Major depression in Chinese Americans: the roles of stress, vulnerability, and acculturation

Associations Between Trauma, Sleep, and Cognitive Impairment Among Latino and Asian Older Adults

BACKGROUND/OBJECTIVES

Trauma survivors with chronic post-traumatic stress disorder (PTSD) have been found to have cognitive impairment. But little is known about these outcomes among Latino and Asians who comprise more than 80% of the U.S. immigrant population. They also experience disparities in PTSD and dementia care albeit increased exposure to trauma. This study aimed to (1) examine the association between trauma exposures and PTSD with cognitive impairment in a sample of Latino and Asian older adults; and (2) assess whether sleep quality attenuated the PTSD-cognitive impairment association.

DESIGN

Cross-sectional secondary analysis of baseline data from the Positive Minds-Strong Bodies randomized controlled trial on disability prevention.

SETTING

Community-based organizations serving minority or immigrant older adults in Massachusetts, New York, Florida, or Puerto Rico.

PARTICIPANTS

Hispanic/Latino and Asian/Pacific Islander adults aged 60 or older eligible per randomized controlled trial screening for elevated mood symptoms and minor-to-moderate physical dysfunction (n = 134 and n = 86, respectively).

MEASUREMENTS

Neuropsychiatric measures were cognitive impairment (Mini Montreal Cognitive Assessment (MoCA)), PTSD (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual-5), trauma exposure (Brief Trauma Questionnaire), depression (Patient Health Questionnaire-9), generalized anxiety (Generalized Anxiety Disorder Scale-7), and daytime sleepiness (Epworth Sleepiness Scale).

RESULTS

Mean age was 72.8 years and 77.5 years for the Latino and Asian groups, respectively. The Asian group was 100% immigrant, whereas 70.2% (n = 92) of the Latino group was foreign-born. In unadjusted models, higher Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual-5 scores were associated with decreased odds of normal cognitive functioning (MoCA ≥25) in the Asian group (odds ratio (95% confidence interval) = .93 (.87, .99)), but not the Latino group (odds ratio (95% confidence interval) = .99 (.95, 1.05)). This association remained significant after adjusting for covariates. Daytime sleepiness did not moderate the association between PTSD and cognitive functioning in the Asian group.

CONCLUSION

Higher PTSD symptoms were associated with cognitive impairment in Asian, but not Latino, older adults. Clinicians serving older Asians should integrate trauma and cognitive screening to ensure this growing, underserved population receives appropriate evidence-based treatments.

Adaptation of an Evidence-Based Intervention for Disability Prevention, Implemented by Community Health Workers Serving Ethnic Minority Elders

INTRODUCTION

Changing demographics have created substantial unmet needs for mental health and physical disability services for immigrant and racial/ethnic minority elders. Workforce shortages can be reduced by task-shifting to community health workers (CHWs) who speak the same language and share the culture of these elders. Yet, implementation of interventions offered by CHWs requires adaptations of content and delivery, ideally under clinical supervision.

OBJECTIVE

To culturally adapt two evidence-based interventions, offered in community settings, to address mental health and physical disability prevention for diverse minority elders.

METHODS

We followed the Castro-Barrera stepped model for cultural adaptation of two evidence-based interventions into one combined program of disability management and prevention delivered by CHWs. We used feedback from key stakeholders, including four clinical supervisors, 16 CHWs, 17 exercise trainers, and 153 participants, collected at three time points to further adapt the intervention to a diverse population of elders.

RESULTS

Adaptations for administration by CHWs/exercise trainers included: systematization of supervision process, increased flexibility in sessions offered per participants' needs, inclusion of self-care content, modification of materials to better reflect elders' daily life experiences, and greater focus on patient engagement in care. Areas for additional adaptation included enhancing examples with culturally relevant metaphors, incorporating visual aids, and training CHWs in the importance of building trust.

CONCLUSION

This study identifies key aspects of the cultural adaptation process that facilitates broader cultural sensitivity of service delivery by CHWs to diverse elders in community settings.

Acculturation and mental distress among Russian and Iranian migrants in Germany

Several studies have stressed a correlation between difficulties in acculturation and mental distress or even mental disorders. The stress related to the process of acculturation can lead to depressive symptoms by way of changes in the activity of the HPA axis. However, it remains difficult to measure acculturation stress, as difficulties in acculturation strongly depend on subjective interpretations of every day experiences. The association between acculturation stress and mental distress was examined in two different migrant groups in Germany, 202 migrants of Russian and 100 of Iranian origin. In both migrant groups a significant correlation between acculturation stress and mental distress was found, yet no significant association between acculturation stress and length of residency in Germany. These findings will have to be replicated with representative samples and also with other migrant groups, both in and out of treatment. Considering the fact that the Russian sample was younger and nonetheless had relatively high acculturation stress scores, prevention of future mental health problems among migrants will have to focus on easing the process of integration into the host society.

