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Depression and Culture in the TOP DD Network Study: Assessing Depressive Symptoms, Self-Harm, and Hospitalization among Dissociative Patients across Four Cultures

Bethany L Brand

Depressive symptoms, Non-suicidal Self-injury (NSSI), and suicide attempts are common and often require intensive interventions among individuals with complex Dissociative Disorders (DDs). Most of the treatment research on DDs has been conducted in the United States. The present study examined depressive symptoms and disorders, NSSI, suicide attempts, and psychiatric hospitalizations among DD patients participating in outpatient treatment from the United States, Canada, Australia, and Norway. Analyses showed that patients from the United States and Canada had fewer lifetime and recent hospitalizations compared to Norwegian and Australian DD patients. There were no cross-cultural differences in suicide attempts, NSSI, depressive symptoms, or types of depressive disorders. Our findings regarding rates of hospitalization are likely due to cross-cultural differences in health care utilization and systems, rather than to phenomenology related to depression. The relative uniformity of these symptoms and depressive disorders across cultures may indicate that dissociation, and possibly trauma, has a consistent link with depressive symptomatology regardless of one’s culture. We discuss the implications for training clinicians and future research.

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