Cultural Formulation and Gender Disparities in Major Depressive Disorder: A Qualitative Analysis

Abstract

The purpose of this study was to investigate the influence of cultural formulation on Major Depressive Disorder (MDD) with respect to gender disparities in Pakistani patients. The study aimed to translate and adapt the Cultural Formulation Interview (CFI) - Patient Version from English to Urdu, ensuring its cultural and linguistic validity and reliability. The study was conducted in two phases. Phase one involved cross-cultural translation of the CFI, following a forward-backward method by bilingual experts. Content validity was assessed by seven independent clinical psychologists, and the final version was pilot-tested on two MDD patients. In Phase Two, a descriptive cross-sectional study was conducted to explore gender differences in depression among 12 purposively selected participants (6 men and 6 women) aged 18-60, diagnosed with mild to moderate MDD. Data were analyzed using thematic analysis to identify cultural influences on gender disparities in MDD. The findings revealed that cultural and societal factors significantly shaped the mental health experiences of men and women differently. Male participants primarily faced pressure due to societal expectations and financial responsibilities, while female participants were more affected by emotional stress related to family expectations and gender roles. Females experienced MDD symptoms due to external factors, such as relationship challenges, whereas males' symptoms were linked to internal conflicts influenced by cultural norms. This study emphasizes the importance of considering cultural and gender-specific factors in the assessment and treatment of MDD, to better understand the unique mental health challenges faced by men and women in Pakistan.