Two Key Studies of Sociocultural Explanations of Major Depressive Disorder (MDD) (HL IB Psychology)

Lewinsohn et al. (1990)

Key study one (the Behavioural explanation): Lewinsohn et al. (1990)

Aim: To compare the amount of positive reinforcement received by patients with MDD and non-depressed participants.

Participants: 30 patients with MDD, a disorder other than depression and a control group of people who did not have MDD i.e. this was a quasi experiment.

Procedure: 

• Participants were asked to complete questionnaires conducted daily over a 30-day period which required them to give a self-rating of mood using a depression adjective checklist e.g. ‘I feel lucky/active/happy/miserable/gloomy/dull today’ etc.

• They were also asked to fill in a ‘Pleasant activities’ schedule on a daily basis over the same 30-day period, which involved scheduling and participating in positive activities aimed to boost mood and encourage feelings of wellbeing

• The pleasant activities schedule included 320 activities such as participating in a sport, engaging in meditation, reading, spending time with a good friend 

• Each pleasant activity was rated according to how pleasurable it was per individual and how often they engaged in each activity

• Positive reinforcement was operationalised as the key determinant of whether the pleasant activities were a) enjoyed and b) repeated (i.e. each pleasant activity was rated twice on a scale of 0-3, one scale for enjoyment and one scale for repetition)

Results: Positive correlations (which were statistically significant) were found between rating of mood and number of pleasant activities engaged in i.e. the more pleasant activities a participant was involved in, the higher was their mood rating.

Conclusion: There may be a link between the positive reinforcement derived from pleasant activities and mood (specifically good mood, feeling upbeat and optimistic).

Evaluation of Lewinsohn et al. (1990)

Strengths

• The use of standardised questionnaires, rating scales and correlational analysis means that the study has some degree of reliability

• The longitudinal design of the study means that the participants were able to track their mood mapped to pleasant activities in real time which increases the validity of the findings

Limitations

• The participants may have succumbed to social desirability bias, providing responses which cast them in the best light (this can happen on an unconscious level which makes it particularly difficult to factor out)

• The researchers reported that they found significant individual differences in the participants’ responses which affects the validity of the findings as it leaves unanswered questions as to what it is about pleasant activities specifically that boosts mood

Karasz (2005)

Key study two (the Cultural explanation): Karasz (2005)

Alison Karasz

Aim: 

• To investigate why members of ethnic minority groups with MDD symptoms are less likely to consult a clinician than members of Caucasian middle class groups

• To examine differences in how mental illness is conceptualised between two different cultural groups dependent on each group's exposure to the medical model of depression

Participants: 

• 36 participants who had immigrated to the USA from South Asian (SA) countries and 37 European Americans (EA)

• This sample demographic was relevant as prior research has suggested that people from South Asian cultures tend to view MDD symptoms as social/emotional reactions to situations while European Americans are more likely to view MDD as a mental illness/disease which requires treatment from a clinician i.e. the medical model

• The SA group had low levels of acculturation: they rarely used English in their daily lives, preferring to communicate in their native language; they tended to socialise only with others of their native culture

• The EA group were more financially secure and had higher levels of academic attainment than the SA group: they were also twice as likely to work in professional occupations outside the home

Procedure: 

• The researchers used a model known as the illness representation model (IRM) to explore the different ways in which the participants viewed mental illness

• The IRM suggests that there are five dimensions to the identity of the illness, its timeline, its consequences,its causes and how the illness can be controlled as follows:

  • Identity: how has the illness and its attendant symptoms been identified/labelled?

  • Timeline: how long is the illness likely to last from first symptoms to recovery?

  • Consequences: what are the likely impacts of this illness on the person and on others in their life?

  • Causes: what specific beliefs are in place to explain the onset and development of the illness?

  • Control: how much control does the individual have over the illness?

• The participants were given a short description of a woman suffering from MDD-like symptoms: they were then asked to use the five IRM criteria to explain the woman’s symptoms, likely cause(s), how long the MDD might last, how she might seek to manage it etc.

• Semi-structured interviews were conducted to gather the data outlined in the above bullet point

Results:

• One very noticeable difference between the groups was that the EA group provided much longer responses than the SA group: the EAs tended to offer multiple interpretations of the scenario whereas the SAs tended to offer one fairly simple explanation of the woman’s illness

• The identification of mental illness differed between the groups: the SAs saw MDD as a social and moral issue rather than as a distinct illness whereas the EAs viewed MDD as a clear medical disorder/illness

• The SA group suggested that MDD should be treated by self-management techniques i.e. exerting control over mood/behaviour rather than seeking medical consultation

• The EA group came up with an array of possible explanations for the woman’s MDD symptoms including hormonal, neurological, situational stress-related

Conclusion:

• The researchers suggest that concepts, attitudes and behaviours surrounding mental illness provides a ‘mirror reflecting cultural realities’ (p.1635)

• The interviews with each cultural group highlighted the differences in the ways that each group explains mental illness generally, and MDD in particular

• The findings of the study indicate that SA cultures do not view MDD symptoms as evidence of disease/illness rather they are practical (but very real and potentially very damaging) problems which need to be solved either by the individual or by the community; this in turn explains their reluctance to seek medical treatment for MDD

• The biomedical model is limited in its attempts to explain MDD from a cultural perspective as it is only a Western view of disease

Evaluation of Karasz (2005)

Strengths

• The use of semi-structured interviews allowed the participants to speak freely about the topic which increases the validity of the findings due to the insightful qualitative data

• The use of IRM provided the researcher with a standardised framework from which to guide the interview which adds a measure of control to the procedure which increases reliability

Limitations

• The attitudes of immigrants may be different to those of South Asians who have remained in their native countries so the results have limited generalisability

• It is possible that the researcher succumbed to an ethnocentric bias i.e. their own cultural background may have influenced the ways in which they reported their findings