This is a review of 40 years of research on Depression on how cultures may affect the manifestation of depression symptoms in different cultures. Key findings are: "depression is a brain disease" "its manifestations are shaped by culture" "new research opportunities on big data and Memetics can help us understand better gene-environment interaction"

1. Depresyon
Epidemiyolojisi:
Tanı
ve Belirti Kümeleri
Ne Etki yapıyor?
Prof. Dr. T. Bedirhan Üstün

2. In many parts of Chinese
society, the experience of
depression is physical
rather than psychological.
Culture and Depression
Arthur Kleinman, M.D.
N Engl J Med 2004; 351:951-953

5. Etic – Emic Approaches
ETIC
* Phonetic
* Pronunciation rules
* external categorization
* Global - Universal
* More structured
EMIC
* Phonemic:
* sounds produced
* Within culture interpretation
* Local – specific - Relativistic

6. Combinations within ICD/DSM-ology
Depressive Disorder F32.0
A. Low mood
Loss of interest
Low energy
1. Appetite (decrease, increase)
2. Body weight (decrease, increase)
3. Sleep (decrease, increase)
4. Psychomotor (decrease, increase)
5. Libido loss
6. Low self esteem
7. Guilt, self blame
8. Irritability, worry
9. Thoughts of death …Suicide Ideation
B.
8 combinations
126 combinations

7. Study Associated features of depressed mood/sadness
Bolton et al., 2012 “thinks a lot with hand on chin,”
“makes people sick”
“person is unstable/unbalanced/cannot think straight”
“food does not taste good/unable to eat,”
“because of sadness the person stays alone”
Halbreich et al.,
2007
loss of pleasure,
risk-taking behaviors
irritability,
Kaiser et al., 2014 “thinking too much,”
“distance in one's thoughts,”
“becoming quiet, cannot cry”
“sadness really lies in one's thoughts”
Lim et al., 2013 “spirit fall”
“the heart falls down”
Meyer et al., 2014 “thinking too much,”
“afraid of the boss,”
“not earning enough money,” “think about the future,” “lack of
everything”
Murray et al., 2006 “worries,” “losing sleep,” “thinking too much,” “losing appetite,”
“withdrawal,” “loneliness,” “suffering inside” “feeling hopeless,

8. How is depression experienced around the world?
A systematic review of qualitative literature
https://doi.org/10.1016/J.SOCSCIMED.2016.12.030

9. World Mental Health Surveys:
12 month prevalence of MOOD
disorders
Kessler & Üstün, 2008 CUP
0% 2% 4% 6% 8% 10% 12%
United States
Ukraine
France
Netherlands
Colombia
Lebanon
Belgium
Spain
Mexico
Italy
Germany
Japan
PRC Beijing
PRC Shanghai
Nigeria
Prevalence

10. * 1952 DSM I
* 1968 DSM-II
* 1980 DSM-III
* 1987 DSM-III-R
* 1994 DSM-IV
* 2000 DSM-IV-TR
* 2013 DSM 5
* ICD-6
* ICD-8
* ICD-9
* ICD-10
* ICD-11

12. • IN YOUR LIFETIME
• TWO WEEKS OR LONGER
• NEARLY EVERY DAY
• SAD
• EMPTY
• DEPRESSED
• FOR MOST OF THE DAY

13. * Criterion Equivalence
The CIDI Depression Questions relate to the same established criteria
of ICD/DSM
* Content Equivalence
Depression exists and is measured
* Semantic Equivalence
Same meaning is given to Depression literally & culturally
* Technical Equivalence
CIDI questions allow the measurement of Depression in the same way
* Metric Equivalence
Same item-response characteristics exist
* Conceptual Equivalence
Underlying the Depression, the same construct is being measured
Cross- cultural Applicability of CIDI

14. 1. Depression is expressed in
both physical and psychological symptoms
* What you get is what you ask – how you ask
* Stem Questions vs Symptom Clusters
2. Most invariant symptoms in depression:
* Loss of vitality – slowing down
* Thoughts of death and suicidality varies due to culture
3. Whatever the symptomatology is FUNCTIONING
decreases
“Personal” Summary

15. * Phenomenology
* Psychopathology
* Syndromes
* Clinical Intuition
* Expert Consensus
Phenotypes
Neuroscience
Physiology
Epidemiological
Validation
Evidence base
Change of Paradigm

16. Duygu
Yaşantı
Biliş

18. Duygu
Yaşantı
Biliş
• Korku
• Öfke
• Üzüntü
• Haz- keyif
• Tiksinme
• Şasırma
• (güven)
• (kaygı)

19. Duygulanım Yelpazesi
Mutluluk Üzüntü

20. Öğrenilmiş Çaresizlik

21. Depression

22. Depression
“Dysregulation of mood homeostasis”
* Stuck in ‘blues’ ( Area 25 )
* Hypothalamus:
* Appetite, energy,
* Brain Stem & RAS
* Sleep
* Amygdala & insula
* Anxiety, mood
* Hippocampus
* Memory processing, attention
* Frontal Cortex
* Self-esteem, insight
Emotion
Cognition

23. Yerkes National Primate Research Center
Thomas R. Insel 1993-2002

24. the genetic difference between
humans and chimps is less than 2%,

26. * Human babies are born into a culture
* Culture is everything that humans have
created against nature:
* Gender, sexuality, …
* Religion
* Education
* Social structures
* …..
* DNA of CULTURE = “Meme”
* Monkey like human-cub grows into a child
that implicitly acquires:
* incest taboo …
* aspirations …
* sexual orientation …
Humans Culture
&

27. Questions & Answers
bustun@ku.edu.tr
@ustunb
bedirhan-ustun