Contrasting depression among African Americans and major depressive disorder in the DSM-V
| Published date | 19 March 2018 |
| Date | 19 March 2018 |
| DOI | https://doi.org/10.1108/JPMH-12-2016-0061 |
| Pages | 11-19 |
| Author | Sirry Alang |
| Subject Matter | Health & social care,Mental health,Public mental health |
Contrasting depression among African
Americans and major depressive disorder
in the DSM-V
Sirry Alang
Abstract
Purpose –The purpose of this paper is to identify symptoms that constitute a shared cultural model of
depression among African Americans and to compare these accounts with criteria for major depressive
disorder (MDD) in the 5th edition of the Diagnostic Statistical Manual of mental disorders (DSM-V).
Design/methodology/approach –Data werecollected in a disproportionatelyBlack urban neighborhoodin
the USA and analyzedusing cultural consensusanalysis (CCA). In total, 34 AfricanAmericans participated in a
free-listing exercise to elicit common indicators of depression in the same community. Another 40 key
informants completed a survey to rate how common each indicator was in the same community. Factor
analysiswas performed, factor loadingswere used to weight the responsesof each informant in the survey and
then aggregatedto determine the most significant indicators or components ofthe shared model depression.
Findings –Indicators of depression included classic symptoms in the DSM-V such as sadness and lack of
motivation. However, other indicators that are inconsistent with symptoms of MDD in the DSM-V such as
paranoia and rage were common and constituted a shared model of depression in the sample.
Research limitations/implications –Some symptoms common among African Americans that are not in
the DSM-V or on research instruments developed based on the DSM could be overlooked in epidemiological
surveys and in clinical assessments of depression.
Practical implications –The provision of mental health care might benefit from a better understanding of
how contextual factors shape expressions of distress among African Americans.
Originality/value –This study identify culturally salient symptoms of depression among African Americans
independent of clinically defined criteria.
Keywords Culture, Depression among blacks, DSM-V, Idioms of distress
Paper type Research paper
Introduction
Mental disorders are subject to interpretations that are shaped by cultural and contextual factors.
Cross-national studies have explored variations in how people express disorders such as
depression (Furnham and Malik, 1994; Keys et al., 2012; Lange et al., 2002). Depression can be
somaticized or expressed as a physical problems like pain or fatigue or even dizziness (Kirmayer
and Young, 1998; Kleinman and Good, 2004; Lee et al., 2007). Research suggests that in the
USA, African Americans are more likely than whites to somaticize depression and other mental
disorders ( Jones-Webb and Snowden, 1993; Snowden, 1999).
Most of the research that explores depression and its prevalence among African Americans
employs community-based samples using survey instruments that are coherent with criteria for
diagnosing disorders in the Diagnostic Statistical Manual (DSM). One reason why community or
general population-based studies are preferred instead of clinical samples for assessing racial
differences in meeting criteria for depression is that people who belong to minority groups in the
USA have little access to mental health services (Alegría et al., 2015; Wells et al., 2001;
Cook et al., 2014) and, as a result, are less likely to be diagnosed in the clinical setting.
Received 31 December 2016
Revised 3 October 2017
Accepted 9 December 2017
The author would like to thank the
residents of the neighborhood that
is the setting for this study for their
participation and comments.
Sirry Alang is based at the
Department of Sociology and
Anthropology, Lehigh
University, Bethlehem,
Pennsylvania, USA and the
School of Public Health,
University of Minnesota,
Minneapolis, Minnesota, USA.
DOI 10.1108/JPMH-12-2016-0061 VOL. 17 NO. 1 2018, pp. 11-19, © Emerald Publishing Limited, ISSN 1746-5729
j
JOURNAL OF PUBLIC MENTALHEALTH
j
PAG E 11
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