese patients often report physical symptoms (e.g., insomnia, energy loss).

    • Euro-Canadian patients report more psychological symptoms (e.g., worthlessness, depressed mood).

Explaining Cultural Differences in Depression

Social Stigma

  • Greater stigma in Chinese culture around admitting psychological issues may lead to underreporting.

Salience of Symptoms

  • Cultural focus may lead individuals to emphasize certain symptoms over others.

Bipolar Disorder

  • Characterized by emotional swings between depression and mania (hyperactivity, euphoria).

  • Cultural variation in prevalence, highest in the US and New Zealand.

Social Anxiety Disorder (SAD)

Symptoms

  • Fear specific to social situations.

  • Fear of being scrutinized and experiencing social rejection.

  • Symptoms include:

    • Distress in social interactions

    • Avoidance of interactions

    • Disproportionate fear/anxiety to actual situation.

Cultural Variation in Prevalence of SAD

  • SAD is about 0.5% in East Asia vs. about 7% in North America.

  • East Asians may exhibit more symptoms but are less frequently diagnosed.

Cultural Perspectives on Shyness and Social Anxiety

  • East Asian cultures may view shyness positively, while Western cultures view it negatively.

  • East Asians in Western contexts may report higher SAD symptoms.

Taijin Kyoufushu (TKS)

  • Comparable to SAD, but focuses on fear of physical symptoms (e.g., blushing).

  • Includes concern that these symptoms might offend others.

Schizophrenia

Symptoms

  • Characterized by disorganized thinking, perceptions, and emotions. Diagnostic criteria includes:

    • Delusions

    • Hallucinations

    • Disorganized speech

    • Disorganized behavior

    • Negative symptoms.

Universality of Schizophrenia

  • Worldwide prevalence: about 1%.

  • Genetic factors play a major role:

    • 2% likelihood if related to a cousin,

    • 9% if sibling,

    • 48% if identical twin.

  • Environmental factors can also influence onset.

Cultural Variability of Schizophrenia

  • Some cultures have different types of schizophrenia prevalence:

    • Paranoid schizophrenia more common in the UK (70%) than in India (15%).

    • Catatonic schizophrenia prevalence varies, with higher rates in India.

Suicide Statistics and Cultural Variations

  • Higher rates observed in cultures such as Sri Lanka and Guyana.

  • Notable lower rates in countries like Nepal and Haiti.

  • Men generally exhibit higher rates than women.

Case Study: Micronesia

  • Shifts in suicide rates over the years, particularly among young men.

  • Most common method is hanging.

  • Trends suggest social factors, such as intergenerational conflict, play a significant role in suicides.

Case Study: First Nations in Canada

Findings

  • Higher suicide rates for First Nations youth compared to non-natives.

  • Cultural persistence correlated with lower suicide rates in communities.

Cultural Variation in Suicide – Japan

  • Cultural acceptance of ritual suicide (seppuku) as a means to maintain honor.

  • Reflects how cultural understandings of suicide can influence rates and responses.