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Neurological, Psychiatric, and Developmental Disorders: Meeting the Challenge in the Developing World
Several authors also imply that Cartesian mind–body dichotomies are absent from certain cultural worldviews. Nichter (1982), for example, noted that South Havik Brahmin women express distressed emotions and other social problems in terms of dietary preference for certain foods, religious metaphors, or humoral imbalance in the body. Chinese popular explanations of mental illness ascribe problems to an imbalance in the psychosocial, physiological, or supernatural environment.[14,15] In African societies, health is viewed as more social than biological, and a unitary concept of psychosomatic interrelationship exists, with an apparent reciprocity between mind and matter. Because these conceptualizations strongly influence how people express the experience of psychological distress and dysphoric mood, standardized instruments may not be applied accurately without regard to cultural differences among populations. Nevertheless, studies show that depression is found in countries around the world with significantly different cultural traditions and levels of economic development.[17,18 and 19]
The majority of people with depression eventually consult primary care doctors or nurses. While the overall symptoms of depression are ubiquitous in population surveys, research has shown somatic symptoms to be the most common presenting features of depression in developed as well as developing societies.[20,21 and 22] Most commonly, patients present with physical symptoms such as lack of energy or vitality, fatigue, and aches and pains.[20,23,24 and 25] Several studies in developing countries indicate that when people with depression present with somatic symptoms, they will upon questioning also report that they have experienced classic psychological symptoms of depression.[20,26,27]
SCOPE OF THE PROBLEM
Depressive disorders are common around the world and are associated with significant disability.[18,28,29,30 and 31] Depression is a long-term illness that produces significant psychological, physical, and functional disability.[28,32,33 and 34]. In a study conducted in Malaysia, over half the patients with chronic depression had dysfunctional behavior and experienced significant disabilities. Indeed, depression is estimated to be the leading cause of disability worldwide, accounting for more than 1 in 10 years of life lived with disability. Those suffering from depressive disorders also have high premature mortality, both from suicide and from physical illness.[ 17,18,35,36] Prevalence rates for depression vary among and between countries, but age of onset, social and environmental risk factors, and the preponderance of depressive disorders within families are similar across many cultures.
Once recognized, depression can often be treated effectively. Though treatments are often not entirely curative, they offer significant relief from many of the debilitating symptoms of depression and can significantly improve the level of social functioning. Yet depressive disorders still remain largely underdiag-