Week 3-Culture, Health & Wellbeing

Question 1

Define Cross-Cultural Psychology (Shiraev & Levy, 2016)

Answer 1

“The critical and comparative study of cultural effects on human psychology.” (i.e., how the culture each individual lives in, affects their behaviour)

Question 2

Define non-communicable diseases and give examples

Answer 2

A disease that is not directly transferrable from one person to another

– Cancer
– Heart Disease
– Stroke

Question 3

What are some lifestyle choices that can lead to disease?

Answer 3

– Sedentary lifestyle
– Poor diet
– Smoking

Question 4

How has diabetes diagnosis prevalence increased over the years?

Answer 4

Diabetes diagnoses have doubled in the last 15 years in the UK. It is estimated that 1 in 10 UK adults will have diabetes by 2030 (Iacobucci, G. (2021).

Question 5

What is the prevalence for diseases in developing countries?

Answer 5

■ Common diseases include Hepatitis A/B/C, Ebola, mumps, influenza (i.e., developing countries have more communicable diseases)

■ Social and economic progress- some developing countries have had an increase in non-communicable/incommunicable diseases.

■ 41 million people each year die by NCDs- 74% of all global deaths but majority of these deaths are in developing countries (this can be a result of technology, education, barriers to healthcare etc.,)

■ Some communicable diseases are on the decline
– TB
– Gastro viruses

Question 6

What was included in the WHO Report (2021) regarding the causes of disease and death in infants and small children? (5 years and below)

Answer 6

■ Every infant and child has the right to good nutrition according to the “Convention on the Rights of the Child”.

■ Undernutrition is associated with 45% of child deaths.

■ Breastfeeding (820,000) lives saved versus bottle feeding (however generic and stigmatising to assume everyone can breastfeed)

■ In 1955, 210 out of every 1000 babies died before the age of 5 (20.6 million). By 1995, this had fallen to 78 out of every 1000 (10.6 million) (and we expect that to continually decrease).

■ Overall, infant mortality is reducing but fate is determined by biology and environment of the child. Environment includes culture.

■ Developed countries-decline since 1940s is due to improved sanitation, housing, food and water supply and hygiene.

■ Also a decline in childhood diseases (scarlet fever, heart disease) worldwide, particularly in the developed world.

■ Over 50 years later, there is a similar decline in developing nations (just at a slower rate compared to developed countries because economic progress is not as fast).

■ But, not all data is recorded. Least developed nations have not progressed as much and rates are declining more slowly.

■ In lesser developed countries, the odds of survival are heavily stacked against the child.

Question 7

How can the environment work against infants and small children disease wise?

Answer 7

■ Local health facilities do not always exist. Where they do, they are ill-equipped, poorly supplied and inadequately staffed.

■ Often child struggles for life in a crowded, unhygienic and poorly ventilated environment (perfect environment for communicable diseases). Environments that are hot and crowded facilitate the transmission of respiratory infections and malaria.

■ Most of the deaths are preventable - 2 million a year die from diseases for which there are vaccines (it’s just because they are inaccessible).

■ More than 95% of children across the world were not immunised. Since the WHOs Expanded Programme (1974) approximately 20% remain not immunised

Question 8

What was included in the WHO Report (1998) regarding disease and death in infants and small children?

Answer 8

■ In the developing world, in 1995, about 7.5 million children died from one of the following 5 conditions:
1. Malaria
2. Malnutrition
3. Measles
4. Acute respiratory infections
5. Diarrhoea
■ Other major causes: pregnancy and childbirth, sepsis and AIDS (AIDS can be passed on through pregnancy).
■ Symptoms can be similar so not always possible to know the exact cause.

Question 9

What are the statistics seen in older children and young adults?

Answer 9

■ Between 5-19, health has improved generally across the world.

■ Time of experimentation- hazards, STDs, alcohol consumption, drug use etc.,

■ By 2025, this group is expected to account for a quarter of the world’s total population (hints where clinical areas should be looking at to improve on things and show it is under-researched).

■ Deaths are usually preventable but gender differences are apparent for health issues across cultures (e.g., pregnancy in women increases chances of illness and death and should be included for future research and interventions).

■ Population of women marrying under 20 is declining but in Sub-Saharan Africa approximately 20% of females between 15-19 have been/are married.

Question 10

What are the statistics seen relating to sexual health and pregnancy in Developing Countries? (World Health Statistics, 2019)

Answer 10

■ Every day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth.

■ 94% of all maternal deaths occur in low and lower middle-income countries.

■ Young adolescents (ages 10-14) face a higher risk of complications and death as a result of pregnancy compared to other older women.

