Culture Sensitive Intervention Approaches to Depression - Coursework Example

Culture Sensitive Intervention Approaches to Depression Name Institution Name Date Introduction Clinical and social scientists have continuously researched and studied the symptoms and factors associated with depression for a long time. The basis of their respective studies and research are premised on the classification systems based on Western diagnostic. Some of the researchers and scientists concur some symptoms such as helplessness, loss and emptiness associated with depression are universal in nature. However, the social and personal implications of these symptoms are unclear across cultures. Cross-cultural studies of depression have provided mechanisms and means of studying and researching on whether our moods are similar across numerous cultures, and the cultural environments also contribute to the situation. Understanding the culture and contribution of culture in the intervention of depression and the current analysis is based on Asians (Eastern cultural backgrounds) who seek assists in Australia (Western cultural backgrounds). Controversies of Intervention Understanding depression and seeking appropriate medication/intervention is affected by numerous obstacles (Collins, Zimmerman & Howard, 2011). One major impediment is the definition of depression, which is premised on the Western cultural assumptions. The Western culture have influenced understanding and dealing with depression in three major ways. The most common aspect is the feeling good and positive emotion, which the Western culture’s emphasis (Halbreich & Karkun, 2006; Grant, Wardle & Steptoe, 2009). Western cultures believe positive emotion and feeling good are important and the symptoms such as decreased self-esteem, lack of interest in certain activities, and moodiness indicates abnormal and unhealthy living (Hofmann, Asnaani & Hinton, 2010). It can be attributed to the cultural, social associations in which Western cultures view individuals as autonomous, self-contained and independent (Fazel, Wheeler & Danesh, 2005). However, in the Eastern cultures, which encourages and champion interdependent associated the symptoms with social context challenges and interpersonal disturbances (Steptoe, Tsuda & Tanaka, 2007). Relation symptoms that are associated with depression such as failure to maintain interpersonal associations/obligations and social withdrawals are seen as salient factors and may not be realized within a specified time when compared with other forms of depressive symptoms. Another unique component of Westernized depression is an association of mind and body (Steptoe, Tsuda & Tanaka, 2007). Depression has been characterized as originating from either biological or mental disturbances. Based on history and on the Western views, depression intervention includes psychological measures, such as psychotherapy (Halbreich & Karkun, 2006; Grant, Wardle & Steptoe, 2009). As the technology and understanding of the medical problem is understood especially after is an association with neurobiological bases, medical strategies, such as the use of antidepressants has been used to treat the problem. However, the Eastern cultures view that the body and the mind are mutually constitutive and related and it can be seen as the way intervention is accorded (Fazel, Wheeler & Danesh, 2005; Ryder et al., 2008). For example, the traditional Chinese medicine and acupuncture are examples that link the body to the mind (Hofmann, Asnaani & Hinton, 2010). Hence, it can be concluded that even the treatment of depression can be embraced through the same perspective (Collins, Zimmerman & Howard, 2011). Ethnographic, Biomedical, Psychological Approach In providing the appropriate intervention to an Asian who is leaving in Australia, one of the interventions is through ethnographic approach (Collins, Zimmerman & Howard, 2011). The ethnographic approach state that even if the people from a given culture experience same symptoms based on the definition of Western culture, the implications and meanings, sometimes, varies significantly (Fazel, Wheeler & Danesh, 2005; Grant, Wardle & Steptoe, 2009). Practitioners supporting this approach argue on focusing ion the values, norms and structures that determine the meaning of depression based on specific culture context and comparing the collected information with the Western culture (Hofmann, Asnaani & Hinton, 2010). It can be achieved through behavioral observations and ethnographic interviews. Biomedical approach, which is commonly employed by psychiatrists and psychologists assumes do not consider the aspects of cultural context and believe individuals share depression symptoms across the cultures (Fazel, Wheeler & Danesh, 2005). The prevalence of depression in numerous nations across the world is used to understand depression through post-hoc fashion. For example, the use of interviews and collection of information through structured strategies, and analyzing the information may arise with unique distinctions (Steptoe, Tsuda & Tanaka, 2007). Research has shown that Asian cultures report fewer rates of depression when it is compared with Western cultures and may be attributed to mental illness perceptions (Collins, Zimmerman & Howard, 2011). In providing the appropriate intervention, environmental stressors should be understood. Westernization and Urbanization have been shown to contribute immensely to the presence of depression (Halbreich & Karkun, 2006). The urban areas usually report higher rates of depression when it is compared with the rural areas (Fazel, Wheeler & Danesh, 2005; Ryder et al., 2008). In addition, the socioeconomic levels and situations influence the view of depression(s) (Collins, Zimmerman & Howard, 2011). The socioeconomic situations may inhibit or be one of the reasons contributing to the depression symptoms. For example, the socioeconomic position may be of poverty meaning that the individuals may have depression because of challenges of poverty while the rich