Background: Urban slum populations face elevated risks for developing depression including poverty and large-scale migration due to climate change. The overall purpose of this dissertation was to use quantitative and qualitative methods to inform depression detection, prevention, and treatment in vulnerable urban slum-dwelling men of Bangladesh and generate recommendations on care provision and development of culturally sensitive psychiatric screening and interventions.
Methods: This dissertation adopted a two-paper model and used mixed-methods for a cross-sectional study, and interviews for a qualitative study. The first study used latent class analysis (LCA) to empirically test a continuum and staged model of depression among 18 to 29-year-old men (n=824) in an urban slum in Bangladesh. Qualitative interviews (n=60) were conducted with members of each latent class to understand experiential differences among class members. In the second study, the same qualitative interviews were used to explore culturally and linguistically salient idioms of distress, causes of distress, coping strategies, ethnopsychology and ethnophysiology, within the greater sociocultural context of urban Bangladesh, to inform the development of culturally sensitive psychiatric screening instruments and psychological interventions. Deductive themes were identified a priori from theoretical literature and inductive themes were generated using content analysis and grounded theory techniques.
Results: In the first study, LCA derived 3 latent classes: (1) Severely distressed (n=211), (2) Distressed (n=329), and (3) Wellness (n=284), which indicates that LCA can be used to inform a staged model of depression. Across the classes, some symptoms followed a continuum of severity: ‘levels of strain’, ‘difficulty making decisions’, and ‘unable to overcome difficulties.’ However, other symptoms such as ‘anhedonia’, ‘concentration issues’, and ‘unable to face problems’ only emerged in the severely distressed class. Qualitatively, groups were distinguished by severity of tension, a distress idiom. In the second study, terms described an ethnophysiology consisting of the heart-mind (mon), mentality (manoshikota), mood (mejaj), head (matha or ‘brain’), and body (shorir), and idioms related to disruptions of bodily and mental processes. Other idioms were related to sadness, hopelessness, anger, worry, burnout, and severe mental illness. The English word tension was the most common and central idiom of distress. Tension existed on a continuum, from mild tension described as motivating behavioral change, to moderate distress including worry, rumination and somatic complaints, to severe psychopathology including anhedonia and suicidality. Respondents connected tension to states of burnout and severe mental illness. These pathways were summarized in an ethnopsychological model. Coping strategies included instrumental problem-solving approaches and efforts at reducing negative affect due to stressors.
Discussion: Latent class derived groups can be referred to appropriate tiers of care according to severity of symptoms as outlined by the staged model of depression. A cluster of distress symptoms seemed to be on a continuum, while severe symptoms aligned with depressive disorder only emerged for the severely distressed group. A ‘distress-continuum, depression-threshold’ model of depression is proposed. Preventive services targeting ‘Distressed’ individuals can potentially prevent progression into full-blown disorder. A range of idioms of distress, including tension can be utilized to inform the development of culturally sensitive measurement tools and interventions.
|Advisor:||Kohrt, Brandon A.|
|Commitee:||Colón-Ramos, Uriyoán , Ndiaye, Khadidiatou , Sandberg, John , Sarker, Malabika , Sorel, Eliot|
|School:||The George Washington University|
|School Location:||United States -- District of Columbia|
|Source:||DAI-A 82/7(E), Dissertation Abstracts International|
|Subjects:||Public health, Gender studies, South Asian Studies, Mental health|
|Keywords:||Depression, Idioms of distress, Latent class analysis, Mixed methods, Slums|
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