Depressive disorders in ethnic minorities in the doctor's office

Doctors often find the diagnosis and treatment of psychiatric disorders in non-Western ethnic minorities difficult. Not only do language and culture form barriers to understanding, the symptoms of these disorders can be expressed in unfamiliar ways. We describe three cases that illustrate how the clinical presentation of depression in ethnic minorities living in the Netherlands can differ from that of Dutch patients. While the core symptoms of depressive disorder are similar, ethnic minority patients exhibit somatic symptoms more frequently. On average, they also have more severe symptoms, more psychiatric comorbidity such as anxiety and psychosis; the illness is also more often complicated by a multitude of social problems. Improving the diagnosis and treatment of depression in ethnic minorities requires knowledge and the exploration of potential differences in symptom presentation and the patient's explanatory models of mental illness. Patients and physicians also need to discuss their mutual expectations, in order to reach a consensus about treatment goals.