■ Prevalence patterns for STDs in developing countries are 10-15 times higher for gonorrhoea and 3 times higher for chlamydia.

■ In developed countries, children have to stay in some form of work/education until 18. Higher education predicts lower rates of pregnancy at young ages and fewer pregnancy-related complications (not a cause but an association)

-This prevalence of issues between developed and and developing countries show that there must be factors inbetween mediating health & well-being e.g., accessibility to medication due to socioeconomic status

Question 11

What are the statistics relating to Working children and adolescence?

Answer 11

■ Number of working children aged between 5-17 is 152 million. The majority are in developing countries (Asia, Africa & Latin America) (International Labour Organisation, 2017).

■ The United Nations Economic Commission for Latin America and the Caribbean (2015) reported that poverty in those regions would rise by 10-20% without adolescents’ income (kids must work otherwise it has a detrimental impact on the family financially)

■ Hazardous industries, long hours with no rest and conditions are mentally/physically dangerous (can lead to accidents and deaths BUT no work=financial struggle which is another risk factor for illness and death) additionally stress could arise which can cause long-term health problems

Question 12

What is one of the most important contributors to ill health in Adults in Developed Countries, and what is associated with it?

Answer 12

■ In Western countries, obesity is one of the most important contributors to ill health.

■ Positive association between socio-economic status and obesity is apparent in men and women: more affluent (rich) and higher educational attainment more likely to be obese across cultures (Dinsa et al., 2012; Kumar, Mangla & Kundu, 2022).

■ Popkin et al. (2012) reductions in physical activity due to increased sedentary behaviour (office job). Since the 1970s, there has also been a shift towards increased reliance on processed foods especially since Brexit (Ruíz-Roso et al, 2020).

■ Obesity has progressed to a top-priority international issue (Haidar & Cosman, 2011).

■ Smoking and alcohol consumption increases the risk of some cancers and mental health disorders (can also cause obesity)

Question 13

Define HIV and AIDS

Answer 13

■HIV:
– Attacks the body’s immune system
– 5-10% of infections are transmitted from mother to child-pregnancy, delivery or breastfeeding (UNAIDS, 2012) (i.e., not simplistic to just breastfeed to save lives)

■AIDS:
– Developed when a person with HIV’s immune system is weak and they cannot fight off the disease

Question 14

What are the statistics when relating to health and wellbeing in Older people?

Answer 14

■ In developed nations, people live longer and are healthier-better standards of living and healthcare so developed countries have a particularly ageing population.

■ The ageing of the world’s populations is the result of the continued decline in fertility rates and increased life expectancy. This demographic change has resulted in increasing numbers and proportions of people who are over 60 (WHO, 2022).

■ Between 2015 and 2050, the proportion of the world’s population over 60 years will nearly double from 12% to 22%.

■ Family care has declined so social services and community care is utilised much more.

■ Arthritis, loss of sight and hearing are more common in this population.

■ Age-specific rates for cardiovascular disease in Japan and USA have halved in past 30 years (WHO Report, 1998).

■ Globalization, technological developments (e.g., in transport and communication), urbanization, migration and changing gender norms are influencing the lives of older people in direct and indirect ways.

Question 15

Who did COVID-19 impact the most?

Answer 15

■Global outbreak- deaths in at least 95 different countries.

■ Travelling largely contributed to the spreading of the virus ‘globalisation of health issues.’

■ Old people are/were more likely to be affected and people with pre-existing health conditions.

■ Italy has one of the world’s oldest population.

Question 16

What is Depression?

Answer 16

■ Widely used classification system- ICD-10 (WHO, 2023)
– Persistent sadness or low mood; and/or
– Loss of interests or pleasure
– Fatigue or low energy

■ At least one of these, most days, most of the time for a minimum of two weeks

■ Associated symptoms:
– Low self-confidence
– Suicidal thoughts/acts
– Disturbed sleep

Question 17

What is the prevalence of depression?

Answer 17

■ Looked at huge differences in prevalence across 14 cities of the world (WHO, 2001)
– 29.5% Santiago (Chile)
– 11.6% Ankara (Turkey)
– 2.3% Nagasaki (Japan)

■ Are differences across 18 countries
– Over 89,000 participants who have had a Major Depressive Episode across their lifetime (Bromet et al., 2011):
– 21.0% France
– 17.9% Netherlands
– 8.0% Mexico

-Highlights there are massive differences in different countries and therefore cultures

Question 18

What are some impacts and causes of mental health issues?

