Understanding depression across cultures: a social identity perspective

Abstract

There is now considerable evidence showing that culture shapes psychological processes, and this extends to depression and psychopathology more generally. In particular, an understanding of the processes and mechanisms through which culture influences depression is important not only to clinical practice, but also in the designing of interventions to promote resilience to depression. For example, such cultural understanding helps therapists to determine whether and when clients will be influenced by culture and its norms, and accordingly, the impact on their expression, assessment, diagnosis, and treatment of depression. The present thesis adopts a social identity perspective to advance research on the cultural underpinnings of depression in three research streams that investigate (a) the symptomatic presentation of depression, (b) cultural factors associated with vulnerability, and (c) resilience, to depression. Much of the work on the relationship between culture and the expression of depression has centered on Asians’ tendency to emphasize somatic symptoms of the condition over psychological symptoms. However, despite extensive investigation of Asian somatization, there has been little progress in explaining how and when culture affects depression expression. To address this gap, the studies in Chapter 2 drew on social identity principles and processes to explain when culture and its norms would affect somatization. Three studies were conducted to investigate the role of cultural identity on somatization; predicting that norm endorsement would occur only when individuals identified with their culture. The key finding was that among Asians, normative expectations of collectivism predicted somatization, but only when participants strongly identified with Asian culture. These findings highlight the centrality of identification processes to cultural influence on depression. Investigations of culture and depression expression tend to conceptualize the Western perspective as the frame of reference or norm. That is, Asian somatization is commonly viewed as dysfunctional in Western contexts, whereby Asians and their emphasis on somaticizing depression is often portrayed as “that which needs to be explained”. In Chapters 3 and 4, we shifted focus to studying the effect of Western culture on depression, an arguably neglected area of research. More importantly still, the socially potent nature of cultural norms in exerting influence tends to be overlooked in the literature of this field. Hence, the studies in these chapters drew on a norm-based approach to characterize cultural influence, and investigated the effects of specific collective-level cultural factors (i.e., social norms) associated with vulnerability to depression among Westerners. Along these lines, the study reported in Chapter 3 examined whether and why social norms communicating the value of happiness (that happiness is desirable) could potentially make individuals feel worse (i.e., more depressed). We also investigated differences in these effects across cultures (Asian, Western). In this study, happiness norms were found to be associated with higher levels of depression symptoms among Westerners, but lower levels of symptoms in Asians. Additionally, we found that negative self-reflections in response to unhappiness mediated this relationship for Westerners only. This suggests that the influence of happiness norms differ across cultures. In Chapter 4, this reasoning was extended and used to examine social norms for unhappiness (that unhappiness is undesirable) as a potential explanatory mechanism underlying the commonly demonstrated cultural differences in the negative emotion-wellbeing link. Here, the research focused on determining whether such norms could help explain why negative emotions have fewer adverse effects on the wellbeing of Asians than they have for Westerners’ wellbeing. This study showed that unhappiness norms could help to account for the finding that negative emotions only have a limited impact on the wellbeing of Asians; underscoring the socially potent nature of cultural norms. In the final empirical chapter, the research focused on studying the cultural factors associated with resilience to depression. In four studies, we examined whether belonging to multiple groups protected against developing depression for Asians to the same extent as Westerners. Results showed that multiple group memberships conferred fewer wellbeing benefits for Asians, relative to Westerners. Moreover, the findings suggested that this was a reflection of Asian norms about relationships and support seeking, making Asians more reluctant to utilize their group memberships for support resources due to concerns about burdening others. The evidence highlights that culture and its norms can influence the extent to which individuals draw on support resources from group memberships, which in turn, affects their wellbeing and depression. In sum, the present thesis demonstrates the utility of social identity processes and mechanisms (i.e., cultural identification, cultural norms, multiple group memberships) to explain how, when, and why culture shapes depression expression. This research has important practical implications. In clinical practice, such cultural understanding can help therapists become more aware of cultural variability, and how (and the degree to which) clients will be influenced by culture and its norms. Additionally, in designing interventions to promote resilience to depression, the findings support the targeting of social variables that are associated with depression.