Sigma Theta Tau International's 29th International Nursing Research Congress

Cross-Cultural Perspectives on Depression: Concepts and Management

Rainier Castillo Moreno-Lacalle, MSN, RN Mary Grace Lacanaria, PhD Myra Bangsal, BSN Mae Rose Bay-ya, BSN Kristine Ann Erese, BSN Lourrie Ann Gabol, BSN Meriam Geronimo, BSN Saintly Blaise Legiralde, BSN Marfil Mae Lomandas, BSN Ma. Mae Menzi, BSN Cici Donna Real, BSN Keanu Ufina, BSN John Michael Brico Solis, SN School of Nursing, Saint Louis University, ,

Aim: To describe the cultural perspectives in terms of causes, responses, and signs and symptoms of depression by the: Kankana-eys, Ilocanos, and Maranaos in the Philippines and to determine the culturally-based management for depression across the cultures.

Background: The intricate complexity surrounding depression might be grounded from cultural subtlety. The protracted base of depression has ignited interest on deeper understanding and finding the relevant management that might be deeply embedded in cultures. Therefore, to bring light to this might counteract the burgeoning prevalence and impact of depression across different culture.

Methods: Ethnographic design was employed with interviewing a total of 41 participants. The participants are traditional healers, local cultural experts, writers of books, local religious leaders, and with the age ranging 46-85 years old and all have personally witnessed and/or performed cultural practices on depression. To enhance the richness of the study, crystallization of data gathering were done that is including structured interview, field notes (immersion), focus group discussions, documentary analysis, and observational analysis. The study focused on describing the cultural perspectives on meanings, causes, and attitudes, and culturally-based management on depression from Baguio City, Municipalities of , , and , Province of , and Vigan City, Philippines.

Findings: The three cultures have similarities and differences with wide ranging attributions: including magico-spiritual influence, relational problems, economic pressure, emotional, somatic, and chemical causes. The signs and symptoms of depression are grouped based on physical, social, behavioural, and psychological aspects. Attitude towards depression is positive namely: curiosity, sympathy, and extending social support. Culturally-based management was divided into three domains: preventive, curative, and rehabilitative interventions. Conclusions: The beliefs and management on depression cuts across tradition, culture, religion, and medical influences. These interrelationships form part of their understanding of depression, many of which are still rooted in magico-spiritual approaches.

Recommendations: These findings suggest inclusion of culturally sensitive and appropriate health care to address the needs of a person with depression. More so to disseminate the various cultural concepts and management on depression.

Title: Cross-Cultural Perspectives on Depression: Concepts and Management

Keywords: Concepts, Cross-cultural and Depression

References: Australian Psychological Society (2012) A review of depression diagnosis and management. Retrieved from https://www.psychology.org.au/publications/inpsych/2012/february/manicavasagar/

Buultjens, M., Robinson, P., & Liamputtong, P. (2008). A holistic programme for mothers with postnatal depression: Pilot study. Journal of advanced nursing, 63(2), 181-188.

Center for Disease Control (2011) Mental Health Basics. Retrieved from http://www.cdc.gov/mentalhealth/basics.htm

Chong W., Aslani, P.,& Chen, T. (2013). Health care provider’s perspectives of medication adherence in the treatment of depression: A qualitative study. Psychiatry Psychiatry Epidemiology, 48:1657-1666. Ciftci, A., Corrigan, N. & Corrigan, P. (2012). Mental Health Stigma in the Muslim Community. Journal of Muslim Mental Health, 7(1), 17- 32. http://dx.doi.org/10.3998/jmmh. 10381607.0007.102

Department of Health (2011) Woeful Suicide.Retrieved from: http://www.doh.gov.ph/content/woeful-suicide.html

Deresky, H. (2014) International Management Managing across borders and cultures. Upper Saddle River, New Jersey: Pearson Education

Julien, D., Gauvin, L., Richard, L., Kestens, Y., & Payette, H. (2013). Longitudinal Associations Between Walking Frequency and Depressive Symptoms in Older Adults: Results from the VoisiNuAge Study. Journal of the American Geriatrics Society, 61(12), 2072-2078.

Polit, D. & Beck, C. (2008) Nursing Research: Generating and Assessing Evidence for Nursing Practice (8th Ed.)Philadelphia, PA: Lippincott Williams & Wilkins. Videbeck, S. (2011). Psychiatric-Mental Health Nursing. (5th edn) Philadelphia: Lippincott Williams & Wilkins

World Health Organization (2015) Depression. Retrieved from http://www.who.int/topics/depression/en/

Abstract Summary: This study attempts to determine the concepts and management on depression of three ethnic groups in the Philippines. The researchers employed an ethnographic design of 41 informants including traditional healers, local cultural experts, writers of books, and local religious leaders.

