Kaufman Carol E, Beals Janette, Croy Calvin, Jiang Luohua, Novins Douglas K
Centers for American Indian and Alaska Native Health.
J Consult Clin Psychol. 2013 Dec;81(6):1040-51. doi: 10.1037/a0034342. Epub 2013 Sep 9.
Depression is a major debilitating disease. For American Indians living in tribal reservations, who endure disproportionately high levels of stress and poverty often associated with depression, determining the patterns and correlates is key to appropriate clinical assessment and intervention development. Yet little attention has been given to the cultural context of correlates for depression, including the influence of family, cultural traditions or practices, or community conditions.
We used data from a large representative psychiatric epidemiological study among American Indians in 2 reservation communities to estimate nested individual and multilevel models of past-year major depressive episode (MDE) accounting for family, cultural, and community conditions.
We found that models including culturally informed individual-level measures significantly improved the model fit over demographics alone. We found significant community-level variation in the probability of past-year MDE diagnosis in 1 tribe even after accounting for individual-level characteristics.
Accounting for culture, family, and community context will facilitate research, clinician assessment, and treatment of depression in diverse settings.
抑郁症是一种主要的致残性疾病。对于生活在部落保留地的美国印第安人来说，他们承受着与抑郁症相关的过高压力和贫困，确定其模式及相关因素是进行适当临床评估和制定干预措施的关键。然而，很少有人关注抑郁症相关因素的文化背景，包括家庭、文化传统或习俗以及社区状况的影响。
我们使用了来自对两个保留地社区的美国印第安人进行的一项大型代表性精神疾病流行病学研究的数据，来估计考虑了家庭、文化和社区状况的过去一年重度抑郁发作（MDE）的嵌套个体和多层次模型。
我们发现，包含具有文化内涵的个体层面测量指标的模型，相较于仅考虑人口统计学因素的模型，能显著改善模型拟合度。即使在考虑了个体层面特征之后，我们仍发现一个部落中过去一年MDE诊断概率存在显著的社区层面差异。
考虑文化、家庭和社区背景将有助于在不同环境中对抑郁症进行研究、临床医生评估和治疗。
