The United State of America fascinate the immigrants from all over the world. People prefer to visit or relocate the United States of America due to advance living standards and economic growth that appropriate effective strategies include innovation in the field of communication and information technologies. America is full of the diverse population regarding race, ethnicity, religion, sect, traditions, and language. A large proportion of various immigrants consist of (USSR) Union of Soviet Socialist Republics. Due to diversity in population, the immigrants or minority encounter many challenges to get equal healthcare facilities. As health care is the fundamental component of every society for maintenance of prosperous health and wellbeing. In the contemporary health issues, the mental disorders are pervasive and enduring aspects of every society.
Depression
Depression is one of the standard mental health issues of the current times. The immigrants encounter the prejudices and discrimination from society; as a result, they develop the symptoms of depression and become more vulnerable towards mental disorder. The immigrants relocate to America with many dreams, but the changed environment, culture, atmosphere and diet pattern may cause some health issues as well. The psychologists play a crucial role in delivering and maintaining the best mental health care services to the society. As the cultural marginality theory provides an extensive framework for better understanding of efficient immigrant patient care system.
Depression may lead to other severe mental disorders such as personality disorder, antisocial personality, schizophrenia, and may increase the risk for medical diseases, morbidity, and mortality. The prevalence of Depression is high inhabitants of the United States and FSU immigrants with an associated high risk of suicide. The third leading cause of death is Suicide among youth between the ages range of 10 to 24 years. Around 5% to 6% of Russian immigrants, experience significant depressive symptoms, and the lifetime ratio of considerable depression is reaching up to 20%. According to a study, the cause of many behavioral problems also found to be associated with alcoholic consumptions, unsafe sexual activity, suicide, and substance abuse, self-injurious, life-threatening and risky behaviors.
The Theory of Cultural Marginality
The theory of Cultural Marginality provides an extensive framework for better understanding the immigrant's needs, health-related problems and solutions as well. The method of Marginality first conceived by Robert Park (1928) in "Migration and the Marginal Man" to yield a two world belongingness of immigrants, their homeland, and America. In recent decades with the increased prevalence of multicultural society, the problem of multicultural identity has been a topic of extensive debate in the current past decade. The people were suffering from many psychological problems and identity crises; therefore, the broad theoretical framework was presented to understand the challenges faced by immigrants. The purpose of these middle-ranged theories did not merely focus on the understanding of the problem, but to design a therapeutic intervention plan to eradicate the causes. The psychologist’s psycho educates the people that we cannot change the environment, but our perspective to perceive the things. The diversion from one thought to another one; bring significant change in mood and thinking. They develop high adaptability skill by elaborating the happiness is all about choices.Park assumed marginality take place when the immigrant excluded or unaccepted by a dominant group due to prejudice, fundamental thinking and diverse identity. The feeling of rejection and isolation adversely affect the mental health of the Russian Immigrants, and they start feeling depressed. When taking into account Russian immigrants, it is significant to take into consideration the further issues such as acculturation and adaptation that may escort the development of depression. The current study aims to imply a Cultural Marginality theory to conduct an accurate assessment and provide culturally sensitive therapy to Russian Speaking immigrants.
The theory of the marginal man is highly interrelated with depression, because if an individual faces rejection does not feel himself a part of any culture or group that creates a feeling of low self-esteem. As many studies indicated that rejection is highly associated with low self-esteem that further leads to depression. The mismatch between the original immigrant identity and new cultural heritage distort the self-image of immigrants. This kind of marginality termed as encapsulated marginality. The intercultural studies and cross-cultural communication directly affect the psychological well-being of an individual. The construct of the marginal man, comprised of some other aspect such as assimilation, the stranger, and cultural identification.
The marginal man strives for his place in a new culture and on the other hand, wants to save his true identity and culture heritage. The Robert refers this stag as constructive marginality. The struggle for adjustment in the new culture is very challenging, but a few may succeed, and many suffer from identity crises. The critical hindrance to maintaining a balance between the old and new cultural exchange should be root out. The Russian Immigrants seek the least psychological help when encountering with depression.
