DepresyonEpidemiyolojisi:

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Prof. Dr. T. Bedirhan Üstün

In many parts of Chinese society, the experience of depression is physical rather than psychological.

Culture and DepressionArthur Kleinman, M.D.N Engl J Med 2004; 351:951-953

Etic – Emic Approaches

ETIC* Phonetic

* Pronunciation rules

* external categorization* Global - Universal* More structured

EMIC* Phonemic:

* sounds produced

* Within culture interpretation* Local – specific - Relativistic

Combinations within ICD/DSM-ologyDepressive Disorder F32.0

A. Low mood

Loss of interest

Low energy

1. Appetite (decrease, increase)

2. Body weight (decrease, increase)

3. Sleep (decrease, increase)

4. Psychomotor (decrease, increase)

5. Libido loss

6. Low self esteem

7. Guilt, self blame

8. Irritability, worry

9. Thoughts of death …Suicide Ideation

B.

8 combinations

126 combinations

Study Associated features of depressed mood/sadness

Bolton et al., 2012 “thinks a lot with hand on chin,” “makes people sick” “person is unstable/unbalanced/cannot think straight” “food does not taste good/unable to eat,” “because of sadness the person stays alone”

Halbreich et al., 2007

loss of pleasure, risk-taking behaviors irritability,

Kaiser et al., 2014 “thinking too much,” “distance in one's thoughts,” “becoming quiet, cannot cry”“sadness really lies in one's thoughts”

Lim et al., 2013 “spirit fall” “the heart falls down”

Meyer et al., 2014 “thinking too much,” “afraid of the boss,” “not earning enough money,” “think about the future,” “lack of everything”

Murray et al., 2006 “worries,” “losing sleep,” “thinking too much,” “losing appetite,” “withdrawal,” “loneliness,” “suffering inside” “feeling hopeless,

How is depression experienced around the world?A systematic review of qualitative literature

https://doi.org/10.1016/J.SOCSCIMED.2016.12.030

World Mental Health Surveys: 12 month prevalence of MOOD

disordersKessler & Üstün, 2008 CUP

0% 2% 4% 6% 8% 10% 12%

United StatesUkraine

FranceNetherlands

ColombiaLebanonBelgium

SpainMexico

ItalyGermany

JapanPRC Beijing

PRC ShanghaiNigeria

Prevalence

* 1952 DSM I * 1968 DSM-II * 1980 DSM-III* 1987 DSM-III-R* 1994 DSM-IV* 2000 DSM-IV-TR* 2013 DSM 5

* ICD-6 * ICD-8* ICD-9

* ICD-10

* ICD-11

• IN YOUR LIFETIME• TWO WEEKS OR LONGER

• NEARLY EVERY DAY• SAD

• EMPTY• DEPRESSED

• FOR MOST OF THE DAY

* Criterion Equivalence

The CIDI Depression Questions relate to the same established criteria of ICD/DSM

* Content Equivalence

Depression exists and is measured

* Semantic Equivalence

Same meaning is given to Depression literally & culturally

* Technical Equivalence

CIDI questions allow the measurement of Depression in the same way

* Metric Equivalence

Same item-response characteristics exist

* Conceptual Equivalence

Underlying the Depression, the same construct is being measured

Cross- cultural Applicability of CIDI

1. Depression is expressed in both physical and psychological symptoms* What you get is what you ask – how you ask* Stem Questions vs Symptom Clusters

2. Most invariant symptoms in depression:* Loss of vitality – slowing down * Thoughts of death and suicidality varies due to culture

3. Whatever the symptomatology is FUNCTIONING decreases

“Personal” Summary

* Phenomenology

* Psychopathology

* Syndromes

* Clinical Intuition

* Expert Consensus

P h e n o t y p e s

N e u r o s c i e n c e

P h y s i o l o g y

E p i d e m i o l o g i c a l

Va l i d a t i o n

E v i d e n c e b a s e

Change of Paradigm

Duygu

Yaşantı

Biliş

Duygu

Yaşantı

Biliş

• Korku• Öfke• Üzüntü• Haz- keyif• Tiksinme• Şasırma

• (güven)• (kaygı)

Duygulanım Yelpazesi

Mutluluk Üzüntü

Öğrenilmiş Çaresizlik

Depression

Depression“Dysregulation of mood homeostasis”

* Stuck in ‘blues’ ( Area 25 )

* Hypothalamus: * Appetite, energy,

* Brain Stem & RAS* Sleep

* Amygdala & insula* Anxiety, mood

* Hippocampus* Memory processing, attention

* Frontal Cortex* Self-esteem, insight

Emotion

Cognition

Yerkes National Primate Research CenterThomas R. Insel 1993-2002

the genetic difference between humans and chimps is less than 2%,

* Human babies are born into a culture* Culture is everything that humans have

created against nature:* Gender, sexuality, …* Religion* Education* Social structures* …..

* DNA of CULTURE = “Meme”* Monkey like human-cub grows into a child

that implicitly acquires:* incest taboo …* aspirations …* sexual orientation …

Humans Culture&

Questions & Answers bustun@ku.edu.tr

@ustunb

bedirhan-ustun