Understanding Patients’ Cultural Perception of Mental Illness Crucial to Effective Treatment

Clinicians diagnosing and treating depression among members of ethnic minorities, especially immigrants, need to go beyond mere translation to engage patients, said Albert Yeung, M.D., Sc.D., director of primary care studies in the Massachusetts General Hospital Depression Clinical and Research Program.

“Sometimes there is no concept of depression as we know it in non-Western cultures,” said Leung at APA’s 2015 annual meeting in Toronto today, drawing on his work with Chinese immigrants at the South Cove Community Health Center in Boston’s Chinatown.

Even when a word like “depression” is translated, immigrant patients may still not know what it means because the term is not part of their vocabulary. Patients at South Cove are most likely to complain of physical symptoms, sleep or appetite problems, or irritability but rarely “sadness or depressed mood,” he said. “We have to understand what is in the minds of our patients,” said Yeung. “That means accepting multiple explanatory models of illness.”

It also means asking patients about their own thoughts about their illness, its causes, and their concerns about it as well as the results they hope to achieve from treatment. “Symptoms can serve as common platforms for engaging patients,” said Yeung. “If they have sleep problems, we can offer them a treatment.”

As with any patient group, it is critical to keep connected to patients, whether that involves follow-up phone calls or even a switch to telepsychiatry.