Depression Diagnosis & Treatment and Cultural Issues Information for Primary Care Physicians

Information from the Surgeon General's report on Mental Health in 1999 affirms that racial and ethnic minorities in the United States are less likely than whites to seek mental health treatment. Members of minority groups may be more likely to delay seeking treatment until the symptoms are more severe. Minorities turn more often to primary care providers rather than mental health specialists.

The level of physical illness in the United States is higher for racial and ethnic minorities in terms of cardiovascular disease, diabetes, cancer, etc. Higher rates of physical illness put minorities at more risk for mental health problems, particularly depression.

A patient's culture may affect their presentation of symptomatology. Some ethnic groups are more likely to express their somatic symptoms, i.e. Asians (dizziness) rather than emotional ones. Cultures also vary as to the meaning they give to mental illness; cultural meanings have strong affects on whether people are motivated to seek treatment.

The following excerpts summarize findings from the 1999 Surgeon General's report on minorities and mental health:

African Americans

• African-Americans may metabolize psychiatric medications more slowly than whites.
• African-Americans often receive higher dosages than whites leading to more side effects and increasing their likelihood of stopping their medications.
• The newer selective serotonin reuptake inhibitors, which have fewer side effects, are prescribed less frequently to African Americans.
• Many African-Americans prefer counseling over drug therapy
• African-Americans rely more on spirituality to help them cope and often rely on their ministers.
• African-American women have one of the lowest suicide rates, while young males have a higher than average suicide rate

Latino/Hispanic Americans

• Less than 1 in 11 Hispanic Americans contact mental health specialists.
• Less than 1 in 5 Hispanic Americans contact their primary care physician regarding mental health symptoms.
• One national study showed that 24 percent of Hispanics with depression and anxiety received appropriate care compared to 34 percent of non-Hispanic whites.
• Another study found that Hispanics were only half as likely to receive a diagnosis of depression or be prescribed anti-depressant medication as non-Hispanic white patients.

Asian Americans/Pacific Islanders

• Older Asian American women have the highest suicide rate of all women over 65 in the United States.
• Preliminary studies suggest that this group responds similarly to psychotropic medicines but at lower average dosages.
• This group has extremely low utilization of mental health services. Shame and stigma contribute to these lower utilization rates.
• One study showed that only 12 percent of Asian Americans would mention their mental health issues to a friend or relative, compared to 25 percent of whites

Native American Indians and Alaska Natives

• Rates of depression ranked from 10 percent to 30 percent among Native American Indians in various studies.
• Some studies suggest that Native American Indians seek mental health treatment as frequently as whites.
• The rate of suicide for American Indians and Alaska Natives is 1.5 times the national rate.

What You Can Do

• Use a depression screening tool with all patients with complex diseases on an annual basis or as needed.
• Pay particular attention to screening minority patients with somatic symptoms for depression.
• Include a depression screening tool with your new patient history form.
• Consider ethnic/racial differences in response to antidepressant medication when prescribing.

To view this report in it's entirety, please visit http://www.surgeongeneral.gov/library/reports.htm.