Contrasting depression among African Americans and major depressive disorder in the DSM-V

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 were collected in a disproportionately Black urban neighborhood in the USA and analyzed using cultural consensus analysis (CCA). In total, 34 African Americans 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 analysis was performed, factor loadings were used to weight the responses of each informant in the survey and then aggregated to determine the most significant indicators or components of the 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.