Culture and Depression: A Cross-Cultural Meta-Analysis of the Zung Self-Rating Depression Scale

Abstract

Cultural differences in the prevalence and symptomatology of depression have been well documented. Eastern samples typically display lower prevalence rates of depression coupled with greater reporting of somatic symptoms, while Western samples have higher prevalence rates and report more psychological symptoms. Scholars have argued that both collectivism and economic factors might explain these cultural differences. Less emphasis has been placed on cultural differences of depression levels, and whether dimensions of cultural variability and country-level factors can explain any observed differences. This study reports a cross-cultural meta-analysis of studies using the Zung Self-Rating Depression Scale (SDS), examining mean scores of the SDS across 89,989 individuals from 30 countries. As expected, clinical samples showed higher depression scores compared to general population samples. Notably, income inequality (indexed by the Gini index) was weakly related to SDS scores, with higher levels of depression observed in nations with lower levels of inequality. In addition, SDS scores were not related to measures of collectivism. The results suggest that while economic factors do influence depression levels in a given society, differences in the emphasis societies place on the interdependence between individuals and the group do not exert any influence.