may have challenges because of changing and complexities associated with their respective financial requirements. Affective and somatic symptoms can elaborate further when it comes to understanding depression (Fazel, Wheeler & Danesh, 2005; Grant, Wardle & Steptoe, 2009). The somatic approach is included in the diagnostic scheme in which physical symptoms that cannot be explained is used to analyze the condition (Steptoe, Tsuda & Tanaka, 2007). Affective symptoms incorporate a group of psychiatric diseases and it provides a mechanism for differentiating across the different psychiatric medical conditions (Halbreich & Karkun, 2006; Ryder et al., 2008). Employment of both strategies enables the practitioner to understand the symptoms and to diagnose the condition appropriately (Soenens et al., 2012). Moreover, it allows the practitioners to understand the symptoms of different diseases that can be associated with depression in which the doctor may make the wrong diagnosis. In such approach, it is possible to understand the variables associated with depression across cultural diversity (Collins, Zimmerman & Howard, 2011). The current approaches to diagnosis have unique characteristics. The current intervention measures consider self-report data without introducing the aspect of cultural variables. In reviewing the depressive symptoms, it is important to use numerous variables to diagnose the problem effectively (Fazel, Wheeler & Danesh, 2005; Ryder et al., 2008). The variables employed should be clearly defined to differentiate the cultural variables associated with the disease and variables associated with other conditions. The variables will then be compared with the self-report ensuring the doctor has important information to arrive at a definite conclusion (Soenens et al., 2012). Hence, the doctor has numerous sources of information and data, which are important in effective decision-making processes (Collins, Zimmerman & Howard, 2011). Understanding the psychological factors such as social functioning, cognitive and emotional requirements enable understanding the depressive conditions (Hong & Woody, 2007). For example, depression has shown to impair emotional perception cues: for instance detecting negative and positive emotional words when it is compared with nondepressed individuals (Halbreich & Karkun, 2006; Grant, Wardle & Steptoe, 2009). The information shows depression influences the physiological and behavioral aspects of emotional functioning. Furthermore, depressed persons demonstrate more disgust, anger and contempt when compared with nondepressed persons when they are exposed to disgusting events (Steptoe, Tsuda & Tanaka, 2007). In medical perspective, depressed individuals report smaller skin conductance responses and higher rates of the heart (Lu et al., 2006). The information demonstrates that behavioral and psychological components influences and elaborates when it comes to depression (Fazel, Wheeler & Danesh, 2005). In intervention processes, it is important to review the behavior of the individuals and determine the conditions in enabling effective diagnosis. Due to the nature and circumstances associated with cultural views and perspectives, the following are some of the appropriate intervention measures that can be employed in addressing depression: Randomized Controlled Trials Randomized controlled trials (RCT) are experimental studies in which assessment of intervention is done through collection of data before and after the intervention process. The strategy is aimed at comparing intervention with other available intervention or with no intervention (Weisz, Jensen-Doss & Hawley, 2006). The role of RCT is to provide comparative information and to minimize bias. It is possible to compare the intervention strategies with control group. Some of the biases that will be avoided include allocation, performance, assessment, attrition, and allocation concealment since placebo will play an important role in the approach. The advantages of RCT include provision of the strongest empirical evidence of an intervention efficacy. In addition, RCT allows tailoring the study to answer a specific research question. With RCT, it is possible to address the challenges associated with bias (Bateman & Fonagy, 2009). The disadvantages of the process include ethical considerations, high dropout due to lack of incentive to participate, and when compared to other methods, other methods such as observational design are better. Moreover, prior knowledge is required and the outcome should have meaningful clinical components to determine the effectiveness of the processes since the facts are unknown. Meta-Analysis Technique It is a statistical technique, which allows combination of findings from independent studies. It enables collection of data from numerous randomized control trials and allows determination of effectiveness of the healthcare interventions (Bond, Drake & Becker, 2008). The advantages of meta-analysis include confirmatory data analysis, greater statistical power, it is an evidence-based resource and the information analyzed can be extrapolated to the entire population, which has been affected. The disadvantages include study populations heterogeneity, and requirement of advanced statistical techniques. In addition, the RCT studies may not provide enough data for analysis and inclusion. Furthermore, it is time consuming and difficult to indentify appropriate studies, which can be analyzed. Evidence Based Practice Evidence based practice is the utilization of the current best evidence in making decisions that influences the health of individual patients. The evidence is current and frequently updated to include the current information and approaches. Some of the analysis includes the accuracy of diagnostic tests, exposure to particular agents, prognostic factors and other valid research, which are integral to the success of the intervention (Biegel et al., 2009). Evidence based practices includes best external evidence, individual clinical expertise