Ability to detect depression in ethnic minority groups: a UK Biobank cohort study

Background Evidence on ethnic differences in depression in the UK is mixed, and the suitability of current screening tools is under question. Objective To examine ethnic differences in depression identification, symptom reporting and phenotypes among middle-aged and older adults in the UK. Methods We assessed lifetime depression in 502 140 UK Biobank participants using an established algorithm. Depression symptoms were assessed using the Composite International Diagnostic Interview-Short Form data from the 2022 mental health follow-up. Latent class analysis (LCA) identified depression phenotypes. Logistic regression models adjusted for age, sex, deprivation and physical health assessed ethnic differences in depression identification, symptom reporting and phenotype membership. Findings Overall, 23.7% of participants met study criteria for a lifetime history of depression. Compared with White participants, depression identification was significantly lower in all ethnic minority groups except the mixed group. Black, other Asian and South Asian participants were less likely to report core depression symptoms (prolonged sadness or loss of interest). LCA produced four phenotypes: major depression, somatic depression, non-somatic depression and subthreshold depression. Black (adjusted OR (aOR) 1.70, 95% CI 1.32 to 2.20), other Asian (aOR 1.73, 95% CI 1.21 to 2.46) and South Asian (aOR 1.63, 95% CI 1.26 to 2.10) participants were more likely than White participants to belong to the somatic depression phenotype. Conclusions Lower rates of depression identification among ethnic minority groups may reflect limitations in how depression is defined, perceived and detected within these populations. Clinical implications Depression may present more somatically in some ethnic minority groups. Clinicians may need to adopt more culturally informed assessment approaches to ensure accurate detection and appropriate support.