What is at stake? Exploring the moral experience of stigma with Indian-Australians and Anglo-Australians living with depression

Abstract

This article applies the framework of moral experience to examine the cultural experience of stigma with Indian-Australians and Anglo-Australians living with depression in Melbourne, Australia. To date few studies have examined this dynamic in relation to mental illness and culture, and no studies have applied this framework in a culturally comparative way. Based on 58 in-depth interviews with people with depression recruited from the community, we explicate how stigma modulates what is at stake upon disclosure of depression, participants' lived experience following that disclosure, and how practices of health-seeking become stigmatised. Findings show that the social acceptance of depression jars against participants' experience of living with it. Denialism and fear of disclosure were overwhelming themes to emerge from our analysis with significant cultural differences; the Anglo-Australians disclosed their depression to family and friends and encountered significant resistance about the legitimacy of their illness. In contrast, many Indian-Australians, especially men, did not disclose their illness for fear of a damaged reputation and damaged social relations. For Indian-Australians, social relations in the community were at stake, whereas for Anglo-Australians workplace relations (but not community relations) were at stake. Participants' experiences in these settings also influenced their patterns of health-seeking behaviors and age and inter-generational relationships were important mediators of stigma and social support. These findings illuminate how stigma, culture, and setting are linked and they provide critical information necessary to identify and develop customised strategies to mitigate the harmful effects of stigma in particular cultural groups.

Becoming a patient-illness representations of depression of Anglo-Australian and Sri Lankan patients through the lens of Leventhal’s illness representational model

“…Aligning with prior research, our results highlight that regardless of culture, the diagnosis of depression is associated with significant consequences including stigmatisation, discrimination as well as significant financial and social costs (Baines & Wittkowski, 2013; Brijnath & Antoniades, in press; Karasz et al, 2009; Yang et al, 2007). The communities differed in terms of what was considered to be a significant social consequence; Sri Lankans described the impact depression had on family harmony and standing in the community, whereas Anglo-Australians considered depression to permeate all aspects of life, with the most profound impact on professional performance.…”

How do mental health practitioners operationalise cultural competency in everyday practice? A qualitative analysis

“…However, research with Indian-Australian patients with depression suggest that neither culture, gender nor age affect the therapeutic relationship. Instead mutual understanding and rapport appear to be more important [ 59 ]. Whether this applies in other immigrant communities would require further investigation.…”

Stigma and discrimination related to mental health and substance use issues in primary health care in Toronto, Canada: a qualitative study

“…Stigma and discrimination exist worldwide, relating to both mental health (Mascayano et al, 2016;Pescosolido et al, 2008;Stuart et al, 2012) and substance use (Corrigan et al, 2017;Room, 2005;Van Boekel et al, 2013). Many factors influence the under-detection of mental illness in PHC settings, including differing socio-cultural expressions of mental illness (Brijnath & Antoniades, 2018;Kirmayer et al, 2017;Kirmayer & Pedersen, 2014), and the stigma associated with mental illness (Michels et al, 2006;Sapag et al, 2018). Stigmatizing attitudes and practices among health providers are welldocumented (Corrigan, 2004;Schulze, 2007), and clients of mental health services have reported stigmatizing treatment from both general practitioners and psychiatrists (Thornicroft et al, 2007).…”