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Psychosocial mechanisms underlying cultural differences in depressive and anxiety symptom reporting and presentation: a comparison of Greek-born immigrants and Anglo-Australians in Melbourne

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Annals of General Hospital Psychiatry20032 (Suppl 1) :S93

  • Received: 1 November 2003
  • Published:


  • Beck Depression Inventory
  • Hierarchical Regression Analysis
  • Impression Management
  • Unique Predictor
  • Stigma Scale


To what extent do certain explanatory factors contribute to cultural variations in the manifestation and levels of depression and anxiety between Greek-born immigrants and Anglo-Australians? Confounding factors examined included age and socio-economic status. Explanatory factors examined included stress, trait negative affectivity, self-focused attention, impression management, illness concern, demand characteristics and stigma attributed to emotional and psychological phenomena.

Material and Methods

Three hundred and nine subjects (mean age = 65 years) participated in the study, 158 respondents were Anglo-Australians and 151 were Greek-born immigrants recruited from Greek and Anglo-Australian social clubs in Melbourne.

Respondents completed the following: Beck Depression Inventory -2, State-Trait Anxiety Inventory, Stress Scale, Self-Focused Attention Scale, Positive and Negative Affect Scale, Illness Concern Scale, Balanced Inventory of Desirable Responding and a Stigma Scale.

Greek-born participants were interviewed in their own homes due to low literacy levels and Anglo-Australians completed self-report questionnaires returned by post. All participants provided written consent after being informed about the study.

Group differences were examined using analyses of variance and covariance with the covariates being socio-economic status, sex and age. Within group hierarchical regression analyses were used to examine the relative contributions of various factors to the level of depression and anxiety.


Greek-born subjects experienced higher levels of depression and anxiety than Anglo-Australians. Group differences were found for all explanatory variables. For the Greek-born, stress, trait negative affectivity, impression management and self-focused attention were unique predictors of the level of depression whereas lower age, stress and trait negative affectivity were unique predictors for the level of anxiety. For the Anglo-Australians, lower socio-economic status, trait negative affectivity, illness concern, lower impression management and stigma were unique predictors of the level of depression whereas trait negative affectivity, illness concern, lower impression management, self-focused attention and stigma were unique predictors of the level of anxiety.


Once accounting for confounding variables, this study demonstrated differences between cultural groups in level and contribution to depression and anxiety scores of psychosocial factors that contribute to symptom augmentation/reduction.

Cultural differences in presentation of depression and anxiety may be better understood by the degree to which psychosocial processes underlying symptom experience and reporting may be differentially salient in different cultures.

Authors’ Affiliations

Department of Psychiatry, The University of Melbourne; Centre for International Mental Health, School of Population Health, The University of Melbourne; and Victorian Transcultural Psychiatry Unit, Level 2, Bolte Wing, St. Vincent's Hospital, 14 Nicholson St, PO Box 2900, Fitzroy, Victoria, 3065, Australia


© The Author(s) 2003