• Culture;
  • depression;
  • elderly;
  • women


Purpose: To introduce advanced practice nurses to the concept of Hwa-Byung, a culture bound syndrome that is now accepted as a psychiatric term.

Data sources: Information from the Diagnostic and Statistical Manual and selected research and clinical articles.

Conclusions:Hwa-Byung is a culture-bound syndrome caused by long-standing suppressed anger prevalent among older immigrant women of Korean heritage. Although the concept of Hwa-Byung was reported more than a decade ago, it has not been studied cross-culturally nor described sufficiently in the literature.

Implications for practice: The use of appropriate guidelines and an understanding of Hwa-Byung is essential for proper assessment, diagnosis (especially to distinguish it from clinical depression), and culturally sensitive management of this condition. Korean versions of screening tools are provided as online supporting information.