7 Tools to Identify Depression

Another important factor in the identification of depression is cultural norms, which affect how people interpret the symptoms of depression and their cause. “Indeed, evidence exists that even the specific symptoms associated with such psychiatric conditions as depression show impressive cultural variability.”¹⁶ Some cultures do not have a word or phrase that describes depression, and others, such as the Chinese, experience symptoms that are physical rather than emotional. Patients from traditional Chinese cultures will express being “bored” and feeling fatigue, pain, dizziness and generalized discomfort, but not sadness.¹⁷

To provide optimal care for individuals from ethnic and cultural minorities with depression, we must understand and accommodate their beliefs when we explain etiology and treatment options. For example, 63% of African Americans believe that depression is caused by personal weakness, and two-thirds believe that prayer is the most effective form of treatment.¹⁸ They typically refer to depression as “having the blues” and attribute it to stressful life events. For some ethnic groups, conforming to the norms of the group and including their opinions and desires are essential components of care, even superseding what individuals or professionals might think is best. This may deter some patients from seeking care and contribute to higher dropout rates from treatment.¹⁹

Another concern that applies to depression screening tools is that they might be incompatible with patients from some minority cultures, especially non-English speakers.²⁰ In this case, when words in the tool are translated literally, they may lose their intended meaning. Other times, the symptoms that are described are actually accepted behaviors in a particular culture. For example, in Latino cultures crying is not only prevalent, but an expected behavior in certain situations. Further, questions that ask whether the patient perceives that “people don’t like me” or people are “unfriendly” are common beliefs in the African American community, which has experienced significant racism.²⁰

Prevalence of Depression with Arthritis

Research indicates that there are high levels of co-occurrence between OA, RA and depression. Prevalence rates in RA are reported to be in the range of 9.5–41%, and the prevalence for patients without RA is closer to 4.5%.²⁰ There are multiple reasons why there is so much variability in these reported rates. A recent article in Rheumatology reviewed 72 articles, which examined co-occurrence of RA and depression. In these articles depression was measured using 40 different definitions and there may have been significant discrepancies for how depression was diagnosed. Further, studies used a variety of screening tools, and even within the same tool, used different cutoff points for diagnostic purposes. Therefore, the same tool may have revealed different rates of depression. Some of the studies reported on were of poor quality or used small samples. However, this review reveals that for patients with comorbid depression and RA, there are poorer health outcomes with increased pain, additional comorbidities and higher rates of mortality.²⁰