The cultural shaping of depression: Somatic symptoms in China, psychological symptoms in North America?

TLDR

The expectation that Chinese people express distress somatically is a central prediction of cultural psychopathology, yet empirical studies have been infrequent and yielded mixed results. The authors compared symptom presentation in 175 Chinese and 107 Euro‑Canadian outpatients using spontaneous problem report, structured clinical interview, and symptom questionnaire methods. Chinese outpatients reported more somatic symptoms while Euro‑Canadians reported more psychological symptoms, with the cultural difference mediated by externally oriented thinking, and the larger, more consistent psychological effects suggest that Western psychologization may be more culturally specific than Chinese somatization.

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.