Content Outline: Introduction

1. The impact of depression is deep and extensive: 2. 350 million people are suffering from depression (WHO, 2015). 3. By year 2020 projected to be the second major public health concern (CDC, 2011). 4. Australian government spends $12.6 billion for depression medical management (APS, 2012). 5. 5million (3%) of the Filipino may have depression, for every 90 Filipino patient only 30 will consult a health professional (WHO, 2004). 6. People suffering from depression are poorly understood leading to social stigma and devaluation. 7. The effect of depression extends to family and society. 8. The intricate complexity surrounding depression (as mental or socio-cultural illness) might be grounded from cultural subtlety. 9. Italy: collectivistic society has higher level of depression (Fastame & Penna, 2014). 10. African–Americans, Romanians, and Bulgarians: Spirituality is associated with depression (Black, Gitlin, & Burke, 2011).

Body

1. Ethnographic design 2. Theoretical sample (N=41) including traditional healers, writers of books, and local religious leaders with age range from 41 to 89 years old. 3. 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. 4. The three cultures have similarities and differences with wide ranging attributions: including magico-spiritual influence, relational problems, economic pressure, emotional, somatic, and chemical causes. 5. The signs and symptoms of depression are grouped based on physical, social, behavioural, and psychological aspects. 6. Attitude towards depression is positive namely: curiosity, sympathy, and extending social support. 7. Culturally-based management was divided into three domains: preventive, curative, and rehabilitative interventions.

Conclusion

1. The beliefs and practices on depression cuts across tradition, culture, religion, and medical influences. 2. These interrelationships form part of their understanding of depression, many of which are still rooted in magico-spiritual approaches.

First Primary Presenting Author Primary Presenting Author Rainier Castillo Moreno-Lacalle, MSN, RN Saint Louis University School of Nursing Assistant Professor Baguio Philippines

Professional Experience: November 3, 2011- to date: Nursing Faculty Saint Louis University- School of Nursing, Baguio City Philippines Responsible for designing syllabus, following up students in the clinical, laboratory, and classroom setting, making research, and leading community extension projects. June 2, 2008- October 31, 2011: Clinical Coordinator/ Nurse Educator Northern Luzon Adventist College-School of Nursing, Pangasinan, Philippines Creating schedule for faculty and students. Teaching students in the clinical, laboratory, and classroom setting. May 1, 2008- May 30, 2008: Nurse Trainee, Premier General Hospital- Baler Aurora, Philippines Implementing nursing care plan, working collaboratively with doctors and other allied health workers. June 15, 2007- April 30, 2008: Public Health Nurse, Rural Health Unit MunicipalHealthCenter, Dinalungan Aurora, Philippines Designing and implementing Department of Health's programs. Author Summary: Rainier C. Moreno-Lacalle is an assistant professor at Saint Louis University-School of Nursing Baguio City, Philippines. He considers himself as a lifelong learner, beginning writer, and a health advocate. For the moment, he is into finishing his PhD in Nursing at Saint Louis University. His research interests are evidence-based practice, conceptual development, postmodern methods, and mental health promotion.

Second Secondary Presenting Author Corresponding Secondary Presenting Author Mary Grace Lacanaria, PhD Saint Louis University School of Nursing Dean Baguio Philippines

Professional Experience: 1988-2002- Faculty/ Department Head/ Graduate Program Coordinator Saint Louis University-School of Nursing, Baguio City Philippines 2002-present- Dean Saint Louis University-School of Nursing, Baguio City Philippines Author Summary: Dean Lacanaria Association of Deans in the Philippines, College of Nursing (ADPCN). Dr. Lacanaria’s impeccable accomplishments in the nursing education have built her the image of trust and respect.

Third Author Myra Bangsal, BSN Saint Louis University School of Nursing Recent Graduate of BSN Baguio Philippines

Professional Experience: 2017- Took the Philippine Nursing Licensure examination given by the Professional Regulation Commission 2013-2017- Bachelor of Science in Nursing (BSN) Saint Louis University- School of Nursing Baguio City Philippines 2013-2017- Bachelor of Science in Nursing (BSN) Saint Louis University Baguio City Philippines Author Summary: The author is a recent graduate (Batch 2017) of the Bachelor of Science in Nursing at Saint Louis University-School of Nursing in the Philippines. She plans to work as a Registered Nurse in a local hospital in their province.

Fourth Author Mae Rose Bay-ya, BSN Saint Louis University School of Nursing Recent Graduate of BSN Baguio Philippines

Professional Experience: 2017- Took the Philippine Nursing Licensure examination given by the Professional Regulation Commission 2013-2017- Bachelor of Science in Nursing (BSN) Saint Louis University- School of Nursing Baguio City Philippines Author Summary: The author is a recent graduate (Batch 2017) of the Bachelor of Science in Nursing at Saint Louis University-School of Nursing in the Philippines. She plans to work as a Registered Nurse in a local hospital in their province.

