Week4 - Psych&129C& Week&4&...

Info icon This preview shows page 1. Sign up to view the full content.

This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: Psych&129C& Week&4& Spring&2015& Cultural&Concepts&of&Distress&& Depression&& DSM&Cultural&Concepts&of&Distress& Ways&that&people&understand&and&experience&their&illness&as&well&as& communicate&their&symptoms& •  Cultural'Syndromes:'clusters&of&symptoms&that&tend&to&coCoccur&in& a&specific&cultural&group&and&are&recognized&as&a&coherent&paFern& of&experience& •  Cultural'Idioms'of'Distress:&ways&of&expressing&distress&that&may& not&involve&specific&symptoms&or&syndromes&but&provide&a& collecJve,&shared&ways&of&experiencing&or&talking&about&personal& concerns&“I’m&depressed”&“I’m&stressed&out”&“I’m&having&trouble& with&my&nerves”& •  Cultural'Explana8ons:&indicate&culturally&recognized&meaning&or& eJology&for&symptoms,&illness&or&distress& CULTURE&BOUND&SYNDROMES&HAVE&BEEN&REPLACED& Cultural&Concepts&of&Distress:& Syndromes& •  Khyal'or'“wind'a=acks”'–Symptoms&include&panic&aFacks,& anxiety,&Jnnitus,&neck&soreness,&catastrophic&cogniJons&that& khyal&may&rise&in&the&body,&along&with&blood&and&cause&serious& effects&(compress&lungs&to&cause&shortness&of&breath,&enter& cranium&to&cause&Jnnitus,&dizziness,&blurry&vision).&&Thought&to& be&triggered&by&worrisome&thoughts,&standing&up&too&quickly,& odors,&agoraphobic&cues.&&& –  Cultural&Syndrome&among&Cambodians& their version of stress or impairment Idioms&of&distress& •  NerviosC'general&state&of&vulnerability&to&stressful&life& experience&and&to&difficulty&life&circumstances.&&Includes&a& range&of&symptoms&of&distress&like&headaches,&neck&pain,& irritability,&stomach&problems,&sleep&problems,&nervousness,& trembling,&dizziness&etc.& –  Idiom&of&distress&among&LaJn&Americans& Text Cultural&ExplanaJon& •  Kufungisisa—thinking&too&much&among&the&Shona&of& Zimbabwe.&&Causes&anxiety,&depression&and&somaJc& problems.&&Usually&individual&interpersonal&and&social& problems.&&& –  Brain&fag&in&Nigeria&(studying&too&much)& •  Maladi'moun'(“sent&sickness”)CHaiJ.&&Interpersonal&envy&and& malice&cause&people&to&harm&their&enemies&by&sending& illnesses&such&as&psychosis&and&depression.&&People&who&are& aFracJve,&intelligent&or&wealthy&are&perceived&as&very& vulnerable.& Key&features&of&concepts&of&distress&& •  They&do&not&have&a&1:1&correspondence&with&a& DSM&disorder& –  But&ofen&share&features&in&common&with&many& disorders& –  E.g.&nervios& •  There&is&a&wide&range&of&severity;&some&that& would&not&be&considered&“clinical”&& •  Cultural&concepts&change&over&Jme&& moderate to severe impairment DEPRESSION' Depression&criteria& ethnic minority groups have more somatic issues •  •  •  •  •  •  •  •  •  Depressed&mood&most&of&the&day,&nearly&every&day,&as&indicated&by&either& subjecJve&report&(e.g.,&feeling&sad&or&empty)&or&observaJon&made&by&others&(e.g.,& appears&tearful).&(In&children&and&adolescents,&this&may&be&characterized&as&an& irritable&mood.)& Markedly&diminished&interest&or&pleasure&in&all,&or&almost&all,&acJviJes&most&of&the& day,&nearly&every&day& Significant&weight&loss&when&not&dieJng&or&weight&gain&(e.g.,&a&change&of&more& than&5%&of&body&weight&in&a&month),&or&decrease&or&increase&in&appeJte&nearly& every&day.