Background: the clinical presentation and management of major depressive disorder (MDD) are shaped by cultural meanings, social norms, and health-system contexts. While cross-national differences in depression have been widely discussed, comparative evidence focusing on psychiatrists’ everyday clinical practice remains limited. Examining how depression is recognised and managed across cultural settings is essential for developing context-sensitive models of care. Aim of the study: the aim of this investigation is to analyze how the clinical practice of psychiatrists and psychiatry residents regarding major depressive disorder (MDD) is influenced by the different social, cultural, and organizational paradigms that characterize five nations (Italy, Brazil, Nepal, Germany, and Japan). Through a comparative analysis of data collected on an international scale, the study aims to enrich the global understanding of the dynamics involved in managing depressive pathology. The ultimate goal is to promote culturally sensitive, sustainable, and equitable models of care, highlighting the need to integrate transcultural perspectives into the development of international psychiatric guidelines, thereby overcoming the limitations of standardization based exclusively on Western-centric models. Methods: this international cross-sectional study was conducted among a sample of psychiatrists and psychiatry residents using an anonymous online questionnaire available in English, Italian, and Japanese. The investigation explored clinical phenomenology at onset, perceived severity markers, and the impact of socio-cultural determinants on major depressive disorder (MDD), while also examining diagnostic practices and therapeutic strategies for partial response and treatment-resistant depression (TRD). Data collection took place between July and October 2025, initially involving 165 clinicians. To ensure methodological robustness, country-level comparative analyses were restricted to nations with 10 or more respondents, resulting in a final analytic sample of 156 participants from Italy, Brazil, Nepal, Germany, and Japan. Group differences were assessed using non-parametric statistical tests and permutation-based inference procedures. Results: marked cross-country differences were observed in symptoms most commonly associated with the onset of depression, with somatic presentations reported more frequently in Nepal and less frequently in Germany, and insomnia was particularly salient in Japan. Psychiatrists’ perceptions of the role of spirituality, stigma, traditional healing practices, and barriers to care varied substantially across contexts. Diagnostic approaches differed, with greater reliance on standardised instruments in Germany and Nepal and greater emphasis on clinical judgement in Brazil. Although selective serotonin reuptake inhibitors were widely used as first-line treatment, notable variation emerged in adjunctive pharmacological strategies, psychotherapy referral, hospitalisation criteria, and approaches to TRD. Conclusions: this study highlights that the conceptualization and treatment of depression are inextricably linked to cultural frameworks and local healthcare architectures. These findings underscore the urgent need to transcend universalistic diagnostic and therapeutic models by integrating transcultural perspectives into international guidelines. Such an evolution is essential to ensure that care for major depressive disorder (MDD) is not only clinically effective but also ethically equitable and truly responsive to the specific needs of diverse global contexts.
Presupposti: La presentazione clinica e la gestione del disturbo depressivo maggiore (MDD) sono fortemente influenzate da fattori culturali, sociali e dai sistemi sanitari. Le evidenze comparative sulla pratica psichiatrica quotidiana sono però ancora limitate. Scopo dello studio: Analizzare l'impatto dei diversi paradigmi socio-culturali e organizzativi sulla pratica clinica per l'MDD in cinque nazioni (Italia, Brasile, Nepal, Germania e Giappone). L'obiettivo è promuovere modelli di cura culturalmente sensibili e integrare una prospettiva transculturale nelle linee guida internazionali. Materiali e metodi: È stata condotta un'indagine trasversale tramite questionario online anonimo (luglio-ottobre 2025) rivolto a psichiatri e specializzandi. Lo strumento ha esplorato i sintomi all'esordio, l'impatto dei fattori socio-culturali, le prassi diagnostiche e la gestione della depressione resistente (TRD). Il campione analitico finale è composto da 156 clinici provenienti dai cinque Paesi selezionati. Risultati: Sono emerse marcate differenze transnazionali. A livello sintomatologico, le presentazioni somatiche sono risultate più frequenti in Nepal e rare in Germania, mentre in Giappone è prevalsa l'insonnia. Anche il peso attribuito a spiritualità, stigma, cure tradizionali e barriere sanitarie è variato notevolmente. Sul piano clinico, sono emersi approcci diagnostici eterogenei (uso di test standardizzati in Germania/Nepal vs giudizio clinico in Brasile). Nonostante gli SSRI siano la prima scelta ovunque, si sono osservate forti differenze nelle strategie farmacologiche aggiuntive, nei criteri di ricovero, nell'invio alla psicoterapia e nella gestione della TRD. Conclusioni: La concettualizzazione e il trattamento dell'MDD sono intrinsecamente legati al contesto culturale e sanitario locale. È essenziale integrare prospettive transculturali nelle linee guida internazionali per garantire un'assistenza clinica equa, efficace e rispondente alle specifiche esigenze globali.