Symptoms and Experience of Depression Among Chinese Communities in the West: A Scoping Review

Despite the increasing presence of Chinese communities in the West, their experiences of depression and the variations in symptoms or presentation are not well understood. Using Arksey and O'Malley's methodical framework, we conducted a scoping review of the published literature, using electronic databases MEDLINE and PsycINFO, and searched for articles published since 1999. Out of 1177 articles identified, 21 met the inclusion criteria. Thematic synthesis revealed valuable scholarly work on (1) depression rates, migration, and contextual determinants, (2) causation beliefs and help seeking, (3) acculturation and symptoms, (4) presenting symptoms and somatization, and (5) culturally sensitive assessment and care. Overall, this review has identified the importance of contextual determinants in the development of depression, low rates of seeking of professional help, subtle variations in somatization, and knowledge gaps in culturally sensitive care. The findings suggest that, rather than treating migration as a cause of mental distress, the accompanying conditions and events need to be further examined and addressed as potential risk or protective factors. Subtle variations in somatization are also evident, and future scholarly work should examine the notion of cultural scripts-namely, that people attend and react to particular experiences in culturally based ways. For this reason (among others), practice models need to develop strategies for culturally sensitive care, such as co-construction of illness narratives and finding common ground. Given the stigma of mental illness and the low level of seeking professional help, the role of primary care should be expanded. Further studies investigating mental health issues beyond depression are also warranted in the studied community.

Acculturative Stress, Social Problem Solving, and Depressive Symptoms among Korean American Immigrants

The present study examined the relationship among acculturative stress, social problem solving, and depressive symptoms among 107 Korean American immigrants. Hierarchical regression analysis showed that acculturative stress significantly predicted depressive symptoms controlling for different domains of acculturation. With regard to the role of social problem solving, among the five dimensions of social problem solving (i.e., positive problem orientation, negative problem orientation, rational problem solving, impulsive/careless style, and avoidant style), negative problem orientation and impulsive/careless style significantly predicted depressive symptoms. Avoidant style significantly interacted with acculturative stress, indicating that avoidant style is associated with depressive symptoms when acculturative stress is high. The study underscores the impact of culture as well as severity of stress on the relationship among acculturative stress, coping, and depressive symptoms among Korean American immigrants.

The Cortisol Awakening Response Mediates the Relationship Between Acculturative Stress and Self-Reported Health in Mexican Americans

BACKGROUND

The assessment of acculturative stress as synonymous with acculturation level overlooks the dynamic, interactive, and developmental nature of the acculturation process. An individual's unique perception and response to a range of stressors at each stage of the dynamic process of acculturation may be associated with stress-induced alterations in important biological response systems that mediate health outcomes. Evidence suggests the cortisol awakening response (CAR) is a promising pre-clinical biomarker of stress exposure that may link acculturative stress to self-reported health in Mexican Americans.

PURPOSE

The aim of the current study was to examine whether alterations in the CAR mediate the relationship between acculturative stress and self-reported health in Mexican Americans.

METHODS

Salivary cortisol samples were collected at awakening, 30, 45, and 60 min thereafter, on two consecutive weekdays from a sample of adult Mexican Americans. Acculturative stress and self-reported health were assessed. Data were aggregated and analyzed (n = 89) using a mixed effects regression model and path analysis.

RESULTS

Poorer self-reported health was associated with attenuated CAR profiles (primarily due to a diminished post-awakening rise in cortisol) predicted by both moderate and high levels of exposure to acculturative stress. Stress-induced alterations in the CAR mediated the relationship between exposure to acculturative stressors and self-reported health.

CONCLUSIONS

Findings demonstrate that different levels of acculturative stress are associated with distinct CAR profiles and suggest the CAR is one possible biological pathway through which exposure to culturally unique stressors may be linked to health disparities.

Depression among Asian-American Adults in the Community: Systematic Review and Meta-Analysis

OBJECTIVES

In this systematic review, we provide an overview of the literature on depression among Asian-Americans and explore the possible variations in depression prevalence estimates by methodological and demographic factors.

