Medical Illustration Department Royal Perth Hospital
Abstract
Depression has been identified as a significant global health problem. However, to date, there has been little research into the most appropriate strategies to use in the prevention of depression. There is even less research about the understanding that people of culturally and linguistically diverse backgrounds have of the conditions encompassed by the term ‘depression’, (or more culturally and linguistically specific representations of unhappiness) and of the ways in which these conditions may be prevented.
The Listening to Diverse Voices: multicultural mental health promotion research project, a collaboration between Murdoch University and the East Metropolitan Population Health Unit, funded by Healthway, investigated these issues within a variety of minority communities and in consultation with service providers, in Perth, Western Australia, during the period 2001-2004. The objective of the research was to identify cultural differences in understandings and experiences of ‘depression’ and appropriate ways of dealing with such issues.
The research used focus groups and interviews to explore understandings of social and emotional wellbeing and of ‘depression’ among members of a number of Horn of Africa communities in Perth, including the Sudanese, Somali, Eritrean and Ethiopian communities; as well as other communities including those from Croatia, Bosnia, China and Indigenous Australians. Service providers too were canvassed for their concerns and experiences. Over 200 people participated in the research. Participants came from a variety of ethnic and class backgrounds, and while some entered Australia under the ‘skilled migrant’ category, many came under the ‘humanitarian program’ and had experienced life in refugee camps in other parts of the world before coming to Australia.
Because of cultural sensitivities, separate focus groups were conducted with men, women and young people, for some communities. Most focus groups, apart from those with youth, were conducted by bilingual facilitators, in community languages, and were then transcribed verbatim and translated. Some focus groups and all interviews were conducted in English. It is important to note that the use of such groupings does not imply internal homogeneity of individuals, experiences, perspectives or concerns.
All interviews and focus groups were undertaken using a semi-structured, standardised schedule. Interview and focus group questions were designed to elicit participants’ understandings of mental health, social and emotional well-being, depression, causes of depression and recommendations for appropriate treatments and/or interventions. Interviews and focus groups were taped, transcribed and translated, where necessary, and the transcripts studied for common themes. These themes were then taken back to the communities for comment, and the summaries adapted according to this further feedback. While it is not claimed that the participants are ‘representative’ of the communities of which they are members, the research team feels confident that the issues identified are among the most common concerns of these communities.
Perhaps the most surprising finding is that issues seen by communities as likely to cause emotional (or mental) distress, are social and settlement issues, rather than being biomedical in nature, or being seen as the result of pre-arrival trauma (although this was one factor identified). The result of this is that while some of the issues may be dealt with from within a ‘population health’ perspective and organisation, most are outside population health parameters. Therefore this information is being provided to a wider audience in the hope that other government departments, non-government organisations and individuals will also take action to address some of these issues.
This summary sheet contains a brief summary of the various issues identified by the Bosnian and Croatian community as leading to what Westerners might call ‘depression’ and their suggestions for solutions. Our commitment to hearing the voices of these communities is reflected in our use of direct quotations taken from the interviews and focus groups. The opinions expressed are from research participants and do not necessarily represent the views of the authors. For information about the findings from all other communities, see the East Metropolitan Population Health Unit Website: http://www.health.wa.gov.au/home/ or Murdoch University Website: http://www.murdoch.edu.au
