Journal of Genetic Counseling

, Volume 22, Issue 5, pp 613–624 | Cite as

Exploring Culture-Specific Differences in Beliefs about Causes, Kinship and the Heritability of Major Depressive Disorder: The Views of Anglo-Celtic and Chinese-Australians

  • Mimi Xu
  • Lilian Zou
  • Alex Wilde
  • Bettina Meiser
  • Kristine Barlow-Stewart
  • Bibiana Chan
  • Philip B. Mitchell
  • Mariana S. Sousa
  • Peter R. Schofield
Original Research


The aim of this study was to explore cultural differences in causal attributions and beliefs about heritability of major depressive disorder (MDD). Face-to-face interviews with Anglo-Celtic- and Chinese-Australians community members with a family history of MDD were conducted and subjected to a rigorous qualitative analysis, using the computer software NVivo. Sixteen Anglo-Celtic-Australians and 16 Chinese-Australians were interviewed. Both groups believed that a combination of genetic and environmental factors contributed to MDD, that stress was an important cause of MDD, and that coping factors were significant moderators of the impact of stress on MDD. Both cultural groups believed that the causes of MDD affecting multiple family members included a shared family environment and a “contagion effect”, in addition to genetics. Unique to the Chinese-Australian group was the beliefs that parental pressures to exceed academically contributed to MDD; this cultural group also reported beliefs that depression was due to God’s will or alternatively fate, which in turn was related to attributions to feng shui and auspicious dates. This study documented key culture-specific differences in beliefs about causes and inheritance of MDD; such differences have major implications for clinician-patient communication about genetic risk associated with having a family history of MDD.


Cross-cultural Beliefs Causation Depression Chinese Anglo-Celtic 



We are very grateful to the people who participated in this study and so generously shared their views. This study was supported by the Faculty of Medicine, University of New South Wales. Associate Professor Bettina Meiser is supported by a Career Development Award Level 2 from the National Health and Medical Research Council of Australia.

Disclosure of Interest

The authors do not have any conflict of interests. The authors have full control of all primary data and agree to allow the journal to review their data if requested.