& Insomnia&(inability&to&sleep)&or&hypersomnia&(sleeping&too&much)&nearly&every&day& Psychomotor&agitaJon&or&retardaJon&nearly&every&day& FaJgue&or&loss&of&energy&nearly&every&day& Feelings&of&worthlessness&or&excessive&or&inappropriate&guilt&nearly&every&day& Diminished&ability&to&think&or&concentrate,&or&indecisiveness,&nearly&every&day& Recurrent&thoughts&of&death&(not&just&fear&of&dying),&recurrent&suicidal&ideaJon& without&a&specific&plan,&or&a&suicide&aFempt&or&a&specific&plan&for&commikng& suicide& Depression&across&US&ethnic&groups& •  Mostly&similar&among&African&American&and& White/Euro&Americans&when&demographic,& sociocultural&and&ses&factors&are&controlled& –  Some&data&to&support&lower&levels&in&AA& •  Asian&Americans&have&lower&prevalence&rates& than&White/Euro&Americans&& •  Hispanics&tend&to&have&higher&rates&of& depressive&symptoms&than&majority,& parJcularly&Puerto&Ricans&& higher rates of depression among minorities than caucasians when SES, race, and other factors are not controlled for ExplanaJons&for&variance& ExplanaJons&for&variance&& —> Depression Differential Risk factors •  Recent&migraJon& recent migration for some groups (not necessarily MexicanAmerican immigrants –  TraumaJc&experiences& –  SeparaJon&form&parents&and&friends& –  DifficulJes&adjusJng&to&a&new&environment&& - Loss of culture —> Native Americans - Acculturative stress - Discrimination treatment is used to help tribal groups increase their resiliency and uphold their culture ProtecJve&factors& •  Social&support&and&family&support&can&be& protecJve&& •  Immigrant&status&as&protecJve& for some –  In&depression,&the&Immigrant&paradox&applies&to& Cubans&and&Mexican&immigrants& However, there are other factors, not risk or protective… reporting differences: - stigma (public and private) - health literacy can be important in finding appropriate healthcare - cultural explanatory models —> how do they perceive causes (biological or transient interpersonal issues)? some cultures say it’s a part of life, get over it do they have sources of information, is there access to research their issues There&is&underdetecJon& –  Primary&care&physicians&more&likely&to&detect& anxiety&and&depression&in&White/Euro&Americans& than&LaJnos&and&African&Americans&& •  This&happens&in&other&countries&as&well& •  WHY?& Why&differenJal&detecJon?& •  Differing&explanatory&models&(biological,& interpersonal,&moral,&social&problem&etc)&& •  Language&& •  PaJent&provider&communicaJon& –  An&intercultural&encounter&& •  HelpCseeking& •  NonCtradiJonal&healers&(spiritual&or&community& leader)&& •  Social&sJgma& •  SomaJc&symptoms& SomaJc&symptoms&& •  In&the&presence&of&somaJc&symptoms,& depression&less&likely&to&be&diagnosed& –  Some&cultures&may&focus&on&somaJc&symptoms& when&they&are&distressed&rather&than&mood& features&or&cogniJve&features& In order to increase cultural competency of health care providers, they need to be informed of patients’ perception of their illness. Some patients may view focus on the physiological issues of depression as opposed to mental illness Ethnic&differences&in&somaJc& symptoms?& •  Research&supports&some&differences& –  Chinese&people&have&lower&rates&of&depression;& deny&depression&or&express&it&somaJcally& –  In&Korea&also&lower&rates& •  Same&somaJc&emphasis&when&describing& depression&in&Arab&and& SomaJc&Symptoms&cont.& •  LaJnos&& –  Greater&endorsement&of&somaJc&symptoms& –  more&likely&to&report&pain&symptoms&together& with&their&depression&& –  Consider&case&of&nervios& Speaking of one’s worries as physical complaints Psychological symptoms may take on more somatic issues in Latino groups Nervios;&cultural&idiom&that&includes& somaJc&presentaJon&& •  A&generalized&state&of&distress,&found&in&numerous&cultures& •  Both&physical&and&emoJonal&distress&that&emerges&from&conflicts&in& life&(family,&parenJng,&marriage);&ofen&in&context&of&social& disadvantage& •  Can&represent&an&acceptable&mode&of&distress& •  Symptoms&include&headaches,&backaches,&trembling,&lack&of& appeJte&and&sleep,&faJgue,&physical&agitaJon,&menstrual& irregularity,&vomiJng&during&enJre&pregnancy,&lump&in&the&throat,& difficulty&breathing,&chest&pain,&stomach&ache,&nausea,&diarrhea,& flatulence,&dizziness,&blurred&vision,&fevers&and&sweaJng&among& others&&& •  Psychological&symptoms&include&irritability,&anger,&sadness,& obsessive&ideaJon,&overwhelming&concerns,&lack&of&concentraJon,& confusion,&crying&spells,&fears,&anxiety&and&erraJc&behavior&& •  