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Gendered portraits of depression in Swedish newspapers
Umeå University, Faculty of Social Sciences, Department of Sociology.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
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2008 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 18, no 7, 962-973 p.Article in journal (Refereed) Published
Abstract [en]

Mass media are influential mediators of information, knowledge, and narratives of health and illness. In this article, we report on an examination of personal accounts of illness as presented in three Swedish newspapers, focusing on the gendered representation of laypersons' experiences of depression. A database search identified all articles mentioning depression during the year 2002. Twenty six articles focusing on personal experiences of depression were then subjected to a qualitative content analysis. We identified four themes: displaying a successful facade, experiencing a cracking facade, losing and regaining control, and explaining the illness. We found both similarities and differences with regard to gendered experiences. The mediated accounts of depression both upheld and challenged traditional gender stereotypes. The women's stories were more detailed, relational, emotionally oriented, and embodied. The portrayal of men was less emotional and expressive, and described a more dramatic onset of depression, reflecting hegemonic patterns of masculinity.

Place, publisher, year, edition, pages
Newbury Park, Calif.: Sage Publications , 2008. Vol. 18, no 7, 962-973 p.
Keyword [en]
depression, experiences, gender, illness and disease, media
Identifiers
URN: urn:nbn:se:umu:diva-10126DOI: 10.1177/1049732308319825OAI: oai:DiVA.org:umu-10126DiVA: diva2:149797
Available from: 2008-06-18 Created: 2008-06-18 Last updated: 2011-04-11Bibliographically approved
In thesis
1. Struggling for clarity: cultural context, gender and a concept of depression in general practice
Open this publication in new window or tab >>Struggling for clarity: cultural context, gender and a concept of depression in general practice
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Many depressed patients attend primary health care, and minority-group patients often see general practitioners for depressive symptoms. The diagnosis and classification criteria of depression and guidelines for management are based on symptoms. However,expressions of depression can vary with culture and gender but the diagnostic tools and guidelines are not adapted to gendered or cultural context and have shown to be poorly applicable in clinical practice. The purpose of this thesis was to analyse how socio-cultural factorswith focus on gender and ethnicity and their intersections- could influence the concept of depression from the perspectives of the patient and patient descriptions, of medical experts as well as general practitioners. By viewing these different perspectives I have tried to illustrate how depressive symptoms are expressed and interpreted in different gendered socio-cultural contexts and how they become a disease entity. Furthermore, I want, in particular, to illustrate a variety of difficulties that GPs may face during the process of care when meeting and treating men and women from different countries showing symptoms which may indicate depression.

Study I. The aim of the study was to explore the reasons for and patterns of attendance among Roma women in primary health care and to shed light on health problems of the Roma. Four Roma women were interviewed in-depth. The data were audiotaped and analysed according to Grounded Theory. The resuIts showed that the daily life of women was characterized by marked hierarchical order and rules formed by gender, age and the collective culture. Young women had most rules to follow and if the rules were broken it was easy to end up outside the collective and display depressive symptoms or pain. The gendered, collective culture could both construct and/or form the concept of illness among the Roma women.

Study II. The aim of the study was to highlight the gendered representations of lay persons´ experiences of depression by drawing on personal stories of depression that appeared in Swedish newspapers. The data were then subjected to a Qualitative Content Analysis. The mediated accounts of depression both upheld and challenged traditional gender stereotypes. The women’s stories were more detailed, relational, emotionally oriented, and embodied. The portrayal of men was less emotional and expressive, reflecting hegemonic patterns of masculinity. The media representations of gendered healthrelated beliefs and behaviours may influence the way patients, physicians and other health care professionals understand and communicate about issues of mental health and depression.

Study III. The aim of the study was to explore how authors of medical articles wrote about different symptoms and expressions of depression in men and woman from various ethnic groups as well as to analyse the meaning of gender and ethnicity for expressions of depression. Through a search in the medical database PubMed 30 scientific articles were identified and included in the analysis. The result and the discussion section of each article was analysed with Qualitative Content Analysis. The analysis showed that culture and gender formed the expressions of depression, how depression was interpreted and the diagnosis of depression. The analysis of the articles identified a western point of view, which could lead to “cultural or gender gaps” and which could also influence the diagnosis of depression.