METHODS

Six databases were used to identify studies reporting a prevalence estimate for depression in Asian-American adults in non-clinical settings. Meta-analysis was used to calculate pooled estimates of rates of depression by assessment type. Statistical heterogeneity was assessed for subgroup analyses by gender, age, ethnicity, and other participant characteristics.

RESULTS

A total of 58 studies met the review criteria (n = 21.731 Asian-American adults). Heterogeneity across the studies was considerably high. The prevalence of major depression assessed via standardized clinical interviews ranged between 4.5% and 11.3%. Meta-analyses revealed comparable estimated prevalence rates of depression as measured by the Center for Epidemiologic Studies Depression Scale (35.6%, 95% CI 27.6%-43.7%) and the Geriatric Depression Scale (33.1%, 95% CI 14.9%-51.3%). Estimates varied by Asian racial/ethnic group and other participant characteristics. Estimates of depression among special populations, which included maternity, caregivers, and homosexuals, were significantly higher than estimates obtained from other samples (58.8% vs 29.3%, p = .003). Estimates of depression among Korean and Filipino-Americans were similar (33.3%-34.4%); however, the estimates were twice as high as those for Chinese-Americans (15.7%; p = .012 for Korean, p = .049 for Filipino).

CONCLUSION

There appears to be wide variability in the prevalence rates of depression among Asian-Americans in the US. Practitioners and researchers who serve Asian-American adults need to be sensitive to the potential diversity of the expression of depression and treatment-seeking across Asian-American subgroups. Public health policies to increase Asian-American access to mental health care, including increased screening, are necessary. Further work is needed to determine whether strategies to reduce depression among specific Asian racial/ethnic groups is warranted.

Major depression in China-to-US immigrants and US-born Chinese Americans: testing a hypothesis from culture-gene co-evolutionary theory of mental disorders

BACKGROUND

In this study, the culture-gene co-evolutionary theory of mental disorders was used to test the hypothesis that major depression was less prevalent in China-to-US immigrants who migrated to the US as adults than in US-born adult Chinese Americans.

METHODS

Data from the Collaborative Psychiatric Epidemiology Surveys (CPES) were extracted for secondary data analyses on the rates of major depression disorder (MDD) and major depressive episode (MDE) in the two groups.

RESULTS

Findings showed that for life time MDD, the rates for China-to-US immigrant and US-born Chinese were 5.3% and 7.9% for men and 8.5% and 33.1% for women. For 12-month MDD, the corresponding rates were 2.2% and 3.4% for men, and 4.7% and 12.6% for women. For life time MDE, the corresponding rates were 6.8% and 8.8% for men; for women the rates were 8.5% and 33.1%. For 12-month MDE, the rates were 2.2% and 4.4% for men; the rates were 4.7% and 12.6% for women. Controlling for age, education level, income, BMI, marital status, and income-to-needs ratio, China-to-US immigrant women remained less likely to have life time major depression than US-born Chinese American women.

LIMITATIONS

While the study has the strength of utilizing nationally representative datasets, the approach is limited as the data sources lack the capacity to investigate how the strength of connection with the collectivist culture might be related to major depression in the immigrant group.

Stress, illness, and the social environment: depressive symptoms among first generation mandarin speaking Chinese in greater Los Angeles

This study documents the indirect effects of social and environmental variables as mediated by immigrant stress and physical health. Using data from a large dual frame sample of first generation mandarin speaking Chinese immigrants in metropolitan Los Angeles counties with the largest groups of Chinese immigrants, this study uses a path analytic approach to trace how predictors are related to depressive symptoms and to measure direct and indirect influences of variables. Although bivariate analyses suggested that many predictors were associated with depressive symptoms, multivariate path analysis revealed a more complex structure of mediated associations. In the multivariate path analysis only reports of physical health and immigrant stress were directly related to depressive symptoms (P < 0.05), while acculturation, time in the US, income, US citizenship, and distance of persons on whom one could rely were related to stress (but not to physical health status) and only to depressive symptoms as mediated by stress. Age and educational attainment were related to health status (and to stress as mediated by physical health) and to depressive symptoms as mediated by both health and stress. These variables were also unrelated directly to health status and to depressive symptoms. Associations were evaluated using statistical significance, P < 0.05. This study demonstrates the significance of stress and health as mediators of variables in the larger context of the physical environment and suggests that the mechanisms linking ecological characteristics of immigrants to depressive symptoms may be stress and physical health among immigrants.