  1. Austin, J., & Honer, W. (2007). The genomic era and serious mental illness: a potential application for psychiatric genetic counselling. Psychiatric Services, 58(2), 254–261.PubMedCrossRefGoogle Scholar
  2. Australian Bureau of Statistics. (2007). 2006 Census of Population and Housing Cat. No. 2068.0 - 2006 Census Tables. Canberra: Australian Bureau of Statistics.Google Scholar
  3. Barlow-Stewart, K., Yeo, S., Meiser, B., Goldstein, D., Tucker, K., & Eisenbruch, M. (2006). Towards cultural competence in cancer genetic counseling and genetics education: lessons learned from Chinese-Australians. Genetics in Medicine, 8(1), 24–32.PubMedCrossRefGoogle Scholar
  4. Berry, J. (1997). Immigration, acculturation and adaptation. Applied Psychology: An international Review, 46, 5–34.Google Scholar
  5. Blignault, I., & Ponzio, V. (2008). A qualitative study of barriers to mental health services utilisation among migrants from mainland China in South-East Sydney. The International Journal of Social Psychiatry, 54(2), 180–190.PubMedCrossRefGoogle Scholar
  6. Brown, C. (1998). Underutilisation of Mental Health Services by Asian-Americans residing in the United States. Issues in Mental Health Nursing, 19(3), 225–240.PubMedCrossRefGoogle Scholar
  7. Chan, B., & Ritchie, J. (2011). Perceptions of Chinese Australians on seeking help for mental health problems: a qualitative study. International Journal of Mental Health Promotion, 13(4), 36–45.CrossRefGoogle Scholar
  8. Chen, S., Zhang, W., & Zhang, J. (2009). Stigma and schizophrenia. [Letter]. The Lancet, 373(9672), 1335.CrossRefGoogle Scholar
  9. Corrigan, P. (2005). On the stigma of mental illness: Practical strategies for research and social change. Washington: American Psychological Association.CrossRefGoogle Scholar
  10. Counseling across cultures. (2008). (6th edition ed.). Los Angeles: Sage Publications.Google Scholar
  11. Crystal, D. S., Chen, C., Fuligni, A. J., Stevenson, H. W., Hsu, C. C., Ko, H. J., et al. (1994). Psychological maladjustment and academic achievement: a cross-cultural study of Japanese, Chinese, and American high school students. Child Development, 65(3), 738–753.PubMedCrossRefGoogle Scholar
  12. Eisenbruch, M. (1990). Classification of natural and supernatural causes of mental distress: development of a Mental Distress Explanatory Model Questionnaire. The Journal of Nervous and Mental Disease, 178(11), 712–719.PubMedCrossRefGoogle Scholar
  13. Hesketh, T., Ding, Q., & Jenkins, R. (2002). Suicide ideation in Chinese adolescents. Social Psychiatry and Psychiatric Epidemiology, 37(5), 230–235.PubMedCrossRefGoogle Scholar
  14. Hsin Yang, L., & Pearson, V. (2002). Understanding families in their own context: Schizophrenia and structural family therapy in Beijing. Journal of Family Therapy, 24(3), 233–257.CrossRefGoogle Scholar
  15. Huberman, A., & Miles, M. (2002). The qualitative researcher's companion. Thousand Oaks: Sage Publications, Inc.Google Scholar
  16. Joiner, T., Jr., & Katz, J. (1999). Contagion of depressive symptoms and mood: meta-analytic review and explanations from cognitive, behavioral, and interpersonal viewpoints. Clinical Psychology: Science and Practice, 6(2), 149–164.CrossRefGoogle Scholar
  17. Joiner, T. (1994). Contagious depression: existence, specificity to depressed symptoms, and the role of reassurance seeking. Journal of Personality and Social Psychology, 67(2), 287–296.PubMedCrossRefGoogle Scholar
  18. Joiner, T., Alfano, M., & Metalsky, G. (1992). When depression breeds contempt: reassurance seeking, self-esteem, and rejection of depressed college students by their roommates. Journal of Abnormal Psychology, 101(1), 165–173.PubMedCrossRefGoogle Scholar
  19. Jorm, A., Christensen, H., & Griffiths, K. (2005). Public beliefs about causes and risk factors for mental disorders. Social Psychiatry and Psychiatric Epidemiology, 40(9), 764–767.PubMedCrossRefGoogle Scholar
  20. Katz, J., Beach, S., & Joiner, T., Jr. (1999). Contagious depression in dating couples. Journal of Social and Clinical Psychology, 18(1), 1–13.CrossRefGoogle Scholar
  21. Kuyken, W., Brewin, C., Power, M., & Furnham, A. (1992). Causal beliefs about depression in depressed patients, clinical psychologists and lay persons. The British Journal of Medical Psychology, 65, 257–268.PubMedCrossRefGoogle Scholar
  22. Lam, A., & Kavanagh, D. (1996). Help seeking by immigrant indochinese psychiatric patients in Sydney, Australia. Psychiatric Services, 47(9), 993–995.PubMedGoogle Scholar
  23. Lam, C., Tsang, H., & Corrigan, P. (2010). Chinese lay theory and mental illness stigma: Implications for rehabilitation practices. Journal of Rehabilitation, 76(1), 35–40.Google Scholar
  24. Levinson, D. (2006). The genetics of depression: a review. Biological Psychiatry, 60(2), 84–92.PubMedCrossRefGoogle Scholar
  25. Link, B., Phelan, J., Bresnahan, M., Stueve, A., & Pescosolido, B. (1999). Public conceptions of mental illness: labels, causes, dangerousness and social distance. American Journal of Public Health, 89(9), 1328–1333.PubMedCrossRefGoogle Scholar
  26. McKeon, P., & Carrick, S. (1991). Public attitudes to depression: a national survey. Irish Journal of Psychological Medicine, 8(2), 116–121.Google Scholar
  27. Meiser, B., Mitchell, P., Kasparian, N., Strong, K., Simpson, J., Mireskandari, S., et al. (2007). Attitudes towards childbearing, causal attributions for bipolar disorder and psychological distress. A study of families with multiple cases of bipolar disorder. Psychological Medicine, 37(11), 1601–1612.PubMedCrossRefGoogle Scholar
  28. Meiser, B., Mitchell, P., McGirr, H., Van Herten, M., & Schofield, P. (2005). Implications of genetic risk information in families with a high density of bipolar disorder: an exploratory study. Social Science and Medicine, 60(1), 109–118.PubMedCrossRefGoogle Scholar
  29. Ng, C. (1997). The stigma of mental illness in Asian cultures. Australasian Psychiatry, 31(3), 382–390.Google Scholar
  30. Parker, G., Chan, B., Tully, L., & Eisenbruch, M. (2005). Depression in the Chinese: the impact of acculturation. Psychological Medicine, 35(10), 1475–1483.PubMedCrossRefGoogle Scholar
  31. Parker, G., Gladstone, G., & Chee, K. T. (2001). Depression in the planet's largest ethnic group: the Chinese. The American Journal of Psychiatry, 158(6), 857.PubMedCrossRefGoogle Scholar
  32. Phelan, J. (2005). Geneticization of deviant behaviour and consequence for stigma: the case of mental illness. Journal of Health and Social Behaviour, 46(4), 307–322.CrossRefGoogle Scholar
  33. Phelan, J., Bromet, E., & Link, B. (1998). Psychiatric illness and family stigma. Schizophrenia Bulletin, 24, 115–126.PubMedCrossRefGoogle Scholar
  34. Ryder, A., Bean, G., & Dion, K. (2000). Caregiver responses to symptoms of first-onset psychosis: a comparative study of Chinese-and Euro-Canadian families. Transcultural Psychiatry, 37(2), 255–266.CrossRefGoogle Scholar
  35. Sheehan, D., Lecrubier, Y., Sheehan, K., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry, 59(Suppl 20), 22–33.PubMedGoogle Scholar
  36. Sheikh, S., & Furnham, A. (2000). A cross-cultural study of mental health beliefs and attitudes towards seeking professional help. Social Psychiatry and Psychiatric Epidemiology, 35(7), 326–334.PubMedCrossRefGoogle Scholar
  37. Tseng, W. (1985). Chinese culture and mental health. New York: Academic Press.Google Scholar
  38. Turner, J., Biesecker, B., Leib, J., Biesecker, L., & Peters, K. F. (2007). Parenting children wtih Proteus Syndrome: Experiences with, and adaptation to, courtesy stigma. American Journal of Medical Genetics. Part A, 143A, 2089–2097.PubMedCrossRefGoogle Scholar
  39. United States Census Bureau. Race reporting for the Asian population by selected categories: 2010 retrieved.Google Scholar
  40. Volkmar, B. (2000). The concept of contagion in Chinese medical thought: Empirical knowledge versus cosmological order. History and Philosophy of the Life Sciences, 22, 147–165.PubMedGoogle Scholar
  41. Weissman, M., Wickramaratne, P., Adams, P., Wolk, S., Verdeli, H., & Olfson, M. (2000). Brief screening for family psychiatric history: the family history screen. Archives of General Psychiatry, 57, 675–682.PubMedCrossRefGoogle Scholar
  42. Wilde, A., Meiser, B., Mitchell, P., & Schofield, P. (2011). Community attitudes to genetic susceptibility-based mental health interventions for healthy people in a large national sample. Journal of Affective Disorders, 134(1–3), 280–287.PubMedCrossRefGoogle Scholar
  43. Williams, B., & Healy, D. (2001). Perceptions of mental illness causation among new referrals to a community mental health team: 'Explanatory model' or 'exlanatory map'. Social Science & Medicine, 53, 465–476.CrossRefGoogle Scholar
  44. Wong, F., Lam, Y., & Poon, A. (2010). Depression literacy among Australians of Chinese-speaking background in Melbourne, Australia. BMC Psychiatry, 10(1), 7.PubMedCrossRefGoogle Scholar
  45. WonPat-Borja, A. J., Yang, L. H., Link, B. G., & Phelan, J. C. (2010). Eugenics, genetics, and mental illness stigma in Chinese Americans. Social Psychiatry and Psychiatric Epidemiology, 47(1), 145–156.PubMedCrossRefGoogle Scholar
  46. Yang, L., & Kleinman, A. (2008). ‘Face’ and the embodiment of stigma in China: the cases of schizophrenia and AIDS. Social Science & Medicine, 67, 398–408.CrossRefGoogle Scholar
  47. Yeo, S., Meiser, B., Barlow Stewart, K., Goldstein, D., Tucker, K., & Eisenbruch, M. (2005). Understanding community beliefs of Chinese Australians about cancer: initial insights using an ethnographic approach. Psycho-Oncology, 14(3), 174–186.PubMedCrossRefGoogle Scholar
  48. Yoon, P., Scheuner, M., Peterson-Oehlke, K., Gwinn, M., Faucett, A., & Khoury, M. (2002). Can family history be used as a tool for public health and preventive medicine? Genetics in Medicine, 4(4), 304–310.PubMedCrossRefGoogle Scholar
  49. Zubenko, G., Hughes, H., Stiffler, J., Zubenko, W., & Kaplan, B. (2002). Genome survey for susceptibility loci for recurrent, early-onset major depression: results at 10cM resolution. American Journal of Medical Genetics, 114(4), 413–422.PubMedCrossRefGoogle Scholar