Answer 18

■ In Europe depressed feelings varied across countries but also genders (i.e., different between countries and within)

■ First symptoms of mental illness emerge before the age of 25 for half of those affected so the environment is important (people are developing mental health issues younger and younger and this may be due to things such as social media, cost of living crisis etc.,)

■ Trauma, childhood neglect, sexual abuse can trigger the development of mental health issues in later life (Sitko et al., 2014).

■ In the working age group (adults) more working days are lost due to mental disorders than physical conditions in developed nations (WHO Report, 1998) so important to figure out the factors on why this is the case.

Question 19

What is Schizophrenia?

Answer 19

■ Key symptoms (DSM-5; APA (2013)) (2 or more)
– Delusions
– Hallucinations
– Disorganised speech
– Disorganised or catatonic behaviour
– Negative symptoms
Essentially, out of touch experiences with reality

■ Social or occupational dysfunction
■ Significant duration
■ Different subtypes (e.g. paranoid, catatonic)

Question 20

What is the prevalence of schizophrenia across countries?

Answer 20

■Varies across 192 countries (WHO, 2004)

Highest:
– Indonesia
– Philippines
– Thailand
– Malaysia
– Sri Lanka

Lowest:
– Australia
– Iceland
– Monaco
– San Marino
– Malta

-There’s a clear link between the richness of countries and prevalence of schizhophrenia

Question 21

How do symptoms of schizophrenia differ in cultures?

Answer 21

■ Physical (somatic) symptoms
– More in non-western than western countries
– Chinese participants presented with more physical symptoms than Euro-Canadian outpatients (Ryder et al., 2008)

■ Feelings of guilt
– More in Swiss (68%) and Canadian patients (48%) than Iranian (32%) (Jablensky et al., 1981)

-Why do symptoms differ? Is there greater stigmatisation in Western Cultures due to norms?

Question 22

How is Dementia an umbrella term? (i.e., what comes under the umbrella?)

Answer 22

-Alzheimer’s disease
-Frontotemporal dementia
-Vascular dementia
-Dementia with Lewy’s body
-Parkinson’s disease dementia
-Corticobasal degeneration
-Progressive supranuclear palsy

Question 23

What is the prevalence of Dementia? (Prince et al., 2013)

Answer 23

■ Systematic review and meta-analysis to estimate prevalence of dementia in people aged 60 and over in 21 regions (1980-2009).

■ Estimated 36.5 million people with dementia worldwide in 2010.

■ Prevalence between 5-7% in most of the worlds regions.

■ Higher in Latin America and lower in sub-Saharan Africa.

■ In 2010, 58% of people with dementia lived in low or middle income countries and this figure is expected to rise.

Question 24

What is Treatment and Stigma like in developing countries?

Answer 24

■ There is stigma towards mental illnesses across the world but more so in the developing world (Abuhammad & Dalky, 2019) (areas with less education and lower socioeconomic status).

■ Beliefs about mental health are passed down through generations but in the developing world education in young people is beginning to change their views.

■ In developing world, young people often do not seek help for mental illnesses as they are afraid of the consequences (WHO Reports, 1998) (due to how they’re perceived).

■ Mental illness is often seen as God-given (i.e., this is their karma) and people are viewed as possessed (Starnino, 2016). This can prevent young people from getting married and settling down as they struggle to find a suitable partner.

■ In poorer countries, old and young people with mental illnesses become a burden on the family as they can’t work and earn a living (so the family have another person to look after rather than provide).

■ People are often referred to as ‘crazy’ and abandoned.

■ Organisations are working to improve the knowledge and awareness of mental health illnesses in developing countries

-Important to not develop interventions as a one-way solution but rather specific to the cultures

Question 25

What is the Pakistan Institute of Living and Learning?

Answer 25

– Not for profit research organisation established in 1998.

– Help with the well-being and resilience building organisation, dedicated to promoting mental health wellbeing across Pakistan.

– Events to raise awareness about issues surrounding mental illnesses.

-Their values equate to equality such as teamwork and lead by example

-Their objects include developing and testing culturally appropriate treatments (as tends to be eurocentric not translating well to less developing countries)

-Their mission is to improve the health and wellbeing of people and innovative and state of the art mental health care which is culturally appropriate

Question 26

What did Putnam (2001) say about Group Identity in the book Bowling Alone?

Answer 26

“People are not only more likely to participate in group activities when they are well but are also more likely to be well because they participate in such group activities.”

Question 27

Define identity

Answer 27

Identity is a way of making sense of who we are, in a way that reflects our interactions and responses to others (Wetherell & Mohanty, 2010).