Resilience and depressive symptoms in mainland Chinese immigrants to Hong Kong

PURPOSE

Immigrants are highly vulnerable to the development of psychological problems such as depressive symptoms, which calls for further study of immigration in the Eastern context. Identification of factors that protect against depressive symptoms would inform interventions to enhance immigrant adaptation.

METHODS

This survey recruited 1,205 individuals who are adult immigrants from mainland China to Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) was used to screen them for depressive symptoms. Participants also completed assessments for acculturative stress, discrimination and rejection, and personal and family resilience.

RESULTS

The results showed that participants reported considerable depressive symptoms. After controlling for socio-demographic characteristics, acculturative stress, and discrimination and rejection, personal resilience was associated with fewer depressive symptoms. Family resilience added significant explanation of variance to predict depressive symptoms over and above the individual variables, including personal resilience.

CONCLUSIONS

Our findings draw attention to the role of resilience as a protective factor against mental distress when facing adversities, while highlighting the central importance of family as an emotional resource for immigrant adjustment in the Chinese context. As personal resilience can increase with interventions, our results can inform trials to enhance adaptation among mainland Chinese immigrants in Hong Kong.

The immigrant paradox among Asian American women: are disparities in the burden of depression and anxiety paradoxical or explicable?

OBJECTIVE

We evaluated potential explanations for advantaged mental health status among immigrant Asian American women compared to U.S.-born Asian American women.

METHOD

In a nationally representative sample of 1,030 women (185 U.S.-born, 368 early-life immigrants [arrived before 25 years of age], 477 late-life immigrants), we examined the hypothesis that increased exposure to social risk factors mediate nativity-based differences in lifetime prevalence of depression and anxiety disorders. Indicators of social class were also examined as protective factors enjoyed by U.S.-born women that may suppress observed nativity-based disparities. We also examined whether there were group differences in reactivity to stress in predicting disorder.

RESULTS

U.S.-born women were twice as likely as late-life immigrants to report lifetime history of depression (odds ratio [OR] = 2.03, 95% CI [1.35, 4.54]) and anxiety (OR = 2.12, 95% CI [1.34, 5.19]). Nativity differences in perceived discrimination, family conflict, and cultural conflict explained disparities in rates of disorder. There was no support for the contention that immigrant women were more psychologically hardy or resilient to social stress.

CONCLUSION

Findings suggest that the gap in mental health status between U.S.- and foreign-born Asian American women would indeed be magnified if differences in social status were accounted for, but also that ready explanations for the so-called immigrant paradox are found in differential levels of reported stress exposure.

A meta-analytic study: the relationship between acculturation and depression among Asian Americans

Acculturation is an important and popular cultural research variable among specific ethnic populations that is used to explain the process of assimilating into the host culture. Acculturation has often been used to account for psychosocial changes and health outcomes and has been used to explain health disparities among ethnic groups. Using Asian Americans as an illustrative ethnic group, the authors see that researchers have highlighted the influence of acculturation on health outcomes. Some researchers suggest that this relationship is positive, whereas others postulate that the opposite is true. Because of the highly complex and divergent findings in the literature, this meta-analysis addresses the question of how acculturation (as measured by acculturation scales) is related to depression (a specific mental health outcome) among the Asian American population living in North America. Analyses were based on 38 studies. The meta-analyses reveal that when acculturation is measured as assimilation to the American culture, there is a small but statistically significant negative relationship between acculturation and depression scores. When acculturation is measured as orientation to the Asian culture, the relationship between acculturation and depression scores is also negative, but not statistically significant.

Depression, anxiety, and suicidal ideation among Chinese Americans: a study of immigration-related factors

The aim of this study was to identify anxiety, depression, and suicidal ideation disparities among Chinese Americans and how immigration-related factors affected the outcomes. We tried to explain the differences as a function of the Chinese culture. Data were derived from the National Latino and Asian American Study, the first national epidemiological survey of these populations in the United States. We used only the Chinese sample (N = 600) and focused on depressive disorder, anxiety disorder, and suicidal ideation. The United States-born Chinese and those Chinese who immigrated to the United States at 18 years or younger were at higher risk for lifetime depressive or anxiety disorders or suicidal ideation than were their China-born counterparts who arrived in the country at or after 18 years of age. For Chinese Americans, immigration-related factors were associated with depression and anxiety disorders and suicidal ideation. The higher prevalence of these disorders might be attributed to the psychological strains experienced by those who are at higher risk of cultural conflicts.

