Ethical Implications of Cultural Barriers to the Depression Diagnosis: Conversations with Primary Care Physicians

Abstract

This article explores ethical issues raised by Primary Care Physicians (PCPs) when diagnosing depression and caring for cross-cultural patients. This study was conducted in three primary care clinics within a major metropolitan area in the Southeastern United States. The PCPs were from a variety of ethnocultural backgrounds including South Asian, Hispanic, East Asian and Caucasian. While medical education training and guidelines aim to teach physicians about the nuances of cross-cultural patient interaction, PCPs report that past experiences guide them in navigating cross-cultural conversations and patient care. In this study, semi-structured interviews were conducted with seven PCPs which were transcribed and underwent thematic analysis to explore how patients’ cultural backgrounds and understanding of depression affected PCPs’ reasoning and diagnosing of depression in patients from different cultural backgrounds. Ethical issues that arose included: limiting treatment options, expressing a patient’s mental health diagnosis in a biomedical sense to reduce stigma, and somatization of mental health symptoms. Ethical implications, such as lack of autonomy, unnecessary testing, and the possible misuse of healthcare resources are discussed.

A Data-Driven Analysis of Sociocultural, Ecological, and Economic Correlates of Depression Across Nations

“…However, two forms of underreporting may be difficult to capture through variation in mental health infrastructure. First, mental illness is stigmatized in many cultures, which may lead people to avoid diagnosis or treatment for their symptoms (Botha et al, 2017; Cagliero, 2020; Krendl & Pescosolido, 2020; Zisberg, 2017). To some extent, a cultural stigmatization of mental health is related to the prevalence of mental healthcare workers, since countries with frequent stigmatization of mental health disorders should have less mental healthcare infrastructure.…”