Dejman Masoumeh, Ekblad Solvig, Forouzan Ameneh-Setareh, Baradaran-Eftekhari Monir, Malekafzali Hossein
Department of Psychiatry, Welfare and Rehabilitation University, Tehran, Iran.
Arch Iran Med. 2008 Jul;11(4):397-406.
As one of the most prevalent diseases globally and as an important cause of disability, depressive disorders are responsible for as many as one in every five visits to primary care doctors. Cultural variations in clinical presentation, sometimes make it difficult to recognize the disorder resulting in patients not being diagnosed and not receiving appropriate treatment. To address this issue, we conducted a qualitative pilot study on three ethnic groups including Fars, Kurdish, and Turkish in Iran to test the use of qualitative methods in exploring the explanatory models of help-seeking and coping with depression (without psychotic feature) among Iranian women.
A qualitative study design was used based on an explanatory model of illness framework. Individual interviews were conducted with key informant (n=6), and depressed female patients (n=6). A hypothetical case vignette was also used in focus group discussions and individual interviews with lay people (three focus groups including 25 participants and six individual interviews; n=31).
There were a few differences regarding help-seeking and coping mechanisms among the three ethnic groups studied. The most striking differences were in the area of treatment. Non-psychotic depressive disorder in all ethnicities was related to an external stressor, and symptoms of illness were viewed as a response to an event in the social world. Coping mechanisms involved two strategies: (1) solving problems by seeking social support from family and neighbors, religious practice, and engaging in pleasurable activities, and (2) seeking medical support from psychologists and family counselors. The Fars group was far more likely to recommend professional treatment and visiting psychiatrists whereas the other two ethnic groups (i.e., Turks and Kurds) preferred to consult family counselors, psychologists or other alternative care providers, and traditional healers.
The study has educational and clinical implications. Cultural reframing of the patient's and family's perceptions about mental illness and depression may require community education. Family counseling, family therapy, and also religious practices can be used to empower the patient.
作为全球最常见的疾病之一以及导致残疾的重要原因，抑郁症患者占初级保健医生门诊量的五分之一。临床表现的文化差异有时会使该疾病难以识别，导致患者未被诊断以及未得到适当治疗。为解决这一问题，我们对伊朗的三个民族（法尔斯族、库尔德族和土耳其族）进行了一项定性试点研究，以测试使用定性方法探索伊朗女性寻求帮助及应对抑郁症（无精神病性特征）的解释模型。
基于疾病框架的解释模型采用定性研究设计。对关键 informant（n = 6）和抑郁女性患者（n = 6）进行了个体访谈。还在焦点小组讨论以及与非专业人士的个体访谈中使用了一个假设病例 vignette（三个焦点小组，共 25 名参与者，以及六次个体访谈；n = 31）。
在所研究的三个民族中，在寻求帮助和应对机制方面存在一些差异。最显著的差异在治疗方面。所有民族的非精神病性抑郁症都与外部压力源有关，疾病症状被视为对社会世界中某一事件的反应。应对机制涉及两种策略：（1）通过向家人和邻居寻求社会支持、宗教活动以及参与愉悦活动来解决问题，（2）向心理学家和家庭顾问寻求医疗支持。法尔斯族更倾向于推荐专业治疗并拜访精神科医生，而其他两个民族（即土耳其族和库尔德族）则更愿意咨询家庭顾问、心理学家或其他替代护理提供者以及传统治疗师。
该研究具有教育和临床意义。对患者及其家人关于精神疾病和抑郁症的认知进行文化重构可能需要社区教育。家庭咨询、家庭治疗以及宗教活动都可用于增强患者的能力。
