Symptoms of depression and their management among low-income African-American and White mothers in the rural South

Objective. This study examines experiences of depressive symptoms among a group of 32 low-income, African-American and White mothers of young children who resided in rural Eastern North Carolina, USA.

Design. Women's experiences of depressive symptoms were elicited through a series of longitudinal ethnographic interviews, including an explanatory models interview specifically designed to elicit their beliefs about the causes, symptomatology and help-seeking behavior and management of depressive symptoms.

Results. A content analysis of interview data indicated that most women (11 African-Americans and 15 Whites) reported having depressive symptoms currently or in the past. Both African-American and White women perceived the main causes of these symptoms as being relationship problems with a spouse, a partner, or a family member; lack of finances; and parenting stresses. There were no differences in the depressive symptoms African-American and White women reported, but there were differences in how they managed these symptoms and where they sought help. Most of the African-American women sought no formal treatment (i.e., pharmacotherapy and/or psychotherapy), but instead turned to their religious faith to deal with their feelings. White women were more likely to seek formal treatment.

Conclusion. These findings provide insights into the ways in which women in one nonurban area in the USA explained and experienced depressive symptoms and demonstrate differences in help-seeking behaviors that can be linked to beliefs about depression and perceptions of societal responses to those who have it, as well as to perceptions of and experiences with the health-care system. Results have implications for the implementation of education, intervention, and treatment programs in more culturally sensitive ways.     

Explanatory models of depression in Greek‐born and Italian‐born immigrants living in Australia: Implications for service delivery and clinical practice

Introduction: The current study examined cultural differences in explanatory models of depression in a community‐based sample of mid to older aged Greek‐born and Italian‐born immigrants living in Melbourne, Australia. Methods: Participants took part in a 1‐h face‐to‐face interview with a bilingual interviewer. During this interview, information related to the participant's explanatory model of depression were examined, including causes, important symptoms, course and development, consequences and treatment. Results: Overall, participants followed a “social” based as opposed to a “disease” based model to describe depression. The Italian‐born participants were also found to hold concurrent beliefs for the course and treatment of depression. Discussion: The clinical and service implications of these results are discussed.     

Causal explanations of distress and general practitioners' assessments of common mental disorder among Punjabi and English attendees

Background: The literature on the primary care assessment of mental distress among Indian sub-continent origin patients suggests frequent presentations to general practitioner, but rarely for recognisable psychiatric disorders. This study investigates whether cultural variations in patients' causal explanatory models account for cultural variations in the assessment of non-psychotic mental disorders in primary care. Methods In a two-phase survey, 272 Punjabi and 269 English subjects were screened. The second phase was completed by 209 and 180 subjects, respectively. Causal explanatory models were elicited as explanations of two vignette scenarios. One of these emphasised a somatic presentation and the other anxiety symptoms. Psychiatric disorder was assessed by GPs on a Likert scale and by a psychiatrist on the Clinical Interview Schedule. Results Punjabis more commonly expressed medical/somatic and religious beliefs. General practitioners were more likely to assess any subject giving psychological explanations to vignette A and English subjects giving religious explanations to vignette B as having a significant psychiatric disorder. Where medical/somatic explanations of distress were most prevalent in response to the somatic vignette, psychological, religious and work explanations were less prevalent among Punjabis but not among English subjects. Causal explanations did not fully explain cultural differences in assessments. Conclusions General practitioners' assessments and causal explanations are related and influenced by culture, but causal explanations do not fully explain cultural differences in assessments. Accepted: 18 September 2001     

Making sense of illness: late-in-life migration as point of departure for elderly Iranian immigrants' explanatory models of illness

This article is based on data gathered through 60 qualitative interviews conducted within the realm of three research projects that have used culture-appropriate lenses to study the postmigration situation of late-in-life Iranian immigrants to Sweden. The findings gathered through these studies were interpreted against the backdrop that culturally appropriate nursing theories provide. This meant that it was, at times, these elders backgrounds as cultural others that were implicitly used to make sense of the various issues that were brought to the fore by these studies. The particular issue with which this article is concerned is the unusualness of these elders explanatory models of illness. Inspired by the concept definition of situation in the symbolic interactionist perspective and by the feeling that this perspective might bring about a different interpretation of the original findings regarding their understandings of illness and disease, we set out to conduct a secondary analysis of these elders explanatory models of illness. The findings presented in this article will show how the elderly Iranian immigrants interviewed in these three studies utilize the process of late in life migration as a point of reference for their understandings of what has caused the illnesses from which they suffered. Hereby we will suggest that the unusualness of their explanatory models of illness might be best understood if we focus on what they shared as immigrants (i.e., the fact that the process of late-in-life migration has made their culture obsolete) as opposed to what they shared as Iranians (i.e., their culture of origin).     

Exploring the Use of Explanatory Models in Nursing Research and Practice

Purpose: To address the lack of information in nursing for delivering culturally appropriate care and provide a framework for nurses to incorporate diverse beliefs and health needs into research and practice. People interpret and react to health and illness events within a cultural system. However, the nursing literature contains little about how to elicit cultural beliefs.
Organizing Framework: Use of Kleinman's (1980) concept of explanatory models (EMs) is explored first, by describing the concept as it was developed by Kleinman, and second, by illustrating how it was used in three research studies conducted between 1990 and 1994.
Method: Individual in-depth interviews were conducted with community-based convenience samples. Data were analyzed using content analysis. Explanatory models were explored with healthy people, with people following illness, and with people having a condition with potential health risks, to illustrate their usefulness in nursing research and practice.
Conclusions: The findings provide a beginning understanding of the complex linkages between beliefs and actions and demonstrate the versatility and usefulness of EMs for nursing research and practice. Assessing models offers one means for researchers and clinicians to explore health beliefs and the linkages between beliefs and behaviors.     

Explanatory style as a risk factor for illness

Some have speculated that explanatory style puts an individual at risk for illness. Study 1 supports this hypothesis by showing that college students who believe that stable + global factors caused bad events experienced more days of illness in the following month and visited physicians more frequently in the following year than students who explain bad events with unstable + specific causes. These findings held even when level of previous illness was controlled. Study 2 explores some of the possible links between explanatory style and poor health. College students who believe that stable + global factors caused bad events reported more unhealthy habits, lower efficacy to change these habits, and more stressful occurrences than students who explain bad events with unstable + specific causes.Thanks are expressed to Connie Burton for assistance in gathering data, and to Martin Seligman and Lisa Bossio for advice in preparing this paper. Neil Jacobson and several anonymous reviewers also made helpful suggestions that are gratefully acknowledged. Some of these data were presented at the 94th Annual Convention of the American Psychological Association, Washington, D.C., August 1986.