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).