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The influence of stigma on depression, overall psychological distress, and somatization among female Turkish migrants

Published online by Cambridge University Press:  15 April 2020

A. Heredia Montesinos*
Affiliation:
Department of Psychiatry and Psychotherapy at St Hedwig Hospital, Charité - University Medicine Berlin, Germany. Grosse Hamburger Straße 5–11, 10115Berlin, Germany
M.A. Rapp
Affiliation:
Department of Psychiatry and Psychotherapy at St Hedwig Hospital, Charité - University Medicine Berlin, Germany. Grosse Hamburger Straße 5–11, 10115Berlin, Germany
S. Temur-Erman
Affiliation:
Department of Psychiatry and Psychotherapy at St Hedwig Hospital, Charité - University Medicine Berlin, Germany. Grosse Hamburger Straße 5–11, 10115Berlin, Germany
A. Heinz
Affiliation:
Department of Psychiatry and Psychotherapy, Charité – Berlin, Germany
U. Hegerl
Affiliation:
Ulrich Hegerl, M.D., Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
M. Schouler-Ocak
Affiliation:
Department of Psychiatry and Psychotherapy at St Hedwig Hospital, Charité - University Medicine Berlin, Germany. Grosse Hamburger Straße 5–11, 10115Berlin, Germany
*
*Corresponding Author. E-mail address:[email protected] (A. Heredia Montesinos)
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Abstract

Background

Even though some studies suggest that in Mediterranean and non-western cultures more somatic and less psychological symptoms are reported, this so-called ‘somatization’ hypothesis has been challenged. Reviews show that somatic symptoms are a core component of depressive episodes regardless of cultural background. The expression of symptoms might be related to the psychosocial, social and cultural context surrounding the patient rather than ‘ethnicity’ or related constructs. Also, stigma associated with mental disorders can affect patients'symptom presentation.

Methods

The interrelationships of perceived stigmatization (Explanatory Model Interview Catalogue - Stigma Scale), depression (Beck Depression Index II), overall psychological distress (Symptom Checklist-90-R), and somatic symptoms (The screening for SOMATOFORM SYMPTOMS II) was assessed in a sample of female patients with Turkish descent with a diagnosis of depression (N = 63).

Results

Depression, overall psychological distress, and somatic symptoms were positively and significantly related. Stigma was positively related to depression and overall psychological distress. There was no significant relationship between stigma and somatic symptoms, neither among the severely depressed group (N = 39), nor among the less depressed group (N = 24).

Conclusion

The positive relationships between stigma, depression, and overall psychological distress indicate that patients who are more depressed and who have higher levels of overall psychological distress experience their condition as more stigmatizing. Since somatic symptoms and stigma were not related (neither positively, nor negatively), it appears that depressive symptoms and other symptoms of psychological distress affect concerns about stigmatizing attitudes in a way that somatic symptoms do not. This result challenges common assumption of the ‘somatization’hypothesis, i.e. that depression is ‘somatized’because of concern about stigmatizing attitudes.

