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"Did you hear that your spirit was sad?" Culture is key when assessing the mental health of Australians



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If a doctor suspects that a patient may be at risk of depression, they will probably ask about mood, appetite, sleep patterns, and energy levels and concentration of the person, among other questions.

But the understanding of mental health is different between cultural groups. Thus, when a doctor keeps track of mental illness, it is important that you consider the patient's culture.

Many Aboriginal and Island Australians in the Torres Strait have an integral vision of health, which may differ from non-native Australians, who tend to adopt a more individualistic approach. With regard to mental health, social and emotional well-being is essential for the "spirit" of many aboriginal peoples and the islands of the Straits of Torres.

For the peoples of the first nations of Australia, routine detection tools have not always seemed appropriate. Previous research has found that many of the questions are lost in translation. Some people who should have scored a lot to indicate their risk of depression were much lower, losing treatment opportunities.



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When a diagnosis of depression is based on the answers to a set of questions, it is important that the language used in these questions will help the understanding of a person with mental illness.

The good news is that we now have a culturally specific validated tool, developed with members of the aboriginal community and the islands of the Torres Strait, to detect depression for indigenous Australians.

We anticipate this will allow doctors to identify many aboriginal people and people with mental illness who may have been diagnosed. And better our ability to accurately diagnose depression, the better our ability to deal with it.

The new projection tool

The specific cultural selection tool is called aPHQ-9. It is an adapted version of the existing tool, called PHQ-9: nine questions Australian and foreign doctors use routinely to check depression.

In our research published today in the Medical Journal of Australia, we have demonstrated that the specific tool for culture is effective in detecting depression among Aboriginal Australians and residents of the Strait of the Hill that live in urban areas, Rural and remote.

Family doctors now have access to a questionnaire specifically designed to detect depression among Aboriginal Australians and islanders in Torres Narrow.
From shutterstock.com

About 500 native participants and the Narrow Strait of Torres completed the new questionnaire and participated in a psychiatric interview structured by an expert doctor who had not seen their responses.

The results of the questionnaire were compared with the results of the interviews and it was found that the new tool reliably identified those who needed an additional assessment of their mood and those that probably did not have depression.

The culturally specific tool contains questions about the same topics as the original, but it has been presented in a way that is better aligned with the aboriginal understandings of mental health and well-being.



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How are the questions different?

Along with the differences in the understanding of mental health, there are important differences between the communication styles used in the non-autochthonous culture of Australia and those of the aboriginal populations and inhabitants of Narrow of the Towers. For example, white Australians often use a more direct communication style.

This example shows how the new elements of the tool are subtle differences in the cultural understanding of mental health and communication styles.

The original questionnaire asks "During the last two weeks, how many times did you bother with any of the following problems:

  • little interest or pleasure to do things?
  • feeling down, depressed or desperate? "

The adapted tool asks "During the last two weeks:

  • You've felt loose, did not you want to do anything?
  • Have you felt unhappy, depressed, really good, that your spirit was sad? "

Words such as "slack" and "spirit" are more consistent with native English. Spirit implies a holistic understanding of health, according to the health definition of many aboriginal and island Australians in the Strait of Torres.



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Another question is to ask about "leaving your family low." This also coincides with a holistic view of the health and the importance of the family in the Aboriginal culture and the island of the Strait of Torres, but it may seem out of place in a consultation with a non-Indian Australian.

Many aboriginal and island citizens of the Torres Strait will recognize that the language of the new tool has been developed respectfully in a culturally appropriate way. They are likely to have more confidence in the doctor and the service that manages the questionnaire and give answers that reflect their true mood.

Physicians now can use the new tool

During the period 2014-15, more than half (53.4%) of Aboriginal peoples and the islands of the Strait of Torres, aged 15 and over, reported that their satisfaction in life was eight out of ten or more. Almost one in six (17%) said they were completely satisfied with their lives. These positive data bear witness to the continued resistance of the aboriginal people and the inhabitants of the Torres Strait.

But, over the years, there were events such as colonization, racism, the relocation of people outside their lands and the forced removal of children from the family and community, which altered the ability to recover, Beliefs and cultural practices of many Aboriginal Australians and insulars in Torres Narrow. In turn, these factors have affected their social and emotional well-being.

This could explain why the aboriginal and island villages in the Torres Strait are twice as likely to be hospitalized for mental health disorders and die of suicide rather than their non-native counterparts.

Teens between 15 and 19 are five times more likely than non-indigenous teenagers to die of suicide.

The importance of being able to identify people with greater risk can not be underestimated.



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Although the selection of all aboriginal peoples and the islands of the Torres Strait, which present general depression practices, is not recommended, the new questionnaire is a free, easy-to-manage, culturally acceptable tool for examining peoples Aborigines and inhabitants of the Torres Strait with a high risk of depression.

Among people who are at greater risk of depression there are people with chronic illnesses, a history of depression and those who have been exposed to abuses and other adverse events.

Without a culturally appropriate tool, people with depression and suicidal thoughts may fly under the radar without having a culturally appropriate instrument. This questionnaire will make it easier for important discussions and the provision of treatment and services for the most needy.

If this article raises problems for you or for someone you know, call Lifeline at 11 11 14. Visit the Beyond Blue website to access specific resources for Aboriginal people and residents of the Torres Strait.

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