Contrasting Depression Among a Sample of African Americans with Major Depressive Disorder in the DSM

Research has consistently explored cross national variations in how people express depression. In the United States (U.S.), depression and other mental illnesses are often conceptualized and measured based on Western psychiatry. Researchers have suggested that some measurement instruments might not necessarily capture the experiences of African Americans and persons who belong to race and ethnic minority groups in the U.S. The current study identifies symptoms that constitute a shared model of depression among African Americans, and compares them to symptoms of major depressive disorder (MDD) in the fifth edition of the Diagnostic Statistical Manual of Mental Disorders (DSM –V).  Data were collected in a disadvantaged urban neighborhood in Minneapolis, MN and analyzed using cultural consensus analysis (CCA). Indicators of depression were elicited using a free-listing technique. 40 key informants were selected to rate how common each indicator of depression was among African Americans. Factor analysis was performed on key informants and their factor loadings were used to identify significant indicators of depression.  Results suggest that key informants were drawing from a shared belief system about depression. The most significant indicators of depression included classic symptoms in the DSM-V such as sadness, lack of motivation, low self-esteem, and hopelessness.  However, there were other significant indicators inconsistent with classic symptoms of MDD such as paranoia, violent behavior and rage.  These differences might be due in part to contextual factors that shape the expression of distress. An important implication of these findings is that expressions of depression that are not in the DSM-V might be overlooked in clinical assessments.  Therefore, mental health providers might benefit from a better understanding of how context shapes expressions of depression.