Cultural and global perspectives

Depression and disease-related psychological problems in type 2 diabetes (T2DM), termed diabetes distress (DD), is a global problem and negatively impacts quality of life, self-management, and cardiovascular mortality. However, risk factors for and consequences of emotional distress vary and have different cultural meaning. In the East and low- to middle-income countries (LMIC), contextual factors, socio-demographics, low socio-economic status, and sub-optimal health/medical services predispose DD more than in the West and high-income countries (HIC). People from non-Western and LMIC may hold a more stigmatizing view of depression leading to mislabelling depression due to somatization, underdiagnosis, and a lack of clinical care. The prevalence of depression and DD is generally double in LMIC compared with HIC. There is a lack of direct and good-quality evidence of depression and DD’s effects on clinical outcomes, therefore improving access to effective treatment for depression and DD remains a global challenge.