Managing Depression

Some Asian, Middle Eastern and African parents may be less likely to endorse beliefs that are consistent with a biopsychosocial model of mental illness than are European parents (Stewart et al., 2012; Yeh et al., 2004). Asian and other CALD parents are more likely to endorse sociological causes (eg bullying, racism and discrimination, peer influence) (Vontress, 2007). These attributions contraindicate the kind of help provided in traditional mental health settings. The literature points to higher stigma against mental illness in CALD groups, and the relationship between parental knowledge and acceptability of treatment. Two sets of variables appear to play an important role in help-seeking and the ability to benefit from formal systems of mental health care for CALD children and young people (Stewart et al., 2012): beliefs about the causes of and solutions to mental illness; and knowledge about treatment options and their efficacy. Of particular concern is that practitioners may underestimate their CALD client’s and their parents’ need for psycho-education and of the encouragement needed to communicate information about the side-effects of medication. These factors may together contribute to lower rates for effective treatment of CALD adolescents. The following points will improve communication and engagement with CALD clients and their families:

• Many instruments to screen, assess severity, or track depressive symptoms have not been normed for ethnic minority youth. Their use should be supplemented with qualitative information (see the CALD Assessment Tool for Children and Young People and the Assessing Intergenerational conflicts tool in the Assessing Migrant and Refugee Children and Adolescents section).
• Be aware of diagnostic bias, such as over diagnosis of disruptive behaviour disorders in ethnic minority boys. Be careful in assessing previously diagnosed youth or those who may present with symptoms that obscure an underlying depressed mood.
• Clinicians can play an important role in observation and delineation of common presentations that fall outside the formal templates for diagnosis (see Somatic presentations in the Cultural Presentations of Distress section and the Cultural Formulation Interview tool) (see the Assessing Migrant and Refugee Children and Adolescents).
• Health literacy can be lower, particularly in less acculturated clients and parents. Clients and parents who do not ask about or voluntarily communicate information about side-effects may be at risk of low adherence.