Mental health - cultural competence.

BACKGROUND Depression, and its associated anxiety, is very common in the community and frequently managed in general practice. Yet it remains a problematic concept. Differing views of depression influence both clinical practice and research. OBJECTIVE This article discusses the way each patient's culture interacts with other important contexts of clinical practice to shape how depression is understood and managed. DISCUSSION Cultural and linguistic diversity interacts with socioeconomic factors in determining the known prevalence of depression and anxiety. Detection of depression may be shaped by expectations and assumptions of both the general practitioner and patient. Language and communication barriers mean interpreters are critical to mental health care. Culturally sensitive care for depression requires a reflective approach based on a negotiated understanding of the patient's experiences and symptoms.