Cultural explanatory models and help seeking behavior in major depressive disorder

Objective: Both with the high lifetime prevalence rates, as well as the degree of disability and lost productivity, depression is a serious psychiatric disorder with high cost to society. So in order to reduce the burden of disease, it is important to develop strategies for the diagnosis, prevention and treatment of depression. Prevailing classification systems are still criticized as reflecting only Western concepts of disease and not being sufficient to use in every culture. The aim of this study is to put forward the pattern of distress, perceived causes and help-seeking behaviors in depression; and discuss the impact of culture on the findings.Methods: The study consisted of a random sample of 42 adults aged 18 years or older recruited from a university outpatient clinic, who were diagnosed with major depressive disorder based on DSM-IV criteria. Data were collected by means of Hamilton Depression Scale (HAM-D), Explanatory Models Interview Catalogue EMIC), Symptom Checklist-90-Revised (SCL-90) and Ways of Coping WoC) questionnaires.Results: Most of the patients (88,1%) presented with spontaneous reports of emotional or functional symptoms, 73,8% with cognitive and 66,6% with somatic symptoms. The most spontaneously reported symptoms were social withdrawal (50,0%), nervousness (38,1%), sadness (35,7%) and feeling of crying (35,7%). On further probing mostly reported symptoms were reluctance (100%), sadness (97,6%), mental restlessness (92,1%), feeling tense (90,5%) and fatigue (90,5%). Although not being reported spontaneously, loss of sexual desire and guilt feeling were reported by 73,8% and 52,4% of patients respectively.Half (50,0%) of the patients reported relationship problems with partners as the cause of their distress. Narratives of perceived causes showed other blaming in 59,5% and self-blaming in 35,7%. And other-blaming were correlated with high hostility and paranoid SCL subscale scores.When the patterns of prior help-seeking of the patients were analyzed, mental health professionals (52,3%) and non-psychiatric health professionals (23,8%) were mostly reported. 92,3% of patients reporting emotional symptoms as most troubling had sought help first from psychological/psychiatric care and 66,7% of patients reporting somatic symptoms as most troubling had sought help from non-psychiatric health workers.Conclusion: The two concepts of explanatory models and cultural formulation are closely intertwined. Cultural explanatory models can determine both the symptomatology and the help-seeking behavior in depression. Besides determining the distribution of the complaints, cultural framework is thought to also affect their reporting rates. Thus neglecting culturally sensitive approaches may lead to a loss of effectiveness in psychiatric assessment. To define depression within the framework of cultural variables could enhance our clinical practice by revealing barriers to reach the appropriate diagnosis and treatment.Key Words: Depression, culture, explanatory models