Diversity Issues in the Diagnosis, Treatment, and Research of Mood Disorders Edited by Sana Loue and Martha Sajatovic. Oxford University Press. 2007. £37.99 (hb). 320pp. ISBN: 9780195308181

In the post-globalisation world, the movement of goods and people has created a more complex environment within which cultural influences are becoming more pertinent, not only in diagnosis but in management as well. This multi-authored volume aims to provide some of the context related to diversity, starting with the role of culture. There is no doubt that an understanding of cultures is imperative to make sense of individual experiences related to emotional distress, how distress is expressed, how help is sought and how cultures decide where and how much resources are to be targeted. Cultural competence in mental healthcare therefore becomes a major issue. The observations that Black and minority ethnic patients have less access to mental health services, with those available being of relatively poor quality, are seen on both sides of the Atlantic. The diagnosis of mood disorders in ethnic minorities brings with it specific issues related to explanatory models as well as comorbidity and access to primary care. In addition, culture-specific diagnoses or culture-bound syndromes bring with them another dimension.

A chapter devoted to the epidemiology of mood disorders highlights the problems related to such studies. Cultural influences in treatment modalities and negotiating treatments are helpfully signposted by Westermeyer in a well-written, erudite chapter. Access and healthcare-seeking indicate barriers as well as type and quality of care. A review of complementary and alternative medicines is provided, emphasising the importance of understanding their use and efficacy as well as safety. Use of interpreters and language is important, and training of such individuals needs to be appropriate and adequate. In post-migration societies, families too become multi-cultural, and varying expectations and models of the delivery of healthcare become significant. How culture should be factored into understanding outcomes forms an interesting and helpful overview. Chapters on psychopharmacology, legal and ethical issues and strategies for recruitment of Black and minority ethnic participants into research provide a helpful synthesis of observations. The last chapter deals with training. There is much here that will be of interest to clinicians and researchers dealing with Black and minority ethnic patients with mood disorders. However, lack of a more international, rather than purely American, overview and a tendency to describe each population group limits its usefulness this side of the Atlantic.