The sociocultural approach looks at the role that environmental factors play in our mental health.  This includes not only stressors in our environment but also the resources in our community that are available to help us cope with those stressors. Sociocultural models of mental illness tend to be more holistic than the arguments proposed by other approaches.

Vulnerability models are not only linked to gender differences. They have been used to explain both gender and class differences in the prevalence of depression.  A study by Hays, Turner & Coates (1992) found that gay men diagnosed with HIV were more likely to exhibit depression, as well as a faster onset of full-blown AIDS when they were rejected by family members and thus lacked protective factors.

One of the limitations is how we measure "stress." Holmes & Rahe's Social Readjustment Rating Scale has ranked the stress levels of different life events to determine how much stress an individual has experienced in the past year.

Although this assessment is frequently used, there is evidence that shows that smaller more consistent stressors may play an even more significant role in one's overall mental health. This could be because larger life events can eventually be interpreted and seen as having significance or meaning, whereas the hassles are seen as irritation and without purpose.

Another limitation is that studies of vulnerability models are often case-studies, making it difficult to generalize to larger populations. However, it does appear that environmental stressors do have universal effects on our physiology.  Although protective factors may vary among communities, research on stress may help us to understand the relationship between our physiological response to stress and the onset of the disorder.  

Vulnerability models are unable to explain why some people develop depression when exposed to environmental stressors, but they do potentially help us to potentially prevent the disorder by providing more protective factors for individuals who may be at risk for the disorder. As with the other approaches, it is difficult to argue social stressors are the cause of depression. It is only with the interaction of biological factors that the stressors appear to lead to the disorder.

Cultural models of depression

One of the limitations of many of the theories of the etiology of disorders is that they do not account for cultural differences.  Different cultures manifest different symptoms for what psychologists believe is the same disorder. 

Early research in abnormal psychology argued that disorders like depression were absent from many cultures.  This was because psychologists were adopting an etic approach to their research – that is, they were using Western designed tests and looking for a Western set of symptoms.  Sociocultural researchers criticized this approach - arguing that affective symptoms are typical of individualistic cultures where people are encouraged to "express themselves," but may be less typical in collectivistic cultures. It may also be the case that it is not the symptoms that are really that different among cultures, but rather what patients report is what is different.

Parker, Cheah & Roy (2001) studied two sets of depressed out-patients, both living in their home countries.  The first group was Malaysian Chinese and the second group was Australian Caucasian. In both cases, they were asked what their primary symptom was which led to them seeking medical help.  In addition, they were asked to complete a survey of both physiological and cognitive symptoms of depression – ranking each symptom with regard to intensity and distress.  The results showed that 60% of the Chinese and only 13% of Australians identified a somatic symptom as their reason for seeking help.  Australians were more likely to identify mood or cognitive difficulties. However, when comparing the inventory of symptoms that they experience, there was no significant difference in the number of somatic symptoms between the two groups. The Chinese did, however, report a much lower rate of cognitive symptoms.

Kirmayer (2001) argues that cultures have "explanatory models" for disorders. His theory is that cultures create socially acceptable sets of symptoms for mental distress. Since cultures are continually evolving, especially in the era of globalization, these explanatory models may change.  This change in explanatory models may account for a seeming "rise" in the disorder within a culture.  In the case of Japan, depression used to be seen as a need for spiritual guidance and/or time with family. They did not see depression as a "disorder," but rather sadness was seen as a way of tightening one's bonds with family and the community. Sadness, grief, and melancholy were accepted as inevitable parts of life. As Japan has become more Westernized, Western symptoms of depression have become more common.

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Prevalence of disorders