Presentation is loading. Please wait.

Presentation is loading. Please wait.

Depression Through Chinese Eyes: a window into public mental health in multicultural Australia Bibiana Chan, SPHCM PhD thesis supervisors: Prof. Maurice.

Similar presentations


Presentation on theme: "Depression Through Chinese Eyes: a window into public mental health in multicultural Australia Bibiana Chan, SPHCM PhD thesis supervisors: Prof. Maurice."— Presentation transcript:

1 Depression Through Chinese Eyes: a window into public mental health in multicultural Australia Bibiana Chan, SPHCM PhD thesis supervisors: Prof. Maurice Eisenbruch, Prof Gordon Parker, A/Prof Jan Ritchie

2 Roadmap of presentation Why study depression? Why study depression? Migration, Acculturation, Transcultural Psychiatry Migration, Acculturation, Transcultural Psychiatry Cultural Construction of Illness & TCM Cultural Construction of Illness & TCM Methodology Methodology Quan statistical findings & Qual thematic analysis Quan statistical findings & Qual thematic analysis Cultural Competent Psychiatry Cultural Competent Psychiatry Limitations Limitations Where do we go from here? Where do we go from here?

3 Why study depression? 1. WHO named clinical depression as the 2 nd greatest burden of disease (DIYS) Mathers and Loncar, High prevalence of Major Depression in Western cultures Kessler et al. 1994, Low prevalence in Chinese at different sites 3. Low prevalence in Chinese at different sites Chen et al 1993, HK; Hwa et al 1996, Taiwan; Murray & Lopez 1999, Shen et al. 2006, China. 4. Cross-cultural studies: high prevalence Centre w low threshold, low prevalence Centre w high threshold Simon et al

4 Help-seeking Western Culture Chinese Culture Depression Migration Acculturation Chinese in Sydney

5 Cross-cultural Comparisons M1M1 Control Chin-Aust Chin-China % English Language confidence M2M2 MoMo

6 Time Chart of Important Events end of 19th C. Gold Rush May 4 Student Movement 1919 R.C 1911 Peoples Republic of China 1949 Culture Revolution/Riots in HK White Australian Policy Abolished (Whitlam)1974 Sino-British Talks( ) Tienanman Square Student Movements 1989 Global Economic Recession/Migration Peak(1991-2) Taiwan-China Conflict/Hansonism (Anti-immigration) The New Millennium & GST 2000 Sept. 11, 2001 War on Iraq & SARS,2003 l....l....l….l….l….l….l….l….l….l….l….l….l….l….l….l….l….l….l….l….l….l….l….l…l….l New Australian Citizenship Test, Sept 2007

7 Cultural construction of illness Kleinman seminal study in Hunan, China in 80s, coined the term Explanatory Models. Kleinman seminal study in Hunan, China in 80s, coined the term Explanatory Models. Somatisation Vs Psychologisation (Kirmayer, Cheng, Parker) Somatisation Vs Psychologisation (Kirmayer, Cheng, Parker) SJSR gains popularity in 80s but declined in 1990s when CCMD-II became widely used in China (Lee & Kleinman 1997) SJSR gains popularity in 80s but declined in 1990s when CCMD-II became widely used in China (Lee & Kleinman 1997) Body-Mind Link - Conceptualization of Depression in Chinese (Ying 2002) Body-Mind Link - Conceptualization of Depression in Chinese (Ying 2002) Examples in other cultures (Major Depression, Evil eyes, nervos, susto) Examples in other cultures (Major Depression, Evil eyes, nervos, susto)

8 Traditional Chinese Medicine Harmony and Yin/Yang Balance at cosmological, society, family and individuals physical level Harmony and Yin/Yang Balance at cosmological, society, family and individuals physical level Body-mind link Excessive Emotions as cause of illness (threaten harmony of group) Excessive Emotions as cause of illness (threaten harmony of group) as the long term goal (c.f. treating acute illness) fit well with viewing mental illness as chronicNourish Life as the long term goal (c.f. treating acute illness) fit well with viewing mental illness as chronic

9 Pre-migration M igration Post-migration Vulnerability Resilience Acculturation Mental Disorder Support Self Bhugras Model Receiving country Country o f origin

