A pilot study of depression among American Indian patients with research diagnostic criteria.

In a pilot study of depression among American Indians, 86 patients from three different tribal cultures were evaluated utilizing systematic diagnostic criteria. Similarity of symptom patterns was greater than differences between those patient groups drawn from the tribes and m comparison to non-Indian patterns of depression. Among the Indian patients major depression occurred in three distinct subgroups: an uncomplicated pattern, a secondary depression in association with a past history of alcoholism, and a complicated depression superimposed upon an underlying chronic depression or personality disorder. Each of these three disorders requires a distinctive diagnostic approach and each disorder may be influenced by cultural factors. High rates of depression among American Indians have been widely reported by treating clinicians (Shore & Manson, 1981). In addition, increased suicide rates among certain Indian tribes have been confirmed by various investigators (Shore, 1975; Kraus & Bailer, 1979; Levy & Kunitz, 1971). These findings have been attributed to rapid cultural change, epidemic patterns of alcohol abuse, increased rates of physical illness, accidents and deaths, and demoralization secondary to enforced dependency. This paper reports the first phase of a research project on major depression in three American Indian tribes. The study was designed to explore the relationship of depression to several of the above