Vector Volume 12 Issue 2 - 2018

Asia OR Afghanistan OR India OR Sri Lanka OR Nepal
OR Bhutan OR Maldives OR Pakistan; and Stigma,
Public Perception, Understanding, OR Health Literacy.
Studies were excluded if they were not published
English language articles relating to depression in
South Asian cultures.
Results
Relevant studies were found about samples in
India (n = 3), Pakistan (n = 1), Afghanistan (n = 1),
Bangladesh (n = 1) and Sri Lanka (n = 1). The Afghan
sample reflected a migrant Afghan population. No
depression-specific articles were found about the
Maldives, Bhutan and Nepal.
Understanding of depression as a disease
Participants generally professed a poor medical
understanding of depression and other mental
illnesses. Many in the Liu et al. study (42.77%) could
not answer what the word ‘depression’ meant to
them.[4] In the Indian state of Maharashtra, 87.5%
of community members did not acknowledge
depression as a real medical illness.[10] However,
participant groups frequently employed locally
appropriate terminology when presented with a
depression case study or vignette. Bangladeshi
respondents referred to chinta rog or “worry illness”.
[5] The Dari language speaks of asfurgdadi, the low
mood and grief associated with hardships.[11] Using
tailored vocabulary greatly improved communication
between researchers and participants.[5]
Both participants with depression and communities
in general stressed the physical manifestations of the
disease.[4, 5, 6, 9] The most commonly identified
somatic symptoms associated with depression
included fatigue, pain, numbness, sleeplessness,
headache, breathlessness, and shaking.[5, 6, 9, 11]
While several psychological symptoms were also
listed,[5, 11] the physical aspects of the disease
dominated and were often the main reasons to seek
help.[6]
Aetiology of depression
An overwhelming majority of study participants
described depression through a psychosocial
understanding of its origins, emphasising the
suffering individual’s social context. In rural Indian
villages, depression is seen as an accumulation and
escalation of grief or stress.[4] Many studies identified
poverty and unemployment as major contributors to
these pressures.[5, 6, 9] In Bangladesh it is believed
that all tension rogs or “anxiety illnesses” are due
to obhab, a (typically material) need of some kind
caused by poverty.[5] Culturally specific financial
stressors included an inability to provide dowry
and education for all of one’s daughters.[5] Other
stressors ranged from female reproductive problems
and domestic violence to social inequality, injustice,
and trauma.[4, 6, 9, 11] Refugees interviewed by
Alemi et al. described language difficulties, family
separations and cultural clashes.[11]
A number of participants attributed depression to
religious, supernatural or spiritual factors. A vignette
about a woman with depression in Liu et al.’s
study prompted participant theories about divine
punishment and black magic.[4] Many raised the
possibility of spiritual possession.[4]
The Liu et al. study was an outlier in terms of
biological explanations for aetiology— 54% of
respondents linked depression to a disease of the
brain and 33.8% believed it was inheritable.[4] The
presentation of these options in a questionnaire,
as opposed to the open-ended interviews of other
studies, may have contributed to this divergence. But
some of the external causative factors identified by
participants, like “problems in the environment”[6]
and polluted air,[4] also hint at a biological
understanding of depression’s causes.
Perception of individuals with depression
Expressions of stigma were common. In two
of the Indian studies the majority of individuals
believed depression is a sign of weakness.[4, 10] In
the Kermode et al. study,[10] 40% of community
members concurred that people with depression
are dangerous, 52.1% said they are erratic and
42.5% believed they should be avoided. Similarly, a
large minority of respondents in the Liu et al. study
described those with depression as unpredictable
(43.8%), hard to talk with (40.5%), and a cause of
familial shame (45.1%).[4]
Despite this, most individuals expressed a
willingness to remain the neighbours, friends and
co-workers of someone with depression.[4, 10]
These opinions were more likely in respondents who
regarded depression as a “sign of weakness” instead
of a genetic or biological disease. However, only
60.8% of participants were willing to accept someone
with depression marrying into their family.[10]
Bangladeshi respondents echoed these doubts about
the marriage prospects of people with depression.[5]
Understandings of treatment
Most participants across the studies thought
depression would be difficult—if not impossible—to
remedy without assistance.[4, 10, 11]
Pharmaceutical treatments were often poorly
understood and warily regarded. Medication was
restricted to treating the physical symptoms of
depression.[9] Some participants were concerned
about the addictive potential of using drugs to treat
depression.[4] In Bangladesh, tablets were the option
of last resort, partly due to cost.[5] Bangladeshi
respondents instead prioritised poverty alleviation,
good health and positive family relations.[5]
Opinions of medical practitioners were generally
positive. The patients in the Naeem et al. study
professed a strong faith in doctors despite minimal
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