Lucy Tully

Depression in the Chinese: the impact of acculturation

BACKGROUND Studies of depression in the Chinese have long identified low rates and a greater likelihood of somatization, findings which could reflect cultural influences or real differences. We report a study from a western region examining the impact of acculturation on depression to clarify the role of cultural factors. METHOD In a Sydney-based study, Chinese subjects (n = 385) and a matched control group of 143 non-Chinese subjects completed either a Chinese or English questionnaire assessing state and lifetime depression, attributional style, depression recognition and help-seeking. The impact of acculturation was examined by several strategies. RESULTS Any tendency by the Chinese to somatize depression appeared to be attenuated by acculturation. State depression levels countered the view that Chinese necessarily deny depression. Lifetime depression rate differences were also attenuated by acculturation, with Chinese subjects being less likely than controls to judge episodes as a distinct disorder and to seek professional help. CONCLUSIONS Results suggest that Australian Chinese do not differ intrinsically in recognizing and ascribing depressive symptoms, and that the greater the degree of acculturation, the greater the tendency for reporting persistent and impairing depressive episodes.

The validity and utility of patients’ daily ratings of mood and impairment in clinical trials of bipolar disorder

Objective:  Traditional cross‐sectional clinician‐rated measures have limited use in clinical trials of bipolar disorder. We examine the validity and usefulness of patients’ daily ratings of mood and functional impairment during a treatment trial.

Cross-cultural validation of the DMI-10 measure of state depression: The development of a Chinese language version

Depression measurement tools in cross-cultural research require careful design and thorough validation to ensure that cognitive concepts in one culture can be appropriately translated and applied to a differing culture. The aim of this study was to validate the Chinese version of a screening measure of state depression, the 10-item Depression in Medically Ill (DMI-10), and we report three interdependent studies. An initial bilingual test-retest study identified four (of the 10) items as having poor cross-cultural validity. A second study involved focus groups participants exploring the meaning of translated items with Chinese speakers. The third study repeated the bilingual test-retest analyses on the modified DMI-10 form and demonstrated improved correlation coefficients on all items and an excellent overall correlation (r = 0.87) between the Chinese and English versions. The Chinese DMI-10 should prove useful as a tool in cross-cultural research to understand the Chinese experience of depression. The findings of this study have methodological implications for cross-cultural research on depression.

Why am I depressed? : An investigation of whether patients' beliefs about depression concur with their diagnostic subtype

We investigated whether patients’ beliefs about the causes of their depression concurred with their diagnostic subtype. Depressed patients (N = 196) attending a tertiary referral clinic completed a questionnaire regarding putative biological and nonbiological causes of their depression. Subtyping diagnoses of melancholic or nonmelancholic depression were made. Patients with nonmelancholic depression were more likely to attribute nonbiological factors as the cause of their depression than those with melancholic depression, whereas patients with melancholic depression were no more likely to attribute biological factors as the cause of their depression. Patients can distinguish differing causes of depression. The implications of the findings for the current classificatory systems of depression are discussed.

How low do we go? Is duration of a ‘high’ integral to the definition of bipolar disorder?

Objective: There has been considerable debate about the diagnostic rules for bipolar II disorder, particularly the 4-day duration criteria for hypomanic episodes. This study examined whether highs lasting minutes or hours differed from longer highs in terms of clinical features and symptom severity. It also examined whether duration of highs predicted bipolar disorder being diagnosed. Method: A total of 518 subjects with significant episodes of depression and ‘highs’ completed a web-based self-report questionnaire. Those who reported their longest highs lasting minutes or hours were compared with those who reported longer durations of highs on a range of clinical variables and measures of symptom severity. Results: Subjects whose highs lasted minutes or hours reported clinical features and severity of symptoms similar to those whose highs lasted 3–7 days. However, the odds of being diagnosed with bipolar disorder for those with highs lasting 3–7 days were almost three times higher than for those whose highs lasted minutes or hours. Conclusion: The 4-day DSM-IV minimum-duration criteria for hypomania may lead to failure to diagnose subjects with brief highs who have true bipolar disorder and thus should be reconsidered.

Patient satisfaction with the Black Dog Institute Depression Clinic.

Objective: The aim of this paper is to report on patient satisfaction with the Black Dog Institute Depression Clinic, a tertiary referral service providing assessment and treatment advice to patients with mood disorders. Method: Patients who attended the Depression Clinic over the period 2006–2007 received questionnaires in the mail assessing satisfaction with the services received. Of the 321 patients attending, 114 (35%) replied. Results from 110 patients were subsequently analysed. Results: Overall, patients were very satisfied with the services received. However, a number of priority areas were identified including provision of information about diagnosis, causal factors and treatment options; managing patient expectations about services offered; the need for improvement of communication between patient and psychiatrist; and the need for adequate de-briefing for those who receive an unexpected or differing diagnosis. Conclusions: Patient satisfaction is a central component in shaping clinical service development to ensure delivery of effective health care. Findings from this study have implications for the improved delivery of psychiatric services.