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Epidemiology

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Racial Issue

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African Americans

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Research has shown that African Americans define, express, and experience depression in distinct ways. African Americans have described depression as feeling “stuck”, “down”, “unable to move”, and hopeless. [1] In Sirry Alang’s 12-month study of a predominantly Black neighborhood in the Midwestern US, African Americans reported that individuals in their community, including themselves, expressed depression through anger, aggression, and excessive socialization with friends and family in order to deny or hide feelings of depression. [2] In addition, African Americans report somatic symptoms, such as pain or numbness throughout the body.[3] A 2003 study of individuals seeking psychotherapy found that in comparison to Caucasian Americans, African Americans experience more insomnia, decreased sex drive, and decreased appetite as the severity of their depression increases.[4] Researchers note that these expressions of depression differ from the commonly used DSM-V criteria used to diagnose individuals with major depressive disorder. [4][3][1]

Studies show that African Americans see depression as a sign of weakness. [2][1] In particular, African American men deny and suppress depressive symptoms due to the stigma of mental health problems and cultural expectations that men should hide their emotions. [1] Parents may not acknowledge their children’s depression because they mistake the symptoms for something else, they doubt treatment will help, and/or they fear being at fault for their children’s depression. [5]

Research has shown a correlation between depression and financial hardships in African American communities.[6][7][1] Interpersonal conflicts, such as family issues, are also commonly cited causes of depression [7][1] In a study in New York, ministers of predominantly African American churches attributed depression to the stress of institutional racism and other stressors related to being African American in the US. [7]

For African American adolescents, maternal support has been shown to be a protective factor against depression.[8] Some studies suggest that employment, non-sport extracurricular activities, familism, predominantly minority schools, inductive parenting, social activities, and teacher relationships protect against depression.[8] Religiosity has not been shown to protect against depression for African American adolescents.[8] However, research suggests that African American adults tend to seek support from ministers or priests[9] and that church-based depression services may be a feasible way to support individuals with depression. [1][9]

Asian Americans

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There is inconsistent data about the prevalence of depression among Asian Americans. Several studies suggest that Asian Americans experience depression at higher rates compared to other ethnic groups,[10][11][12][13][14] while others posit that the rates are lower or comparable to other groups.[11][15][16][17] The true prevalence of depression is difficult to measure because of the lack of comprehensive studies and the large variety of ethnic groups within the Asian American population. Overall, Asian Americans underutilize mental health services.[15][12][18] Asian Americans may not seek mental health services due to the lack of culturally competent mental health professionals.[18] In addition, the desire to “save face” to avoid bring shame on one’s family or self may prevent Asian Americans from getting help.[12][19][20]

Asian Americans who experience depression commonly report physical or somatic symptoms such as appetite changes, headaches, sleep problems, and fatigue.[16][3] Although research tends to emphasize how Asian Americans report bodily complaints, Asian Americans also report experiencing depressive moods and feelings, such as sadness.[16][21][3]

It is important to note that commonly used tools to diagnose depression in the US may not be able to detect depression in Asian Americans, due to differences in the ways depression may be expressed.[15][16] For example, in Western cultures, depression may be defined as feeling helpless. In contrast, Eastern Asian cultures that value “selfless subordination” may not associate helplessness with depression.[16]

In the Asian American Literary Review’s DSM: Asian American Edition, Aileen Alfonso Duldulao, an epidemiologist who has been diagnosed with major depressive disorder along with other mental health disorders says, "Yet I would have never characterized what I have experienced using DSM-V derived symptomatic descriptions or ICD-10 diagnostic criteria. I’ve experienced highs and lows, and marveled at the depth of my own sadness from what seems like afar. I’ve cried incessantly for losses so deep that a language of loss no longer exists."[22]

Asian culture may influence how individuals define depression. For example, Vietnamese Americans may experience some depressive symptoms that cannot be translated into English.[15] Similarly, a study of Asian Indian Americans suggests that that older Asians who only speak one language are more likely to present depression in ways that match how it is expressed in their homeland.[23] In Chinese culture, shenjing shuairo, or neurasthenia, is defined as a weakness of the nerves and mental and/or physical fatigue.[24] Culture-bound syndromes such as shenjing shuairo have been shown to have some overlap with definitions of depression in the DSM and ICD, which are commonly used to detect depression.[3] Researchers have found that 40% to 90% of patients diagnosed with neurasthenia met the criteria for depression and showed improvement after taking antidepressant medications.[3]

Researchers have found that depressed Asian Americans are more likely to report having negative relationships with family members and being unable to talk to family members about their problems or worries.[25] In particular, Asian American high school students dealing with depression report that their parents do not show much interest their feelings and ideas. [14] Several studies have also shown that depressed Asian American adolescents and young adults tend to experience conflicts with their immigrant parents, arising from differences in how they adapt to culture in the US.[12][26] Family disharmony may occur when Asian American children integrate into the mainstream culture, while their parents hold onto their own ethnic culture, values, and language.[12][26]

Asian Americans experiencing depression may feel like they are not accepted in the US. In a study of Asian Americans with major depression, 21% reported experiencing high levels of racial discrimination and 43% reported moderate levels of racial discrimination.[10] Furthermore, Asian American adolescents who identify more with their ethnic culture and less with American culture have higher levels of depression than adolescents who identify more with American culture.[26] However, a different study shows that depressed Asian Americans who are integrated in American culture may feel like outsiders in both the Asian community and Asian American community because they feel like they cannot fully identify with either culture.[13] On the other hand, parents experiencing depression are more likely to feel separated from the Asian American and Anglo communities.[13] These different findings may point to how Asian Americans’ depression is linked to their sense of belonging in groups overall.

