IB Psychology: Paper 2 2010

IB
Psycholo
Let’s Revise… gy
Abnormal
Psychology
 Analyse the aetiology of

Socio-cultural uni-polar depression:

socio-cultural explanations
of depression

explanations
of
uni-polar
depression
 IB Psychology: Paper 2 2010

Socio-Cultural Explanations of Uni-Polar

Depression
Social origins of depression, Brown and Harris (1978, 1986)
Brown & Harris (1978)

These researchers investigated social factors linked with depression in a population of working class
women in Camberwell, in London. Initially they discovered that 82% of depressive episodes
followed stressful life events. However, they also found that only 20% of women who experienced a
'life event' became depressed. This led them to distinguish between vulnerability factors and
provoking factors.

Vulnerability factors included things like the loss of a mother before 11 year of age; three or more
children under 14 living at home; no job outside the home; and the lack of an intimate, confiding
relationship

Provoking factors were things like losing employment, divorce or separation, bereavement, moving
house, moving school or changing jobs

The idea was that you could experience a stressful life event (a provoking factor) without developing
depression, but that people with one or more vulnerability factors are much more likely to become
depressed in the presence of a provoking factor.

One striking finding was that people with a lack of a confiding relationship were four times more
likely to develop depression in the presence of a provoking factor. This demonstrates the importance
of good relationships to mental health.

Poverty and depression: In their general population study, Brown & Harris found that 23% of the
working class women had been depressed in the previous year compared with only 3% of the
middle-class women. This is probably because working class women were more likely to have been
subject to the vulnerability and provoking factors above.

Marital status and depression: Brown & Harris found that women who were widowed, divorced or
separated had relatively high rates of depression.

Brown and Harris (1978) work supports the diathesis stress model, i.e. that people my have some
form of diathesis, either a inherited biochemical predisposition or some vulnerability due to past
experiences that may mean you are more at risk in the facer of certain provoking factors or
stressors; however stressors may not trigger depression in those without the pre-existing diathesis..

Brown and Harris also point out that life events that are similar to previous traumatic events may be
particularly likely to trigger depression.

In second study Brown et al (1986) explored how self esteem and social support provided by a
husband, partner or best ‘friend’ affected the likelihood of suffering depression in the year following
a stressful life event. Previous research suggested low self esteem might be factor which made
 IB Psychology: Paper 2 2010
depression more likely in this circumstance but others argued that low self esteem was an effect of
depression not a cause. They used a prospective design, whereby factors affecting Pps lives could be
recorded as they happened rather than asking already depressed people to look back and comment
on life events (which would then be seen in a distorted way due to their depression).

Procedure

Prospective longitudinal study in which primary data was collected using semi-structured interviews

Sample: Working class women aged 18-50 living in North London; husbands were in manual labour
occupations, at least one child under 18, at home; recruited by invitation from GP; sample also
included some single mothers; final sample of 435 were randomly selected from all those who
responded to the invitation, 91% involved from stage 1.

What did they do? Measures of self esteem and personal ties (relationships) recorded and
psychiatric histories were taken; 12 months later data was collected about psychiatric disorders
within that 12 month period; further measures were taken of life events stress and social support;
Experienced interviewers were used; 60 of the sample were interviewed intensively and 21 of these
took part in a test of reliability, 11 were re-interviewed by another interviewer and the original
tapes/transcripts’ for the other 10 were re-coded by a second person; inter-rater reliability was
established.

Results 353 women were left in the sample at the end of the 12 month period (89% of the sample);
42 were not followed up (of these 3 had moved aboard and 2 dropped out due to illness); Of the
353, 50 cases of depression had been diagnosed at the first assessment and so they were not
included in the follow up stage as they were already depressed; thus the 303 remaining women
were interviewed; 50% had suffered a severe life event or major difficulty in the last 12 months; 32
women had become depressed; 91% had experienced a major life event in the 6 months preceding
depression onset; however 23% of women had also experienced a similar life event but had not
developed depression.

Of these women that became depressed, 33% had poor self esteem when the study started and had
faced a life event in the 6 months before onset (33%) however, 13% of women without low self
esteem developed depression following a life event, 4 % of women with low self esteem and no life
events developed depression, 1% (one person) without low self esteem or a life event became
depressed.

Of those women who said they had support at the crisis point, 92% said it had been helpful and this
was regardless of whether they went onto develop depression or not; however, some women said
that they felt they did have support from ‘close ties’ when the study first started but had not
received support from ‘close ties’ during a crisis point and 42% in this situation went onto become
depressed (they felt let down?), the percentage was only slightly higher for those women who had
no support at the start or at crisis (44%).

Conclusions: Support from a partner or significant other to confide in is helpful in protecting women
from developing depression, particularly when a crisis happens, however, if these ‘close ties’ are not
available to provide support during crises points, this can actually be a risk factor in the development
 IB Psychology: Paper 2 2010
of depression. Social support is a complex issue; it is not enough just to ask whether a person
has support available and assume that they will be protected as it is the perception of
availability of that support at time of need which is most important; when expectations are
raised and then not fulfilled this is associated with depression. It is suggested that self
esteem is the internalisation of our expectation and perception of available social support.

