Contextual Effects of Ethnicity, Gender, and Place on Depression; Case Study of War Related Stress for Kurdish Women


1 Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, USA

2 Center for Research on Ethnicity, Culture and Health (CRECH), School of Public Health, University of Michigan, Ann Arbor, USA

3 Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA

4 Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran


Contextual factors such as ethnicity, gender, place, and their intersections determine the social condition that populations and individuals live in. As a result, environmental stressors that shape exposures, and also resilience and vulnerabilities are specific to the population. This emphasizes the role of the intersection of such contextual factors in studying psychosocial causes of depression. The aim of this case study is to review the role of war related stress as a unique environmental cause of depression among Kurdish women who live in the Middle East. First, we reviewed the literature on the direct effects of ethnicity, gender, place, and their intersections on depression. Then we discussed the contextual (indirect) effects of these factors in modifying the effect of (resilience and vulnerability to) risk factors of depression. Then we reviewed the evidence highlighting the role of war related stress as a unique social cause of depression among Kurd women. We hope this paper provides an example of how social causes of depression depend on intersections of ethnicity, gender, and place. We argue that depression should be seen as a condition, with population specific causes and consequences. We also believe that ethnicity, gender, and place help clinicians and public health officials to better approach depression within populations. Contextual factors should not be undermined in approaching depression across population groups. In this view, context not only determines the exposure to the risk and protective factors, it also changes the vulnerability and resilience to them. Thus we need to better understand how ethnicity, gender, place, and their intersections modify separate, additive, and multiplicative effects of risk and protective factors on depression.