The psychologists may serve their best services to educate the diverse population about the effectiveness of health care services specifically assessment and management of depression or stress. The USA population consults psychologists more than any other healthcare practitioner and trusts their skills. Therefore, the professional attitude of psychologist toward client regardless of ethnic, racial and regional disparities may play a significant role in the betterment of the healthy community.
The empathetic feelings for patient problems, usage of natural medicine or therapy terminology and appropriate verbal and non-verbal gesture may be helpful for the Russian Immigrants to discuss their problems and collaboratively work for the betterment of their issues. The collaboration psychologist and client may bring beneficial results to root out the depression among Russian Immigrants. The cultural and lingual diversity between health care practitioner and patient have been a barrier to facilitate them with adequate treatment. The contemporary modes of health care in America enforce some obligation to psychologists through the code of conducts and code of ethics.
The Russian Immigrants take the least advantage of health care services and are unfamiliar with the effectiveness of therapeutic intervention. The acceptance and respect from psychologists may be helpful in establishing Rapport building and increased their likeliness to take more health care services when the encounter with depression. The cultural Marginality theory defined that the rejection from the dominant group causes the feeling of low self-esteem, loneliness, stress, and depression.
The availability of healthcare services with acceptance and respect helps in developing high self-esteem and decreasing the level of depression. Secondly, the psychologists continually prefer the patient desires, need and wants in problematic situations; collaboratively make the assessment, and management plan according to the feasibility of the client. It is mandatory for psychologists to provide security and safety regarding health, rights and moral support to fix the depression and anxiety for the problem and from the therapeutic process. She/He is answerable for making the formed decision with the collaboration of health practitioners notably to eradicate the depressive symptoms and teach the client the better coping skills.
Psychologists owe the similar duties to self as implements to others including competence, character integrity, and persistence. Such as the Russian Immigrants strives for making an identity in new culture, they need moral support and guidelines to adjust themselves, the RN provides in-depth support in promoting, sustaining the self-management and coping strategies among clients. The psychologists independently or collaboratively struggle to establish and enhance the ethical framework of professional settings to serve the best practices to the clients. The psychologist's endeavors research, scholarly inquiry to develop the latest framework of psychological or medical problems and treat their client with the latest therapeutic plans.
The psychologists strive to defend human rights, to promote equality, to reduce health disparities with the cooperation of other healthcare professionals. The psychologists from another ethnic group may show some biases toward their ethnic group. There is needs to hire the cultural competent staff, from diverse cultural intend to train to eradicate prejudice and discrimination. In this way, the cultural biases and discrimination may eradicate from health care. An assessment and management plan for eliminating the depressive symptoms of Russian Speaking Immigrant should be designed in the Russian language. Each is unique regarding personality pattern and experiences and culturally heritage. The symptoms of depression also vary among people, therefore, adapt the validated linguistic scale should be used for the Russian speaking Immigrants. Many assessment tools are available that are valid and reliable for American residents but may not be as accurate for Immigrants.
For the assessment of depressive symptoms among Russian Immigrants, many screening tools are available such as Patient Health Questionnaire Depression Module (PHQ-9). The PHQ-9 comprised of 49 items and divided into psychological, interpersonal and somatic complaints. The scale has sound psychometric properties and should be validated in the Russian language to assess the nature and level of Russian Speaking Immigrants.
Beck Depression inventory is also handy screening tools for the assessment of severity of depression. BDI comprised of 21 self-reporting items with sound psychometric properties. The Russian translation of BDI may bring fruitful result in the assessment of severity level of Russian immigrants, and the management action can also be designed accordingly to facilitate them.
Duke Anxiety-Depression Scale (DUKE-AD) serves in screening the anxiety and depression among people. The Duke-AD scale comprised of 7 items based on DSM III-R, the brief nature of scale is feasible to administer and collection information. All the above scales are in the English language, and all the Russian American immigrants are not well familiar with the English language and find hard to comprehend the terms associated with depression. Therefore, the above scale needed to be validated in the Russian language so make it user-friendly for the participants. No depression-screening tool covers all the aspects that have been addressed in Culturally Marginality Theory (Choi, 2014). Therefore, the validate language of the depressive screening tools should use to assess the exact depressive symptoms of Russian Immigrants.
The concept of "Marginal Man" has caused considerable controversy fundamentally due to a primarily negative connotation perceived towards the notion.