Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment.
This article reviews cultural variations in the clinical presentation of depression and anxiety. Culture-specific symptoms may lead to underrecognition or misidentification of psychological distress. Contrary to the claim that non-Westerners are prone to somatize their distress, recent research confirms that somatization is ubiquitous. Somatic symptoms serve as cultural idioms of distress in many ethnocultural groups and, if misinterpreted by the clinician, may lead to unnecessary diagnostic procedures or inappropriate treatment. Clinicians must learn to decode the meaning of somatic and dissociative symptoms, which are not simply indices of disease or disorder but part of a language of distress with interpersonal and wider social meanings. Implications of these findings for the recognition and treatment of depressive disorders among culturally diverse populations in primary care and mental health settings are discussed.
Kirmayer
L J
LJ
Division of Social and Transcultural Psychiatry, McGill University, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec. laurence.kirmayer@mcgill.ca
D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology; D001294:Attitude to Health; D002170:Canada / Q000453:epidemiology; D003144:Communication Barriers; D003431:Cross-Cultural Comparison; D003466:Cultural Characteristics; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology; D005006:Ethnicity / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008519:Medicine, Traditional; D010817:Physician-Patient Relations; D010821:Physicians, Family; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology; D013577:Syndrome; D009626:Terminology as Topic; D016312:Treatment Refusal; D014481:United States / Q000453:epidemiology