Depression Discrimination More Severe in High Income Countries

According to a study published in this month’s British Journal of Psychiatry, people diagnosed with depression in high-income countries are more likely to limit their behavior and community participation because of the anticipation of discrimination. The researchers point to cultural differences between high-income and developing societies as a possible reason for this difference. They also suggest that the biomedical model of mental illness, prevalent in industrial societies, “results in stigmatization and rejection from the outside, and self-attribution and self-blame from the inside.”

The authors suggest that to reduce stigma and discrimination in high-income countries we must move past messages that emphasize a “neurobiological conception of mental disorders,” and “shift to an emphasis on competence and inclusion.”

Using an international survey of 1082 people diagnosed with major depressive disorder (MDD) in 34 countries, the researchers, led by Dr. Antonio Lasalvia from the University of Verona, compared both experienced stigma and anticipated stigma across different countries. They found anticipated discrimination is more severe for people with depression in higher-income countries.

Anticipated discrimination has real life consequences for people suffering from depression. For example, expecting discrimination discourages people from applying for jobs or getting involved in their communities, which can further exacerbate depression symptoms. Researchers call this the “why-try effect,” when “respondents scoring high on the anticipated discrimination items not only anticipate discrimination, they also decided to give up and not pursue their goals.”

In their interpretation of the findings, the authors speculate that higher anticipated discrimination in developed nations may be due to the way different social norms and values facilitate or hinder people with depression to involve themselves in important life activities. In their study, people living in high-income countries expressed twice as much anticipated discrimination in the workplace and researchers note that, in these societies, it is much more difficult for people with gaps in their work record to resume their positions. Also, the work environments in industrialized nations are more likely to be impersonal, intensely competitive, and characterized by more “bureaucratic regimentation.”

“Thus, even when a person recovering from a severe episode of major depression finds a job, the profound sense of marginality and insecurity lingers on.”

Another reason for the increased alienation and atomization of depressed patients in high-income countries may be related to Western society’s emphasis on independence, leading to social relationships that are “more likely to be bilaterally defined, contractual in nature and subject to constant re-evaluation and revocation.”

“It is thus plausible that the intense individualism characteristic of some Western societies might not be conducive to recovery from mental ill health. Along with their emphasis on independence, self-reliance, and personal freedom, individualistic value orientations also tend to foster fierce competition, frequent life changes, and alienation, and they do not usually provide the kind of structured, stable and predictable environments that allow people with mental health conditions to recuperate at their own pace and to be reintegrated into society.”

The researchers also point to a distinction between the way traditional societies in low-income countries typically locate the causality of psychiatric problems outside of the body and the way Western industrialized societies find causality in a person’s biology.

“The notion that mental disorders are simply ‘brain diseases’ that exist as such in nature has proved to be extremely damaging to those with mental ill health. This notion is responsible for unwarranted and destructive pessimism about the chances of recovery, and has ignored what is actually going on in these people’s lives, in their families and in the societies they live in.”

 

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Lasalvia, A., Van Bortel, T., Bonetto, C., Jayaram, G., van Weeghel, J., Zoppei, S., … & ASPEN/INDIGO Study Group. (2015). Cross-national variations in reported discrimination among people treated for major depression worldwide: the ASPEN/INDIGO international study. The British Journal of Psychiatry, 207(6), 507-514. (Full Text)