10 Mixed methods Quantitative Tools Quantitative Tools Depression state Depression state DMI-10 DMI-10 Acculturation Acculturation Suinn-Lew scale Suinn-Lew scale Self-depression? Self-depression? Y/N item Y/N item Help-seeking Help-seeking 5-choice item 5-choice item Qualitative Tools Qualitative Tools A projective test A projective test 2 scenarios, 1F & 1 M 2 scenarios, 1F & 1 M Acculturation Acculturation Suinn-Lew scale Suinn-Lew scale Self-depression? Self-depression? Narrative, disclosure Narrative, disclosure Help-seeking Help-seeking Narrative, disclosure Narrative, disclosure The meaning of emotional distress :MDEMS The meaning of emotional distress :MDEMS

11 Assumptions Migrants are disposed to likely to trigger clinical depression Migrants are disposed to high acculturation stress likely to trigger clinical depression Low acculturated Chinese less familiar with Western medical model of depression, thus in structuring Survey, Low acculturated Chinese less familiar with Western medical model of depression, thus in structuring Survey, avoid pre-disposing informants to one model or another. No-help sought? (missing data): definitive list of possible help-seeking strategies in survey. No-help sought? (missing data): definitive list of possible help-seeking strategies in survey.

12 Demographics & Depression (survey group) ChineseControls Showing degree of acculturation Low n= 243 High n = 115 n = 143 Age Bachelor Degree 21%42%22% Not in workforce 39%10%9% Age at Migration N/A SLAS N/A Depressive Episode* 27.9%37.6%49.2% Episode >4 wk* 14.4%16.8%28.8%

13 Assimilation Integration Separation Marginalization Berrys 4-fold Acculturation Model Level of Identification with heritage culture Level of identification with host culture

14 Australian Vs Chinese Self-Identity

15 Recognition of depressive symptoms among Low- Acc and High-Acc Chinese Core symptom s Depressed, loss of interest, motivation, and helpless Somatic Symptoms Insomnia, heaviness in chest, body-ache pain… Salient to Low-Acc Chinese Non-somatic (Cognitive) Symptoms Suicidal thoughts, feelings of worthlessness, Salient to High-Acc Chinese Chinese Recognition of symptoms

16 Most Troubling Symptoms (self-nominated) Low-AccChinese n=71 Weighted score High-Acc Chinese n=47 Weighted score Aust n=65 Weighted score Insomnia 67 (1) 20 (2) 18(6) depressed 42 (2) 39(1) 24 (5) Anxious & tense 31 (3) 25(5) 46 (1) X motivation 20 (4) 27(4)29(2) withdrawn 18 (5a) 14(6) 25 (3a) Hopeless 18 (5b) 11(10) 10 (11) Sadness 9 (12) 29 (3) 16 (7) Fatigue 7 (14) 20(6) 25 (3b)

17 Most nominated EMs Low-Accn=59High-Accn=44Austn=60 χ 2 df = 2 Life Stress Work Stress Relationship Study-related Health-related * Family Challenges * Finance Migration N/A 1.69 df=1

18 Episode less than 4 weeks No. of Informt

19 Episode more than 4 weeks %

20 Diagrammatic representation of the detail help-seeking pathway of Low-Acc Chinese.

21 Diagrammatic representation of the detail help-seeking pathway of Australians (5) Rx (1) Rx Australians (n = 38) (2) No help (36) Help Sought (6) Informal Help (35) Prof Help (2)Herbalist (27) GPs (14) Psychologist (15) Specialist (12) No-specialist (14) Anti- Depressant (1) No Anti- Depressant (6) Anti- Depressant (6) No Anti- Depressant (2) (2) Anti- Depressant (2) No Anti- Depressant (2) Rx (2) Rx (5) (1) no other help (1) (1) (4) No Rx (4) No Rx (9) No Rx

22 Help-seeking Puzzle Self-help Family & Friends Cultural Values Spiritual Chinese Medicine GP Psycho Therapy Counselling Community Support Psychiatrist Normalize Depression Multisectoral Collaboratn Empowerment of consumers Recognition of professional help

23 Lay Illness Concept Sick in the body Unwell in the mind Permanent serious Attacked by pathogens Mental Illness Psychological Mind State Emotional Ups & Downs Imbalance Not Physical SJSR Schizophrenia Manic Depressives Highly Stigmatized Start to attract stigma Self-talk, suicidal Mad, Craz y Violent, out of control Could snap out Short course Could get worse Could it be SJSR?