There are some culturally specific resources for Asian Americans dealing with depression. The Asian LifeNet Hotline, which can be reached at 1-877-990-8585, is a 24-hour hotline with crisis counselors who can speak different over 140 languages including Cantonese, Mandarin, Japanese, Korean, and Fujianese.[27] In Boston, the Asian Women’s Action for Resilience and Empowerment (AWARE) project provides culturally sensitive group psychotherapy for Asian American women. The group helps participants learn how to cope with depression and recognize that they are not alone.[18]

  1. ^ a b c d e f g Bryant, Keneshia; Haynes, Tiffany; Greer-Williams, Nancy; Hartwig, Mary S. (2014-06-01). ""Too Blessed to be Stressed": A Rural Faith Community's Views of African-American Males and Depression". Journal of Religion and Health. 53 (3): 796–808. doi:10.1007/s10943-012-9672-z. ISSN 0022-4197. PMC 3639295. PMID 23288483.
  2. ^ a b Alang, Sirry M. (2016). ""Black folk don't get no severe depression": Meanings and expressions of depression in a predominantly black urban neighborhood in Midwestern United States". Social Science & Medicine. 157: 1–8. doi:10.1016/j.socscimed.2016.03.032. PMID 27054710.
  3. ^ a b c d e f Noël, La Tonya; Whaley, Arthur L. (2012-10-01). "Ethnic/Racial Differences in Depression among U.S. Primary Care Patients: Cultural Considerations in Screening and Detection". Journal of Ethnic & Cultural Diversity in Social Work. 21 (4): 314–330. doi:10.1080/15313204.2012.729180. ISSN 1531-3204. S2CID 143170615.
  4. ^ a b Ayalon, Liat; Young, Michael A. (2016-07-27). "A Comparison Of Depressive Symptons In African Americans And Caucasian Americans". Journal of Cross-Cultural Psychology. 34 (1): 111–124. doi:10.1177/0022022102239158. S2CID 145602974.
  5. ^ Lindsey, Michael A.; Brown, Danica R.; Cunningham, Michael (2017). "Boys do(n't) cry: Addressing the unmet mental health needs of African American boys". American Journal of Orthopsychiatry. 87 (4): 377–383. doi:10.1037/ort0000198. PMID 28691838. S2CID 4645251.
  6. ^ Plowden, Keith O.; Adams, Linda Thompson; Wiley, Dana (2016). "Black and Blue: Depression and African American Men". Archives of Psychiatric Nursing. 30 (5): 630–635. doi:10.1016/j.apnu.2016.04.007. PMID 27654249.
  7. ^ a b c Hankerson, Sidney H.; Watson, Kalycia Trishana; Lukachko, Alicia; Fullilove, Mindy Thompson; Weissman, Myrna (2013-08-01). "Ministers' Perceptions of Church-Based Programs to Provide Depression Care for African Americans". Journal of Urban Health. 90 (4): 685–698. doi:10.1007/s11524-013-9794-y. ISSN 1099-3460. PMC 3732678. PMID 23471573.
  8. ^ a b c Scott, Sarah M.; Wallander, Jan L.; Cameron, Linda (2015-12-01). "Protective Mechanisms for Depression among Racial/Ethnic Minority Youth: Empirical Findings, Issues, and Recommendations". Clinical Child and Family Psychology Review. 18 (4): 346–369. doi:10.1007/s10567-015-0188-4. ISSN 1096-4037. PMID 26374228. S2CID 207101750.
  9. ^ a b Hankerson, Sidney H.; Lee, Young A; Brawley, David K.; Braswell, Kenneth; Wickramaratne, Priya J.; Weissman, Myrna M. (2015). "Screening for Depression in African-American Churches". American Journal of Preventive Medicine. 49 (4): 526–533. doi:10.1016/j.amepre.2015.03.039. PMC 4575828. PMID 26232907.
  10. ^ a b Chae, David H.; Lee, Sunmin; Lincoln, Karen D.; Ihara, Emily S. (2012-06-01). "Discrimination, Family Relationships, and Major Depression Among Asian Americans". Journal of Immigrant and Minority Health. 14 (3): 361–370. doi:10.1007/s10903-011-9548-4. ISSN 1557-1912. PMC 3501208. PMID 22083344.
  11. ^ a b Chen, Jian-Ping; Chen, Hongtu; Chung, Henry (September 2002). "Depressive disorders in Asian American adults". Western Journal of Medicine. 176 (4): 239–244. PMC 1071741. PMID 12208829.
