Becoming a patient-illness representations of depression of Anglo-Australian and Sri Lankan patients through the lens of Leventhal’s illness representational model

Abstract

Background: Depression is prevalent globally. While the uptake of mental health services is poor in the general community, the lack of service engagement is particularly profound in migrant and refugee communities. To understand why there is under-utilisation cross-cultural comparisons of how people make sense of mental illnesses such as depression are essential. Aims: To verify how differing cultural aetiologies about depression influence mental health service use, this study investigated illness representational models of depression held by Sri Lankan migrants and Anglo-Australians living with depression. Methods: In-depth interviews ( n = 48) were conducted with Sri Lankan migrants and Anglo-Australians living with depression to explore their illness beliefs. Data were analysed using Leventhal’s illness representational model. Results: Significant overlaps in illness representational models were noted but distinctive differences were found between causal and chronicity beliefs; Sri Lankan migrants more frequently endorsed depression as a time-limited condition underpinned by situational factors, whereas Anglo-Australians endorsed a chronic, biopsychosocial model of depression. Discussion and conclusion: Findings highlight the importance of forging a shared understanding of patient beliefs in the clinical encounter to ensure that interventions are coherent with illness beliefs or at least work towards improving mental health literacy. Differences in illness beliefs also provide insights into possible interventions. For example, psychosocial interventions that align with their illness beliefs may be more suited to Sri Lankan migrants than pharmaceutical or psychological ones.