Depression kills more than a self: Concepts of mental distress amongst Pakistanis

This thesis investigates the role of culture in the experience of distress and depression amongst British Pakistanis. Part I of the thesis addresses the tensions inherent between psychiatry and anthropology in the field of cross cultural psychiatry. In essence, the opposing epistemological and methodological positions taken by the two disciplines has resurrected the age old universalist / relativist debate. The influence of these positions on the results produced are discussed with reference to the cross cultural study of depression. It is argued that in the field of ethnic minority mental health an integrated approach is required, which is both meaningful to the cultural minority in question and the wider cultural system. This thesis adopts such an approach by using quantitative and qualitative methods to comparatively research the symptom pattern and explanatory models of distress / depression in British, British Pakistani and Pakistani respondents. Part II of the thesis describes three quantitative studies. These involve the use of a British standardised screening instrument, juxtaposed with a Pakistani standardised screening instrument for measuring the symptoms of distress / depression. In addition a multicultural explanatory model questionnaire was used to investigate cross cultural perceptions of health beliefs. Together these findings statistically suggest some cross cultural variation in symptom patterns and explanatory models. To further investigate the cultural themes that emerged from these studies, a detailed interview study was conducted with half of the Pakistani and British Pakistani respondents. This is described in Part III. This study demonstrates the interconnection between wider cultural themes of meaning and their role in shaping the experience of distress / depression in Pakistanis. Part IV reviews and draws together the findings of the studies to develop an indicative explanatory model of distress / depression in Pakistanis which highlights the role of culture. The theoretical and methodological implications and applications of this research are discussed