Question 28

What is Self Categorisation Theory? (Turner et al., 1987)

Answer 28

People categorise themselves at different levels:
■ Superordinate e.g., human
■ Intermediate (social) e.g., culture
■ Subordinate (personal) e.g., individual identity (e.g., extroverted)

Question 29

What is Social Identity Theory? (Tajfel & Turner, 1979)

Answer 29

-Emphasizes intergroup processes and describes how identification contributes to differences in attitudes and behaviours towards ingroups (“us”) and outgroups (“them”).

■ Social identity research suggests that belonging to more social groups promotes better mental health (Cruwys et al., 2013).

Question 30

What is the link between Social Identity Theory and Health?

Answer 30

■ McIntyre, Elahi & Bentall (2016)- cultural identities play central role in mitigating the psychological precursors of mental health.

■ Disidentification and social disconnection after migrating could initiate mental health issues (due to loss of identity)

■ Jetten et al (2017)- suggests that social identities (e.g., societies) play an important role in managing and improving health and wellbeing.

■ Implicit Emirati identification associated with lower paranoia among female students in the UAE (UAE=either British or American curriculum). Implicit American identification associated with higher paranoia (Thomas, Bentall, Hadden, & O’Hara, 2017).

Question 31

Give examples of loss of identities

Answer 31

■ Family and Friends- not in close proximity (e.g., different countries), how easy is it to remain in contact?

■ Culture- food, clothes (i.e., harder/fewer access to these things once enjoyed culturally)

■ Hobbies- moving from a hot country where an individual plays lots of outdoors sports

■ Language- How easy is it to learn a new language? (also makes it harder to communicate for support when difficulties in learning new language)

■ Religion- moving from somewhere most people share your religion to being a minority

Question 32

What occurs between Young and Old People when moving countries and cultures?

Answer 32

■ Children moving cultures not received much attention until more recently.

■ Were treated as baggage that weighs down parent (Orellana et al., 2001). Old people are also often viewed as baggage.

■ But children become key mediators in migration- cultural and linguistic mediators (Antonini, 2010).

■ Easier for children to adopt new identities in comparison to the elderly-neuroplasticity, routine, knowledge etc.

■ Adolescents who travel alone experience significant developmental implications (Orellana et al., 2001).

Question 33

What happens when people move across cultures i.e., migrate?

Answer 33

■ People migrate for different reasons but often it can be a time of stress and anxiety- refuge, asylum, work (i.e., economic migration), retiring, studying etc.,

■ Birman and Trickett (2001) suggests that the reasons for migration will impact health outcomes. Forced migration rather than voluntary has a greater impact on people’s health and wellbeing. So some populations,
such as students, may not experience detrimental effects.

■ Transitions involve trying to understand what is happening to oneself (Zittoun, 2008).

■ Leads to acculturation- the psychological and cultural change experienced by an individual following the move to a new context.

Question 34

What are 4 Acculturation strategies identified by Berry (1997)?

Answer 34

1. Integration: an individual maintaining their old cultural identity whilst also forming and maintaining a new cultural identity. Is the most helpful for migrants’ social adjustment and mental health (Berry, Kim, Minde, & Mok, 1987)
2. Assimilation: refers to an individual embracing their new culture whilst no longer identifying with their original culture.
3. Separation: occurs when an individual rejects their new culture but maintains their original culture.
4. Marginalisation: the original and new culture are rejected by an individual.

Question 35

What is the most stressful acculturation strategy according to Berry?

Answer 35

-Marginalisation

■ Berry suggested this is the most stressful acculturation strategy - people who utilise this strategy usually have worse mental health, physical health and wellbeing.

■ Study assessing Asian-American student immigrants found that the students most at risk of mental health symptoms were those who reported to feeling trapped between the two cultures (Yeh, 2003).

■ Second-generation Greek-Canadians (Sands & Berry, 2009) and Korean-Canadians (Berry et al., 1987) reported worse mental health symptoms when they did not identify with their original or their new culture.

Question 36

Where does distinction lie?

Answer 36

■Distinction lies in the extent to which cultures promote individual values over collective values.

■Applies on a personal level - can be personally collectivist while culture is individualist. This is particularly important if individual has moved across cultures.

Question 37

What is an Individualistic culture?

Answer 37

■Individualist culture- goals of the individual
take precedence over the goals of the group. (I)

■Independent construct of the self (Markus & Kitayama, 1991).

■Oyserman et al. (2002)- Independent, Goal
driven, Competitive, Private, Self-improvement

■Most important concern is for yourself

Question 38

Give examples of individualistic cultures

Answer 38

■UK
■USA
■Australia
■Canada
■Netherlands
■Poland
■Italy

-These are countries which tend to be richer

Question 39

What is a Collectivist culture?

Answer 39

■Collectivist culture - goals of the group take
precedence over the goals of the individual.
(WE i.e., friends, family etc.,)

■Interdependent construct of the self (Markus & Kitayama, 1991).

