Counseling Today asked Carlos Zalaquett, professor and coordinator of the clinical mental health counseling program at the University of South Florida, to weigh in on the role of diversity in depression. Zalaquett, the associate editor of the Journal of Multicultural Counseling and Development, has researched depression among different client populations.
Counseling Today: How does diversity play into the topic of depression?
Carlos Zalaquett: In several ways. Here are some examples. Some epidemiological studies suggest that major depression is reported at a higher rate by African Americans (4 percent) and Hispanics/Latinos (4 percent) than European Americans (3.1 percent). Persons with less than a high school diploma (6.7 percent) and high school graduates (4 percent) are more likely to report major depression than those with at least some college (2.5 percent).
Ethnicity still influences the diagnosis and treatment of depression. Some studies suggest that African Americans are significantly less likely to receive a depression diagnosis than European Americans. And those diagnosed with depression were less likely to be treated.
Thus, it is central to develop counseling and public health initiatives to address this persisting disparity in care because if untreated, depression [can] impact the individual’s quality of life in major ways: physically, emotionally, behaviorally, socially, spiritually and job- or work-wise. Furthermore, the importance of depression becomes central as America ages. Depression is a significant public health problem for older Americans because approximately 6.6 percent of elder Americans experience an episode of major depression each year.
CT: Are there cultural or racial risk factors that can propel depression?
CZ: Some of the key aspects are tensional race/ethnic relationships, stereotyping, discrimination, lack of access, education and poverty, just to name a few.
CT: Are there different ways of handling or identifying depression that can vary based on culture or race?
CZ: Interestingly, I have observed depression across cultures. But, remember that culture affects how a client communicates their emotional or mental health needs, how they describe and understand the symptoms they are experiencing, how open they are to counseling or psychotherapy, and the kind of interventions they are willing to accept and the resources they may be willing to use.
CT: Are there multicultural aspects counselors need to be aware of in order to best treat depressed clients depending on their culture, race, ethnicity, etc.?
CZ: I believe there are many, but for the sake of time I will say that awareness, knowledge and skills in working with a diverse clientele will facilitate the process of identifying and counseling clients experiencing depression. The known multicultural competencies would critically assist in understanding how diverse clients understand, experience and describe depression. For example, clients from low socioeconomic status tend to provide somatic complaints as expression of their depressed mood (e.g., headaches, pain). Also, in some cultures, depression may be described as physical sensations (e.g., “heaviness” felt in parts of the body), while in others, depression is described in more general ways (e.g., having “nerves”). In addition, in some cultures it is considered inappropriate or taboo to discuss depression or mental health issues outside of the immediate family. Furthermore, some clients may view it as shameful or dishonorable to discuss personal issues with a counselor. Last example, men may have more difficulties than women speaking about their mental health; they may see depression as a sign of weakness.
Click here to read our November cover story, “Eyes wide open,” which focuses on diagnosing depression in clients, even those who are often the most “invisible,” and treating what is a very treatable illness.