Thoughts on cross-cultural studies on the epidemiology of depression.

A considerable number of studies have been conducted on the epidemiology of depression across cultures. These studies have relied on two basic research methods: treated cases and untreated cases. However, limitations in these two methods make it impossible to arrive at any substantive conclusions about ethno-cultural variations in the rates of depression. The treated cases approach fails to control for the fact that individuals in a culture do not have equal access to psychiatric facilities nor equal motivation to psychiatric care. The untreated cases approach, which is based on community surveys, is limited by differences in the definition of depression, the diagnostic signs used to identify depression, and variations in the degree of professional contact with the potential "cases.' In addition, current cross-cultural depression studies are faced with the problems of poor diagnostic reliability for depressive disorders and profound differences in the manifestation and experience of depression among different ethno-cultural groups. Many ethno-cultural groups do not demonstrate any of the psychological components of depression associated with its presence among Western groups. An entirely new approach to the cross-cultural study of depression appears warranted. Four steps are suggested to facilitate future studies: (1) An emic determination of disorder categories in different cultures; (2) The establishment of symptom frequency, intensity, and duration baselines, (3) Objective symptom pattern determination through multivariate data processing techniques: (4) Comparative studies using similar methodologies with culturally relevant definitions of disorder.