Fifth Author Kristine Ann Erese, BSN Saint Louis University School of Nursing Recent Graduate of BSN Baguio Philippines

Professional Experience: 2017- Took the Philippine Nursing Licensure examination given by the Professional Regulation Commission 2013-2017- Bachelor of Science in Nursing (BSN) Saint Louis University- School of Nursing Baguio City Philippines Author Summary: The author is a recent graduate (Batch 2017) of the Bachelor of Science in Nursing at Saint Louis University-School of Nursing in the Philippines. She plans to work as a Registered Nurse in a local hospital in their province.

Sixth Author Lourrie Ann Gabol, BSN Saint Louis University School of Nursing Recent Graduate of BSN Baguio Philippines

Professional Experience: 2017- Took the Philippine Nursing Licensure examination given by the Professional Regulation Commission 2013-2017- Bachelor of Science in Nursing (BSN) Saint Louis University- School of Nursing Baguio City Philippines Author Summary: The author is a recent graduate (Batch 2017) of the Bachelor of Science in Nursing at Saint Louis University-School of Nursing in the Philippines. She plans to work as a Registered Nurse in a local hospital in their province.

Seventh Author Meriam Geronimo, BSN Saint Louis University School of Nursing Recent Graduate of BSN Baguio Philippines

Professional Experience: 2017- Took the Philippine Nursing Licensure examination given by the Professional Regulation Commission 2013-2017- Bachelor of Science in Nursing (BSN) Saint Louis University- School of Nursing Baguio City Philippines Author Summary: The author is a recent graduate (Batch 2017) of the Bachelor of Science in Nursing at Saint Louis University-School of Nursing in the Philippines. She plans to work as a Registered Nurse in a local hospital in their province.

Eighth Secondary Presenting Author Corresponding Secondary Presenting Author Saintly Blaise Legiralde, BSN Saint Louis University School of Nursing Recent Graduate of BSN Baguio Philippines

Professional Experience: 2017- Took the Philippine Nursing Licensure examination given by the Professional Regulation Commission 2013-2017- Bachelor of Science in Nursing (BSN) Saint Louis University- School of Nursing Baguio City Philippines Author Summary: The author is a recent graduate (Batch 2017) of the Bachelor of Science in Nursing at Saint Louis University-School of Nursing in the Philippines. She plans to work as a Registered Nurse in a local hospital in their province.

Ninth Author Marfil Mae Lomandas, BSN Saint Louis University School of Nursing Recent Graduate of BSN Baguio Philippines

Professional Experience: 2017- Took the Philippine Nursing Licensure examination given by the Professional Regulation Commission 2013-2017- Bachelor of Science in Nursing (BSN) Saint Louis University- School of Nursing Baguio City Philippines Author Summary: The author is a recent graduate (Batch 2017) of the Bachelor of Science in Nursing at Saint Louis University-School of Nursing in the Philippines. She plans to work as a Registered Nurse in a local hospital in their province.

Tenth Author Ma. Mae Menzi, BSN Saint Louis University School of Nursing Recent Graduate of BSN Baguio Philippines

Professional Experience: 2017- Took the Philippine Nursing Licensure examination given by the Professional Regulation Commission 2013-2017- Bachelor of Science in Nursing (BSN) Saint Louis University- School of Nursing Baguio City Philippines Author Summary: The author is a recent graduate (Batch 2017) of the Bachelor of Science in Nursing at Saint Louis University-School of Nursing in the Philippines. She plans to work as a Registered Nurse in a local hospital in their province.

Eleventh Author Cici Donna Real, BSN Saint Louis University School of Nursing Recent Graduate of BSN Baguio Philippines

Professional Experience: 2017- Took the Philippine Nursing Licensure examination given by the Professional Regulation Commission 2013-2017- Bachelor of Science in Nursing (BSN) Saint Louis University- School of Nursing Baguio City Philippines Author Summary: The author is a recent graduate (Batch 2017) of the Bachelor of Science in Nursing at Saint Louis University-School of Nursing in the Philippines. She plans to work as a Registered Nurse in a local hospital in their province.

Twelfth Author Keanu Ufina, BSN Saint Louis University School of Nursing Recent Graduate of BSN Baguio Philippines

Professional Experience: 2017- Took the Philippine Nursing Licensure examination given by the Professional Regulation Commission 2013-2017- Bachelor of Science in Nursing (BSN) Saint Louis University- School of Nursing Baguio City Philippines Author Summary: The author is a recent graduate (Batch 2017) of the Bachelor of Science in Nursing at Saint Louis University-School of Nursing in the Philippines. He plans to work as a Registered Nurse in a local hospital in their province.

Thirteenth Author John Michael Brico Solis, SN Saint Louis University School of Nursing Student Nurse Baguio Philippines

Professional Experience: Currently a senior student of the Bachelor of Science in Nursing program at Saint Louis University Baguio City, Philippines 2013-present- Bachelor of Science in Nursing (BSN) Saint Louis University- School of Nursing Baguio City Philippines Author Summary: The author is a senior student of the Bachelor of Science in Nursing at Saint Louis University-School of Nursing in the Philippines. He plans to work in a local hospital in the Philippines