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
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.
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.
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.
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