Full text of DOI:10.1177/136346150103800204

transcultural
psychiatry
June
2001
ARTICLE
Perceptions of Depression in a
Community Sample in Dubai
SULTANA O. Y. SULAIMAN, DINESH BHUGRA, &PADMAL DE SILVA
King’s College, London
Abstract Although words describing depression may not exist across all
cultures, the symptoms of depression do. In a study of the Arab community
in Dubai, we conducted four focus groups, two each with males and females,
to identify the terms and descriptions people use for depression, what
symptoms they associate with it, their views on its causes, and their strat-
egies for coping with it. All individuals knew someone who met the descrip-
tion of depression. The key symptoms of depression identified included:
social withdrawal, feeling afraid, irritability, loss of sleep, loss of appetite,
sadness, crying, excessive thinking, feeling bored and loss of interest in sex.
Causes of depression identified included: stresses in the family and in the
society, relationships, lack of support, marital conflicts, and problems with
children. The most effective coping strategy identified was that of going to
religious places and talking to religious professionals.
Key words Arabic • community • concepts • depression • explanatory
models • focus groups • Islam
Int r oduct ion
Depression as a feeling and an expression exists across cultures although
the words to express it may be different. Current medical concepts of
depression portray it as a psychiatric condition characterized by specific
affective, cognitive, behavioural and somatic symptoms. Marsella, Sartorius,
Vol 38(2): 201–218[1363–4615(200106)38:2;201–218;017416]
Copyright © 2001 McGill University

Tr anscult ur al Psychiat ry 38(2)
Jablensky, and Fenton (1985) suggested that popular concepts of de-
pression resemble the medical concepts. Bhugra, Baldwin, and Desai
(1997) reported that, in a group of Punjabi women in the U.K., the recog-
nition of symptoms of depression and its causation, especially in terms of
social factors, was similar to the medical models, although their views on
treatment diverged. These subjects saw religious places and religious
professionals as appropriate contacts for help. They saw depression as part
of life, suggesting that, although the Punjabi language does not have words
that are directly equivalent to the English word depression, the concepts
were clear and understandable among the population. Irrespective of the
symptoms, cultural factors affect all aspects of depressive experience and
disorder, and must be taken into account for an accurate understanding of
depression.
Marsella et al. (1985) claimed that, although no conceptually equivalent
terms for depression exist in many non-European cultures, this does not
mean that depressive disorders do not exist. However, it is likely that the
subjective experience of depression, its behavioural manifestations and the
social responses to it differ across cultures. Marsella (1980) posited that,
although individuals from different cultural groups have similar psycho-
logical states, the recognition of a problem, its interpretation and social
responses to it vary. Bebbington (1993) suggested that some cultures use
conceptualizations of dysphoria that differ from the syndromes employed
by western scientists, but that it is possible to identify a common core
of symptoms and terms which can be recognized as conforming to
depression.
There are few epidemiological studies of depression in the Middle
East. El-Islam (1975) reported a culture-bound neurosis in Qatar
characterized by giddiness, palpitations, nausea and general fatigue.
Ghubash (1992), in findings from a two-stage survey in the United Arab
Emirates (UAE), found that among 188 females of Arab origin inter-
viewed, 46% had non-specific neurotic symptoms and 20.7% had
specific neurotic symptoms (13.7% depression and 7% anxiety). Good,
Good, and Moradi (1985), in a study in Iran, found that depressives had
poor concentration, rumination, forgetfulness, numbness, and aches and
pains. El-Islam and colleagues (El-Islam, Moussa, Malasi, Suleiman, &
Miraza, 1988) reported that Arab patients use metaphors for depression
in their presentation.
The present study was conducted in Dubai, part of the United Arab
Emirates, with a population of about 350,000, of which 32% are Arabs and
30% are female. We were primarily interested in identifying concepts of
depression in the indigenous population, as well as lay views on its causes
and effects, and coping strategies.
