When it comes to diagnosing major depressive disorder (MDD) there is enormous influence from the social environment. This is my second assessment I did on a course from Coursera* which is about the social context of mental health.
Depression, according to the World Health Organization (WHO), will be the secondary cause of global health burden by 2020. Depression is an umbrella label and there are many types of depression, so the focus is on the most common type Major Depressive Disorder (MDD).
Personally, I have suffered multiple episodes of major depression throughout my adult life. I have strongly recovered and am passionate about destigmatising depression to a wide audience, an example of which is this website.
Professionally, I have worked with significant amounts of depressed people, many from marginalised communities such as migrant and the unemployed. I understand the link between social systems and forces playing a paramount role in the formation and diagnosis of the condition.
A diagnosis of MDD is often made by a mental health professional, a general practictioner or psychiatrist, and often by employing the Diagnosistic Statistical Manual (DSM-IV-TR) as a guide (DSM IV). A diagnosis of MDD is not an isolated event because those professionals gain access to patients with permission and agreement from wider systems like families, communities and schools. The experience of depression itself often has a history and gives a person a chance to identify social experiences and internal mood within a pathological framework.
The diagnosis of MDD in the DSM-IV is also reliant on the impairment of functioning from the individual in professional, educational and social domains. People who are not able to cope or function within these systems are likely to present for treatment and diagnosis. Their ability to function within these domains determine the severity of the MDD. Therefore social contexts drive a MDD diagnosis.
Social determinants also play a critical role in the diagnosis of MDD. It is not bad luck that people develop MDD. The experience of depression and persistent lower mood also comes from the effects of other people who put them in those circumstances, as well as biological predispositions and causes. Specific groups within society are more prone to receiving a diagnosis of depression. It is well documented that women run a greater risk in most cultures: overall, women have a 1.5- to 2-times higher risk of suffering from depression compared with men.
It is also well documented that migrant communities also have a greater chance of being diagnosed with MDD. The process of migration leading to depression is indicative of social contexts playing a key role in the diagnosis of depression, because migrant communities are often taken away from key social protections and determinants such as a stable family, communities and fair access to employment. Furthermore, they often transition from sociocentric to egocentric communities and struggle to adapt to radically new cultural and social contexts .
Cultural influence also impacts on the MDD diagnosis. Traditionally, non-Western cultures have reported lower incidences of depression and some cultures struggle to define the word depression in their language, in spite of the World Health Organisation showing that lowered mood occurs and MDD as an experience occurring consistently across cultures. These cultures also have much less mainstream treatments available to them for diagnosis.
The DSM-IV in its multi axial diagnostic method acknowledges the social context when it comes to diagnosis, the third and fourth axis aim to identify any other health conditions impacting on MDD diagnosis and also the psychological, social and environmental stressors influencing MDD. This enables the clinician to form a biopsychosocial perspective when diagnosing and developing a treatment plan. However, it is noted that western culture and diagnosis still places a lot of attention on individual problems and recovery paths and not social ills or systems, this may explain the increase in number of worldwide mood disorders in spite of more robust treatment options.
*Coursera allows people from all over the world to do free online university courses. The quality of this course was exceptional.
People can and do beat depression but it is a long term commitment. Thanks for reading remember to leave comments below (Facebook or WordPress) and follow How I Beat Depression on Facebook, Twitter and YouTube.
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