University of Surrey Study Identifies Critical Diagnostic Gaps in Detecting Depression Among South Asian Diaspora Populations

A University of Surrey review finds South Asian depression symptoms like physical pain and "heart sinking" are often missed by standard UK diagnostic tools.

By: AXL Media

Published: Mar 27, 2026, 10:14 AM EDT

Source: Information for this report was sourced from University of Surrey.

Mismatches Between Clinical Criteria and Lived Experience

Current mental health screening tools in the United Kingdom may be failing the South Asian diaspora by adhering to a narrow, Western-centric definition of depressive disorders. According to Dr. Rose Rickford, a new review of decades of research across the UK, USA, Canada, and Australia shows that South Asian patients experience depression in ways that deviate significantly from the White majority. While the Patient Health Questionnaire-9 focuses heavily on mood and cognitive state, many South Asian individuals present with somatic symptoms that the system is not designed to detect. This disconnect creates a "diagnostic gap" where patients seeking help for genuine psychological distress are overlooked because their symptoms do not fit the established template of the ICD-11.

Somatic Presentations and the Prevalence of Physical Pain

One of the most striking findings of the PAPER Study is that physical pain—including chronic headaches and neck aches—is reported just as frequently as anhedonia among South Asian populations. Anhedonia, or the loss of interest in activities, is considered one of the two "cardinal" symptoms clinicians are trained to prioritize. However, because physical pain is not captured by standard diagnostic criteria, a patient presenting with persistent body aches may be treated for a physical ailment while the underlying depression remains unaddressed. This prevalence of somatization suggests that for many in these communities, psychological suffering is expressed and felt primarily through the body.

The Heart as a Metaphorical and Physical Center of Distress

The review highlights a unique linguistic and sensory phenomenon where depression is described through the "language of the heart." Speakers of Punjabi, Urdu, and Hindi frequently use expressions such as "sinking heart" or "dead heart" to describe their emotional state. Critically, these are not merely metaphors; many participants reported these as physical sensations of pressure, squeezing, and breathlessness. Because the current medical framework views heart-related sensations as cardiac rather than psychiatric indicators, these reports can lead to unnecessary physical testing while the patient's mental health continues to decline in the absence of culturally informed care.