Study IV. The aim of the study was to make a qualitative analysis of medical research articles in order to get a broader view of explanations of depression in men and women in various ethnic groups. Through a search in the medical database PubMed 60 scientific articles were identified and included in the analysis. The result and the discussion section of each article was analysed with Qualitative Content Analysis. The explanations for depression in our study have a strong emphasis on socio-cultural causes with focus on depressed persons from non-western minority groups. Even so, discussion about cultural or gendered explanations for depression was almost missing. We interpreted that the view of minority groups in the articles could be described as a view of “others”. The view of “othering” increases risks for cultural and gender gaps, such as biased scientific knowledge, medicalization of social problems, cultural stereotypes, risk for misdiagnosis of men´s depression, and affects the quality and care of depressed patients.

Studv V. The aim of the study was to explore and analyse how GPs think and deliberate when seeing and treating patients from foreign countries who display potential depressive symptoms. The data were collected in focus group and individual interviews with GPs in northern Sweden and analysed by Qualitative Content Analysis. The study showed that patients’ early life events of importance were often unknown which blurred the accuracy. Reactions to trauma, cultural frictions and conflicts between the new and old gender norms made the diagnostic process difficult. The patient-doctor encounter comprised misconceptions, and social roles in meetings were sometimes confused. GPs based their judgement mainly on clinical intuition. Tools for management and adequate action were diffuse. There is a need for tools for multicultural, general practice care. It is also essential to be aware of the GPs’ own conceptions to avoid stereotypes and not to under-or overestimate the occurrence of depressive symptoms.

Conclusion: The concept of depression is always situated. The gendered socio-cultural norms, beliefs and behaviours can both construct the concept of illness and influence patients’ experiences and expressions of depression as well as form the patient-doctor encounter. The knowledge of medical “experts” is based on a dominating, western view of knowledge, which defines diagnosis and classification criteria of depression as well as guidelines for management. GPs are struggling for clarity between the medical and the clinical practice. The multicultural appearances of depressive symptoms are a challenge for GPs but it is a challenge for society to improve the life circumstances which can lead to a depressed mood and suffering.

Place, publisher, year, edition, pages
Umeå: Umeå university, 2009. 54 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1296
Keyword
depression, gender, ethnicity, qualitative research, general practice
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:umu:diva-26189 (URN)978-91-7264-869-2 (ISBN)
Distributor:
Allmänmedicin, 901 87, Umeå
Public defence
2009-10-23, E04, Umeå Universitet, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-10-06 Created: 2009-09-29 Last updated: 2010-01-18Bibliographically approved
2. Träffad av blixten eller långsam kvävning: genuskodade uttryck för depression i en primärvårdskontext
Open this publication in new window or tab >>Träffad av blixten eller långsam kvävning: genuskodade uttryck för depression i en primärvårdskontext
2010 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[en]
Struck by lightning or slowly suffocating : gendered expressions of depression in a primary health care context
Abstract [en]

Depression is a common mental health problem in primary health care. One third of the Swedish population is expected to experience depression at some point in their lives. The understanding of depression has expanded, both from a lay and primary health care perspective. The number of persons considering themselves as depressed, receiving the diagnosis, and getting treatment for it has increased steadily over the last decades.

Unchanged, however, is that depression is diagnosed twice as often in women as in men, while twice as many men as women commit suicide. These gender differences appear in adolescence. In earlier research biomedical, psychological, and social-cultural explanations of gender differences have been discussed. Patient’s own perspectives have more seldom stood in focus, and men’s narratives in particular are still scarce. In this thesis, gender, i.e. how to be a woman or a man, is considered as a construct, formed and negotiated in social interaction.

