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Globalisation and mental disorders

Overview with relation to depression

Institute of Psychiatry, London, UK

ANASTASIA MASTROGIANNI, MD

Institute of Psychiatry, London, UK

Correspondence: Professor Dinesh Bhugra, PO Box 25, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK

Declaration of interest None. D.B. has presented papers at meetings that have received educational grants from Eli Lilly, Lilly Suisse, Sanofi-Synthelabo, Janssen-Cilag and AstraZeneca. The current paper has not been a part of any such lecture and no fee has been accepted in the context of this paper.

Background Globalisation is the process by which traditional boundaries of cultures are changing. Industrialisation, urbanisation and influence of the media are influencing idioms of distress across cultures.

Aims To discuss the role of globalisation, using the epidemiology, diagnosis, clinical presentation and treatment of depression across various cultures as an example.

Method Recent studies focusing on transcultural aspects of depression were reviewed and summarised.

Results Cultural, social and religious mores account for variations in the presentation of depression across cultures. Somatic symptoms are common presenting features throughout the world and may serve as cultural idioms of distress, but psychological symptoms can usually be found when probed. Feelings of guilt and suicide rates vary across cultures and depression may be underdiagnosed.

Conclusions Training packages could enhance clinicians’cultural competency in multicultural settings. However, globalisation is likely to influence idioms of distress and pathways to care in ways that are difficult to predict.

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