About Harleen: Harleen is dedicated to science communication and is a mental health advocate. With a background in Neuroscience, she has spent four years working on research projects focused on the brain's wiring and its connection to various disorders and diseases. Harleen hopes to merge her interest in Neuroscience with her new role as a Clinical Psychology trainee.
How Depression Manifests Differently
Depression is one of the most common and serious mental health conditions worldwide. It is one of the leading causes of disability and can increase the risk of suicide. However, depression can present differently in the Punjabi community, making it harder to diagnose or prevent individuals from getting the help they need. Instead of the typical emotional signs emphasized in the Western world, like extreme sadness or loss of pleasure, depression in this community is frequently expressed through physical symptoms such as tiredness, pain, and stomach issues.
Why It Can Be Hard to Diagnose
The DSM-5, a guide used by health care professionals worldwide to diagnose mental health conditions, focuses primarily on mental and emotional symptoms. This can lead to underdiagnosis in Punjabi populations because physical complaints are often the primary expression of distress. One study in Canada found that only 61% of people presenting with symptoms of depression that were meaningful in their culture met the DSM-5 criteria to be diagnosed with depression. This is a prime example of how a guide that is primarily used for mental health diagnoses may not always work well in multicultural settings preventing diagnoses, treatment and access to the appropriate health care services.
Physical Symptoms and Cultural Terms
Research shows that Punjabi individuals with depression often report physical issues like trouble sleeping, chronic tiredness, body aches, and stomach problems. Some may even describe their depression using physical terms like a "sinking heart" or "heartache" (dil ghat da), which is associated with painful sensations in the chest or heart. One Indian study found that nearly all participants diagnosed with depression had at least three physical symptoms. Similarly, in Canada, Punjabi patients often described physical problems to their doctors rather than talking about emotions. Because of this, their depression was sometimes overlooked.
In addition to these physical symptoms, like in many Punjabi cultures, Punjabi communities may use the word 'tension' (tenshun) to describe feelings of stress or emotional discomfort. This word can mean anything from everyday stress to deep depression or even suicidal thoughts. Even though ‘tension’ is an English word, its meaning in Punjabi culture is different. Studies show that 'tension' is similar to the Western concepts of depression and anxiety. However, Western mental health systems do not always recognize this, making proper diagnosis and treatment more difficult.
A Better Approach to Mental Health Care
A culturally-sensitive approach to diagnosing and treating depression is crucial to ensuring Punjabi individuals receive appropriate mental health care. The reliance on the Western understanding may overlook key cultural expressions of distress, leading to underdiagnosis and inadequate treatment. Recognizing the importance of physical symptoms and culturally specific terms like "tension" in Punjabi communities can help bridge this gap. Moving forward, healthcare providers should be trained to consider diverse symptom presentations, and mental health frameworks should evolve to incorporate culturally relevant diagnostic tools. By doing so, we can improve access to care, reduce stigma, and ultimately enhance mental health outcomes for Punjabi populations.
References
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Karasz, A., Gany, F., Escobar, J., Flores, C., Prasad, L., Inman, A., Kalasapudi, V., Kosi, R., Murthy, M., Leng, J., & Diwan, S. (2019). Mental Health and Stress Among Punjabis. Journal of Immigrant and Minority Health, 21(S1), 7–14. https://doi.org/10.1007/s10903-016-0501-4
Karasz, A., Patel, V., Kabita, M., & Shimu, P. (2013). “Tension” in Punjabi Women: Developing a Measure of Common Mental Disorder Using Participatory Methods. Progress in Community Health Partnerships: Research, Education, and Action, 7(4), 429–441. https://doi.org/10.1353/cpr.2013.0046
Krause, I.-B. (1989). Sinking heart: A Punjabi communication of distress. Social Science & Medicine, 29(4), 563–575. https://doi.org/10.1016/0277-9536(89)90202-5
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Weaver, L. J., & Karasz, A. (2022). “Tension” and distress in South Asia: A systematic literature review. SSM - Mental Health, 2, 100092. https://doi.org/10.1016/j.ssmmh.2022.100092
World Health Organization. (2017). “Depression: Let’s talk” says who, as depression tops list of causes of ill health. World Health Organization. https://www.who.int/news/item/30-03-2017--depression-let-s-talk-says-who-as-depression-tops-list-of-causes-of-ill-health
