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Thoughts on cross-cultural studies on the epidemiology of depression

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Abstract

A considerable, number of studies have been conducted on the epidemiology of depression across cultures. These studies have relied on two basic research methods: treated cases and untreated cases. However, limitations in these two methods make it impossible to arrive at any substantive conclusions about ethno-cultural variations in the rates of depression. The treated cases approach fails to control for the fact that individuals in a culture do not have equal access to psychiatric facilities nor equal motivation to psychiatric care. The untreated cases approach, which is based on community surveys, is limited by differences in the definition of depression, the diagnostic signs used to identify depression, and variations in the degree of professional contact with the potential ‘cases.’ In addition, current cross-cultural depression studies are faced with the problems of poor diagnostic reliability for depressive disorders and profound differences in the manifestation and experience of depression among different ethno-cultural groups. Many ethno-cultural groups do not demonstrate any of the psychological components of depression associated with its presence among Western groups. An entirely new approach to the cross-cultural study of depression appears warranted. Four steps are suggested to facilitate future studies: (1) An emit determination of disorder categories in different cultures; (2) The establishment of symptom frequency, intensity, and duration baselines, (3) Objective symptom pattern determination through multivariate data processing techniques; (4) Comparative studies using similar methodologies with culturally relevant definitions of disorder.

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  1. University of Hawaii, USA

    Anthony J. Marsella

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  1. Anthony J. Marsella
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Editor's Note: This paper was invited by the editor to complement the preceding review by Bebbington on the epidemiology of depression so that this subject could be viewed more fully in the cross-cultural perspective central to this Journal. The author did not have an opportunity to read Bebbington's paper.

Portions of this paper were supported by Public Health Service Contract HM-42-72-224, awarded to the Institute of Behavioral Sciences, Honolulu, Hawaii. The work is part of the NIMH Clinical Research Branch Collaborative Study on Ethono-cultural Variations in Psychopathology. Send request for reprints to the author c/o: Department of Psychology, Gartley Hall 101E, 2430 Campus Road, University of Hawaii, Honolulu, Hawaii 96822

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Marsella, A.J. Thoughts on cross-cultural studies on the epidemiology of depression. Cult Med Psych 2, 343–357 (1978). https://doi.org/10.1007/BF00048593

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