by Karen G. Martinez, MD, MSc

Culture affects the way we express our thoughts, behaviors and emotions. It is therefore not surprising that there are cultural differences in the way anxiety and depression is manifested and treated. One of the main differences seen across cultures is the way anxiety and depression is expressed.  Someone from a culture where it is common to know psychological terms, could easily describe anxiety and depression using those specific words.  In other cultures, other words might be more common.  For example, being nervous (nervios) is frequently used by Latinos to express anxiety.  In some other cultures, anxiety and depression might not even be expressed in words.  It can take the form of physical symptoms, such as headaches, backaches or stomach discomfort.  Sadness, fear and preoccupation can be channeled through physical symptoms.  These feelings are sometimes even better explained by religious or spiritual beliefs. If this is the case, instead of seeking help from a mental health professional, this person will probably look for counsel with their spiritual guide.  

The way anxiety and depression are expressed is very related to the concept of health literacy, or how much do you know about certain diseases and its treatment.  This knowledge about health has been shown to be higher among members of more privileged groups. In cultures that might use other language or concepts to express their pain or discomfort, lower knowledge about how the established health systems work can limit their communication with health professionals and even affect when they choose to seek treatment.  A fact that is especially important given the persistent health disparity of poor access to quality health care seen in certain ethnical groups within the United States. It continues to be more difficult for an African-American or Latino to access effective health services for anxiety and depression. Language, idioms of distress and health literacy might be involved, but also other socioeconomical factors such as having health insurance or immigration status create barriers to mental health treatments.   

Most of the evidence-based treatments for anxiety and depression include working with thoughts and emotions or making decisions about taking psychiatric medications. These are topics that are usually sensitive for most people. To be able to talk about these topics requires trust.  For some cultural groups, who have been subject to discrimination, trusting the established mental health system can be challenging. Some factors that can affect trust are previous negative experiences with health care providers or having a conflict between their cultural beliefs and the scientific view on mental health.   

Although culture can affect both the way anxiety and depression is expressed and how treatment is accessed, there is no evidence that the treatment for these conditions does not work in all cultures and ethnicities. There are several different forms of effective treatments, from medications to talk therapies, but also exercises and mindfulness practices.  The treatment that will work for each individual is different. The most important fact is that, regardless of culture, someone who is suffering from anxiety or depression should continue to seek treatments until the right one is found.  There are many mental health professionals and clinics that are striving to be culturally sensitive. In other words, services that are open to assessing anxiety and depression in many ways and that help the person find the right treatment that aligns with their culture can be found.  

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About the Author

Karen G. Martinez, MD, MSc is a child and adolescent psychiatrist in San Juan, Puerto Rico.  She is an assistant professor at the University of Puerto Rico where she directs the Center for the Study and Treatment of Fear and Anxiety. As the director of this Center, she leads an interdisciplinary team in the development of research and treatment protocols aimed at improving the assessment and treatment of anxiety in Puerto Ricans.  This Center consists of an interdisciplinary group of psychiatrists, neuroscientists, psychologists and occupational therapists studying the role of physiological fear on anxiety disorders and cultural adaptation of treatments for anxiety disorders.  She is also the principal investigator and director of the NIH funded Hispanic Clinical and Translational Research Education and Career Development Program at the University of Puerto Rico. She completed a Post-doctoral Master’s in Clinical Research in 2006 and has then continued to receive institutional, NIH and Susan G. Komen Foundation support for her research.  Her multiple awards recognize her research work including the Career Development Award from the Anxiety and Depression Association of America (ADAA), and a Minority Faculty Award from the American College of Neuropsychopharmacology (ACNP).  She is an active member of several professional organizations, such as the ADAA where she has spearheaded multiple projects in order to increase outreach to diverse population including being the chair of the Women's Mental Health Special Interest Group.