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Cross-Cultural Perspectives on Depression: Concepts and Management

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Cross-Cultural Perspectives on Depression: Concepts and Management Cross-cultural perspectives on depression: Concepts and Management Myra R. Bangsal RN, Mae Rose T. Bay-Ya RN, Kristine Ann R. Erese RN, Lourie Ann P. Gabol RN RN, Meriam M. Geronimo, Saintly Blaise B. Legiralde RN, Marfil Mae A. Lomandas RN, Ma. Mae R. Menzi RN RN, Cici Donna L. Real, John Michael Brico F. Solis SN, and Keanu U. Ufina RN, Rainer C. Moreno-Lacalle , RN MSN, Dr. Mary Grace C. Lacanaria, RN Saint Louis University Baguio City, Philippines Disclosures Speaker’s Bureau Researchers Ethnic Background Saint Louis University • • Five of us are Ilocano Baguio City, Philippines • Four grew up in Pangasinan. • Three are Tagalog. • One is a Muslim Stock/ Financial Interest • None Background . The impact of depression is deep and extensive: . 350 million people are suffering from depression (WHO, 2015). By year 2020 projected to be the second major public health concern (CDC, 2011). Australian government spends $12.6 billion for depression medical management (APS, 2012). 4.5million (3%) of the Filipino may have depression, for every 90 Filipino patient only 30 will consult a health professional (WHO, 2004). Rationale of the Study . People suffering from depression are poorly understood leading to social stigma and devaluation. The effect of depression extends to family and society. The intricate complexity surrounding depression (as mental or socio-cultural illness) might be grounded from cultural subtlety. Italy: collectivistic society has higher level of depression (Fastame & Penna, 2014). African–Americans, Romanians, and Bulgarians: Spirituality is associated with depression (Black, Gitlin, & Burke, 2011). Filipino Ethnic diversity . Filipino culture is a unique blend of Eastern roots and Western influence (Mendoza, 2001). National Commission of Culture and Arts estimated that there are at least 15 major ethnic groups in Luzon, thirteen in Visayas, and eighteen in Mindanao (Peralta, 2015). Central Intelligence Agency (2015) recounted the distribution as “Tagalog 28.1%, Cebuano 13.1%, Ilocano 9%, Bisaya/Binisaya 7.6%, Hiligaynon Ilonggo 7.5%, Bikol 6%, Waray 3.4%, others 25.3%”; Maranao 1.25%, Igorot 1.5% Purpose . What are the cultural perspectives in terms of causes, responses, and signs and symptoms of depression by the: A. Kankana-eys; B. Ilocanos; and, C. Maranaos? . What are the culturally-based management for depression across the cultures being studied? Methods and Materials . Ethnographic design . Theoretical sample (N=41) including traditional healers, writers of books, and local religious leaders with age range from 41 to 89 years old. Breakdown of participants: Ilocanos (n=10), Kankana-eys (n=22), Maranaos (n= 7) from Baguio City, Municipalities of Kapangan, Buguias, and Kibungan, Province of Benguet, and Vigan City, Philippines. Establishing Trustworthiness . Crystallization= structured interview, field notes (immersion), focus group discussions, documentary analysis, and observational analysis. Data management and analysis: (1) theming, (2) data analysis, (3) coding, and (4) determining emic and etic. Denzin and Lincoln (2012): credibility (i.e., member checking, bracketing, iterative questioning, independent back-translation), dependability (i.e., detailed description), confirmability (i.e., audit trail, self-critical attitude), and transferability (i.e., asking questions to non-participants (and participants) of the study if the results (themes) makes sense to them). Results: Causes Three cultures have similarities and differences with wide range of causes of depression: 1. Magico-spiritual influence (K-117: If the diviner says that depression is caused by magic. He might be possessed or is being cursed…) 2. Relational problems, economic pressures, and emotional sources (I-214: If there is a family problem that they could not be solved.) 3. Somatic and chemical causes (M-267: …like marijuana, shabu, and alcohol. The alcohol’s effect on the brain is temporary unlike the shabu that causes permanent effect). Results: Causes of Depression THEME KANKANA-EY ILOCANO MARANAO MAGICO-SPIRITUAL Spiritual Intervention Touched by unseen Satan (Shaytan) INFLUENCE (Nakabat-bati or Naan- beings/ spirits anungan) (natemengaw) Ancestral Spirit Ancestral Spirits Witchcraft (gamod) Witchcraft (gamod) RELATIONAL PROBLEMS Family dynamics Family dynamics Family dynamics Love Life (panag-ayat) Jealousy/Envy (apal) Love Life (Buhay pag-ibig) ECONOMIC Financial (panggep si siping) Poverty (rigat) Business Failures PRESSURE (Pagkalugi ng negosyo) EMOTIONAL Poor Coping (marigatan ay Loss of hope (naawanan nam- Poor Coping due to man-akseptar si panagbaliw) nama) Loss/Death of a loved one Frustration (napaay) Frustration (na-upay) Frustration (Pagkabigo) Trauma SOMATIC CAUSES Menstruation (mandada) Menstruation (ag-regla) Menstruation (Regla)/ Prolonged or Serious Illness CHEMICAL CAUSE Use of Marijuana Use of Marijuana, Shabu and Alcohol Results: Responses • I-214 “Ket nu kasdiay kapatpatang mi kuma ket haan ko nga ammu nu anya iti kunana met ibaga na met dayjay mariknana ket nu haan mi met nga maawatan kuma haan mi met maibaga dayji aramiden na” (We Curiosity are talking to him so he can verbalize how he feels since if we do not understand, we will not know how to advise him what to do). • K-115 “Ket maasyan ti amin nga umili. Mayka ken mayka ket agpanunut ah ti Finding ikasta na nga mangtulong” ( All members of the community pity him. cause Everyone is thinking of a way to help). • M-334 “Magpupulong-pulong kami, meeting ano ba ang maitutulong natin sa kanya. Kami na mismo mga leaders sa bawat sector nangongolekta ng konting tulong binibigay naming sa kanya…ang ginagawa namin yung mga kapitbahay mayroong magkaproblema doon Social bibisitahin namin, may magkasakit bibisitahin namin, may ma-ospital bibisitahin namin…” (We conduct meetings on how we can help our fellow Muslim. Each leader from each sector will collect donations to give to them. What we do is we visit our neighbors if they have support problems, we also visit them if they are sick and hospitalized.) Results: Signs and Symptoms of Depression (Kankanaey) Physical Social Psychological • Physiologic changes • Isolation(Panaka- • Rapid change/s of • Unable to sleep(Adi isina) emotion/ mood makaseyep) • Hot tempered (Napalungpung di bunget • Changes in actions na) • Aimless walking • Staying quiet (Magay turong ay (Gumiginek) mandan) • Changes in mentation • Not taking a bath • Confused (Matiktikaw) (Adi man amames) • Unable to express • Always thoughts (Adi maka- noisy(Kanayun ay ibaga sin wada sin nangalawngaw) nemnem) • Keep on pacing • Lack of motivation (Mandinad-an) (Kurang si namnama) • Blank stares (Blangko ay panag- ila) Results: Signs and Symptoms of Depression (Ilocano) Physical Social Psychological • Inability to sleep (Haan • Rapid change/s of nga makaturturog) • Isolation (Haan nga emotion/mood makitimtimpuyog ti • Loss of appetite (Haan raragsak) • Aggressiveness nga makapangpangan) (Nakarit) • Loss of weight • Fear (Buteng) (Agkutkuttong) • Suicidal (Agpakamatay) • Body weakness • Easily startled (Nalaka (Agkakapsut) nga makigkigtot) • Easy Fatigability • Changes in mentation (Nalaka nga mabannog) • Lack of concentration • Changes in actions (Haan nga • Excessive alcohol makapasnek) drinking (Sobra nga • Limited focus panagbartek) (Nakuriteng) • Blank stares • Lack of (agmalmalanga/ motivation(Awan agmumutaleng) gaganaygayanna) • Refuse to work (Haanna kayat agtrabaho) Results: Signs and Symptoms of Depression (Maranao) Physical Social Psychological • Unable to sleep • Isolation • Rapid change/s of (nahihirapang (Pagsasarili) emotion/mood matulog) (Maliliwat) • Changes in actions • Hot tempered • Drinking of alcohol (Pagkamainit ng ulo) (Pag-inom ng alak) • Restlessness (Hindi • Blank stares(Tulala) mapakali) • Sadness (Rataaginawa) • Easily Startled (Sawan) • Changes in mentation • Loss of self (Awid- akal) Results: Management (Preventive) Major Themes Kankana-ey Ilocano Maranao Spiritual Prayer to God Prayer to God Tasbik/Jikr Madmad ( prayer Atang Initiatives to unseen spirits) (Prayer to Allah) Amulets Amulets Social Approaches Forgiveness Social interactions Social interactions Diversion Advices Advices Advices Travelling Physical Care Tanggad (taking Avoid alcohol and care of self) drugs Cognitive Stay calm Stay calm Stay calm strategies Thinking clearly Thinking clearly Thinking clearly Praying Beads called Misbah Kankanaey: Dengaw used to prevent depression (sweet flag among the Maranaos grass or Arocus Calamus L.) Results: Management (Curative) MAJOR KANKANA-EY ILOCANO MARANAO Medical Seeking a Seeking a doctor Seeking a doctor Intervention doctor/Psychiatrist Magico- Seeking a mambunong Seeking an albularyo Seeking Pamomolong Perform Mansida Interventions: a.Albularyo spiritual cure (butchering rare animals a. Atang b.Imam/Ustad like monkeys)for: b. Use of tako b.1 Futar a. Nature spirits c. Use of medicinal herbs b.2 use of Muslim b. Ancestral spirits d. Massage cloth b.3 use of leaves Self-employed Kararag: Kararag: Salah/ Tasbik: remedies • Praying to Allah • Praying to God • Praying to God • Sabbar (mapagtimpi) • Self-efficacy • Self-efficacy initiative • Traveling initiatives • Socialization • Socialization Help from Advice Advice Advice Significant Others Materials used by an Ilocano Maranao in Baguio City: Albularyo to perform Tako Praying and Faith to Allah (Permission granted to post) Results: Management (Rehabilitative) Physical Rehabilitation: I-214: “Ah ket kwa ah, annadan da ti bagbagi da ken haandan nga mapmapan dijay lugar nga
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