Preventing depression: Culture and depressogenic cognitive vulnerabilities

Public health is often implicitly conceptualized as the prevention of physical illness, however recent data suggest that mental illnesses in general, and affective disorders (collective name for a group of depression related disorders) in particular, are increasingly relevant to the mission of disease prevention and health promotion. By 2020 Major Depressive Disorder (MDD), is projected as being second only to heart disease in terms of its contribution to the global burden of disease as measured by disability-adjusted life years (Chapman & Perry 2008).  Furthermore ‘The Global Burden of Disease Study’ concludes;  in females, and in developing countries, MDD will become the leading cause of  disease burden, eventually surpassing even heart disease (Murray, Christopher and Lopez 1996).  Despite this anticipated increase in the rates of MDD in developing countries, the vast majority of research aimed at prediction, and prevention has been undertaken with people of  European heritage within Western industrialized nations. Similarly the major theoretical models of affective disorders are based mainly on research involving Euro - America samples. Broadening the population-focus of such research is important if models of MDD are to accommodate reports of cross cultural variations in symptom expression. The symptom profile for depression in  non-Western populations has been reported as being characterized by more frequent descriptions of sleep disturbance, fatigue, and anhedonia (loss of interest in simple pleasures). This distinct symptom profile may reflect a different pathway to depression with its own set of unique psychological risk factors (Bentall 2003).

The present paper reviews the psychological risk factors for depression and explores how those identified as ‘at risk’ can be helped by psycho-educational prevention initiatives. The paper is  global in  context specifically  examining  cross-cultural variability in depressive-symptom expression and the implications for  identifying those at risk the development of effective MDD prevention.