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Met hod
Sampl e
A series of four focus groups was conducted (two with males, two with
females). We followed Krueger’s (1994) guidelines for the composition of
focus groups, which stress the need for broad homogeneity with sufficient
variation in socio-demographic variables such as age, marital, educational,
occupational and socio-economic status. However, we concentrated on
individuals whose social position brought them into contact with large
numbers of people, and who occupied a position of trust and respect
within the community. In this way, we hoped to ensure that their per-
ceptions and responses reflected wide experience of events and problems
in community. Existing members, or employees, of three major institutions
were contacted: the Researchers and Studies Centre in Dubai, the Dubai
Police Headquarters, and the Social and Developmental Association for
Women in Dubai. Only those members of these institutions who were
native to Dubai were considered for selection. Subjects with a history of
any psychiatric illness or disorder were excluded. From a total of 53
subjects (F = 28, M = 25) who were selected, 40 (F = 20, M = 20) partici-
pated in the focus group sessions; 13 subjects were unable to take part for
practical reasons.
Pr ocedur e
Each subject was contacted individually and asked to participate in a group
session. They were informed of the general topics for the session, and an
effort was made to make the participants feel that their experiences and
insights would be of value to the study. The first focus groups for the two
sexes provided a considerable amount of new information, whereas the
second two focus groups provided little new data, suggesting that there
would have been little value in continuing with additional groups.
The focus group interview schedule was based on previous reports
about focus groups theory and practice (Krueger, 1994; Morgan, 1993) and
on previous research carried out in developing countries (Wig et al. 1980).
The schedule had six parts: (i) identifying cases as defined by a vignette;
(ii) a question on the symptoms that such cases may have; (iii) a question
on the subjects’views of depression as an illness or problem; (iv) a question
on the subjects’ knowledge and understanding about the causes of such an
illness or problem; (v) a question about what can be done about de-
pression and where one should seek help; and (vi) several questions on the
subjects’ opinions about the course, seriousness, and the personal, family
and social consequences of such an illness or problem. This schedule
(summarized in Table 1) provided a loose structure for the focus group
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TABLE 1
Outline of focus group interview
1. Do you know any individuals in the community matching this description?
2. What kind of symptoms does she have?
3. Do you think there is a problem? If so, what would you call it?
4. What do you think are the causes of her illness or problem?
5. Is there anything that can be done about it? Who should do it?
6. Do you think that this disorder will get worse? If so, to what extent?
7. Do you think that this disorder is harmful to the individual, her family, or the
community? How?
8. Do you think that this disorder will impair her chances of marriage, or the
continuation of an existing marriage?
9. Do you think that the individual will provoke problems at home during her illness?
10. How much do you think the individual will be capable of work or study?
session, and left some flexibility to explore further issues that might come
up.
The vignette used was one of seven used by Wig et al. (1980), who used
them as a means of portraying several mental disorders without using tech-
nical language. The condition for the vignette chosen for this study was
‘depressive neurosis’. The vignette indicated the age, sex and main
symptoms and behaviour of the person being described, in an interesting
and lively way:
A person complains of different troubles at different times; troubles such as
headaches, pains in the stomach, general weakness of the body and tired-
ness. He/she may not be doing her/his work as well as he/she usually can.
He/she finds it difficult to fall asleep. In addition, he/she is worried about
problems he/she faces (money, children, housing) and is irritable with close
relatives and friends. He/she cannot relax or enjoy him/herself properly.
The basic vignette was translated into Arabic and embellished with local
names and expressions referring to local events and customs. The aim was
to produce an account which gave a concise, yet vivid and easily under-
stood, picture of the clinical condition which at the same time was inter-
esting and striking to the listener. Male focus groups were given this as a
description of a man, while female groups were given this as a description
of a woman.
The focus groups were conducted by the first author. Her presence in
each group did not create any obvious difficulties in data collection. Each
session lasted two hours and was audiotaped to facilitate later analysis. As
soon as each focus group session was completed, the audiotape recording
was transcribed. This was later studied along with the researcher’s notes.
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Result s
Socio-demographic features of the focus group participants are summar-
ized in Table 2.
The mean age of the participants was 33.6 years (range: 23–54) in the
two female focus groups and 34.85 years (range: 27–50) in the two male
focus groups. Females were more likely to be younger, less educated and
belong to a lower socioeconomic class.
The findings of the focus group sessions were organized around the key
topics that were explored in the discussion which followed the vignette.
The following sections present a summary of the main findings along with
some illustrative quotes translated from Arabic.
Femal e Focus Gr oup Sessions
In each group session, participants cited a number of cases they knew or
had heard about with symptoms mentioned in the vignette. A common
theme that emerged was that the individuals whom they knew with these
symptoms were not seriously ill.
