The Synergistic Influence of Life Experiences and Cultural Nuances on Development of Depression: A Cognitive Behavioral Perspective

Abstract

The synergistic influences of everyday life experiences, societal expectations, and cultural nuances affect a person’s ability to successfully manage their life and remain mentally healthy. Persons from culturally and ethnically diverse populations may incur depression when societal expectations and cultural influences are in conflict with each other. Chronic stress, often-referred to as toxic stress, contributes to the development of depression as it is unrelenting, beginning in childhood and continuing into adulthood. This article discusses connections between societal expectations, persons’ cultural perspectives as well as the role that these connections may contribute to in the development of toxic stress and depression. Beck’s Cognitive Behavioral Theory provides a basis to describe the role that synergistic influences play in development of depression for culturally and ethnically diverse persons.

Introduction

The synergistic influence of everyday life experiences, societal expectations, and cultural influences affect a person’s ability to successfully manage their life and remain mentally healthy (Boyd, 2018). Persons from culturally and ethnically diverse population may incur depression when societal expectations and cultural influences are in conflict with each other (Warren, 2017). Health and well-being are contingent on how a person manages chronic stress (Selye, 1976). The appropriate management avoids the development and expansion of chronic stress that produces consequences of unrelenting daily wear and tear on the body (Félix et al., 2018). Early childhood stress including the failure to manage acute and chronic stress affects how children, adolescents, and adults learn, grow, and develop (The Lancet Psychiatry, 2019). Early brain development and functioning alter and this can affect how all ages of persons deal with stress throughout their lives (Franke, 2014; Healthy People, 2020). Early childhood losses may contribute to the development of depression as it affects how children, adolescents, and adults react and interpret their feelings and attitudes regarding themselves, their relationships with others, and their future outcomes (Franke, Rush, John, Brian, & Emery, 1987). Beck’s Cognitive Behavioral Theory provides a basis to describe the role that synergistic influences can contribute to the development of depression for culturally and ethnically diverse persons (Banzhaf & Kunes-Connell, 2019).

The basis of Beck’s cognitive behavioral theory

Cognitive Behavioral Theorists postulate that depressed persons think differently than those individuals who are not depressed (Warren, 2017). Moreover, it is this pattern of thinking that causes persons to become depressed (Beck, 1967). Franke et al., (1987) is the primary developer of cognitive behavioral theory (CBT). Beck hypothesizes persons’ depression grounds out of early childhood loss resulting in dysfunctional, automatic, uncontrollable, and negative thinking. Beck says that a person with depression has cognitions (i.e. schemas) that encompass core beliefs about self, the world environment, and the future (Beck, 1967; Franke et al., 1987). These core beliefs also known as the cognitive triad become automatic and spontaneous in persons who incur depression (Beck, 1967; Franke et al., 1987). This combination of automatic negative cognitions, stress, and development of depression within the lives of children and adults may increase the levels of toxic stress, which leads to problems with daily functioning and productivity for affected individuals (Shern, Blanch, & Steverman, 2014).

Depression is the number one disability globally with over 300 million persons incurring it annually (Alderdice & Newham, 2016; Asad et al., 2017; Healthy People, 2020). Less than half of all persons with depression receive appropriate treatment. Symptoms may include depressed mood most of the day, feelings of sadness, hopelessness, irritability and worthlessness, anhedonia, appetite and sleep disruptions, lack of concentration, and suicidal thoughts (American Psychiatric Association (APA), 2013).

Persons who are depressed are at increased risk for suicide: the World Health Organization (n.d.) indicates that somewhere around 800,000 adolescent and adults annually complete suicide across the world. Suicidal thoughts may become automatic for depressed persons and this intensifies their desire to attempt suicide (Warren, 2017 & Warren, 2018). It is critical that this automatic negative way of thinking be altered in order to help decrease risk of suicide (Warren, 2017). The use of Beck’s Cognitive Theory is a form of solution-focused psychotherapy that helps depressed persons to change their problematic ways of thinking and develop new healthy ways of thinking (Beck, 1967; Burns, 1999; Gillihan, 2018). CBT helps persons understand how their thoughts, feelings, and behaviors fit with each other and how they can change the negative thoughts into positive ones (Beck, 1967; Burns, 1999).

Another component in the development of depression often entails how a person manages stress in their lives. The early losses, cognitive distortions, and automatic negative thinking are additive factors in the stress levels of depressed persons and they combine to produce a toxic level of stress in the lives of depressed persons (Shern et al., 2014). The next section of this articles focuses on the connections between toxic stress and depression.

Toxic stress and depression

Toxic stress refers to the development and consequence of unaddressed negative cognitions due to the occurrence of stress, trauma, and violence in the lives of children and adults (Shern et al., 2014). While some levels of stress are normal and easily managed, a problem ensues when stress becomes chronic, intolerable, and toxic (Franke, 2014). Failure to address and manage stress, resulted in increased problems regarding normal mental and physical functioning (Felix et al., 2018). When stress occurs, cortisol levels initially rise but then stop working when stress becomes chronic (Boyd, 2018). This leads to a failure for the body to recover and return to health and homeostasis (Franke et al., 1987; Opel et al., 2019). This entire process alters and interferes with brain growth, immune functioning, and development in children (Boyd, 2018; Franke, 2014). It also affects how adults then respond and recover, as their ability to appropriately assess and respond to stress and daily life situations alters (Carbray, Cacchione, Limandri, & Warren, 2016). Their mental and physical health becomes negatively affected, productivity decreases, and they feel helpless and cannot think in a health manner and develop automatic negative thoughts about themselves, others, and the future (Beck, 1967; Boyd, 2018; Shern et al., 2014).

