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"Do you feel that your spirit was sad?" Culture is crucial to assessing the mental health of Australian indigenous people



If a doctor suspects that a patient is at risk for depression, among other issues, one may be asked about mood, appetite, sleep patterns, energy levels and concentration.

But the understanding of mental health differs from cultural groups. Therefore, when a physician conducts mental illness testing, it is important to consider the patient's culture.

Many Australians Aboriginal and Torres Strait Islanders take on a holistic view of health, which may differ from non-Indigenous Australians, who often take on more individualistic approach. In terms of mental health, social and emotional well-being is crucial to the "spirit" of many Aboriginal and Torres Strait peoples.

For the peoples of the Australian First Nations, routine verification tools did not always seem appropriate. Earlier research has revealed that many issues are missing in the translation. Some people who should have a high rating suggest their risk of depression significantly lower, omitting potential treatment options.



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Where the diagnosis of depression is based on answers to a set of questions, it is important that the language used in these issues coincides with the understanding of a person about mental illness.

The good news is that we now have a verified culturally-specific tool, developed together with members of the Aboriginal and Torres Strait Islands, to find depression among Australian indigenous people.

We expect this to allow physicians to identify many aboriginal people and Torres Strait islands with mental illnesses that might otherwise be undiagnosed. And the better our ability to accurately diagnose depression, the better our ability to cure.

New probing tool

The culture-specific verification tool is called aPHQ-9. This is a customized version of the existing tool, called PHQ-9 – nine issues routinely used by doctors in Australia and abroad to review depression.

In our research published today in the Medical Journal of Australia, we have shown that the culture-specific tool is effective in detecting depression among Aborigines and Torres Strait Island residents living in urban, rural and remote areas.

General practitioners now have access to a questionnaire designed to see depression especially among Australians and Torres Strait Islanders.
From shutterstock.com

About 500 participants from Aboriginal and Torres Strait Islands filled out a new questionnaire and then participated in a structured psychiatric interview by trained clinicians who did not see their responses.

We have compared the results of the questionnaire with the results of the interviews and found that the new tool reliably identifies those who need further assessment of their mood and those who are unlikely to have depression.

The culture-specific tool contains questions about the same topics as the original but is presented in a way that better aligns the understanding of mental health and the welfare of aborigines.



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How are the issues different?

In addition to differences in understanding mental health, there are significant differences between the communication styles used in non-native Australian culture and those in Aboriginal and Torres Strait peoples. For example, white Australians often use a more direct means of communication.

This example shows how a new tool affects subtle differences in cultural understanding of mental health and communication styles.

The original questionnaire asks, "How much have you been having at least one of the following problems in the last two weeks:

  • little interest or pleasure in doing business?
  • a feeling of weakness, depression or hopelessness? "

The custom tool asks "During the last two weeks:

  • did you feel relaxed, you did not want to do anything?
  • Did you feel unhappy, depressed, really not good, that your spirit was sad?

Words such as "silly" and "spirit" are more in line with Aboriginal English. Spirit implies a holistic understanding of health that is consistent with the definition of health that many Aborigines and Australians from the Torres Strait Island have.



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The question that is being asked about "lowering your family". It is also consistent with the holistic view of the health and importance of families in Aboriginal and Torres Strait cultures, but may seem hopeless in counseling with Australian non-indigenous peoples.

Many Aborigines and residents of the Torres Strait Island will recognize that language in a new respectful tool develops in a culturally appropriate manner. It is more likely that they will trust clinicians and officials who manage the questionnaire and give answers that reflect their actual state of mind.

Physicians can now use a new tool

Between 2014 and 2015, more than half (53.4%) of Aboriginal and Torres Strait residents aged 15 and over reported that their overall satisfaction with life was eight or ten. Almost every sixth (17%) say they are completely satisfied with their life. These positive data testify to the enduring endurance of the Aboriginal people and Torres Strait Islands.

But over the years, events such as colonization, racism, the relocation of people from their countries, and the forcible removal of children from families and communities have disrupted the resistance, cultural beliefs and customs of many Australians and Australians. On the other hand, these factors have influenced their social and emotional well-being.

This may explain why Aborigines and Torres Strait Islands are twice as likely to be hospitalized for mental health disorders and die from suicide than their non-aboriginal colleagues.

Teenagers aged 15 to 19 are five times more likely to die by suicide than non-indigenous teenagers.

The importance of identifying those who are in danger can not be underestimated.



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While it is not recommended to review all Aboriginal and Torres Strait peoples peoples who represent the general practice of depression, the new questionnaire is a free, easily applicable, culturally acceptable tool for the screening of Aboriginal and Torres straits with a high risk of depression.

People who may be at increased risk of depression include people with chronic illness, history of depression, and those who have been exposed to abuse and other adverse events.

Without a culture-friendly tool, Aborigines and residents of the Torres island straits with depression and suicidal thoughts can fly under the radar. This questionnaire will open the way for important discussions and providing the treatment and services to those most in need.

If this article has asked you questions or concerns someone you know, call Lifeline on 13 11 14. Visit the Beyond Blue website to access certain resources for Aborigines and Torres Strait Islanders.


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