Some participants reported symptoms such as social withdrawal, feeling
fearful, loss of appetite, irritability, insomnia, neglecting one’s appearance,
agitation, sadness, aggression, jealousy, paranoid thinking, sensitivity,
TABLE 2
Socio-demographic characteristics of the focus group samples
Demographic variables
Females
(N = 20)
Males
(N = 20)
Age groups
23–29
30–39
9 (45%)
7 (35%)
4 (20%)
4 (20%)
11 (55%)
5 (25%)
40–54
Marital status
Married
Single
11 (55%)
9 (45%)
13 (65%)
7 (35%)
Educational status
Illiterate
5 (25%)
0
Educated
15 (75%)
20 (100%)
Occupational status
Working
Not working
12 (60%)
8 (40%)
20 (100%)
0
Socio-economic status
Low
Middle
High
5 (25%)
12 (60%)
3 (15%)
0
18 (90%)
2 (10%)
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boredom, loss of libido, eating too much, excessive thinking (worries) and
crying. Five participants clearly identified and talked about aches and pains
that their acquaintence had complained of, linked with fearfulness and/or
weakness. For example:
My aunt is in her late forties, always suffering from feelings of fear, crying
most of the time. She complains of general weakness in her body, and she
has no appetite to eat or to sit with anybody. She gets nervous very easily
and cannot sleep well or relax.
My friend is suffering from difficulty in breathing. She cries and she has no
appetite. She does not want to talk. She neglects her appearance, and she
always complains that she feels contractions in her muscles and something
creeping on her skin.
It was clear that there were different opinions about the importance of
crying. Three older women saw it as shameful and unusual for a woman to
cry when she feels depressed, and felt that she should not show her feelings
to others and should keep them to herself. If these feelings were too much
then she should cry only when she was alone. Depression should be‘inside’
and nobody else should know about it. One of them stated:
Women in the past never showed their feelings. . . . A woman kept her
problems inside and tried to act as if she was not depressed and if she wants
to cry she avoids showing that to others . . . but as much as she can she keeps
it hidden inside . . .
Another added:
We are Arabs, we never cry. . . .We endure . . . but these new generations,
they are so soft and weak . . . they cry for any reason. . .
In contrast, the younger women felt that crying was better than keeping
stresses and sad feelings bottled up inside oneself. They believed that hiding
one’s feelings may cause physical illness, and they did not think that there
was anything wrong or shameful in showing one’s feelings. Their responses
included:
If a woman cries she will not suffer from these symptoms, but if she keeps
her feelings inside she will suffer from many other symptoms . . .
A woman who cries feels better . . .
Why should one keep one’s feelings bottled up?
All the participants agreed that there was a problem reflected in these
symptoms, but they also felt that this was not a serious illness. They used
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words such as sadness, fear, depression, bad mood and psychological
illness. Some of them mentioned that it may happen for internal reasons
in some personalities, that it does not always happen for external reasons,
such as life events.
One of the participants said:
I call these symptoms psychological illness . . .
Another added:
I think this is obsession [waswas] because it makes you think too much and
be worried about something that does not exist sometimes . . .
Virtually all the participants said that one of the reasons for depression
may be marital problems, such as polygamy, divorce or emotional
distance between the couple. Some said that the responsibilities of women
were increasing, especially in the matter of bringing up children, because
husbands rarely shared these responsibilities, and were always busy with
their businesses, or distracted with two or more families, if they have
more than one wife. Women felt that this may lead to depression in the
wives.
Passing the age of marriage was a reason for depression for some single
women. Women’s position in the family, which burdened them with a lot
of pressures, without paying attention to their feelings and needs, was
another reason for depression reported by many participants. As one of
them said:
Passing the age of marriage puts the girl in a very bad situation. She has to
face a lot of troubles and pressures from her family and the society, she
has to be tied to her family all her life even after her parents die, she
must live with one of her brothers. She has no right to live by herself.
Nobody will support her . . . not even the government. At least for divorced
and widowed women there are some facilities offered for them by the
government such as a monthly salary and a house or piece of land, but not
for a single woman . . .
All the participants talked in detail about the problems provoked by
polygamous marriages for the first wife and her children. When one
participant said that this kind of marriage is permitted for men in Islam
(men have the right to marry up to four wives), some responded that this
kind of marriage should be allowed only under special conditions and that
the man should be fair to all his wives, although nobody could guarantee
that. Interestingly, the participants stopped talking about this problem at
this point as they realized that they had committed a sinful act by criti-
cizing the practice.