and patient values & expectations. Therefore, it is an umbrella approach in which numerous variables and factors are incorporated into the success of the intervention process. The disadvantages include effect in older professionals where they think the modern approaches discredit their “traditional” approaches. In addition, costs are an obvious limitation when thinking of short term costs (Biegel et al., 2009). Lack of sufficient and extensive evidence impairs the effectiveness of the process. Not all the research and data are available, which can be used for the studies or interventions. The aspect of personal touch does not exist because the effectiveness of the intervention(s) is specific to an individual. Moreover, lack of enough skills especially in the interpretation of the information and data are challenges towards achieving the required goals and expectations. The advantages of evidence-based practice are it is tried and tested methods. It ensures only the approaches and procedures, which have been proven are employed. The patient is also satisfied because of the assurance that the method employed has been used in other instances. It is a proven method. The procedure improves efficiency and effectiveness at an organizational level (Biegel et al., 2009). The healthcare industry requires a collective approach and even each professional contributes to the development of the methodologies and approaches, the entire process becomes effective. Therefore, it ensures the requirements of different stakeholders are addressed. Conclusion In conclusion, cross-cultural factors influence and determine the appropriate intervention. Depression is a common disease and the symptoms sometimes differ because of cultural perspectives and ideologies. For example, the Western culture is of individualism while the Asian (Eastern) culture is of collectivism. Therefore, the definition and symptoms based on Western understanding may differ with symptoms from Eastern. For example, isolation is sometimes associated with depression in the Western culture but in the Eastern culture, isolation may be seen as complications arising from interdependence. To different the symptoms and determine appropriate depression diagnoses, it is appropriate to utilize numerous factors. For example, ethnographic and biomedical approaches may be employed. The benefit of the ethnographic model is encompassing the variables of the society while the biomedical approach utilizes medical based directives. However, the approaches have different challenges, and it is imperative for the practitioners to employ numerous approaches. For example, considering behavior, affective symptoms, self-reporting, cultural variables and other components provides a better means for the doctor to diagnose the problem. Moreover, advancement in technology and cultural competency continues to improve understanding depression symptoms from different cultural backgrounds. Therefore, the doctor should include numerous information and collect numerous data from the patient including historical information to enable effective diagnosis of the program. It also means continues training and development are integral towards creating an environment that encourages cultural diversity in the provision of healthcare. Moreover, the use of best evidence practice is integral to the success of the entire treatment procedure or regime. References Bateman, A., & Fonagy, P. (2009). Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. The American Journal of Psychiatry, 166(12), 1355-1364. Biegel, G. M., Brown, K. W., Shapiro, S. L., & Schubert, C. M. (2009). Mindfulness-based stress reduction for the treatment of adolescent psychiatric outpatients: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 77(5), 855. Bond, G. R., Drake, R. E., & Becker, D. R. (2008). An update on randomized controlled trials of evidence-based supported employment. Psychiatric Rehabilitation Journal, 31(4), 280. Collins, C. H., Zimmerman, C., & Howard, L. M. (2011). Refugee, asylum seeker, immigrant women and postnatal depression: rates and risk factors. Archives of Women's Mental Health, 14(1), 3-11. Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. The Lancet, 365(9467), 1309-1314. Grant, N., Wardle, J., & Steptoe, A. (2009). The relationship between life satisfaction and health behavior: a cross-cultural analysis of young adults. International Journal of Behavioral Medicine, 16(3), 259-268. Halbreich, U., & Karkun, S. (2006). Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms. Journal of Affective Disorders, 91(2), 97-111. Hofmann, S. G., Asnaani, A., & Hinton, D. E. (2010). Cultural aspects in social anxiety and social anxiety disorder. Depression and Anxiety, 27(12), 1117-1127. Hong, J. J., & Woody, S. R. (2007). Cultural mediators of self-reported social anxiety. Behaviour Research and Therapy, 45(8), 1779-1789. Lu, L., Gilmour, R., Kao, S. F., & Huang, M. T. (2006). A cross-cultural study of work/family demands, work/family conflict and wellbeing: the Taiwanese vs. British. Career Development International, 11(1), 9-27. Ryder, A. G., Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S. J., & Bagby, R. M. (2008). The cultural shaping of depression: somatic symptoms in China, psychological symptoms in North America?. Journal of Abnormal Psychology, 117(2), 300. Soenens, B., Park, S. Y., Vansteenkiste, M., & Mouratidis, A. (2012). Perceived parental psychological control and adolescent depressive experiences: A cross-cultural study with Belgian and South-Korean adolescents. Journal of Adolescence, 35(2), 261-272. Steptoe, A., Tsuda, A., & Tanaka, Y. (2007). Depressive symptoms, socio-economic background, sense of control, and cultural factors in university students from 23 countries. International Journal of Behavioral Medicine, 14(2), 97-107. Weisz, J. R., Jensen-Doss, A., & Hawley, K. M. (2006). Evidence-based youth psychotherapies versus usual clinical care: a meta-analysis of direct comparisons. American Psychologist, 61(7), 671. Read More

