When the Body Speaks Before the Mind: Somatic Presentation, Diagnostic Delay, and the Structural Recognition Gap in Depression Across Low‐ and Middle‐Income Countries

Depression remains persistently under‐detected in primary care across low‐ and middle‐income countries, and a major contributor to this failure, alongside workforce shortages, stigma, and limited service access, is the frequency with which the disorder presents first through the body rather than through recognizable affective complaint. Somatic symptoms, including chronic fatigue, pain, sleep disturbance, and gastrointestinal complaints, often constitute the initial expression of depressive illness, particularly in cultural contexts where psychological vocabulary for naming distress is unavailable or socially costly. When these presentations meet primary care systems lacking the training, tools, and workforce capacity to interpret them as depression, the result is a structurally predictable recognition gap. This commentary argues that closing this gap requires culturally adapted clinical training, locally validated screening instruments that assign appropriate weight to somatic complaints, and task‐shifting models that extend assessment and care capacity to non‐specialist health workers. Accounts of the lived diagnostic experience are also proposed as an underutilized evidence base for intervention design.