Neighbourhood factors
Cutrona et al (2006) suggest that poor quality housing and high traffic zones lead to stress which
raises likelihood of depression; social disorder can lead to increased perception of victimisation;
stressors are more likely to cause depression for people who live in neighbourhoods that they class
as unfavourable ,where there may be less social support from neighbours for example. They also
noted that marital stress was greater in “unfavourable” neighbourhoods and the support provided
by partners was reduced and less beneficial.

Cutrona et al (2006) studied 720 African American women aged 24-80 from large range of
neighbourhoods and incomes levels. They were all primary caregivers to children aged 10-12. All
were interviewed twice once in 1997 and again in 1999. They used an interview schedule comprising
items from DSM in order to diagnose MDD, this enabled them to establish whether Pps were
depressed before moving into the neighbourhood block. They also used a29 item checklist was used
to measure life events such as having been a victim of crime during the 2 months prior to the study.
It was noted that being depressed can also increase the likelihood of experiencing certain life events
so the checklist only included events that could not be linked to pre-existing depression.

Those women who reported a greater number of life stressors tended to live in neighbourhoods
characterised by economic disadvantage and social disorder and rates of depression were higher in
this group.

Culture: e.g. Marsella (1979)

Culture Experiences of depression Examples

Individualist Affective symptoms more common, In cultures where identity and self worth are defined
cultures sadness, loneliness, isolation and by wealth/work, depression may be higher in groups
also suicidal ideation and feelings of who are economically disadvantaged and rates of
guilt depression may vary in line with the economy.

Collectivist Larger more stable social networks
cultures to support the individual; identity id
tied in more with the group;
somatisation is more common;
experience bodily symptoms only;
loss of appetite, inability to sleep
etc, stomach and head aches and
pains etc.
Kleinman (1982): Chinese people rarely experience
depression in terms of affective symptoms but will
see the doctors with somatic symptoms of depression
under circumstances which in other cultures might be
experienced as depression.
In other cultures self worth is defined more in terms
of family, friendship or social standing within the
community and thus life events tied to these areas
 IB Psychology: Paper 2 2010
are more likely to link with depression.

Wu and Anthony (2000) less depression in Hispanic

Americans; more collectivist as a sub-cultural group;
greater social support; also Gabilondo et al (2010);
less depression/suicide in Spain than Northern
Europe; increased collectivism; more traditional role
of family and greater religiosity.

Chiao and Blizinsky (2010) have suggested that there

is a relationship between individualism and
depression 9no surprises) but also a negative
correlation between individualism and prevalence of
the short allele relating to serotonin transporters
(associated with depression); this indicates that the
cultural norms where interdependence and support
are championed serve to protect these biologically
more vulnerable groups; (it is also interesting to note
that in these cultures depressive style may in fact be
statistically more common meaning it is not abnormal
and this is why depression does not exist to such a
great extent as a diagnosis?

Societies where Socio-economic status within a
there is overt culture is linked with the
social experience of depression;
inequality powerlessness, discrimination can
lead to feelings of worthlessness
and also the inability to participate
and fully belong within the
materialistic culture
Nicholson et al (2008) looked at three countries
Czech republic, Poland and Russia and found that
men from the most socially disadvantaged groups in
each society were 5 times more likely to be
depressed than matched Pps from higher socio-
economic groups.

Gender Women are 2-3 times more likely to Brown and Harris (1978 and 1986) see above.
be depressed than men (Williams
and Hargreaves 1995) – could be
linked to women’s role in society
(think about Freud’s treatments of
hysteric symptoms in middle class
women; reflecting the sexual
hypocrisy of the age)

It has been said that depression is a disorder of the Western worlds and that people from Eastern
cultures do not suffer depression, or at least not in the same way as Westerners. For example Prince,
(1968) said there was no depression in Africa and regions of Asia although patterns shifted in
colonial countries demonstrating that with increased globalisation and greater Westernisation of
many world cultures, this distinction is far too simplistic. In non-modernised cultures it is likely that
some form of depression exists but it is not diagnosable using the DSM criteria in the same way. This
is where an understanding of culture bound syndromes may be necessary.
 IB Psychology: Paper 2 2010
The WHO has identified common characteristics of depression across four very different cultures;
Japan, Switzerland, Iran and Canada; sad affect, loss of enjoyment, anxiety, tension, lack of energy,
loss of interest, inability to concentrate, ideas of insufficiency, inadequacy and worthlessness, loss of
sexual interest, loss of appetite, weight reduction, fatigue, self accusatory ideas. This fell into line
with findings from a review by Murcphy et al 91967) however, clear cut cultural universals for
depression do not seem to exist.

Social rank and depression

 Price et al (1977) argued that depression was related to social status:

 Increased status → elevated mood

 Decreased status → depressed mood

 Remember the role of serotonin from the biological approach?

 Raleigh & McGuire (1991) investigated Price et al's theory using vervet monkeys

 They found that the alpha males had twice as high serotonin levels as any other male

 When the alpha males lost their position, their serotonin levels dropped

 Most interestingly, if the alpha male was removed and a random male was given serotonin-
boosting antidepressant drugs, this male became the new alpha male every time!

 This extends the findings of Brown & Harris, suggesting that social status in itself might be
related to depression, not just because it tends to coincide with other stressors