Cognitive Vulnerability to Depression: Investigating the Role of Culture
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University of Calgary PRISM: University of Calgary's Digital Repository Graduate Studies The Vault: Electronic Theses and Dissertations 2013-07-16 Cognitive Vulnerability to Depression: Investigating the Role of Culture Epp, Amanda Epp, A. (2013). Cognitive Vulnerability to Depression: Investigating the Role of Culture (Unpublished doctoral thesis). University of Calgary, Calgary, AB. doi:10.11575/PRISM/25348 http://hdl.handle.net/11023/833 doctoral thesis University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission. Downloaded from PRISM: https://prism.ucalgary.ca UNIVERSITY OF CALGARY Cognitive Vulnerability to Depression: Investigating the Role of Culture by Amanda M. Epp A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY DEPARTMENT OF PSYCHOLOGY CALGARY, ALBERTA JULY 2013 © Amanda M. Epp 2013 ii Abstract Differences in the presentation of depressive symptoms between Westerners and Chinese have been reported. These differences, and reported differences in cognition, provided the impetus for this investigation of cultural variation in cognitive processes in depression. Two studies were conducted that utilized data from the same three samples of Euro-Canadians, Chinese-Canadians, and Hong Kong Chinese. Self-construals were measured in the first study and a culture priming method was tested to make causal statements about the role of culture in rumination and avoidance, which were investigated in the second study. A culture prime effect was only found for the Euro-Canadians. The pattern of self-construals largely followed prediction, particularly in consideration of this prime effect; the Euro- and Chinese-Canadians reported greater independence than the Hong Kong Chinese, whereas the Chinese-Canadians and Hong Kong Chinese reported greater interdependence than the Euro-Canadians. The small and inconsistent associations between self-construals and cognitive vulnerability to depression suggested that self-construals may have had a minimal influence on levels of rumination and avoidance. However, the culturally graded nature of the samples, and the largely graded pattern of differences in levels of rumination and avoidance among the samples suggested that the present findings were attributable to some aspect of culture. The fact that the Euro-Canadians largely endorsed greater levels of rumination and cognitive behavioural avoidance than the Chinese samples parallels findings that Westerners psychologise depression more than Chinese. In contrast, avoidant coping was found to be greater among the Hong Kong Chinese, which suggests that avoidant coping may represent a different form of avoidance that is differentially iii prevalent among Chinese and Euro-Canadians. Differences across cultural groups were also found for the associations between levels of rumination and avoidance, and between levels of avoidance rumination and depressive symptoms. The pattern of findings provides evidence that culture influences the use and function of rumination and avoidance in association with depressive symptoms. These results also suggest further questions for empirical investigation. The strengths, limitations, and implications of the research were discussed. iv Acknowledgements I would like to extend my deepest and genuine thanks to my supervisor, Dr. Keith Dobson, for all of his support, guidance, and encouragement throughout the completion of my dissertation. I greatly appreciated your willingness to supervise me in conducting research that is meaningful to me and your thoughtful patience as I progressed along the learning curve. Your knowledge and enthusiasm inspired me to enter the profession of clinical psychology and will continue to inspire me as I advance within the profession. I would also like to express sincere gratitude to the many individuals across two countries, without whom this research would not have been possible: my collaborators at the University of Hong Kong (Drs. Sam Ho and Michelle Chan) and their research assistants, my research coordinators and culture brokers in Calgary (Tammy Cheng and Vivian Lau), my research assistants in Calgary (Vivian Huang, Joyee Lee, Phillip Li, Christopher Chan, Vivian Liang, Karen Lo, Calvin Wong, Angela Wu, Erin Lowden, and Erin Schumlich), and those individuals who generously donated their time to contribute to the research by participating in the study. The feedback and assistance from Phyllis Luk (translation review and edits), Dr. Tak Fung (statistics advice and guidance), the Calgary Chinese Community Services Association (participant recruitment), and members of my supervisory committee (Dr. Penny Pexman and Dr. Daniel Lai), colleagues and fellow graduate students are also most gratefully acknowledged. Finally, I would like to express heartfelt thanks to my husband, Darcy, and my parents, Sue and Helmut, for their unwavering support throughout this journey. Your always loving encouragement made this achievement possible. v The financial support provided for the completion of this research by the Social Sciences and Humanities Research Council (SSHRC), Alberta Innovates – Health Solutions (AIHS), the Alberta Advanced Education and Technology Scholarships Program (Ralph Steinhauer Award of Distinction), the Izaak Walton Killam Memorial Fund for Advanced Studies (Honourary Izaak Walton Killam Memorial Scholarship and Donald N. Byers Memorial Killam Prize), and the University of Calgary is also gratefully acknowledged. vi Table of Contents Abstract…………………………………………………………………………… ii Acknowledgements................................................................................................. iv Table of Contents………………………………………………………………… vi List of Tables……………………………………………………………………... x List of Figures…………………………………………………………………….. xi Introduction………………………………………………………………………. 1 Study 1: Priming Culture............................................................................... 5 Culture operationalized................................................................... 5 Priming self-construals.................................................................... 13 Hypotheses...................................................................................... 15 Study 2: Cognitive Vulnerability to Depression Across Cultures................. 16 Rumination....................................................................................... 16 Avoidance........................................................................................ 18 Cross-cultural studies of rumination and avoidance........................ 21 Rumination............................................................................. 21 Avoidance............................................................................... 23 Understanding cross-cultural differences........................................ 25 Self-construals theory cognitive vulnerability to depression. 26 Self-construals theory and coping.......................................... 26 Summary.......................................................................................... 28 Hypotheses....................................................................................... 28 Method..................................................................................................................... 29 Training and Standardization......................................................................... 29 Participant Recruitment.................................................................................. 30 Participant Selection...................................................................................... 31 Measures........................................................................................................ 32 Background information form......................................................... 32 Self-Construal Scale........................................................................ 32 Vancouver Index of Acculturation…….………………………..... 35 vii Center for Epidemiologic Studies-Depression Scale……..……..... 37 Ruminative Responses Scale……………………..……………..... 39 Cognitive-Behavioural Avoidance Scale………………………..... 40 Cross-Cultural Coping Scale……………………………………... 41 Priming Task: Similarities and Differences with Family and Friends.…….. 42 Translation Procedure…………………………………………………….... 46 Participation and Randomization…………………………………………... 48 Study Protocol…………………………………………………………....... 49 Results…………………………………………………………………………..... 51 Data Entry………………………………………………………………….. 51 Data Integrity………………………………………………………………. 52 Data Analysis Strategy……………………………………………………... 54 Questionnaire data………………………………………………... 54 Priming task data…………………………………………………. 58 Study Participation…………………………………………………………. 62 Preliminary Analyses………………………………………………………. 63 Comparability of samples and effectiveness of randomization…... 63 Gender, education, religion, and employment……………... 67 Study language……………………………………………... 68 Age…………………………………………………………. 68 Depressive symptoms.…………………………………………..... 69 Sample description: acculturation……………………………….... 70 Correlations and internal reliability………………………………. 72 Study 1: Priming Culture…………………………………………………... 77 Baseline self-construals…………………………………………..