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The responses to question 5 about what can be done about depression
varied with the age of the participants. It was clear that the older women
tended to favour faith healing, self-help and acceptance of the situation, or
if necessary, to seek help from relatives or friends. They were less enthusi-
astic about help from professionals.
The younger women, although critical of psychiatric services, did feel
that some cases with these symptoms needed psychiatric help. They were,
however, not much different from the older women in their recommended
ways of dealing with these symptoms. Keeping yourself busy, talking to
members of the family or friends, asking God for help, reading the Koran
and praying, and finding a good faith healer (motawa) were some of the
recommendations. Religion was mentioned several times:
Reading the Koran helps a person to reduce stresses and fears and gives great
strength for facing problems . . .
I think complaining to Allah is enough . . .
A psychiatrist cannot help the depressed patient if the problems which create
this depression still exist, but he maybe able to help her to accept her situ-
ation and try to deal with it.
. . . A psychiatrist cannot help unless he gives her some pills to calm her
down and to help her to sleep . . .
Psychiatrists use only pills or ECT and this is not good for the patient’s
health in general . . .
The general feeling was that the problem would progress to madness
(jinoon) if the person could not cope with it and did not receive any treat-
ment. This question led to an indication of the extent of the participants’
concern and awareness of various conditions which affect women. This
could be seen clearly in some of the responses:
It may progress to madness and she may spend the rest of her life in the
hospital . . .
It may cause sexual problems, she may lose all her interest and enjoyment
in her sexual relationship . . .
It may increase suicidal ideas . . .
The responses to the questions on impact of illness (questions 7–10) and
the next three questions revealed a degree of suffering on the part of the
participants, which may represent the feelings of the majority of women
in United Arab Emirates society. Their responses indicated awareness of a
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larger problem to which they might otherwise not have given attention or
priority: women’s position in the family (especially for married women).
As one participant said:
If there is a woman suffering from depression, the first bad thing that will
happen to her is that her husband will divorce her or get married to another
wife, because men in our society cannot tolerate a depressed woman . . .
One commented on how a woman should respond to a man’s depression:
If a man is depressed the woman should be patient and has to accept the
situation and try to live with it . . .
Concern about stigma was also expressed:
Our society looks at the person who visits the psychiatric clinic as though
he is mad (majnoon) . . . Even the psychiatric hospitals in our society are not
distinguishing between the serious and the simple cases. . . . They mix them
together in the inpatients’ departments. . .
The possible deleterious effects on an existing marriage, and on the chances
of a new one, were acknowledged as a result of an individual becoming
depressed. For example:
It could impair the chances of marriage for some girls who are affected with
these feelings and who have isolated themselves from society . . .
Those who think that marriage is a solution for depression may find them-
selves in more trouble since they may accept anyone who asks them to get
married . . . and maybe end up with someone who is not a good person . . .
Two of the participants believed that depression would act as a poison for
the existing marriage as a result of arguments and an inability to function
properly:
An existing marriage for the woman could be destroyed. Her husband may
divorce her or get married to another wife . . . and he may affect this wife
and children and make a lot of troubles for them . . . and maybe in time this
wife will become depressed . . .
In an existing marriage more problems and sadness and arguments will
provoke serious problems between the couple and the husband may neglect
his wife and get married to a second one . . .
It was strongly felt that the depressed individual could provoke a lot of
problems for her family and for others around her. These problems
occurred at home as well as in friendships. For example:
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She will provoke a lot of problems at home, the children will be neglected
by their mother because she has no interest in anything. She will cause
problems with her husband and that may be a good reason for him to get
married again. There will be problems also with her husband’s family . . .
Similarly, difficulties for a depressed person at work or in study were seen
by some of the women as a clear result of depression. Others saw work or
studying as a potential solution for depression. One participant said:
It will affect her ability to study or work especially if her depressed feelings
are very strong . . .
Another stated:
It depends on her personality . . . some people feel better when they are
involved in work or keep themselves busy by studying . . .
Mal e Focus Gr oup Sessions
A quarter of the participants knew someone in their family circle or
among friends to have these symptoms. Once again, symptoms
mentioned included aches and pains, sadness, pessimism, social with-
drawal, suicidal thoughts, weight loss and crying. However, one participant
felt that there were clear gender differences in presentation and treatment
strategies:
These symptoms are rare among Arab men because they can always find
someone to support them and listen to them.
