Pereira Bernadette, Andrew Gracy, Pednekar Sulochana, Pai Reshma, Pelto Pertti, Patel Vikram
Sangath, 831/1 Porvorim, Goa, India.
J Affect Disord. 2007 Sep;102(1-3):209-18. doi: 10.1016/j.jad.2006.09.025. Epub 2006 Oct 30.
Women, and persons facing social and economic disadvantage, are at greater risk for depressive disorders. Our objective was to describe the explanatory models of illness in depressed women, in particular, their idioms of distress, and their views of their social circumstances and how this related to their illness.
We carried out a qualitative investigation nested in a population based cohort study of women's mental and reproductive health in Goa, India. We purposively sampled women who were ever-married and who had been found to be suffering from a depressive disorder on the basis of a structured diagnostic interview. In-depth interviews were carried out about six months apart exploring stressors in women's lives, a typical day in their recent lives, and their illness narratives (idioms of distress, causal models, impact of illness, help-seeking).
35 women consented to participate in the study, 28 completing both interviews. Women gave expression to their problems primarily through somatic complaints, typically a variety of body aches, autonomic symptoms, gynecological symptoms and sleep problems. There was frequent mention of overall "weakness" and tiredness. Economic difficulties and difficulties with interpersonal relationships (particularly related to marital relationships) were the most common causal models. However, women rarely considered biomedical concepts, for example, the notion that they may suffer from an illness or that their complaints were due to a biochemical disturbance in the brain. Despite the lack of a biomedical concept, most of the participants had sought medical help, typically for reproductive and somatic complaints.
We recommend the use of somatic idioms as the defining clinical features, and a broader, psychosocial model for understanding the aetiology and conceptualization of the clinical syndrome of depression for public health interventions and mental health promotion in the Indian context.
女性以及面临社会和经济劣势的人群患抑郁症的风险更高。我们的目标是描述抑郁女性对疾病的解释模型，特别是她们的痛苦表达方式、对自身社会环境的看法以及这与她们疾病的关系。
我们在印度果阿邦一项基于人群的女性心理和生殖健康队列研究中进行了定性调查。我们有目的地抽取了曾结婚且在结构化诊断访谈基础上被发现患有抑郁症的女性。相隔约六个月进行了深入访谈，探讨女性生活中的压力源、她们近期生活中的典型一天以及她们的疾病叙述（痛苦表达方式、因果模型、疾病影响、寻求帮助）。
35名女性同意参与研究，28名完成了两次访谈。女性主要通过躯体主诉来表达她们的问题，通常是各种身体疼痛、自主神经症状、妇科症状和睡眠问题。经常提到总体的“虚弱”和疲劳。经济困难和人际关系问题（特别是与婚姻关系有关的问题）是最常见的因果模型。然而，女性很少考虑生物医学概念，例如，她们可能患病或她们的主诉是由于大脑生化紊乱的观念。尽管缺乏生物医学概念，但大多数参与者都寻求过医疗帮助，通常是针对生殖和躯体方面的主诉。
我们建议将躯体表达方式作为定义性临床特征，并采用更广泛的社会心理模型来理解印度背景下抑郁症临床综合征的病因和概念化，以用于公共卫生干预和心理健康促进。