24 Implications ( (a) If Chinese are good at recognising symptoms how can they be encouraged to report these symptoms to their doctors? (b) If Chinese GPs are the first port of call in many depression cases, how can GPs be better equipped to make accurate diagnoses? (c) If Low-Acc Chinese are more likely to talk about emotional distress with Chinese herbalists, how will these herbalists then refer their patients to mainstream mental health services? (d) Focus group informants expressed their wish to learn more about clinical depression and its treatment.

25 Cultural Competent Psychiatry Health system (doctors, hospitals, etc) Culturally Competent Psychiatry Chinese GPs & Herbalists Psychotherapy Counselling, CBT* & Family Therapy referral Support groups, Community services Socio-cultural Support Family & Friends

26 Limitations of QUAN survey Have your ever seen a doctor 4 emotional unease? : researchers expected response Vs respondents interpretation? Have your ever seen a doctor 4 emotional unease? : researchers expected response Vs respondents interpretation? Mismatch? Literate (more educated) subjects only Literate (more educated) subjects only medical sample, limited generalizability Recognition of depressive symptoms: Recognition of depressive symptoms: projected response? Intelligent guess? Self-report Vs interview Self-report Vs interview social desirability Vs Subject-interviewer power differential Self-selected subjects (response rate = 64.8%) Self-selected subjects (response rate = 64.8%) those not interested or preferred not to disclose personal info might not have returned the survey

27 Limitations of QUAL study Talking is a preferred activity for female. Explore other format to collect male voices. Focus groups attracted female participants. Talking is a preferred activity for female. Explore other format to collect male voices. People who are currently depressed are too sick to take part. Retold stories – informants told stories of friends or family. People who are currently depressed are too sick to take part. a research methodology to collect informative data. Purposeful sampling recruit those interested to express their views: a research methodology to collect informative data. The balance of giving adequate contents for discussion without being too directive. Embedding life events into scenario; some Chinese could not cope with ambiguity. The balance of giving adequate contents for discussion without being too directive.

28 General limitations Insider Research (both as Chinese and consumer) insights into asking the right questions; could overlook 2 nd generation perspective, Subjective view of one researcher, countered by co-researchers as sounding board Setting up scenario from Chinese migrants perspective, applied well in non-Chinese group; these common life events serve as universal triggers Dual users of TCM & Western Medicine: observed in both GP & herbalist rooms. Future research should ask any previous GP visit or herbalist visit.

29 Limitations involving ethnicity Self-identified as Chinese Self-identified as Chinese Non-Chinese controls - have lived in Australia for at least 20 years or locally born Non-Chinese controls - have lived in Australia for at least 20 years or locally born Limited generalization to Chinese outside Sydney Limited generalization to Chinese outside Sydney Participants recruited from bilingual Chinese GP clinics: majority preferred Chinese questionnaires (low-acculturation) Participants recruited from bilingual Chinese GP clinics: majority preferred Chinese questionnaires (low-acculturation)

30 Where do we go from here? Population mental health – suicide prevention & health promotion (c.f. infant immunization) Normalisation & de-stigmatization – given permission to talk about negative emotions Normalisation & de-stigmatization – given permission to talk about negative emotions Building social capital (resilience, family and cultural values, social inclusion & consumer participation) Building social capital (resilience, family and cultural values, social inclusion & consumer participation) Holistic approach – healthy person, healthy family, healthy school/work place and health society Holistic approach – healthy person, healthy family, healthy school/work place and health society Evaluation of Cultural Competency in practice Evaluation of Cultural Competency in practice

31 Acknowledgement All professional & lay helpers who walked along the journey of recovery with me. NHMRC for the funding to make this research possible. My research supervisors Professor Maurice Eisenbruch, Professor Gordon Parker, A/Professor Jan Ritchie for their intellectual input. All participating GPs, Chinese herbalists, medical centres, and community organizations to facilitate data collection.


Download ppt "Depression Through Chinese Eyes: a window into public mental health in multicultural Australia Bibiana Chan, SPHCM PhD thesis supervisors: Prof. Maurice."

Similar presentations


Ads by Google