This entire process results in a continuing deterioration of mental and physical health that often leads to depressive symptoms and depression in both children and adults (Warren, 2018). Parents’ ability to provide quality parental skills for their children deteriorates. Thus, the cycle of negative thinking regarding the view of self, world environment, and the future permeates and intensifies in the lives of the parent and the child or children that parents are rearing (Shern et al., 2014). Without interventions, mental trauma results in lower productivity for individuals and in the communities in which they live (Boyd, 2018; Franke, 2014). Impoverished, ethnically diverse adults report that negative thinking in communities makes them feel depressed and helpless to escape the situation (Banzhaf & Kunes-Connell, 2019; Shern et al., 2014). Such things as bullying and violence contribute to increasing stress in communities (Romere, Bauman, Borgstrom, & Kim, 2018; Steinbrenner, 2010).

Racial and ethnic diverse perspectives

This article does not focus on particular cultural nuances, as they are too extensive to cover in this article. The focus is on the ideas regarding overall needs of persons who are racially and ethnically diverse and who may present to mental health providers in their practice settings. One of the most important concepts is that the occurrence of stress and depression contributes to trauma in the lives of persons across the lifespan and it is not an isolated event for one country or group of culturally and ethnically diverse individuals (Hatchel, Espelage, & Huang, 2018). The combination of depression and toxic stress contribute to the deterioration of individuals’ mental and physical health and well-being (Hatchel et al., 2018). Other investigators indicate that the experience and negative outcome of depression (including suicide rates) for persons in community settings intensifies when persons are poor, female, bullied, and are racially and/or ethnically diverse (Banzhaf & Kunes-Connell, 2019; Hong, Peguero, & Espelage, 2018; Jadhav & Weir, 2018; Murphy et al., 2018; Patterson, Abu-Hassan, Vakili, & King, 2018; Romere et al., 2018; Skoog, Hallström, & Berggren, 2017; Steinbrenner, 2010; Shern et al., 2014; The Lancet Psychiatry, 2019; U.S. Department of Health and Human Services (USDHHS), 2011; Vancampfort et al., 2018). Issues regarding increasing access to care for children, adolescents, and adults from racially and ethnically diverse population is another component to consider regarding healthcare implications for providers (USDHHS, 2001, 2011).

Persons from racially and ethnically diverse populations have a variety of norms and values that guide their ideas and attitudes toward learning and understanding mental health and treatments that are important to them (APA, 2013; Warren, 2015). Culture is an individual’s way to make sense out of the way they think, feel, perceive, and interact with others in their daily lives (Warren, 2018; 2015). Culture may encompass age, gender, religion, race, class, or any other way in which a person or group defines themselves (Warren, 2018, 2015). There may be a conflict between how racially and ethnically diverse persons perceive their depression and what healthcare providers perceive (APA, 2013). In fact, some persons may not see the need for treatment at all or may perceive it as an invasion into their lives (Purnell, 2019). They may also value the opinion of leaders or experts in their communities (APA, 2013; Purnell, 2019).

The understanding of cultural perspective is critical in increasing mental health providers’ knowledge in this area to help them understand the complete spectrum of patients’ lives in order to provide and develop culturally sensitive education, patient care, and research (Purnell, 2019). Culturally competent care means that a healthcare provider understands that there are differences in how persons perceive their mental and physical selves (Purnell, 2019). In addition, the provider is always continuing to learn more about the cultural nuances of their patients/clients (Warren, 2018). Most importantly, providers need to initially examine and assess their feelings, attitudes, and responses related to cultural perspectives that are different from what they are accustomed to and thus learn to feel a level of comfortableness when encountering these differences (Felix et al., 2018; Purnell, 2019; Warren, 2015). The implications for mental health education, practice, and research are numerous.

Implications for mental healthcare education, practice, and research

It is important that mental healthcare providers understand the synergistic influence involved in the development of depression in the lives of their patients, their families, and communities in which they reside (USDHHS, 2001; 2011). This information is relevant for education of students, faculty, practitioners, and researchers (Warren, 2015, 2018). For those providers who conduct therapy, the use of Cognitive Behavioral Therapy is an important evidence-based tool to use with individuals, couples, and families across the lifespan and in community settings (Franke et al., 1987; Boyd, 2018). This tool is an important one to use as an educational strategy for management of stress and negative thinking (APA, 2013). The reference list has several books that are valuable for use in psychotherapeutic settings as well as teaching students, and providing researchers with an understanding of the cognitive distortions and treatment approaches that comprise depression development. The Beck (1967), Burns (1999) and Gillihan (2018) books are helpful.

Another ready and easy access for diagnostic providers to understand cultural assessment can be located in The Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) (APA, 2013). Each of the disorder chapters discuss the cultural domains for persons. The Cultural Formulation and Glossary of Cultural Concepts of Distress is located in one of the Appendices of the manual.

Conclusion

This article presented information on the synergistic influence that comprise the development of depression. Beck’s Cognitive Behavioral Theory provided the framework regarding how depression develops and alters the ability of children and adults to grow and become productive throughout their lives. The manifestation and negative outcome of depression is different for persons from racially and ethnically diverse populations. This article provides initial suggestions how mental health providers can continue to grow and develop in their knowledge about the domains involved in the development and treatment of depression. Implications for mental health providers include an increased understanding of how depression develops, what interventions may be used to treat the distortions that patients have, and an understanding of the cultural nuances involved in education, practice and research settings.