"Somatization" and "Comorbidity": A Study of Jhum-Jhum and Depression in Rural Nepal

Abstract

Research on depression in non-Western settings has focused on “somatization,” defined as recurrent bodily complaints among persons with psychological distress. Such studies have often recorded higher rates of somatization in non-Western groups compared to Western settings, fueling speculation about cross-cultural differences in the physical manifestation of psychiatric disorders. However, few of these studies have rigorously considered possible physical explanations before diagnosing cases as somatization. For example, bodily complaints may result from comorbid nonpsychiatric physiological illness as opposed to psychological distress exclusively. The present study employs a biocultural framework to investigate the power of comorbid physiological and psychological illness versus somatization to influence bodily complaints. This study examines depression in rural Nepal, focusing on jhum-jhum, a form of paresthesia (subjective numbness or tingling), from a cultural standpoint of its emic explanation and a medical model of its pathogenesis. This study identified a 42 percent prevalence of jhum-jhum (N = 316), with the group reporting jhum-jhum being more depressed than the non-jhum-jhum group. Without further physical diagnosis, those depressed individuals with jhum-jhum might be diagnosed as somatizers. However, in a subsample of individuals (N = 65) with jhum-jhum and high depression scores, physical pathology associated with two-thirds of jhum-jhum cases. After accounting for physiological associations, the estimated prevalence of somatization is no higher than observed in Western settings. These findings suggest, therefore, that claims of cross-cultural differences in somatization should be examined with attention to the local burden of physical disease using adequate biological and cultural methods for assessing comorbidity.