Dysthymia in Minority Population

Dysthymic disorder, also called dysthymia, is a less severe but chronic form of depression and is characterized by depressive symptoms that prevent one from functioning normally for at least two years. Depressive disorders in women often coexist with eating disorders such as anorexia and bulimia, and anxiety disorders such as panic disorders, social phobia, and generalized anxiety disorder. Substance abuse can also co-occur with dysthymia, although this is more common among men than women. Studies have shown that both women and men who have depression and a serious medical illness, such as heart disease and diabetes, tend to have more severe symptoms of both illnesses.

This entry will examine dysthemia incidence and treatment in the United States. Approximately 3 percent of the U.S. population has dysthymia, and a disproportionate number of those are women. Thought to be caused partly by genetics, as studies are beginning to show that depressive disorders are more likely to occur in women with family histories of depression, researchers suggest that chemicals and hormones also play a significant role. Obtaining more accurate rates of the disorder is difficult for several reasons, especially misdiagnosis, because the symptoms of dysthymia are often confused with normal life stressors or major depression. A historical bias against minorities has also resulted in over diagnosis of mental disorders in minority populations. In addition, studies find that minorities are more likely to experience chronic environmental and social stressors like poverty and crime and thus may not recognize dysthymic symptoms. Literature on rates of dysthymia and depression by race/ethnicity has not illustrated a consistent relationship between the two, partly because cultures express emotions differently. For example, some non-Western groups, such as some Asian cultures, do not have the same concrete definition of mental illness that Western mental health professionals base diagnoses upon, which results in lower numbers of diagnosed persons in some populations.

Other reasons for poor estimates of dysthymia in minority populations are barriers to effective care, such as a lack of transportation to a medical facility, lack of childcare, lack of insurance to cover office visits, medication, and/or a specialist, lack of time off from work to visit a doctor and/or obtain medication, language barriers, stigma associated with having a mental illness, mistrust of the medical establishment, and physical health taking priority over mental health.

Nevertheless, the implications of untreated dysthymia can be serious. Persons with dysthymia can experience one or more periods of major depression in their lives, and approximately 10 percent later develop major depression. One study of human immunodeficiency virus (HIV)-positive individuals found that minority women with dysthymia were less likely to receive the most effective treatment therapy available than both minority women without dysthymia and men. Treatment for dysthymic disorders often includes both antidepressant medication and psychotherapy. Women often find medication to be easier and less time consuming than therapy.

The effectiveness of various treatment plans for minorities is contingent upon the recognition of the heterogenity of minorities, and culturally specific treatment is needed. Evidence-based practices and programs have typically been created and evaluated based on whites and persons with higher social and economic status (SES), which is problematic because abundant literature show the necessity of culturally specific treatment programs for minorities, who also tend to have lower SES. Further, some minority populations utilize more informal mental health services which must be acknowledged and supported by healthcare providers to provide the best treatment possible.

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