Abstract
The finding that people of Chinese heritage tend to emphasize somatic rather than psychological symptoms of depression has frequently been discussed in the culture and mental health literature since the 1970s. Recent studies have confirmed that Chinese samples report more somatic and fewer psychological depression symptoms compared to “Western” samples. The question remains, however, as to whether or not these effects are attributable to variation in all the constituent symptoms or to a subset. If the latter, there is the additional possibility that some symptoms might show a divergent pattern. Such findings would have implications for how cultural variations in symptom presentation are interpreted, and would also inform the cultural study of affective experiences more broadly. The current study addressed these issues in Chinese (n = 175) and Euro-Canadian (n = 107) psychiatric outpatients originally described by Ryder et al. (2008). Differential item functioning (DIF) was used to examine whether specific somatic and psychological symptoms diverged from the overall patterns of cultural variation. Chi-square analyses were used to examine atypical somatic symptoms (e.g., hypersomnia), previously neglected in this literature. No DIF was observed for the typical somatic symptoms, but Euro-Canadians reported greater levels of atypical somatic symptoms, and showed higher rates of atypical depression. DIF was observed for psychological symptoms—the Chinese reported high levels of “suppressed emotions” and “depressed mood,” relative to their overall psychological symptom reporting. Chinese outpatients also spontaneously reported “depressed mood” at similar levels as the Euro-Canadians, contrary to prevailing ideas about Chinese unwillingness to discuss depression. Overall, the findings provide a more nuanced picture of how culture shapes symptom presentation and point toward future studies designed to unpack cultural variation in narrower subsets of depressive symptoms.
Highlights
The finding that people of Chinese heritage tend to emphasize somatic rather than psychological symptoms of depression has frequently been discussed in the interdisciplinary literature on culture and mental health
Our understanding of somatization or psychologization may be changed markedly if we find that certain symptoms do not follow the expected cultural pattern, especially if that symptom is central to our understanding of what depression is – we would describe the phenomenon differently, assess it differently, perhaps even explain and treat it differently
The simple comparison of raw item means is not an appropriate analytical technique, since it is known that the two groups differ in their overall reporting of typical somatic symptoms
Summary
The finding that people of Chinese heritage tend to emphasize somatic rather than psychological symptoms of depression has frequently been discussed in the interdisciplinary literature on culture and mental health. Kleinman (1982) inaugurated this line of inquiry in his original field study, which employed anthropological and psychiatric research methods in examining 100 Chinese patients diagnosed with neurasthenia This diagnostic category overlaps with depression but emphasizes somatic symptoms, including fatigue, sleep problems, and muscle pain; the diagnosis was commonly used in China at the time (Ryder and Chentsova-Dutton, 2012). Kleinman’s work became sufficiently wellknown that his findings have been invoked to help explain the remarkably low rates of depression reported in China during this time (Parker et al, 2001b; Ryder and Chentsova-Dutton, 2012)
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