The aim of the study is to explore the gendered face of depression from a patient perspective: How is depression expressed and explained by patients in primary health care, by women and men, adults and adolescents? How are depressed women and men portrayed in the media? How do patient and media accounts of depression compare with the perspective offered in medical research articles?

Method and material The analyses are based on data from three different sources: patient narratives, newspaper portrayals and scientific medical articles.

– 37 in-depth interviews were undertaken with primary health care patients diagnosed with depression. Informants were chosen to include both men and women, grown-ups (Studies I + II) and young adults (Study V) of varying occupational and social class backgrounds. Data were analyzed according to grounded theory.

– 26 articles portraying lay informants with depression (Study III) were drawn from three major Swedish daily newspapers by a search of database Mediearkivet 2002. The articles were analyzed by qualitative content analysis.

–82 scientific articles concerning depression in relation to gender were identified in a PubMed search 2002. The understanding of depression in these articles was explored and compared with findings in the grown-up patient narratives and in the media portrayals by means of discourse analysis (Study IV).

Findings Study I captured women’s and men’s formulations of their experiences of depression. To be marked with demands constituted a central experience for both women and men, but the outward manifestations differed in relation to gender as well as to class. Home and work had different priority. Men talked more about physical distress (often chest pain) than about emotions. Women readily verbalized emotional distress – shame and guilt – while physical symptoms were vague and secondary (often about the stomach). Men dealt with insecurity by aggrandizing their previous competence, women by self-effacement.

Study II disclosed gendered trajectories into depression. Four symbolic illness narratives were identified: struck by lightning, nagging darkness, blackout and slowly suffocating. Most of the men considered their bodies suddenly “struck” by external circumstances beyond their control. The stories of women in the study were more diverse, reflecting all four illness narratives. However, the women had a tendency to blame their own personality and to describe depression as insidious and originating from the inside. The women expressed feelings of guilt and shame but also conveyed a personal responsibility and concern with relationships.

Study III identified four themes in media portrayals of depression: displaying a successful facade, experiencing a cracking facade, losing and regaining control and explaining the illness. The mediated image of depression both upheld and challenged traditional gender stereotypes. The women’s stories were more detailed, relational, emotionally oriented and embodied. The portrayal of men was less emotional and expressive, and described a more dramatic onset of depression.

Study IV revealed gaps in how depression in relation to gender is understood by the patients, the media, and the medical research establishment. There were differences in recognition, in understanding of the reasons, and in contextualization of depression. Although women and men described different symptoms and reasons for falling ill, in scientific articles these gendered differences were conceptualized mainly in terms of hormones and other biological markers.

Study V elucidated the impact of gender on adolescent depression. The young women and men were all striving to be normal, influenced by demanding media images, confronted by identity trouble, and overwhelmed by feelings. They had dreams of an ordinary family and described normative expectations. Getting a safety net of friends and other adults was a way out. Both the young women and men were eager to communicate their distress when given the opportunity. This seemed especially important to some of the young men, who in talking about their emotional problems transgressed gender norms.

Conclusions Patient perspectives enrich the understanding of gendered expressions of depression by making visible transgressions of and breaks with stereotype gender norms. Gender awareness is an important key in clinical consultation. To recognize gendered narratives of illness might have a salutary potential, making depression more visible among men, and relieving self-blame among women. By re-evaluating restrictive gender patterns, the clinician might encourage development of healthier practices of how to be a man or a woman, a development especially important for adolescents.

An integrated model for understanding biological, gender and cultural aspects of depression has yet to be developed. As general practitioners we have a unique possibility to see and to study the whole individual in her social and cultural context.

Place, publisher, year, edition, pages
Umeå: Umeå university, 2010. 59 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1325
Keyword
depression, gender, class, shame, adolescents, media, primary health care, consultation, grounded theory, qualitative research
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:umu:diva-30910 (URN)978-91-7264-935-4 (ISBN)
Public defence
2010-02-12, Betula, NUS, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2010-01-22 Created: 2010-01-21 Last updated: 2011-04-18Bibliographically approved

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Bengs, CaritaJohansson, EvaLehti, ArjaHammarström, Anne

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