Other behaviors considered age appropriate can mask depression, which makes the disorder difficult to identify and diagnose in certain age groups. Children with depres-sion often appear cranky. They may have school phobia, hyperactivity, learning disorders, failing grades, and anti-social behaviors. Adolescents with depression may abuse substances, join gangs, engage in risky behavior, be under-achievers, or drop out of school. In adults, manifestations of depression can include substance abuse, eating disor-ders, compulsive behaviors such as workaholism and gam-bling, and hypochondriasis. Older adults who are cranky and argumentative may actually be depressed.
Many somatic ailments (physiologic ailments) accom-pany depression. This manifestation varies among cultures and is more apparent in cultures that avoid verbalizing emotions. For example, Asians who are anxious or depressed are more likely to have somatic complaints of headache, backache, or other symptoms. Latin cultures complain of “nerves” or headaches; Middle Eastern cultures complain of heart problems (Andrews & Boyle, 2007).