Screening tools for depression in primary care The effects of culture, gender, and somatic symptoms on the detection of depression see also p 292,332 Depression is projected to become the leading cause of disability and the second leading contributor to the global burden of disease by 2020. 1 It is estimated that the devastation caused by depression-defined as the number of years lost to death or disability-by 2020 will be surpassed only by heart disease. 2 Primary care physicians treat more than 50% of patients with mental disorders, and depressive disorders are accurately diagnosed in less than half of the patients who are affected. 3 A patient's culture, gender, and/or predominance of somatic symptoms can impede the detection of depression. This is reflected by biases found in self-reporting screening tools used to detect depression. In this article, we discuss the limitations of self-reporting screening tools for depression with respect to culture, gender, and somatic symptoms and suggest ways to use the results of screening tools to improve the detection of depressive disorders. LITERATURE SEARCH We conducted literature searches of the PubMed and PsychINFO databases (1990-2001) using the search terms Beck Depression Inventory, culture, and validity. Further searches of the PubMed database (1990-2001) included the additional search terms primary care, depression,

In the developed world, the use of selective serotonin reuptake inhibitors (SSRIs) has skyrocketed since 1988, when Prozac was fi rst released in the United States. Biomedical psychiatry's explanation for their success is an unsubstantiated hypothesis that claims SSRIs treat a chemical imbalance in people who suffer from low levels of the neurotransmitter serotonin. Using social evolutionary theory, this article provides an alternative hypothesis for why SSRIs work for some people. SSRIs' success is attributed to their capacity to adapt people to the increased status anxiety occurring in developed nations grappling with the effects of unprecedented global competition. Biomedical psychiatry is depicted as adjusting patients to prevailing social norms rather than contributing to mental health.

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According to the World Health Organization (WHO), depression is a worldwide epidemic. It is believed to be the fourth leading cause of disability, outranking diseases such as iron-deficiency, alcoholism, and chronic pulmonary disease. Manic depression is ranked sixth as a cause of disability, despite that only 2-5 percent of the population is believed to have the affliction. The prevalence of these diseases is predicted to worsen. By the year 2020, it is estimated that the devastation caused by depression, which is defined in terms of the number of years lost to death or disability, will be surpassed only by heart disease. Today, one in five persons is estimated to meet the criteria for clinical depression in her or his lifetime. 1