Cultural dimensions of clinical depression in Bangalore, India

Though rates of depression are comparable across cultures, similar rates may obscure the diversity of the experience and meaning of depression and related behaviour. Appreciation of the social and cultural contexts is crucial in developing culturally sensitive intervention strategies to reduce the burden and disability of depression. Data are required not just to elucidate biological or cognitive understandings of the disorder, but also its social and cultural contexts, especially in non-Western settings. This paper reports cultural epidemiological research studying depression-related experience, meaning, and behaviour with the EMIC in the psychiatric outpatient clinic at the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India. Patients spontaneously emphasized somatic symptoms when asked about the problems that brought them to seek help, but on further probing, they acknowledged feelings of depression and sadness, which they related to various social problems and interpersonal issues. The personal significance and meaning of the symptoms were shaped by cultural notions concerning the human body in health and in sickness. Culturally salient symbols (like heat and cold) and ethnophysiological concepts like nara (nerves) figured prominently as causative factors in their accounts. Patients were dissatisfied and disappointed with allopathic physicians whom they had previously consulted for their problems, who seemed to them not to appreciate their needs and expectations in treatment. Findings show that it is important that clinicians attend not only to questions of diagnosis and clinical formulation according to professional concepts, but also to the experience and meaning of their patients' problems. A cultural epidemiological framework facilitates this process by integrating emic and etic perspectives.