Limited English proficiency and psychological distress among Latinos and Asian Americans

English proficiency is increasingly recognized as an important factor that is related to the mental health of immigrants and ethnic minorities. However, few studies have examined how the association between English proficiency and mental health operates and whether the pattern of association is similar or different among various ethnic minority groups. This paper investigates how limited English proficiency directly and indirectly affects psychological distress through pathways of discrimination for both Latinos and Asian Americans in the United States. Findings suggest that, for Asian Americans, limited English proficiency has an independent relationship with psychological distress over and above demographic variables, socioeconomic and immigration-related factors and discrimination. For Latinos, however, socio-demographic variables and discrimination show a stronger association than limited English proficiency in affecting psychological distress. Different forms of discrimination - everyday discrimination and racial/ethnic discrimination - are equally important for both ethnic groups. Findings underscore the differential role of limited English proficiency for the mental health of Asian Americans and Latinos and suggest the distinctive racial experiences and backgrounds of these two ethnic groups.

Depression in China: integrating developmental psychopathology and cultural-clinical psychology

With a starting point in John Abela's groundbreaking developmental psychopathology research on adolescent depression in China, we aimed to review the state of the literature on Chinese depression across the lifespan. We began with Dr. Abela's published studies relevant to depression in China and our own research with adults before turning to the reference lists of these articles to find additional sources. Then we conducted literature searches using PsycINFO and PubMed to find other relevant studies published between April 2001 and April 2011 . There are two distinct literatures on depression in China. Developmental psychopathology research has emphasized adolescent samples and cognitive models of causation; cultural-clinical psychology and cultural psychiatry research have emphasized adult samples and the meanings associated with emotions, symptoms, and syndromes. Both approaches to the study of depression in China have yielded important findings but have also highlighted issues that could be better addressed by incorporating the other approach. Beyond depression in China, the psychological study of culture and mental health more generally would benefit from greater exchange between developmental psychopathology and cultural-clinical psychology.

A prospective study of social difficulties, acculturation and persistent depression in Pakistani women living in the UK

BACKGROUND

The reasons for the high prevalence of depressive disorders in women of Pakistani origin living in the UK are not clear. The aim of this study was to determine the relative importance of life events, chronic social difficulties and acculturation in a population-based sample of British Pakistani women.

METHOD

A cross-sectional and prospective cohort study of 18- to 65-year-old Pakistani women in UK was carried out. The Schedule for Clinical Assessment in Neuropsychiatry for diagnosis, the Life Events and Difficulties Schedule for social stress and an acculturation questionnaire were used.

RESULTS

Depressive disorder at baseline was associated with older age, social isolation and marked difficulties involving health and close relationships. Depressive disorder at follow-up was associated with severity of depression at baseline, difficulties in close relationships and two aspects of acculturation, especially less acculturation in relation to use of the English language.

CONCLUSIONS

Lack of acculturation, especially less familiarity with the English language, is an independent predictor of persistence of depression in Pakistani women in UK. This needs to be taken into consideration when planning treatment, which also needs to address the personal difficulties associated with persistent depression. The implication of this work is that women of Pakistani origin with depression should be encouraged to receive help in the use of English as one part of treatment that may prevent relapse.

Help-seeking behaviors among Chinese Americans with depressive symptoms

An exploratory survey indicated that the depression prevalence among Chinese Americans is 17.4 percent. Of 516 respondents, 34.9 percent preferred seeking advice from friends or relatives, followed by 30.2 percent not showing any preference when facing a mental health problem. Logistic regression results pointed to three contributing factors: anxiety problems, acculturation concerns, and domestic violence. Learning from these factors, the authors conducted additional analyses to connect depressive symptoms with demographics to explain the underutilization of mental health services. Significant results showed that male Chinese Americans were more likely than female Chinese Americans to seek help from physicians but less likely to seek help from friends. Those who were not employed were more likely than those who were employed to think that a family problem would take care of itself or to seek help from herbalists, from physicians, or from friends. Implications for social work practice are discussed and address risk factors and multicultural considerations.

The relationship between acculturation factors and symptoms of depression: a cross-sectional study with immigrants living in Athens

The process of acculturation observed in immigrants is part of an adjustment to the values and norms of a new society, and possibly the loss of norms of the society of origin. Acculturation has been linked to stress-related psychological disorders such as depression. The present study investigates the relationship between three acculturation domains (everyday life behaviors, wishful orientation/nostos, and ethnic identity) and symptoms of depression in a sample of foreign immigrants living in Athens, Greece. The sample consisted of 317 immigrants who visited two non-governmental organization polyclinics. All participants were interviewed using the Immigrant Acculturation Scale (IAS) and the Center for Epidemiological Studies Depression Scale (CES-D). The results showed that 133 (42%) out of the 317 interviewees were in a depressive state (CES-D > 15). The main finding was that high CES-D scores were related to low scores in the IAS Everyday Life and Wishful Orientation factors, while no relationship was found between depressive symptomatology and the IAS Identity factor. Short duration of stay in Greece, lack of steady job, and lack of residence permit were also related to high CES-D scores. In conclusion, adaptation to mainstream culture daily behaviors as well as the wish to integrate with individuals from the mainstream culture and settle permanently in the new country could be seen as part of an adaptive mechanism that protects the individual from experiencing depressive symptomatology.

Is there a genetic contribution to cultural differences? Collectivism, individualism and genetic markers of social sensitivity

Genes and culture are often thought of as opposite ends of the nature-nurture spectrum, but here we examine possible interactions. Genetic association studies suggest that variation within the genes of central neurotransmitter systems, particularly the serotonin (5-HTTLPR, MAOA-uVNTR) and opioid (OPRM1 A118G), are associated with individual differences in social sensitivity, which reflects the degree of emotional responsivity to social events and experiences. Here, we review recent work that has demonstrated a robust cross-national correlation between the relative frequency of variants in these genes and the relative degree of individualism-collectivism in each population, suggesting that collectivism may have developed and persisted in populations with a high proportion of putative social sensitivity alleles because it was more compatible with such groups. Consistent with this notion, there was a correlation between the relative proportion of these alleles and lifetime prevalence of major depression across nations. The relationship between allele frequency and depression was partially mediated by individualism-collectivism, suggesting that reduced levels of depression in populations with a high proportion of social sensitivity alleles is due to greater collectivism. These results indicate that genetic variation may interact with ecological and social factors to influence psychocultural differences.

Acculturation, psychiatric comorbidity and posttraumatic stress disorder in a Taiwanese aboriginal population

BACKGROUND

This study investigates acculturation and other antecedent psychiatric and socio-environmental risk factors for posttraumatic stress disorder (PTSD) in one aboriginal group (the Bunun) exposed to an earthquake disaster in Taiwan.

METHOD

Respondents (n = 196) were assessed 5 months after the disaster, using a Chinese version of the Schedules for Clinical Assessment in Neuropsychiatry and the Taiwan Aboriginal Acculturation Scale.

RESULT

Four risk factors exerted independent effect on the risk of PTSD, including magnitude of the earthquake, subsequent traumas, antecedent major depressive disorder and acculturation status.

CONCLUSION

Public mental health programs need to consider the liability to PTSD in populations with different ethnicity and socio-cultural environments.

Depressive and anxiety disorders in different ethnic groups: a population based study among native Dutch, and Turkish, Moroccan and Surinamese migrants in Amsterdam

INTRODUCTION

To explore ethnic differences in psychopathology, this study examined the prevalence of depressive and anxiety disorders among different ethnic groups in Amsterdam and determined whether ethnic differences can be explained by socio-demographic differences.

METHODS

A population-based sample of 321 Dutch, 231 Turkish, 191 Moroccan, 87 Surinamese/Antilleans was interviewed by well-trained bilingual interviewers, using the CIDI 2.1. Educational level and income were used as indicators of socio-economic status.

RESULTS

The weighed 1-month prevalence of depressive and/or anxiety disorders was 6.6% (Dutch), 18.7% (Turkish), 9.8% (Moroccans) and 1.2 % (Surinamese/Antilleans). Among Moroccans, the prevalence of affective disorders seemed higher in men than in women, among the Turkish the opposite was observed. Ethnic differences in prevalence could not be explained by socioeconomic differences.

CONCLUSION

Turkish women and men and Moroccan men in Amsterdam seem to have a higher risk of current affective disorders. Ethnicity is an independent predictor of common mental disorders in the Netherlands.

The burden of mental disorders

In the last decade, there has been an increase in interest in the burden of chronic and disabling health conditions that are not necessarily fatal, such as the mental disorders. This review systematically summarizes data on the burden associated with 11 major mental disorders of adults. The measures of burden include estimates of prevalence, mortality associated with the disorders, disabilities and impairments related to the disorders, and costs. This review expands the range of mental disorders considered in a report on the global burden of disease, updates the literature, presents information on the range and depth of sources of information on burden, and adds estimates of costs. The purpose is to provide an accessible guide to the burden of mental disorders, especially for researchers and policy makers who may not be familiar with this subfield of epidemiology.