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MDD: Sociocultural explanations

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  • Module: Major Depressive Disorder/
  • MDD: Sociocultural explanations

Sociocultural etiologies of Major Depressive Disorder

The sociocultural approach looks at the role of environmental factors in the onset of depression. This is a more holistic approach to understanding the disorder. In this component, we will look at the role of poverty and adverse childhood experiences.  We will also look at the role of culture in the disorder.

Key concepts

Before completing the module below, please read the section of the textbook called the Sociocultural approach to depression. When reading this section, please make note of the following important concepts:

  • Adverse Childhood Experiences (ACEs)
  • Diathesis-Stress model
  • Domino causality
  • Explanatory models
  • Vulnerability models

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The role of environmental factors

Please watch the following video with Nadine Burke Harris. You may have already seen this video if you are also studying the health option. If so, watch it again as a refresher of the concept of Adverse Childhood Experiences [ACEs].

When you have finished, read through the study by Felitti et al (1998) that Burke Harris discusses in the video.

Thinking critically

Try to answer the following questions on your own without looking at the answers.  The answers provided are a way for to check your own thinking and learning.

1.  What would be the difficulty of applying Burke Harris's plan to give an ACE's inventory to all children coming in for treatment?

2.  Some have argued that Felitti's original 10 ACE's are culturally or class-biased.  What are some examples of Adverse Childhood Experiences that may have been left off the list?

3. Another criticism of using such a list with patients is that it doesn't take into account protective factors.  What is meant by this statement?

Thinking about causality

Why the nature vs nurture debate is over

Before reading through this section, be sure to read the key study by Brown and Harris (1978).

When I was studying psychology, the big debate was always whether behaviour was because of one's "nature" (genetic or other physical causes) or one's "nurture" (environmental and learned behaviour).  Today, psychologists no longer have this debate.  It is now understood that biological and environmental factors work together to produce behaviour. 

Much of mental illness is an example of "domino causality."  In simple linear causality, one thing directly makes another thing happen and the effects end there. But it is very common for effects to become causes of new events.

What is domino causality?

  • A sequential unfolding of effects over time
  • An extended linear pattern that results in direct and indirect effects
  • Typically has a clear beginning and a clear ending
  • Can be branching where there is more than one effect of a cause (and these may go on to have multiple effects and so on.)
  • Branching forms can be traced back to "stem" causes
  • Allows researchers to predicted anticipated outcomes and find multiple potential places to intervene in order to prevent a negative outcome.

So, the question is - what is the link between Burke Harris and Brown & Harris, besides that they both have the name "Harris?"

You should notice that a common vulnerability factor for women in Brown and Harris's study was the loss of one's mother before the age of 11. This is an example of an ACE.  How is this linked to depression?  This is where we need to link the biology and the sociocultural factors.

    Domino causality and depression

    Researcher Michael Meaney (1988) found that in rats, stress in childhood led to hippocampal cell death and cognitive impairment in old age.  More importantly, he found that this was not the result of damage to the hippocampus in the first few weeks of life, but a gradual process caused by an over-active HPA Axis.  How did that happen?

    Mother rats spend a lot of time licking, grooming, and nursing their pups.  Highly nurtured rat pups tend to grow up to be calm adults, while rat pups who receive little nurturing tend to grow up to be anxious. This makes sense from an evolutionary point of view.  If the rats do not have a parent to take care of them, they need to be ready to defend themselves against predators and cannot simply trust that mom will take care of everything!

    This is an example of epigenetics. The grooming of the baby rats causes the GR gene to be expressed.  This gene regulates glucocorticoid receptor sites - that is, it helps to regulate the stress response. When rats are not groomed, this gene is not turned on, leading to a more sensitive HPA axis.

    Brown and Harris's study was carried out before the Human Genome Project - and before we really understood how powerful epigenetics really is.  What would this domino causality potentially look like?

    Death of a parent  > stress > gene expression > HPA axis dysfunction > high levels of cortisol > hippocampal cell death > Major Depressive Disorder

    And when you look at the study by Brown and Harris, you will see that it was not only about large stressors, but about provoking agents that also led to acute stress - that is, the daily hassles which these women faced. If you have an overactive HPA axis, this means that those stress hormones are causing problems for your overall health including, potentially, major depression.

    Further research linking ACEs and MDD

    Chapman et al (2004) A sample of 9460 adults at a healthcare clinic in San Diego. The study was a cross-sectional study - that is, a questionnaire was administered asking them about ACEs and lifetime as well as recent episodes of depression. The researchers found a strong, dose-response relationship between the ACE score and the probability of lifetime and recent depressive disorders (P<0.0001).

    Thompson et al (2018) 9,421 American adolescents studied over a period of 13 years. Examined the link between the number of ACEs and suicidality. Found that compared with those with no ACEs, the risk of seriously considering suicide or attempting suicide in adulthood increased more than threefold among those with three or more ACEs.

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    The role of culture

    Read through the following presentation on the role of culture.  This topic will be discussed in more detail in the "prevalence" part of this module. For now, read through this carefully and be able to explain the two key terms: explanatory models and globalization.

    Checking for understanding

    You have been asked to write an essay that would evaluate the sociocultural approach to the explanation of one disorder. For each of the following evaluation points, explain what it means with regard to theory or research in the sociocultural approach.

    1

    The sociocultural approach takes a more holistic approach to explaining MDD than other approaches.

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    2

    Much of the research done in the sociocultural approach has high ecological validity, but this can also be problematic.

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    In the sociocultural approach, there are some problems with construct validity.

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    4

    Cross-cultural research is problematic in explaining the origins of MDD.

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    5

    Sociocultural theories tend to be descriptive rather than explanatory in nature.

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    Continue to Research methods and ethics