Usually&have&higher&scores&on&measures&of&anxiety&and&depression& Usually emerges because of parenting issues, divorce, family issues, low income, etc. •  SomaJc&symptoms&linked&to&greater&depressive& severity&and&poorer&quality&of&life&& – But&not&all&studies&support&this& Neurasthenia “weakness of the nerves” related to stress - symptoms of fatigue, anxiety, headache, heart palpitations, high blood pressure, sad mood, neuralgia (nerve pain) - in the DSM until 1980 - still used in some parts of the world, like China or Japan Why&somaJcize?& •  SJgma& •  Findings&from&Asian&and&East&Indian&samples& –  Disorders&like&anxiety&and&depression&are&treated& as&most&socially&disrupJve&but&somatoform& disorders&are&least&social&disrupJve&& –  PaJents&diagnosed&with&“only&somatoform& disorders”&compared&to&“depression&only”&had& lower&sJgma&scores&& Why&somaJcize?& •  Not&the&same&disJncJon&in&“mind”&and&“body”& across&cultures& –  & In&Korean&medicine&vital&organs&are&associated&with&feelings&(lungs& are&related&to&worry,&liver&to&anger,&kidneys&to&fear)& –  Chinese&medicineCDisharmony&of&vital&organs&and&imbalance&of&qi& –  Indian&medicine&(Ayurvedic&system)& •  Relates&to&changes&in&selfCaFenJon&with& increased&acculturaJon& –  Focus&switches&from&somaJc&to&affecJve&& Indian medicine (Ayurvedic system) —> unique pattern of living force and energy that controls various activities of the body-disease emerges when these are not in balance. —> vata (related to breathing ,heartrate, bowel/bladder function) - anxiety, aching confusion; pitta (digestion and hormones) - anger; agigation, inflammation, ulcers; kapha (strength and immunity) - lethargic, sinus congestion, upper respiratory problems Kirmayer&et&al.,&2001& styles'of'clinical'presenta8on'' Who&is&least&likely&to&get&services?& facultaJve& somaJzer& 26%& IniJal&somaJzer& 34%& persisten& somaJzer& 25%& psychologizer& 15%& N&=700&Canadian&paJents& IniJal&somaJc&complaintCwhat&caused&and&half&say&psychological&reason& FacultaJve&–when&prompted&again,&“do&you&think&it&could&be&stress,&worries&etc.& SoluJons&to&mismanaging&somaJc& symptoms?&& emphasize patient-physician confidentiality and communication improve evaluation of patient LimitaJons&of&research& –  Methodological&issues& •  Self&report& •  InstrumentaJon&–&psychometric&properJes& internal/external validity •  Need&more&mixed&methods&research& & Most data is taken from self-report, diagnostic interviews The external validity of the studies has not been experienced because most research data is based on minority groups, not across European-Americans Depression&Measurement& •  Construct&validity?& •  Are&the&same&words&being&used&to&describe& depression& –  Structured&interview&say&“depressed,&sad,&down&in& dumps,&blue”& •  In&study&with&NaJve&Americans,&they&preferred&phrased& such&as&lonely,&empty,&and&feeling&like&crying&& •  Reliability&& •  Is&factor&structure&equivalent&across&groups& Mixed&Methods&Research& qualitative studies = conduct interviews to fully understand what a person is thinking and how they may interpret something… goes beyond structured interview —> how you feel, what do you think, etc? •  QualitaJve&studies&combined&with& quanJtaJve&studies&& •  Provides&inCdepth,&contextualized,&and&natural& but&more&JmeCconsuming&insights&of& qualitaJve&research&coupled&with&the&moreC efficient&but&less&rich&or&compelling&predicJve& power&of&quanJtaJve&research.& ...
View Full Document

  • Winter '16
  • Minority group, –, •  NerviosC'general&state&of&vulnerability&to&stressful&life, •  Kufungisisa—thinking&too&much&among&the&Shona&of, •  Cultural&concepts&change&over&Jme, •  Mostly&similar&among&African&American&and

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern