“Cultural Toolboxes” of Mental Health Care: Depression and Public Construction of the Set of Appropriate Responses in 17 Countries

Central to understanding illness behavior is an understanding of how the public constructs what constitutes an illness and what are appropriate responses to potential illnesses. However, we know little about these cultural toolboxes of scripts, schemas and habitus for depression.  Here we ask: How do individuals’ construct the meaning and response to a set of behaviors that are consistent with DSM-IV diagnoses of major depression? And, how do individuals’ past experiences with mental health problems shape these patterns? Using data from the Stigma in Global Context – Mental Health Study (SGC-MHS), we examine how nationally representative samples of individuals in 17 countries label and suggest what individuals should do, if anything, in response to a vignette describing an individual meeting a criteria for a depression diagnosis.  The ability to examine social construction in a standardized survey results from the design of the instrumentation.  The vignette was followed immediately by an open-ended question, without prompts or lists of possibilities, asking what actions should be taken.  Using latent class analysis, we construct the patterns of suggested actions that make up the cultural toolboxes of lay diagnosis of depression across countries, examining their similarities and differences cross-nationally. Our results show that lay diagnosis is embedded in a broader context of national medical cultures and individual cultural beliefs about mental illness.