■Oyserman et al. (2002)- Relations- family, Duty, Hierarchy (head can be eldest family member), Group Belonging

■Most important concern is for your social
groups

-Is this because they don’t have things like the finance to be independent? pushing community cohesion as a result? Would this social aspect create better mental health outcomes in this regard compared to individualistic cultures?

Question 40

Give examples of Collectivist cultures?

Answer 40

■Argentina
■Brazil
■India
■Indonesia
■Thailand
■Korea

-More likely to be developing countries

Question 41

What is seen in either Individualist or Collectivist Cultures?

Answer 41

■Young are more likely to work in collectivist societies.

■Also, families are often extended and adopt traditional roles. So women take care of family members in the home.

■Care is often distributed between family members rather than healthcare and people are more likely to suffer with preventable health issues.

■Individualism is associated with richer nations. People move away from family members and old people often rely on governmental care.

■Children are seen to be the responsibility of adults so adults need to look after their health.

Question 42

What health issues do Ethnic minorities face in the UK?

Answer 42

Ethnic minorities- worse mental health outcomes.

■There are clear disparities between the mental health symptoms of ethnic minority groups in the UK.

■Elevated rates of psychosis in ethnic minority populations (Van Os et al., 1996; Bhugra et al., 1997; Fearon et al., 2006)

King et al. (2005) large scale study using a general population sample in England:
■Found 12.1% of Black Caribbean subjects had at least one psychotic symptom, 9.9% of Pakistani participants and 6% of White participants (i.e., mental health issues are worse in ethnic minorities but this differs between groups).

■Davies et al. (1996) found Black African and Black Caribbean patients more likely to be detained under the “Mental Health Act, 1983” (their experience as an inpatient is likely worse too).

■So cultural differences exist within countries as well as between different countries.

■Most research within this domain has focused on adults.

■Students have also been extensively researched but it is important to note that students present elevated rates of mental illnesses (see Storrie, Ahern & Tuckett, 2010).

Question 43

What is the Ethnic Density Effect?

Answer 43

■‘Ethnic Density Effect’ – in areas where a low number of ethnic minority people reside, there are worse mental health outcomes among those minority groups (Halpern & Nazroo, 2000) (i.e., worse mental health problems in an area where people don’t look like you).

■Boydell et al., (2001)- 15 electoral wards in
London. Incidence of schizophrenia was greater in ethnic minority groups when they comprised a smaller proportion of the population.

■ Veling et al., (2008) - elevated rates of psychosis in ethnic minority groups apparent in Dutch neighbourhoods that were low in ethnic densities.

■ When people lived in neighbourhoods with a large proportion of their own ethnic group, their psychosis rates were not significantly different from Dutch natives.

■ Similar results in London - no differences in incidence rates of mental health in African-Caribbean individuals compared to White British individuals when African-Caribbean people comprised more than 25% of the neighbourhood (Schofield et al., 2011).

Question 44

What are the impacts of Ethnic Density in Students?

Answer 44

■Elahi et al (2022)–may not always be true for young people, British Pakistani students aged 16-18.

■Living and studying in town that is high in ethnic density.

■Identifying as Pakistani not necessarily associated with better mental health outcomes.

■Complexities in whether young people of ethnic minority, born in England, feel more English or Pakistani.

Question 45

What are Culturally Adapted Interventions?

Answer 45

■ A recent meta-analysis found that culturally adapted interventions were more efficacious than usual treatment in proportion to the degree of adaptation (Degnan et al., 2018).

■ Cognitive Behavioural Therapy (CBT) has been culturally adapted for psychosis in Black British, African Caribbean/Black African and South Asian participants (Rathod et al., 2013).

■ Also CBT has been culturally adapted for South Asian mothers with mild to moderate symptoms of post-natal depression (Khan et al., 2019).

■ Now being utilised in ‘ROSHNI2’ across the UK

Question 46

What is ROSHNI2?

Answer 46

■ Prevalence of postnatal depression in the UK is 15% overall.

■ Prevalence in British South Asian mothers is 19% but the group face barriers when accessing healthcare:
– Lack of culturally and linguistically appropriate services
– Lack of trust/fear of health services (could be due to mismatch of lack of linguistics)
– Lack of awareness of mental illnesses
– Stigma of mental illnesses

■ Positive Health Programme - 12 sessions specific to Asian culture e.g., religion, family.

■ 18 and over, meet DSM-5 criteria and child 12 months old or below (so they meet the homogeneity of the sample).

■ Assessed at baseline and follow-up (after 4 months).

■ Better PND outcomes.