title: The cultural shaping of depression: somatic symptoms in China, psychological symptoms in North America?
abstract: The expectation that Chinese people present distress somatically is a central prediction of cultural psychopathology and has been the subject of considerable theoretical speculation. At the same time, empirical studies have been infrequent and have yielded mixed results. The authors examined symptom presentation in Chinese (n=175) and Euro-Canadian (n=107) outpatients, using spontaneous problem report, structured clinical interview, and symptom questionnaire methods. All 3 methods yielded cross-culturally equivalent somatic and psychological symptom subscales. Chinese outpatients reported more somatic symptoms on spontaneous problem report and structured clinical interview compared with Euro-Canadians, who in turn reported more psychological symptoms on all 3 methods. The relation between culture and somatic symptom presentation was mediated by a tendency toward externally oriented thinking. Difficulties with identifying emotions or describing them to others did not differ significantly across cultures, supporting a nonpathological interpretation of observed differences. Psychological symptom effects were larger and more consistent than somatic symptom effects; because other studies have confirmed the ubiquity of somatic presentations worldwide, these results suggest that Western psychologization may be more culturally specific than is Chinese somatization.
authors.affiliation: Concordia University.
authors.forename: Andrew G
authors.identifier: 0000-0003-3041-7168
authors.initials: AG
authors.lastname: Ryder
authors.affiliation: Asian Initiative in Mental Health.
authors.forename: Jian
authors.initials: J
authors.lastname: Yang
authors.affiliation: Clinical Psychological Research Center.
authors.forename: Xiongzhao
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Clinical Psychological Research Center.
authors.forename: Shuqiao
authors.initials: S
authors.lastname: Yao
authors.affiliation: Clinical Psychological Research Center.
authors.forename: Jinyao
authors.initials: J
authors.lastname: Yi
authors.affiliation: University of British Columbia.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Heine
authors.affiliation: Centre for Addiction and Mental Health.
authors.forename: R Michael
authors.initials: RM
authors.lastname: Bagby
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044466:Asian People / Q000208:ethnology / Q000523:psychology*; D002170:Canada; D002681:China; D003431:Cross-Cultural Comparison; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009440:Neurasthenia / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology; D010552:Personality Assessment / Q000706:statistics & numerical data; D011594:Psychometrics; D013001:Somatoform Disorders / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology; D044465:White People / Q000208:ethnology / Q000523:psychology*