Differenze transculturali nella presentazione e nella gestione del Disturbo Depressivo Maggiore: un'indagine internazionale
TASSOTTO, RICCARDO
2025/2026
Abstract
Background: the clinical presentation and management of major depressive disorder (MDD) are shaped by cultural meanings, social norms, and health-system contexts. While cross-national differences in depression have been widely discussed, comparative evidence focusing on psychiatrists’ everyday clinical practice remains limited. Examining how depression is recognised and managed across cultural settings is essential for developing context-sensitive models of care. Aim of the study: the aim of this investigation is to analyze how the clinical practice of psychiatrists and psychiatry residents regarding major depressive disorder (MDD) is influenced by the different social, cultural, and organizational paradigms that characterize five nations (Italy, Brazil, Nepal, Germany, and Japan). Through a comparative analysis of data collected on an international scale, the study aims to enrich the global understanding of the dynamics involved in managing depressive pathology. The ultimate goal is to promote culturally sensitive, sustainable, and equitable models of care, highlighting the need to integrate transcultural perspectives into the development of international psychiatric guidelines, thereby overcoming the limitations of standardization based exclusively on Western-centric models. Methods: this international cross-sectional study was conducted among a sample of psychiatrists and psychiatry residents using an anonymous online questionnaire available in English, Italian, and Japanese. The investigation explored clinical phenomenology at onset, perceived severity markers, and the impact of socio-cultural determinants on major depressive disorder (MDD), while also examining diagnostic practices and therapeutic strategies for partial response and treatment-resistant depression (TRD). Data collection took place between July and October 2025, initially involving 165 clinicians. To ensure methodological robustness, country-level comparative analyses were restricted to nations with 10 or more respondents, resulting in a final analytic sample of 156 participants from Italy, Brazil, Nepal, Germany, and Japan. Group differences were assessed using non-parametric statistical tests and permutation-based inference procedures. Results: marked cross-country differences were observed in symptoms most commonly associated with the onset of depression, with somatic presentations reported more frequently in Nepal and less frequently in Germany, and insomnia was particularly salient in Japan. Psychiatrists’ perceptions of the role of spirituality, stigma, traditional healing practices, and barriers to care varied substantially across contexts. Diagnostic approaches differed, with greater reliance on standardised instruments in Germany and Nepal and greater emphasis on clinical judgement in Brazil. Although selective serotonin reuptake inhibitors were widely used as first-line treatment, notable variation emerged in adjunctive pharmacological strategies, psychotherapy referral, hospitalisation criteria, and approaches to TRD. Conclusions: this study highlights that the conceptualization and treatment of depression are inextricably linked to cultural frameworks and local healthcare architectures. These findings underscore the urgent need to transcend universalistic diagnostic and therapeutic models by integrating transcultural perspectives into international guidelines. Such an evolution is essential to ensure that care for major depressive disorder (MDD) is not only clinically effective but also ethically equitable and truly responsive to the specific needs of diverse global contexts.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/109095