1. Cultural differences and diagnosing depression

2. Depression around the world Globally, an estimated 350 million people of all ages suffer from depression. Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease Nearly 15% of those living in the 10 rich nations reported having at least one depressive episode in their lifetime. For poorer countries, the prevalence of a depressive episode was only 11%. Researchers found that people living in wealthier nations are more likely to have experienced a depressive episode than those in low and middle-income countries

3. Cultural relativism: This is the view that mental health disorders need to be understood in the context of the person suffering from the disorder This poses a problem when using universal diagnostic manuals such as the DSM which usually are usually created in one specific, often western culture; this then raises the question of whether such manuals are really universal or whether being depressed in Japan has a different meaning to being depressed in America Strong cultural relativist positions would uphold that depression comes in may different forms, just like languages do, whilst weaker cultural relativist positions claim that there are universal elements but that such elements may be expressed differently depending upon culture. However it has also been argued that contributing factors to the onset of depression may be the same across cultures e.g. unemployment and relationships, it may just be that such stressors are more prevalent in some cultures than others

4. Examples of cultural variations: It has been widely reported and accepted that Western cultures tend to display and focus more on the psychological symptoms of depression such as low self- esteem and mood, whilst East Asian patients tend to display more extreme physical symptoms. The basis of this has been said to be that it’s more socially acceptable in the west to display emotional distress than in Asian communities. This idea has been supported by research such as Kua et al’s in 1993. They reported that 72% of people in China who first presented with chest or abdominal pains or headaches were later found to have a mental health problem.

5. A quote from a doctor about the relationship between biological and cultural influences in the onset of depression "the onset of depression triggers a biological response that takes place within a specific social context, resulting in a cascade of somatic and psychological experiences that are interpreted through a particular cultural lens. Careful translation and adaptation of our assessment tools helped us clarify if different approaches lead to different symptom profiles and conclusions about patients."

6. Collectivist/ individualist cultures It has been found that although the collectivism of Eastern cultures creates a strong support system for the group, it produces many stressors that can lead to depression and anxiety. For example, the focus on the group rather than the individual can result in feelings of a lost individual identity and sense of self; historically linked with depression. The cohesiveness of the group can make social mistakes very public and result in feelings of shame and embarrassment by the individual at fault. Research indicates that these feelings are associated with social anxiety within collectivistic societies However it has also been argued that individualistic cultures may lead to greater onset of depression as within such cultures there’s greater disunity and differences between people, which may lead to greater feelings of worthlessness and isolation associated with depression

7. Other issues: Western cultures believe that depression is best treated by drugs due to it being classed as a biological illness. whereas Non-western cultures believe that the mind and body are not separate so believe in treatments such as acupuncture (China) Different cultures believe in different treatments therefore making depression difficult to study across cultures. Culture is a broad term which needs to be more specific in order for us to research it and get accurate meaningful results. Ethical implications in using a western diagnosis in non-western cultures Poorer countries may only believe in treating depression physically as they simply don’t have the facilities, research and money richer countries do to diagnose and treat depression biologically. Difficult to determine whether depression is more prevalent in some cultures or just more diagnosed.