Beyond “somatization” and “psychologization”: symptom-level variation in depressed Han Chinese and Euro-Canadian outpatients

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.

Extending a structural model of somatization to South Koreans: Cultural values, somatization tendency, and the presentation of depressive symptoms

“…This observation has since been empirically supported in several cross-cultural studies (Parker et al, 2001;Ryder et al, 2008;Zhou et al, 2011;Dere et al, 2013) comparing Chinese and 'Western' participants. Ryder and Chentsova-Dutton (2012) proposed that cultural scripts for distress and normative assumptions about symptoms and syndromes in a given cultural context might help shape the experience and expression of depression.…”

Understanding depression across cultures: a social identity perspective

“…It is proposed that social identity theorizing (Tajfel & Turner, 1979;Turner, 1991) With this in mind, in Chapters 3 and 4, we shift attention to studying depression in Western cultures. This is in line with recent work contending that the very concept of somatization rests on the cultural assumption that psychological symptoms are more central to depression, and has thus focused on Western psychologization (Dere et al, 2013;Ryder et al, 2008). More specifically, this research has suggested that psychologization among Westerners represents the larger and more consistent effect, raising the possibility that this may be more culturally specific than Asian somatization (Ryder et al, 2008).…”

“…Despite extensive investigation of somatization of depression (e.g., Dere et al, 2013;Ryder et al, 2008;Simon et al, 1999;Yen, Robins, & Lin, 2000), much of this work has perhaps focused too strongly on the question of whether Asians somaticize.…”

The expression of depression in Asian Americans and European Americans.

“…This is one of a few studies using a nationally representative community sample of Asian and Euro pean Americans that examines both somatic and psychological symptoms. Moreover, with the exception of Uebelacker et al (2009) and Dere et al (2013), the prior clinical and community studies (e.g., Weiss et al, 2009) only carried out frequency (i.e., classical test theory) analyses and did not include DIF analyses, which take into account degree of depressive symptomatology.…”

“…For depression specifically, work using multiple regression (Bimholz & Young, 2012) and nonparametric kernel-smoothing techniques (Santor, Ramsay, & Zuroff, 1994) has examined depressive symptom se verity scores and item bias between groups (i.e., female sexuality groups and males and females, respectively); however, these stud ies did not test for race or ethnicity differences. Another study (Dere et al, 2013) did examine race or ethnicity differences in depressive symptoms. With a clinical sample, Dere et al (2013) used the standardized mean difference technique to assess for DIF among Han-Chinese and European Canadian participants.…”