The men agreed with the women that these symptoms constituted a
problem but views differed as to whether to call it depression, sadness or
irritation. Only one participant identified it as a psychological problem.
Like their female counterparts, men identified the underlying causes as
family difficulties, adverse childhood experiences, and other external
factors such as political and social stresses. The individual’s expected role
and their failure to meet other people’s expectations were also cited as
causes. One participant stated that these problems were related to the indi-
vidual’s own personality:
I think that the cause of depression is a person’s inability to solve his
problems. . . . These problems differ . . . (They) lie in his home, family, and
money.
Another cited monotony at work and helplessness to change anything at
work as a possible cause:
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Sul aiman, Bhugr a, & De Silva: Depr ession in Dubai
The employee who works in a place for a long time without any change in
his situation, I think in time he will feel depressed. Why? Because he feels
unable to change anything.
Once again, the role of religion was central in the discussion:
We say that religion is related to all our life. In the past, if anyone had a
problem he would have gone to one of his older relatives and discussed his
problem with him, but nowadays you cannot trust anybody. It is difficult to
reveal your feelings to anyone, even your relatives. Nobody has time for you
. . . in the past if you had had any social or financial problems, or any kind
of problems, all the people around you would have offered their help and
supported you . . . life in the past was something else and now it is different
. . . People are so much less religious nowadays.
However, one participant was unable to identify the cause and effect when
he said:
I see some people sitting in the mosque not praying and not reading the
Koran but just sitting silently. Are they religious people? Maybe they are
depressed . . .
One participant mentioned the roles of monotony and of diet:
I think there are two ways of causing depression. The first way is inflexibility.
If a person is fixed in one environment, with the same people, his problems
are always the same, and there is nothing new in his life, he will be depressed.
The second way is with food. I think that the food which people eat is related
in some way to depression. . . . If you look at monks and priests they always
depend on vegetarian food while the primitive people always eat meat . . . I
think to find a balance for food and flexibility is very helpful to protect you
from depression.
The men also talked about women’s problems:
Mostly the woman who becomes depressed because she lives with all the
problems and she cannot change anything or make any decisions. . . . She is
worried about society, people, and her family . . . compared to the man’s
situation she is worse off.
As the participants started to talk about depression in women, this
provided an opportunity to explore further what they thought caused it.
The participants suggested a number of factors, including women’s
emotionality, stress from their husbands and family stresses:
Women are more depressed than men . . . because they are emotional . . .
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The reason for depression in women is their husbands . . . I know 18 women
whose husbands were the main reason for their depression . . . and I think
that it is the main reason for depression in UAE society . . .
I think women’s emotional natures are the main reason for their depression,
and because of that nature women are very sensitive and maybe a sad film
can make a woman depressed for a whole day . . .
I think that women’s lack of knowledge about the men’s natures is the reason
for their depression; for example, a man likes to have freedom of movement
. . . to come and go whenever he wants . . . he loves to be free . . . and if a
wife can’t understand that and she tries to do the same as him and go
shopping or visiting friends whenever she wants . . . and tries to be free like
him . . . in this case she will feel that her husband is like the cork in the bottle
and she can’t get out of it easily . . . and this will cause her depression. But a
real woman who knows her duties toward her husband and her children will
stay at home obeying what Allah said in His book . . . I think this kind of
woman will not feel depressed if she doesn’t go out of her house, because
her house is her priority . . .
The gender role expectations were quite striking. As another participant
remarked:
I think that a woman who is used to having that kind of freedom of
movement and being able to visit her friends before her marriage, if after
she gets married her husband tries to prevent her . . . this will create a
conflict between the new life at her husband’s house and her previous life at
her father’s house, and if she couldn’t adapt herself to this new life she will
be depressed . . .
Social roles and expectations for women were also mentioned as possible
causes for depression, as was the social system:
Yes, the men are one of the reasons that women become depressed but not
always . . . and he is not doing that on purpose . . . he is also controlled by a
system which obliges him to do that . . . this system and its traditions and
customs are also a source of depression for men . . . They project their own
depression onto women . . . and in the end she becomes a victim and trans-
fers her depression to her children . . . So the whole system is depressed and
they are only exchanging their roles . . .
