Original Research Report Psychosomatics 40:2, March–April 1999 117 Depression and Demoralization Among Russian-Jewish Immigrants in Primary Care ZINOVIY GUTKOVICH, M.D., RICHARD N. ROSENTHAL, M.D. IGOR GALYNKER, M.D., PH.D., CHRISTOPHER MURAN,PH.D. SARAI BATCHELDER,PH.D., ELENA ITSKHOKI, M.D. The purpose of this study was to examine the levels and nature of psychological distress and depression among Russian-Jewish e ´migre ´s in primary care. Fifty-seven consecutive patients at the primary care clinic were assessed with the Hamilton Depression Scale (Ham-D). The subjects completed self-rating scales, including the Beck Depression Inventory (BDI), Life Orientation Test, Beck Hopelessness Scale, Attributional Style Questionnaire, and Snaith-Hamilton Pleasure Scale. Data on demographics and physical complaints were collected and analyzed. Of the pa- tients studied, 82.5% experienced psychological distress (BDI 10), and 43.9% had clinically significant depressive symptoms (Ham-D 17). BDI and Ham-D scores were significantly corre- lated with the number of psychosomatic complaints, hopelessness, lack of optimism, anhedonia, and dysfunctional attributional style. The distressed, but not depressed, patients had preservation of hedonic capacity. The authors found a high rate of depression based upon Ham-D scores among the Russian-Jewish e ´migre ´s in primary care. The authors suggest that this high rate is attributable to a culturally specific tendency to express distress in somatic terms. The nature of distress was phenomenologically similar to demoralization. (Psychosomatics 1999; 40:117–125) Received December 17, 1997; revised July 19, 1998; accepted July 30, 1998. From the Departments of Psychiatry and Medicine, Beth Israel Medical Center, New York. Dr. Gutkovich is currently at Schneider Chil- dren’s Hospital, Long Island Jewish Medical Center, Division of Child and Adolescent Psychiatry, New York. Address correspondence and re- print requests to Dr. Gutkovich, Schneider Children’s Hospital, Long Is- land Jewish Medical Center, Division of Child and Adolescent Psychiatry, 269–01-76th Ave., New Hyde Park, NY 11040; e-mail: ZGUTKOV @aol.com. Copyright  1999 The Academy of Psychosomatic Medicine. I t is recognized that psychological distress, depression, and psychosomatic illness are elevated in immigrant populations. 1–3 The current wave of Russian-Jewish im- migration to the United States consists of about a quarter of a million people 4 and has been described as a group that has significant difficulties in their cultural adjustment 5–10 and a large proportion of older immigrants. 11 These diffi- culties may be caused by the dramatic differences in values between an authority-oriented Soviet society and an autonomy-oriented American society. 6,7 Another factor may be differences in family structure, with patriarchal, mutually dependent extended families in the former Soviet Union 10,12 vs. more independent family relationships in the United States, differences that are further exaggerated be- cause of the quicker integration of adult children into the American society. 10 Still other causes include lack of in- trinsic motivation (“immigration for the sake of the chil- dren”), 10,13 loss of the professional status very highly val- ued by Russian Jews, 6,12 identity conflict (being unable to see themselves either as Russians or as Jewish- Americans), 6,7,9 and relatively low social support. 9 Several studies have reported elevated distress in Russian-Jewish immigrants to the United States within the community. Increased levels of demoralization, as mea-