Are You Depressed? Depends Where You Live

People are about as depressed as their culture lets them be — or so seems to be the indication from a recent study about rates of depression in various countries around the world. This article in Forbes explains:

…The U.S. tops the list, with 9.6% of the population experiencing bipolar disorder, major depressive disorder or chronic minor depression over the course of a year. That’s compared with a .8% rate documented in Nigeria. The findings are part of a 2004 study of 14 countries by researchers from the World Health Organization (WHO) and Harvard Medical School.

Ronald C. Kessler, professor of health care policy at Harvard Medical School and principal investigator for the study, says the findings are likely related in part to Americans’ willingness to talk about their depression.

“In Nepal, for instance, it’s against the law to be mentally ill,” he says. “No surprise, nobody there admits to being mentally ill. It’s all about what people are willing to tell us.”

Wow — can you imagine a culture in which it is illegal to be mentally ill? Guess it helps keep the disability rolls down, if they even have disability rolls.

Keeping Things Under Wraps

In strikingly undeveloped countries, Kessler says, people don’t talk about being fulfilled. They’re often just focused on making it through the day.

Americans, on the other hand, tend to be forthcoming and have had much more public education about mental illness than most other countries combined, says Mary Guardino, founder of the New York-based national nonprofit mental illness advocacy group Freedom From Fear. Direct-to-consumer ads promoting prescription drugs, which aren’t legal in many countries, also encourage American consumers to seek treatment for depression. [full text]

One reason I am aware of this issue is because there are several people from other countries who work in the residential program where I work. You can tell when you talk with them that they are not culturally trained to be aware of mental illness in the same way that American-born people are.

In this way, I think other cultures may have important things to teach America about its tendency to overdiagnosis and overpathologize normal life experiences such as grief, fear, sadness, anger, and mood variability, particularly in children.

Another important aspect of this study is how it delineates the many different subjective factors that influence the diagnosing of mental illness. The article notes that the way the questions were translated to subjects had an impact on lowering the numbers of those diagnosed, as did the clinicians’ decisions about when to treat patients.