Depression in women or in anybody is due to failure in making decisions or
due to loss of rights and being unable to change it. However, these reasons
differ proportionally from person to person. Men are not always the cause
of women’s depression; there are many things affecting women’s lives: the
conditions of the society, modernization, how the society, family, and men
appreciate women and their participation in life. . . . A lot of reasons . . . I
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believe that women are stronger than men in tolerating all these social
and physical pressures and still managing their lives and continuing their
duties . . .
Once again, talking to others was put forward as a common and import-
ant coping strategy. Reading the Koran was mentioned as a way of coping
with depression, especially as a defence against suicidal thoughts. Some
participants mentioned going to psychiatrists, but feelings were mixed.
Spending time with others, prayers and talking were seen as key strategies.
A man can talk to his family – father, mother, or one of his brothers or
friends . . .
Find a good friend . . .
Mix with other people . . .
I think it is better for him to pray and read the Koran . . .
Mental health professionals were seen as varyingly helpful:
When a person is very seriously depressed then only his faith will prevent
him from committing suicide . . .
I believe that it is a kind of treatment for depression to read the Koran and
pray . . . Allah will protect him . . .
I think it is a psychological situation, if you can persuade yourself that Allah
has cured you then it is a solution . . . but not everybody can do that . . .
I don’t agree, the psychiatric clinics in our country are underdeveloped, they
don’t know anything about psychotherapy . . .
Maybe the psychiatrist increases the risks in the situation when he admits a
new case with some simple symptoms alongside other cases which are very
serious . . .
Participants agreed that, if untreated, the condition could get worse.
He may lose his mind and become mad (majnoon) . . .
He may commit suicide . . .
He may kill his wife and children . . .
Social withdrawal, suicide and family problems were mentioned as being
among the harmful consequences.
It could be very harmful for the individual if he tried to commit suicide . . .
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It will provoke a lot of trouble between the couple at home . . . and he may
be very aggressive toward his wife and his children . . .
He may withdraw from society . . .
Religion was put forward as a protective factor against suicide. Like the
women, men saw depression as a possible cause of divorce, and as a factor
leading to difficulty in getting married.
It may be a reason for divorce . . .
For a single man it will reduce his chances for marriage because he has no
interest in it . . .
Marriage was seen as a treatment for depression and one participant said:
Some people think that getting married will cure your depression. . . .
Maybe it is true because I know a person who was very depressed before his
marriage but now he has changed. . . . He is another person . . .
Like their female counterparts, the male participants also believed that the
individual would pose problems for family and friends.
He may become careless about his family, and neglect his wife and his
children . . .
He may become rude and very nervous for any reason and may harm his
wife . . .
One participant said that it depended on one’s education:
I think it depends on his level of education. . . . If he is aware of his feelings
then he will try to avoid any troubles with his wife or his family, so he might
go out to see some friends and that will help him to relieve these feelings and
be normal with his family . . .
The possible impact on work was recognized by males in a similar fashion
to females:
He will not have any interest in going to work. . . . He will find it difficult to
do that . . .
If his depression is very severe, I think he will not be able to work . . . he will
make a lot of mistakes and this is not to his advantage . . .
However, the aetiology of the problem was also seen as relevant here. One
said:
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It depends on the source of his depression. If it is his work then he will have
a lot of psychological pressures if he goes to his work, but if it is his home,
then he will be glad to escape from home . . .
In the same vein another participant commented on the value of work:
Some people consider work as a therapy . . . and I think if a man doesn’t
work he will be depressed . . .
Discussion
The purpose of this study was to investigate culturally distinctive concepts
of depression of the native people of Dubai, including their views on its
nature, course, treatment and consequences. Several methodological issues
must be borne in mind when interpreting the data. First, by the very nature
of the focus group methodology, it was likely that the views of those indi-
viduals who were more vocal are most prominent. However, care was taken
to ensure that all individuals participated actively. Second, the generaliz-
ability of these findings to other Arab populations cannot be taken for
granted. However, this does not negate the relevance of the findings for the
context of Dubai. Third, there are problems in using case vignettes as the
basis of discussion because these may narrowly focus the views expressed
by the participants. However, we felt that by illustrating the topic we might
get better quality data (cf. Kreuger, 1994). The gender of the researcher
could also be seen as a problem. Having a female researcher conduct the
male focus groups may have influenced the men’s responses to some extent.
The gender of the case vignette, which matched the gender of the focus
group, may also have led to a bias in the responses of the participants.
