Decolonizing mental health: how native languages reshape depression network architecture in 31,276 Peruvians

To date, no studies have investigated the effect of native language on depressive symptom networks. To address this gap, we examined depression symptom network structure across four major cultural-linguistic groups in Peru (Castellano, Quechua, Aymara, and Amazonian indigenous languages). We conducted a network analysis of PHQ-9 depression symptoms using nationally representative data from 31,276 Peruvian participants. Networks were estimated using ggmModSelect with Spearman correlations. Native language groups were compared using permutation tests to evaluate network differences. Depression networks exhibited distinct architectures across groups, with Castellano showing the highest connectivity (22 active edges), followed by Quechua (20 edges) and Aymara (12 edges, p < 0.019). While worthlessness/guilt-suicidal ideation was the strongest universal pathway (r = 0.377–0.44), groups exhibited distinct centrality patterns: Castellano networks centered on depressed mood, Quechua on fatigue, and Aymara on suicidal ideation. Aymara networks showed absence of anhedonia-depressed mood connections (r = 0.00) and unique psychomotor-suicidal ideation pathways (r = 0.27), which requires further exploration. It is suggested that native language may shape depression architecture, suggesting distinct cultural-linguistic patterns that challenge current depression models.