Research report Attitudes about depression and its treatment among mental health professionals, lay persons and immigrants and refugees in Norway Kristi Erdal a, b, ⁎, Namrita Singh a , Annette Tardif a a Colorado College, USA b University of Bergen, Norway article info abstract Article history: Received 11 February 2011 Accepted 27 April 2011 Available online 26 May 2011 Background: Internationally, depression is a common psychological disorder whose treatment depends upon its identification by treating professionals as well as patient utilization of mental health care systems; the latter often being hampered by cultural differences between patients and health professionals. Method: The current study used vignettes of depressed patients which varied the culture and/or social circumstances of the patient to assess whether these variables influenced the conceptualization of depression and its treatment. Participants (N = 722) included mental health professionals, lay people, immigrants, and refugees in Norway. Results: We found that immigrants and refugees, particularly those of non-western origin, endorsed different types of depression treatments from native Norwegians and mental health professionals, and judged who deserved treatment and who was overreacting based on the patient's culture and social circumstances, while native Norwegians did not. Limitations: While widely used cross-culturally, vignette methodology is limited in its generalizability to real clinical situations. Acculturation was not evaluated, which may have influenced the results. Conclusions: Findings support the integration of cultural competency ideals not only into treatment, but also into public health promotions of mental health services for lay people. © 2011 Elsevier B.V. All rights reserved. Keywords: Depression Mental health professionals Immigrants Culture Interventions Depression is a common psychological disorder interna- tionally, affecting approximately 10% of patients in primary care settings; however, it is only recognized in half of the patients with presenting symptoms (Herrman et al., 2002). Treating depression relies not only on its identification by treating professionals but also on patients' attitudes toward the disorder and toward their treatment options. Low levels of patient disclosure and mental health service utilization across a range of ethnicities and cultures have been shown to affect the likelihood that depressive symptoms will be adequately treated (Aalto-Setala et al., 2002; Cabassa, 2007; McCracken et al., 2006; Radford, 2004; Vasiliadis et al., 2007). The cost of undertreatment may be felt not only in psychological and physical suffering, but also in productivity and, potentially, cultural assimilation for those who desire it. There are patterns of mental health service underutiliza- tion and cultural mistrust when comparing majority popula- tions to immigrants and refugees around the world (Lay et al., 2006; Miltiades and Wu, 2008; Nadeem et al., 2007; Shin, 2002). Due to financial, migration and acculturation factors, immigrants (Dalgard et al., 2006; Fenta et al., 2004; Tinghog et al., 2007) and refugees (Brundtland, 2000; Fenta et al., 2004; Lien et al., 2010) have been found to have significantly higher rates of depression than majority groups. Migrant minority groups may face cultural barriers within their own culture to expressing mental illness symptoms and to recognizing symptoms as warranting treatment. And if Journal of Affective Disorders 133 (2011) 481–488 ⁎ Corresponding author at: Department of Psychology, The Colorado College, 14 East Cache La Poudre Street, Colorado Springs, CO 80903, USA. Tel.: +1 719 389 6598; fax: +1 719 389 6284. E-mail address: kerdal@ColoradoCollege.edu (K. Erdal). 0165-0327/$ – see front matter © 2011 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2011.04.038 Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad