Depression is a common affective disorder, and its prevalence is rising in tandem with the worldwide mental health crisis. However, depending on cultural norms and beliefs, its causes may be understood differently. Eastern and Western civilizations are frequently seen as parallel. Western culture is more individualistic, and connected with industrialized countries and technology, whereas Eastern culture is associated with traditionalism and collectivism. While the majority of research is done on a Western population, Jenkins et al. (1991) indicate that sociocultural variables have a substantial influence on the presentation, patterns, diagnosis, and treatment of depression.

            A vast amount of research links depression with low income, lack of access to healthcare, and termination of education. You might have seen how the richest countries have high depression rates and the need for mental health workers. Such results are likely not due to those countries generally having more depressed people, but the access to mental health resources makes it easier for individuals to seek help and therefore self-report. There is also a variety of suggestions why depression is more prevalent in women, but in the cultural context – women often live at a disadvantage in comparison to men, creating additional factors for developing an affective disorder. To understand the prevalence of depression between the West and East one must put the risk factors in the cultural context, for example, gender inequality is higher in Eastern countries, therefore we can infer that the Eastern female population might be at higher risk of developing depression. Overall Asian nationals, including Asian Americans, have a much lower incidence of depression (de Vaus et al., 2018).

            Stigma and the cultural norms tied to depression, or any other mental disorder also vary within cultures. On average, there is more stigmatization among Eastern cultures (Krendl & Pescosolido, 2020). Moreover – sharing your mental struggles with the community can put you at higher risk of being marginalized. Eastern cultures value community and harmony significantly more than Westerners, so naturally being marginalized puts an individual at an even higher risk of their mental state worsening. Expanding on the importance of group harmony, emotional suppression is likely to result in positive social outcomes in the Eastern world, meanwhile, the West sees it as maladaptive.

            Moving on to symptomology. When choosing an assessment, the theme of items can affect its accuracy, since cultures with more traditional social standards, such as Muslim nations, feel less comfortable discussing matters such as sex or suicide, and such topics may be deemed taboo. Furthermore, individuals can interpret their symptoms through their cultural norms, for example, grief being an essential part of life. Another interesting symptom-related concept of East is somatization, it is a tendency to highlight somatic symptoms concerning mental disorders as opposed to relying on emotions. As evidence for this phenomenon, I would like to mention a study that first fired my interest in the topic of cultures and mental health: when Chinese participants were assessed using the Chinese Classification of Mental Disorders, around the same percentage of those with depression in the Western world was found to have Neurosthenia – “weakness of nerves” (Zheng et al., 1994), which is somatologically an alternative to western depression. 

            Finally, treatment can look extremely different in opposite parts of the world. West, infamously takes advantage of prescription drugs when treating depression, like a variety of anti-depressants or mood stabilizers. One may even say that acquiring a prescription became dangerously easy nowadays, however, it is a topic for another post. Another great method is psychotherapy, CBT has been the most effective evidence-based therapy so far. Of course, there are many more treatments, and research progresses and nowadays we can use psychedelic-assisted therapy, CBD, Deep Brain Stimulation, and more. Thanks to globalization these approaches naturally spread to the east, but I would like to make a note about Traditional Chinese Medicine, which can mean different things: acupuncture, acupressure, cupping, physical exercise, herbal medicine, and more. Ye et al. (2019) combine the opposing approaches: western neurotransmitter imbalance and Eastern focus on Liver Qi. The researchers emphasize that through a complex interaction the two are connected and both indeed can play a role in depression. I would like to finish on this note, I have written this text not to compare and decide what is best but simply to lift the curtain so you can take a glance at “what is on the other side”.

            This blog post was brought to you in hopes of raising a topic of cultural sensitivity when it comes to dealing with mental health. Culture always is a huge part of humanity. While the researchers will focus on adjusting assessments and treatment to a variety of cultures, I believe each of us could benefit from exploring those differences and similarities

by Diana Sultanova, Mental Health Intern

References:

De Vaus, J., Hornsey, M. J., Kuppens, P., & Bastian, B. (2018). Exploring the East-West

            Divide in Prevalence of Affective Disorder: A Case for Cultural Differences in

            Coping With Negative Emotion. Personality and Social Psychology Review, 22(3),

            285–304. https://doi.org/10.1177/1088868317736222

Jenkins, J. H., Kleinman, A., & Good, B. J. (1991). Cross-cultural studies of depression. In J.

            Becker & A. Kleinman (Eds.), Psychosocial aspects of depression (pp. 67–99).

Krendl, A. C., & Pescosolido, B. A. (2020). Countries and Cultural Differences in the Stigma

            of Mental Illness: The East–West Divide. Journal of Cross-Cultural

            Psychology, 51(2), 149–167. https://doi.org/10.1177/0022022119901297

Ye, J., Cai, S., Cheung, W. M., & Tsang, H. (2019). An East Meets West Approach to the

            Understanding of Emotion Dysregulation in Depression: From Perspective to

            Scientific Evidence. Frontiers in psychology, 10, 574.

            https://doi.org/10.3389/fpsyg.2019.00574

Zheng, Y. P., Lin, K. M., Zhao, J. P., Zhang, M. Y., & Yong, D. (1994). Comparative study

            of diagnostic systems: Chinese Classification of Mental Disorders-Second Edition

            versus DSM-III-R. Comprehensive psychiatry, 35(6), 441–449.

            https://doi.org/10.1016/0010-440x(94)90227-5