Key idea: Prevalence differs between countries for two kinds of reason: real differences in people's lives, and differences in how cases are counted.
Imagine two countries using the same depression questionnaire. If people in one country describe distress as tiredness and pain rather than sadness, fewer of them tick the boxes, even when they suffer as much.
Why rates differ between cultures: World Mental Health surveys find more lifetime depression in high-income countries (about 15%) than in low- and middle-income ones (about 11%). Part of the gap is real (stress, isolation), part is how distress is described: in some cultures it is reported through the body, not as sadness.
Real differences
- Poverty and stress
- Loss, conflict and violence
- Family ties and support
Counting differences
- How distress is described
- Stigma: people hide symptoms
- Questionnaires built in one culture
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Key idea: Approaches to mental health differ between cultures: who helps, in what words, and whether the family takes part.
In many places help comes first from family, religious leaders or traditional healers, not from a psychiatrist. A treatment that ignores this may never be used, however well it works in trials.
Culture in treatment: Griner and Smith (2006) combined 76 studies: therapy adapted to a client's culture (language, values, family role) worked better, especially when made for one cultural group.
How therapy is adapted to a culture
Language
Therapy in the client's first language, using local words for distress.
Values
Goals that fit what the culture values, such as family harmony.
Family
Family members take part where the culture expects it.
Helper
A helper from the same community, which builds trust.
Language · Values · Family · Helper
Watch out: One culture's treatment is not the standard. Say why a treatment fits, or fails to fit, the people it is used with.