Culture and diversity

April 2010

FocusCulture and diversity

Mental health

Cultural competence

Volume 39, No.4, April 2010 Pages 206-208

John Furler

Renata Kokanovic

Background

Depression, and its associated anxiety, is very common in the community and frequently managed in general practice. Yet it remains a problematic concept. Differing views of depression influence both clinical practice and research.

Objective/s

This article discusses the way each patient’s culture interacts with other important contexts of clinical practice to shape how depression is understood and managed.

Discussion

Cultural and linguistic diversity interacts with socioeconomic factors in determining the known prevalence of depression and anxiety. Detection of depression may be shaped by expectations and assumptions of both the general practitioner and patient. Language and communication barriers mean interpreters are critical to mental health care. Culturally sensitive care for depression requires a reflective approach based on a negotiated understanding of the patient’s experiences and symptoms.

Depression, and its associated anxiety, is very common in the community and frequently managed in general practice. Yet it remains a problematic concept. Contrasting views of depression influence both clinical practice and research. In one perspective, depression is an identifiable disease with clear diagnostic criteria, independent of time, place and culture.1–3 Another view sees depression primarily as a socially constructed phenomenon, closely dependent upon time, place and culture.4 Although polar, these views are not mutually exclusive. Both views are implicated in the work of general practitioners in ‘producing’ depression, whether through extending the reach of diagnosis and therapy or through medicalising individual troubles and worries. This may be driven by a range of interests, including pharmaceutical companies and the medical profession, but also the needs and expectations of patients and communities.5

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Correspondence afp@racgp.org.au

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