4. Conclusions
Depression is highly prevalent in PWE in different countries in Asia and the prevalence rates are consistent with rates reported in the literature from other countries: overall, about 25% of PWE suffer from depression [31]. Interestingly, the apparent cultural, demographic, religious, and ethnic diversity in Asia has not affected the prevalence of this comorbidity significantly. This is notably the case even in countries such as China and Japan, where depression rates in the general population are lower than those in many Western nations [2,5,7,13,14]. Cultural differences in the expression of depression are important and well-recognized. While depression is a universal experience, its acceptance is highly dependent on many social and cultural aspects that interplay with each person’s emotional development over their lifetime [32,33]. For example, in some cultures open expression of grief or suffering is encouraged, while in other cultures such emotions should be concealed. The latter may lead to under-estimation of the depression rate in population and hospital-based investigations. In addition, the role of clinical care may be viewed very differently depending up on the cultural context: for some cultural backgrounds, depression may be considered more of a moral or spiritual problem than a medical one, which may result in reluctance to consulting a physician, reporting symptoms or following medical advice [32]. Despite the growing effects of globalization, such cultural differences seem likely to persist, or even be reinforced by a desire to protect ethnic identity, and should be taken into account when studying depression across international boundaries [34].
