Research projects

Is acculturation the nexus between chronic physical disease and depression and anxiety in a culturally and linguistically diverse (CALD) population?

Principal researchers

Suresh Sundram3
Anastasia Hutchinson1
Marnie Graco1
Rita Wong1
Vicki Lawlor1
Chrissie Risteski1
Tshepo Rasekaba1
Anne-Marie Daw2
Dianne Duncombe2


Northern Health and the University of Melbourne, Department of Medicine:
1 Northern Clinical Research Centre
2 Northern Alliance-Hospital Admission Risk program
3 Northern Psychiatry Research Centre



Award type

Beyond Blue Victorian Centre of Excellence

Project completion year


Project brief

The prevalence of chronic medical conditions such as diabetes, chronic heart failure and chronic respiratory diseases is high, and is increasing in Australia and other Western countries. These chronic conditions have been found to be associated with increased rates of anxiety and depression.

Co-morbid depression and anxiety with chronic physical disease is associated with poor self-care behaviours, higher somatic symptom severity, greater functional impairment, increased medical utilisation and costs, and higher morbidity and mortality. Chronic medical conditions and anxiety and depression are common in older migrant populations; however it is not known whether migration-specific factors influence this relationship or whether it is similar to the mainstream population.

This research project investigated whether there is a link between acculturation and anxiety and depression in people with chronic physical conditions. Acculturation can be defined as the extent to which a minority (here migrant) culture assimilates the values of the majority (host) culture.

The primary aim of this study is to determine the influence of acculturation on symptoms of depression and anxiety in a chronic physical disease population. It is well established that chronic physical illness is associated with an increased risk of depressive symptoms and disorders. Strong evidence indicates that interventions to manage depression are effective in people with multiple chronic diseases. Despite this overwhelming evidence, these disorders are frequently under-diagnosed and under-treated in people with chronic disease.

Key findings

Results of the research indicate that for those in a CALD population who identify with another culture, social networks and support from their culture of origin are an important protective factor against developing anxiety. Individuals whose primary language and education is in a language other than English may have lower levels of acculturation with Australian society and have an increased risk of developing depression.

This project has established that factors associated with lower levels of acculturation (lower English language proficiency) do influence the prevalence of depression in patients from culturally and linguistically diverse backgrounds. In contrast, higher levels of social engagement with their culture of origin were associated with a decreased risk of anxiety symptoms. In this population with moderate to severe chronic disease, disease type and severity were also important factors that influenced the risk of developing depression; this study found that a diagnosis of chronic obstructive pulmonary disease (COPD) was associated with higher odds of depression than a diagnosis of cardiovascular disease or diabetes. This finding probably reflects the higher levels of functional impairment and symptom severity in the group with COPD.

Implications for policy and practice

The high prevalence of symptoms and anxiety and depression amongst individuals from CALD backgrounds with chronic disease means that screening should become a routine part of clinical care for chronic disease management programs based in both primary and secondary care.

Further research is required to establish which approaches to management of anxiety and depression are most acceptable to individuals from CALD backgrounds.

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