Relation symptoms that are associated with depression such as failure to maintain interpersonal associations/obligations and social withdrawals are seen as salient factors and may not be realized within a specified time when compared with other forms of depressive symptoms. Another unique component of Westernized depression is an association of mind and body (Steptoe, Tsuda & Tanaka, 2007). Depression has been characterized as originating from either biological or mental disturbances. Based on history and on the Western views, depression intervention includes psychological measures, such as psychotherapy (Halbreich & Karkun, 2006; Grant, Wardle & Steptoe, 2009).

As the technology and understanding of the medical problem is understood especially after is an association with neurobiological bases, medical strategies, such as the use of antidepressants has been used to treat the problem. However, the Eastern cultures view that the body and the mind are mutually constitutive and related and it can be seen as the way intervention is accorded (Fazel, Wheeler & Danesh, 2005; Ryder et al., 2008). For example, the traditional Chinese medicine and acupuncture are examples that link the body to the mind (Hofmann, Asnaani & Hinton, 2010).

Hence, it can be concluded that even the treatment of depression can be embraced through the same perspective (Collins, Zimmerman & Howard, 2011). Ethnographic, Biomedical, Psychological Approach In providing the appropriate intervention to an Asian who is leaving in Australia, one of the interventions is through ethnographic approach (Collins, Zimmerman & Howard, 2011). The ethnographic approach state that even if the people from a given culture experience same symptoms based on the definition of Western culture, the implications and meanings, sometimes, varies significantly (Fazel, Wheeler & Danesh, 2005; Grant, Wardle & Steptoe, 2009).

Practitioners supporting this approach argue on focusing ion the values, norms and structures that determine the meaning of depression based on specific culture context and comparing the collected information with the Western culture (Hofmann, Asnaani & Hinton, 2010). It can be achieved through behavioral observations and ethnographic interviews. Biomedical approach, which is commonly employed by psychiatrists and psychologists assumes do not consider the aspects of cultural context and believe individuals share depression symptoms across the cultures (Fazel, Wheeler & Danesh, 2005).

The prevalence of depression in numerous nations across the world is used to understand depression through post-hoc fashion. For example, the use of interviews and collection of information through structured strategies, and analyzing the information may arise with unique distinctions (Steptoe, Tsuda & Tanaka, 2007). Research has shown that Asian cultures report fewer rates of depression when it is compared with Western cultures and may be attributed to mental illness perceptions (Collins, Zimmerman & Howard, 2011).

In providing the appropriate intervention, environmental stressors should be understood. Westernization and Urbanization have been shown to contribute immensely to the presence of depression (Halbreich & Karkun, 2006). The urban areas usually report higher rates of depression when it is compared with the rural areas (Fazel, Wheeler & Danesh, 2005; Ryder et al., 2008). In addition, the socioeconomic levels and situations influence the view of depression(s) (Collins, Zimmerman & Howard, 2011).

The socioeconomic situations may inhibit or be one of the reasons contributing to the depression symptoms. For example, the socioeconomic position may be of poverty meaning that the individuals may have depression because of challenges of poverty while the rich may have challenges because of changing and complexities associated with their respective financial requirements. Affective and somatic symptoms can elaborate further when it comes to understanding depression (Fazel, Wheeler & Danesh, 2005; Grant, Wardle & Steptoe, 2009).

Read More