Using consumer perspectives to inform the cultural adaptation of psychological treatments for depression: a mixed methods study from South Asia.
BACKGROUND
Integrating consumer perspectives in developing and adapting psychological treatments (PTs) can enhance their acceptability in diverse cultural contexts.


OBJECTIVE
To describe the explanatory models (EMs) of depression in South Asia with the goal of informing the content of culturally appropriate PTs for this region.


METHODS
Two methods were used: a systematic review of published literature on the EMs of depression in South Asia; and in-depth interviews with persons with depression and family caregivers in two sites in India. Findings from both were analysed independently and then triangulated.


RESULTS
There were 19 studies meeting our inclusion criteria. Interviews were conducted with 27 patients and 10 caregivers. Findings were grouped under four broad categories: illness descriptions, perceived impact, causal beliefs and self-help forms of coping. Depression was characterised predominantly by somatic complaints, stress, low mood, and negative and ruminative thoughts. Patients experienced disturbances in interpersonal relationships occupational functioning, and stigma. Negative life events, particularly relationship difficulties, were perceived as the main cause. Patients mostly engaged in distracting activities, religious practices, and received support from family and friends to cope with the illness.


CONCLUSIONS
The primary data are entirely from India but the studies from the literature review covering South Asia are consistent with these findings. This study also does not include literature in local languages or explore how consumer perspectives change over time.


CONCLUSIONS
EMs can inform cultural adaptations to PTs for depression in South Asia by defining target outcomes, content for psycho-education, and culturally appropriate treatment strategies.
Columbia University, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 11, New York, NY 10032, USA. Electronic address: aggarwa@nyspi.columbia.edu.
Neil Krishan
NK
Aggarwal
Parivartan Trust, Plot no. 20, Vijaya Villa Survey, No. 235A, Sanjay Park, Lane no. 1, Lohgaon Airport Road, Pune 411014, India; Sangath Centre, 841/1 Alto-Porvorim, Sangath, Goa 403521, India. Electronic address: madhs@hotmail.com.
Madhumitha
M
Balaji
Samarth, No. 100, Warren Road, Mylapore, Chennai 600004, India. Electronic address: shubakumar@samarthngo.org.
Shuba
S
Kumar
Samarth, No. 100, Warren Road, Mylapore, Chennai 600004, India. Electronic address: ranimohanraj@samarthngo.org.
Rani
R
Mohanraj
University of Liverpool, Institute of Psychology, Health & Society, Child Mental Health Unit, Alder Hey Children׳s NHS Foundation Trust, Mulberry House, Eaton Road, Liverpool L12 2AP, UK. Electronic address: Atif.Rahman@liverpool.ac.uk.
Atif
A
Rahman
Department of Counselling and Clinical Psychology, Teachers College, Columbia University, 525W 120th Street, New York City, NY 10027, USA. Electronic address: VERDELIH@childpsych.columbia.edu.
Helena
H
Verdeli
Academic Unit of Psychiatry, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK. Electronic address: R.Araya@bristol.ac.uk.
Ricardo
R
Araya
Health Net TPO, Lizzy Ansinghstraat 163, 1073 RG Amsterdam, The Netherlands; Center for Global Mental Health, Institute of Psychiatry, King's College London, Box P029, De Crespigny Park, London SE5 8AF, UK. Electronic address: mark.jordans@hntpo.org.
M J D
MJ
Jordans
Sangath Centre, 841/1 Alto-Porvorim, Sangath, Goa 403521, India. Electronic address: neerjachowdhary@hotmail.com.
Neerja
N
Chowdhary
Sangath Centre, 841/1 Alto-Porvorim, Sangath, Goa 403521, India; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7H, UK. Electronic address: vikram.patel@lshtm.ac.uk.
Vikram
V
Patel
D000223:Adaptation, Psychological; D000328:Adult; D017028:Caregivers; D003466:Cultural Characteristics; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D007194:India; D007398:Interpersonal Relations; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D057545:Social Stigma
Depression; Explanatory models; Psychological treatments; South Asia