Transcultural Aspects of Psychiatric Disorders In Egypt

Depressive Disorders

Transcultural Aspects of Psychiatric Disorders In Egypt
Depressive Disorders
The prevalence of depression among a selected sample of an urban and rural population was found to be 11.4% and 19.7%, respectively. Dysthymic disorder was the most common diagnostic category in the urban population (4.1 %), while adjustment disorder with depressed mood was more frequently encountered in rural population (6.7%). Of the urban population, 1.9% were given the DSM-III-R diagnosis of major affective disorder compared to 3.3% of the rural subjects. The total prevalence was 2.5% . 

The cross-cultural comparison between Western and Egyptian populations revealed some differences. Egyptian studies showed that depression is manifested mainly by agitation; somatic symptoms; hypochondriasis; physiological changes, such as decreased libido and anorexia; and insomnia, which is not characterized by early morning awakening.
 

Symptoms such as ideas of guilt, sin and reproach are not common in Egyptian patients. Gawad and Arafa attempted to compare the Egyptian study with a similar Indian one and two British studies to find any variable qualitative differences between the Egyptian depressive and others.
They observed that symptoms of depressed mood, anxiety, somatic complaints and suicidal tendency are significantly more frequent among Egyptians compared to the British. In contrast, guilt, insomnia and hypochondriasis are significantly more frequent in the British study .
 

The increase in somatic symptoms can be explained by the seriousness with which people in a
given culture view “psychological stress” as compared to “physical illness.” Eastern cultures emphasize social integration more than autonomy (i.e., the family and not the individual is the unit of society). 

Dependence is more natural and infirmity less alien in these cultures. When affiliation ismore important than achievement, how one appears to others becomes vital and shame becomes a driving forcemore than guilt. In the same manner, physical illness and somatic manifestations of psychological distress become better understood,more acceptable, and evoke a caring response rather than a vague complaint of psychological symptoms that can be either disre-garded or considered a stigma of being “soft” or, even worse, “insane.”
Egyptian subjects tend to mask their affect with multiple somatic symptoms that occupy the foreground and the affective component of their illness recedes to the background. Accordingly, they either resort to general practitioners or primary healthcare physicians asking for unneeded investigations, which are costly for a developing country, or they ask the traditional healers to alleviate their sufferings. A considerable number did not ask for help at all, especially in rural populations, where absenteeism from work or inability to face day-to-day affairs are not much criticized by their community.
An Egyptian study was carried out to determine the effect of families’ expressed emotions and patients’ perception of family criticism in predicting depression and to evaluate transcultural differences in assessment of these measures. The results showed that criticism level that best differentiated relapsers and nonrelapsers was a score of 7, which is much higher than previously reported in Western studies, i.e., 2 to 3 critical comments. Expressed emotion is a prognostic factor that should be assessed with consideration of the specific culture and interfamilial
patterns. The use of perceived criticism in the prediction of relapse in depression is questionable.