Depression and Suicide _ ______________________________________________________________________
ASSESSING AND DIAGNOSING DEPRESSION IN SPECIAL POPULATIONS Healthcare providers can create a more comfortable environ- ment for a patient of another culture by acknowledging the impact of culture and cultural differences on physical and mental health [76; 77]. Symptom presentation is influenced by cultural factors, and in some cultures, depression and anxiety may be expressed through somatic symptoms, such as musculoskeletal pain and fatigue. Providers may consider starting the conversation with the patient by focusing on physical symptoms. The concept of depression also varies across cultures, and patients may not seek medical treatment unless symptoms manifest as psychosis, conversion disorders, or significant physical ailments [78].
may be inconsistent with accepting treatment [80; 83]. Latina women are more likely to express distress via depressive symp- toms while Latino men are more likely to externalize distress [82]. When they perceive they need help for an emotional problem, Latina women tend to prefer individual or group therapy over medication [79]. Asian Americans Asian immigrants, especially Chinese Americans, are less likely to use mental health services than other ethnic groups [84]. The discrepancy between aspiration and achievement may better predict psychiatric illness and emotional disturbance than socioeconomic status [85]. Older Patients Major depression or persistent depressive disorder (dysthymia) with an age of onset after 60 years is referred to as late-onset depression. It is characterized by a greater presence of apathy and less lifetime presence of personality pathology than depression of earlier onset. Older patients tend to exhibit more vegetative signs and cognitive disturbance and complain less of dysphoria. In this population, major depression may be misattributed to physical illness, dementia, or the aging process itself [86]. Depression in the elderly is widespread, often undiagnosed, and usually untreated. Several factors contribute to missed diagnoses of depression in the elderly, including differences in presenting symptoms, stereotyping, provider and organizational barriers, and polypharmacy [21].
The assessment and treatment of major depressive disorder should consider the impact of language barriers, as well as cultural variables that may influence symptom presentation, treatment preferences, and the degree to which
psychiatric illness is stigmatized. (https://psychiatryonline.org/pb/assets/raw/sitewide/ practice_guidelines/guidelines/mdd.pdf. Last accessed July 6, 2023.) Strength of Recommendation : I (Recommended with substantial clinical confidence) Women with somatization are more likely to indicate interest in medication and their faith as sources for mental health care. However, ethnic differences tend to be very pronounced regarding medication preferences, with ethnic minority women showing less interest in medication than White individuals born in the United States [79]. Black/African Americans In general, Black/African Americans are more likely than White Americans to seek help for psychologic distress in the primary care settings and are more likely to believe that mental health professionals can be helpful, but also are more likely to believe mental illness will improve on its own [80]. They tend to seek services later and, therefore, face worse outcomes [81]. When they perceive they need help for an emotional problem, African American women tend to prefer individual or group therapy over medication [79]. Latinx/Hispanic Americans Latinx/Hispanic Americans often show psychologic distress differently, and assessment for depressive symptoms alone may not adequately capture their psychologic distress [82]. Latinx/ Hispanic Americans may be more likely to seek treatment for depression in primary care settings, although cultural values
In individuals with late-life depression, the American Psychiatric Association states that the identification of co-occurring general medical conditions is essential, as these disorders may mimic depression or affect choice or dosing of medications.
(https://psychiatryonline.org/pb/assets/raw/sitewide/ practice_guidelines/guidelines/mdd.pdf. Last accessed July 6, 2023.) Strength of Recommendation : I (Recommended with substantial clinical confidence) Differences in Symptom Presentation While DSM-based epidemiology studies suggest that the fre- quency of MDD declines with age, symptom-based assessment studies show increased rates of depression in older adults, especially women [21]. Older adults are less likely than younger adults to report feelings of dysphoria such as sadness, unhap- piness, or irritability, suggesting that the standard diagnostic criteria for depression may be more difficult to apply to older adults or that older adults are disinclined to disclose such feelings [86; 87].
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