Ideally, each group should have been given both male and female vignettes
but constraints of time and resources prevented this. We did not ask about
the status of participants’ marriage (including whether it was polygamous
or monogamous), which would have further influenced both genders’
views. Despite these methodological caveats, we believe that this ex-
ploratory study has yielded useful data.
Complaints of general ill-health were used to describe the depressed
person’s symptoms by a majority of the subjects, regardless of age or
gender. Natives of Dubai were more likely than western peoples to associ-
ate depression with aches, pains, weakness, etc. In some cultures, indi-
viduals may be more likely to somatize emotional problems because the
expression of physical symptoms is culturally more acceptable than the
expression of emotional difficulties in their societies (e.g. Kleinman &
Kleinman, 1985).
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Common somatic symptoms of depression regarded by the native
people of Dubai include:
1. Afeelingof tightnessor constriction in thechest.Thedepressed person
feels unable to take a deep breath, so that he or she may feel short of
breath and sighs repeatedly. The chest is felt to be too tightly packed
with an excess of unpleasant feelings to accommodate the inspiration
of air. Although they may wish to cry in order to relieve this feeling,
they often feel unable to do so. This is comparable with a similar
phenomenon reported by Mirdal (1985) in migrant Turkish women.
2. A feeling of giddiness or faintness (dora) which cannot be attributed
to neurogenic, cardiovascular or metabolic factors. The depressed
person usually locates this feeling in the head.
3. Alimentary symptoms in the form of nausea or sickness and poor
appetite, which are attributed to the abdomen and particularly to the
liver (chabid).
4. Fatigue due to generalized aches. These are described as a subjective
feeling of lack of body energy and soundness (ta’bana), the limbs
suffering the most. Similar feelings have been described in Turkish
patients (Mirdal, 1985), Kuwaiti patients (El-Islam et al., 1988), and
Qatari women (El-Islam, 1975). A key difficulty in deciphering the
data is the non-specific nature of these symptoms which are equally
applicable to anxiety.
Despite the possible impact of the female researcher, some gender differ-
ences emerged. Men were described as ruminating to a greater extent than
women over emotionally upsetting events. In addition, they were seen as
more likely to inhibit feelings of aggression or hostility than women.
Perhaps the time spent ruminating over emotionally upsetting events kept
them in an emotionally heightened state. This tendency for men to remain
upset for longer periods may necessitate more control over feelings of
aggression, which was reflected in their behaviour towards their families.
For example, they preferred to escape from home when they felt low or
depressed to avoid any arguments with their wives.
The responses of the female participants to the questions about whether
depression is harmful to the individual, family and community pointed to
a significant degree of suffering on the part of women in Dubai. The
responses can be seen as reflecting a larger problem in Dubai society
involving women’s position in the family and the stresses associated with
it. The responses of the males, too, showed an awareness of this problem.
The expectations from the female participants that there will be underlying
family conflict was not followed up by the male groups generally. In
addition, the female groups saw religion as a key factor in the management
of depression.
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Sul aiman, Bhugr a, & De Silva: Depr ession in Dubai
Overall, the findings provide insight into the experience of depression
and its social and individual consequences in the Arabic population in
Dubai. Emotional expression and its related variables in a society are
complex, sharing many features with other cultures yet at the same time
showing distinctive features (Kaiser, Katz, & Shaw, 1998). The identifi-
cation of culturally distinctive features has practical value, paving the way
for sensitive clinical inquiry and the effective delivery of therapy for this
population.
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S. SULAIMAN, PHD, is Lecturer in Psychology at Dubai Police College, UAE. Address:
General Dept. of Dubai Police College, PO Box 279, Dubai, UAE.
D. BHUGRA, PHD, MBBS, FRCPSYCH, is Reader in Cultural Psychiatry, Health
Services Research Department at the Institute of Psychiatry, London. His research
interests include social and cultural factors in mental illness and sexual dysfunc-
tion. Address: Health Services Research Department, Institute of Psychiatry, De
Crespigny Park, London SE5 8AF, U.K.
P. DE SILVA, FBPS, is Senior Lecturer in Psychology at the Institute of Psychiatry,
London. Research interests include behaviour therapy, cross-cultural psychology,
spirituality and cognitive therapy. Address: Institute of Psychiatry, De Crespigny
Park, London SE5 8AF, U.K.
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