  12. ^ a b c d e Kalibatseva, Zornitsa; Leong, Frederick T. L.; Ham, Eun Hye; Lannert, Brittany K.; Chen, Yang (2017). "Loss of face, intergenerational family conflict, and depression among Asian American and European American college students". Asian American Journal of Psychology. 8 (2): 126–133. doi:10.1037/aap0000067. S2CID 151447961.
  13. ^ a b c Kim, Su Yeong; Gonzales, Nancy A.; Stroh, Kunise; Wang, Jenny Jiun-Ling (2006-03-01). "Parent–Child cultural marginalization and depressive symptoms in Asian American family members". Journal of Community Psychology. 34 (2): 167–182. doi:10.1002/jcop.20089. ISSN 1520-6629.
  14. ^ a b Song, Suzan J.; Ziegler, Robert; Arsenault, Lisa; Fried, Lise E.; Hacker, Karen (2011-08-15). "Asian Student Depression in American High Schools". The Journal of School Nursing. 27 (6): 455–462. doi:10.1177/1059840511418670. PMID 21844218. S2CID 33305592.
  15. ^ a b c d Gee, Christina B. (2004-05-01). "Assessment of Anxiety and Depression in Asian American Youth". Journal of Clinical Child & Adolescent Psychology. 33 (2): 269–271. doi:10.1207/s15374424jccp3302_7. ISSN 1537-4416. PMID 15136190. S2CID 30166620.
  16. ^ a b c d e Kalibatseva, Zornitsa; Leong, Frederick T. L. (2011). "Depression among Asian Americans: Review and Recommendations". Depression Research and Treatment. 2011: 320902. doi:10.1155/2011/320902. ISSN 2090-1321. PMC 3180820. PMID 21961060.
  17. ^ Kim, Su Yeong; Gonzales, Nancy A.; Stroh, Kunise; Wang, Jenny Jiun-Ling (2006-03-01). "Parent–Child cultural marginalization and depressive symptoms in Asian American family members". Journal of Community Psychology. 34 (2): 167–182. doi:10.1002/jcop.20089. ISSN 1520-6629.
  18. ^ a b c Le, Thomas (2016-04-26). "No More Saving Face: Empowering Asian-American Women to Seek Mental Health Treatment". Pulitzer Center. Retrieved 2017-08-15.
  19. ^ Kramer, Elizabeth J; Kwong, Kenny; Lee, Evelyn; Chung, Henry (September 2002). "Cultural factors influencing the mental health of Asian Americans". Western Journal of Medicine. 176 (4): 227–231. ISSN 0093-0415. PMC 1071736. PMID 12208826.
  20. ^ Talebi, Miki; Matheson, Kimberly; Anisman, Hymie (2013-02-25). "Support, Depressive Symptoms, and the Stigma towards Seeking Mental Health Help". International Journal of Social Science Studies. 1 (1): 133–144. doi:10.11114/ijsss.v1i1.36. ISSN 2324-8041.
  21. ^ Kim, Jean M.; López, Steven Regeser (2014). "The expression of depression in Asian Americans and European Americans". Journal of Abnormal Psychology. 123 (4): 754–763. doi:10.1037/a0038114. PMID 25314263.
  22. ^ Duldulao, Aileen Alfonso (2016). "Methods: Diagnosis: B. Proof". DSM: Asian American Edition. Asian American Literary Review. p. 68.
  23. ^ Diwan, Sadhna; Jonnalagadda, Satya S.; Gupta, Rashmi (2016-06-29). "Differences in the Structure of Depression Among Older Asian Indian Immigrants in the United States". Journal of Applied Gerontology. 23 (4): 370–384. doi:10.1177/0733464804270584. S2CID 143627354.
  24. ^ Schwartz, Pamela Yew (September 2002). "Why is neurasthenia important in Asian cultures?". Western Journal of Medicine. 176 (4): 257–258. ISSN 0093-0415. PMC 1071745. PMID 12208833.
  25. ^ Chae, David H.; Lee, Sunmin; Lincoln, Karen D.; Ihara, Emily S. (2012-06-01). "Discrimination, Family Relationships, and Major Depression Among Asian Americans". Journal of Immigrant and Minority Health. 14 (3): 361–370. doi:10.1007/s10903-011-9548-4. ISSN 1557-1912. PMC 3501208. PMID 22083344.
  26. ^ a b c Wong, Sandra (2001). "Depression Level in Inner-City Asian American Adolescents". Journal of Human Behavior in the Social Environment. 3 (3–4): 49–64. doi:10.1300/j137v03n03_05. ISSN 1091-1359. S2CID 146516465.
  27. ^ "Asian American Suicide Prevention & Education". aaspe.net. Retrieved 2017-08-15.
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