Academic journal article Journal of Health Population and Nutrition

Cultural Dimensions of Depression in Bangladesh: A Qualitative Study in Two Villages of Matlab

Academic journal article Journal of Health Population and Nutrition

Cultural Dimensions of Depression in Bangladesh: A Qualitative Study in Two Villages of Matlab

Article excerpt

INTRODUCTION

Culture plays a significant role in shaping up depressive symptoms, its awareness and impact, and care-seeking. For instance, people with depression have more somatic symptoms in non-Western countries than their counterparts in the West (1). In Bangladesh, Chowdhury found a significant presence of somatic symptoms among 191 patients (2). Farooq et al. found more somatic and depressive symptoms among Asian patients (from India, Pakistan, and Bangladesh) compared to Caucasian patients in a primary-care setting of Britain (3). The sociocultural factors interact with the risk factors that contribute to depression.

For example, poverty and joblessness are known to intensify a sense of failure in certain cultures leading to depression (4). Cultural factors also affect diagnosis and management. It is important to understand the local term(s) and the popular concepts of the causes, effects of particular health problems, and help-seeking in the community if communication is to be improved between patients and healthcare providers (5,6). Patients and their families may have their own ideas about the illness as opposed to clinicians' views. 'Emic' (perceptions of the local community) and 'Etic' (perceptions of professionals) views are captured by the respective explanatory models (7). Anthropologists have extensively discussed a major difference among illness explanatory models, i.e. the physical framework that attributes illness to physical causes and the psychosocial framework that attributes illness to thoughts and emotions, usually resulting from social factors (8).

Studies in Latin America describe culturally-constructed idioms, such as nerves as the somatization of emotional distress, resulting from status deprivation (9). In Bangladesh, anthropological studies among the urban poor have described specific lay terms to describe emotional distress, such as chinta rog (worry illness), and associated it with various physical, emotional complaints and existential conditions of the entire body (10). The urban poor felt that socioeconomic deprivations caused their worries which resulted in various illnesses. Poverty and everyday sufferings were, thus, embodied and expressed through the body. In 2001, a study among rural women in Matlab found that the major reason for reported emotional stress was poverty (defined as the chronic deficit of daily necessities). Only non-poor women emphasized other reasons, such as family problems, death of a close relative, etc. (11). The study investigated the link between microcredit and emotional well-being but did not explore the 'depression experience' any further. Islam and colleagues found that people in urban settings did not perceive depression to be a mental disorder (12). Since there has been no such study done in a rural setting, we hardly know if this is also the case in the villages in Bangladesh. In fact, very little information is available on the perceptions of depression in rural Bangladesh. Published data from Bangladesh so far have focused on postnatal depression or depression as co-morbidity among patients with leprosy (13,14).

In 2005, the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) conducted a non-communicable disease (NCD) risk-factor survey to collect data on depression in Block A and B of the ICDDR,B intervention area in the Matlab subdistrict, 65 km southeast of Dhaka, the capital city of Bangladesh. Personal communication with the ICDDR,B investigator of the 2005 survey revealed that the rate of depression was only 0.8%. In the survey instrument, depression was defined by the word bishonnota.

The usual practice of forcing the Western psychiatric diagnostic concepts to be recognized in non-Western contexts with literal translations may have methodological pitfalls (15). Sometimes, it is because the English word 'depression' may not be translatable to Bangla in terms recognized by the rural people in Bangladesh. …

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