Cross-cultural understandings of depression

Women from cultural backgrounds in which mental illness is stigmatised are hesitant to describe their experiences in psychological terms. In many cultures there are no words to describe mental illness. It is more likely that in Asian, Middle Eastern and African cultures depressive symptoms will be viewed as social problems or emotional reactions to situations (Kokanovic et al, 2012). Mothers from CALD backgrounds may resist a diagnosis of depression because of the negative cultural associations with moral and mental weakness, when their culture values strong, stoic motherhood in the face of difficulty and hardship. Many fear being labelled “mad” or “crazy”. Cultural backgrounds also have an important influence on ways of expressing depression. Women from Asian, Middle Eastern and African backgrounds may exhibit depression through somatic rather than emotional symptoms with the consequence that PND may not be detected in a maternity setting unless culturally appropriate screening tools are used (Department of Health, Government of Western Australia, 2006). A woman’s culture influences the meaning that she assigns to her experience of childbirth and her help-seeking behavior (Chan et al., 2009). For example, Chinese women diagnosed with postnatal depression in a study by Chan et al., (2009) displayed a great deal of anger towards their mothers-in-law and husbands as they attributed their unhappiness to others and not to themselves.

The central values of Chinese and other Asian cultures are honour, dignity, and family ties. Motherhood is regarded as the social duty of a woman. Asian women may feel shamed that they cannot fulfil the mothering role and that they have been diagnosed as having a mental illness (Chan et al., 2009). The woman and her family will avoid others knowing. The family may deny the woman’s depression and refuse medication and treatment (Chan et al., 2009). Women feel threatened in situations where there is a marriage breakdown, that a diagnosis of mental illness will mean that their husband and his family will be given custody. Women in such situations need careful explanation about their legal rights and entitlements in New Zealand. Furthermore, women need explanation that accepting medication and treatment will help their recovery and their ability to parent their baby.

For migrant and refugee-background women, the disruption to traditional practices particularly maternal support for the new mother exacerbates their vulnerability to postnatal depression. While migrant women attribute postnatal unhappiness and distress similarly to non-immigrant women, their situations are more difficult due to a lack of family support and barriers to formal supports (Dennis & Chung-Lee 2006; Kokanovic et al, 2012). The differences in expectations between the roles of new mothers in their ethnic communities and New Zealand views of appropriate mothering create tensions. Women from migrant and refugee backgrounds find themselves faced with unfamiliar standards and pressure from their host culture, over postnatal activity for example, which leads to distress (Morrow et al 2008). For example, in Somalia during the postpartum period a woman is expected to rest and her primary responsibility is breastfeeding the newborn. Traditionally, family and community members take care of the other children, the house, and meal preparation. The mother is given special foods to help her recuperate. When the newborn is awake but not breastfeeding, other women take care of the baby so the mother can rest. After the birth, the mother and baby stay indoors for 40 days known as afatabah. At the end of 40 days, there is a celebration at the home of a friend or a relative.

Be alert to the woman’s expressions of isolation and depression.

At home (in Somalia) all our relatives and neighbours care for us after the baby is born, they cook us porridge and help with all the household chores. Here we are expected to get up and do everything as soon as the baby is born and when we go home we are very alone.
(Denholm & Jama, 1997)