Copyright information

© National Society of Genetic Counselors, Inc. 2013

Authors and Affiliations

  • Mimi Xu
    • 1
  • Lilian Zou
    • 1
  • Alex Wilde
    • 2
    • 3
  • Bettina Meiser
    • 4
    • 11
  • Kristine Barlow-Stewart
    • 5
    • 6
  • Bibiana Chan
    • 7
  • Philip B. Mitchell
    • 2
    • 3
    • 8
  • Mariana S. Sousa
    • 4
  • Peter R. Schofield
    • 8
    • 9
    • 10
  1. 1.School of MedicineUniversity of New South WalesSydneyAustralia
  2. 2.School of PsychiatryUniversity of New South WalesSydneyAustralia
  3. 3.Black Dog InstituteSydneyAustralia
  4. 4.Prince of Wales Clinical SchoolUniversity of New South WalesSydneyAustralia
  5. 5.Sydney Medical SchoolUniversity of SydneySydneyAustralia
  6. 6.Centre for Genetics Education NSW HealthRoyal North Shore HospitalSydneyAustralia
  7. 7.Centre for Primary Health Care and EquityUniversity of New South WalesSydneyAustralia
  8. 8.Brain SciencesUniversity of New South WalesSydneyAustralia
  9. 9.Neuroscience Research AustraliaSydneyAustralia
  10. 10.School of Medical SciencesUniversity of New South WalesSydneyAustralia
  11. 11.Psychosocial Research Group, Dickinson Building 3Prince of Wales HospitalRandwickAustralia

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