Type
Research Article
Copyright
Copyright © 2012 Elsevier Masson SAS

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References

Beck, A.T., Steer, R.A., Brown, G.K.Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation: 1996.Google Scholar
Bhui, K., Bhugra, D., Goldberg, D., Sauer, J., Tylee, A.Assessing the prevalence of depression in Punjabi and English primary care attenders: the role of culture, physical illness and somatic symptoms. Transcult Psychiatry 2004; 41: 307322.CrossRefGoogle ScholarPubMed
Derogatis, L.R.Symptom Checklist-90-Revised: Administration, scoring and procedures manual. 3rd edition. Minneapolis: National Computer Systems, Inc., MN 55440; 1994.Google Scholar
Diefenbacher, A., Heim, G.Somatic Symptoms in Turkish and German Depressed Patients. Psychosom Med 1994; 56: 551556.CrossRefGoogle ScholarPubMed
Hoge, E.A., Tamrakar, S.M., Christian, K.M., Mahara, N., Nepal, M.K., Pollack, M.H., et al.Cross-cultural differences in somatic presentation in patients with generalized anxiety disorder. J Nerv Ment Dis 2006; 194(12): 962966.CrossRefGoogle ScholarPubMed
Karamustafalioğlu, O.Major Depressive disorder, mental health care, and the use of guidelines in the Middle East. J Clin Psychiatry 2010; 71(1) E1: e07.CrossRefGoogle ScholarPubMed
Keyes, C.L.M., Ryff, C.D.Somatization and mental health: A comparative study of the idiom of distress hypothesis. Soc Sci Med 2003; 57: 18331845.CrossRefGoogle ScholarPubMed
Kirmayer, L.J., Young, A.Culture and somatization: Clinical, epidemiological, and ethnographic perspectives. Psychosom Med 1998; 60(4): 420430.CrossRefGoogle ScholarPubMed
Kirmayer, L.J.Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment. J Clin Psychiatry 2001; 62(13): 2228.Google ScholarPubMed
Kirmayer, L.J.Culture, context and experience in psychiatric diagnosis. Psychopathology 2005; 38: 192196.CrossRefGoogle ScholarPubMed
Kirmayer, L.J., Looper, K.J.Abnormal illness behavior: physiological, psychological and social dimensions of coping with distress. Curr Opin Psychiatry 2006; 19: 5460.CrossRefGoogle ScholarPubMed
Kirmayer, L.J., Sartorius, N.Cultural models and somatic syndromes. In: Regier, D.A., editor. Somatic presentations of mental disorders: Refining the research agenda for DSM-V (pp. 1939). Arlington, VA US: American Psychiatric Publishing, Inc.; 2009.Google Scholar
Kleinman, A.Patients and healers in the context of culture. An Exploration of the borderland between Anthropology, Medicine, and Psychiatry. University of California Press, Berkeley, Los Angeles: London; 1980.Google Scholar
Parker, G., Gladstone, G., Chee, K.T.Depression in the planet's largest ethnic group: The Chinese. Am J Psych 2001; 158: 857864.CrossRefGoogle Scholar
Raguram, R., Weiss, M.G., Channabasavanna, S.M., Devins, G.M.Stigma, depression, and somatization in South India. Am J Psych 1996; 153: 10431049.Google ScholarPubMed
Rao, D., Young, M., Raguram, R.Culture, somatization, and psychological distress: symptom presentation in South Indian patients from a public psychiatric hospital. Psychopathology 2007; 40: 349355.CrossRefGoogle ScholarPubMed
Rief, W., Hiller, W., Heuser, J.SOMS—Das Screening für Somatoforme Störungen. Manual zum Fragebogen. [SOMS—The screening for somatoform symptoms]. Bern: Huber-Verlag: 1997.Google Scholar
Silveira, E.R., Ebrahim, S.Social determinants of psychiatric morbidity and well-being in immigrant elders and whites in east London. Int J Geriatr Psychiatry 1998; 13: 801812.3.0.CO;2-Z>CrossRefGoogle ScholarPubMed
Simon, G.E., Von Korff, M., Piccinelli, M., Fullerton, C., Ormel, J.An international study of the relation between somatic symptoms and depression. N Engl J Med 1999; 341: 13291335.CrossRefGoogle Scholar
Ulusahin, A., Basoglu, M., Paykel, E.S.A cross-cultural comparative study of depressive symptoms in British and Turkish clinical samples. Soc Psychiatry Psychiatr Epidemiol 1994; 29: 3139.Google ScholarPubMed
Van Brakel, W.H.Measuring health-related stigma—A literature review. Psychol Health Med 2006; 11(3): 307334.CrossRefGoogle ScholarPubMed
Van Hook, M.P.Challenges to identifying and treating women with depression in rural primary care. Soc Work Health Care 1996; 23: 7392.CrossRefGoogle ScholarPubMed
Weiss, M.G., Doongaji, D.R., Siddhartha, S., Wypij, D., Pathare, S., Bhatawdekar, M., et al.The Explanatory Model Interview Catalogue (EMIC). Contribution to cross-cultural research methods from a study of leprosy and mental health. BJP 1992; 160: 819830.CrossRefGoogle Scholar
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