A qualitative study to explore views of patients, carers and mental health professionals’ views on depression in Moroccan women

ABSTRACT

Moroccans make up a large immigrant population but no prior research has been carried out with them. This paper focused on understanding depression and its management among Moroccan women through exploration of their view of the cause, presentation and treatment of depression, as well as that of their carers and mental health professionals. This study was conducted in a Moroccan psychiatric hospital. Data was collected using audiotaped, semi-structured interviews carried out by psychiatrists, lasting 30 minutes. Participants included: (1) outpatients with a diagnosis of depression, (2) relatives of patients and (3) psychiatrists and psychologists. A total of 30 interviews were conducted in French/Arabic and translated into English. The analysis involved NVivo. The results highlight delayed presentations in the majority of patients and physical symptoms of depression with an emphasis on anger. Most patients and relatives ascribed depression to a social problem, with an emphasis on depleted patience. Patients’ expectations of management depicted a bio-psycho-spiritual-social model of illness. Although half of all patients mentioned the evil eye as a potential cause, few saw traditional healers. Patient socioeconomic conditions and insufficient psychological training render psychotherapy an unexploited tool. This study reflects the importance of educating professionals with regards to diagnosis and therapy in non-Western cultures.

KEYWORDS:

• Women
• depression
• culture
• traditional
• Moroccan

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Fatema-Zahra El Rhermoul was a final-year medical student from Southampton School of Medicine at the time of this project, and will be starting her foundation training at Imperial College Healthcare NHS Trust, London. She was born in Morocco and completed her bachelor degree in Human Physiology at Boston University in the USA. She then integrated Southampton school of Medicine. Fatema-Zahra has always been fascinated by the role of Moroccan women and psychiatry and upon discovering Professors David Kingdon and Farooq Naeem’s work on cultural psychiatry, reached out to them to explore Moroccan culture during her fourth-year research project.

Farooq Naeem is a Professor of Psychiatry at Queen’s University. He was trained in Psychiatry in Liverpool, UK. In addition to CBT for common mental health disorders, he received training in CBT for psychosis from Professor David Kingdon. Farooq pioneered techniques for culturally adapting CBT along with David Kingdon. He has conducted nearly 15 RCTs along with colleagues from Southampton and Manchester Universities in England. He is considered a leader in global mental health. He has worked as an expert in Lean Thinking and Quality Improvement in England, Canada and in some of the developing countries. He currently leads Canada–China and Canada–Middle East Collaborative that aim to culturally adapt and promote CBT. He works with a team of IT experts and has developed a CBT-based therapy program that can be delivered through web and apps, eGuru. He has written 6 books and has published more than 100 papers in peer-reviewed journals. His areas of research include CBT, Psychosis and Culture with an overall aim to improve access to CBT.

David Kingdon is Professor of Mental Health Care Delivery at the University of Southampton, UK, and honorary consultant adult psychiatrist for Southern Health NHS Trust. He has previously worked as Medical Director for Nottingham Health Care Trust and Senior Medical Officer (Severe Mental Illness) in the UK Department of Health. He now does policy and implementation work for NHS England and is editor of their mental health websites. He chaired the Expert Working Group leading to the Council of Europe’s Recommendation 2004(10) on Psychiatry and Human Rights (1996–2003). His research interests are in cognitive therapy of severe mental health conditions and mental health service development on which he has published over 150 papers, chapters and five books translated into languages including Mandarin, Japanese, Greek, Italian, and French. He received the Aaron T Beck award for exceptional cognitive therapy in 2015.

Lars Hansen is a consultant psychiatrist working in early intervention in psychosis in Hampshire, UK. He is also an Honorary Senior Lecturer at Southampton University. He trained in Copenhagen, Paris and London. His research is mainly around schizophrenia and suicide. Dr. Lars has published about 100 scientific articles on Psychiatry in various Journals and has written books of his own. He has presented his work at numerous meeting and conferences around the world as well as contributed to programs on BBC, ITV and Channel Four on mental health issues.

Jallal Toufiq is a professor of psychiatry at the Rabat Faculty of Medicine as well as the director of the Ar-Razi University psychiatric hospital in Morocco, and head of the national centre for drug abuse prevention and research in morocco. He is also an elected member of the International narcotics Control Board (INCB).