From culture to symptom: Testing a structural model of “Chinese somatization”

Abstract

"Chinese somatization" has been frequently discussed over the past three decades of cultural psychiatry, and has more recently been demonstrated in cross-national comparisons. Empirical studies of potential explanations are lacking, however. Ryder and Chentsova-Dutton (2012) proposed that Chinese somatization can be understood as a cultural script for depression, noting that the literature is divided on whether this script primarily involves felt bodily experience or a stigma-avoiding communication strategy. Two samples from Hunan province, China-one of undergraduate students (n = 213) and one of depressed psychiatric outpatients (n = 281)-completed the same set of self-report questionnaires, including a somatization questionnaire developed in Chinese. Confirmatory factor analysis demonstrated that Chinese somatization could be understood as two correlated factors: one focusing on the experience and expression of distress, the other on its conceptualization and communication. Structural equation modeling demonstrated that traditional Chinese cultural values are associated with both of these factors, but only bodily experience is associated with somatic depressive symptoms. This study takes a first step towards directly evaluating explanations for Chinese somatization, pointing the way to future multimethod investigations of this cultural script.

Cross‐cultural comparison of symptom networks in late‐life major depressive disorder: Yoruba Africans and the Spanish Population

“…1 This concept has been the basis of several studies of cultural psychopathology in the general population. [2][3][4][5][6][7][8][9] There is an emerging body of research suggesting that, rather than being an evidence of difficulty in describing experiences in psychological terms, somatisation can sometimes be the predominant mode of symptom presentation depending on context. 5,10 Preferential symptom reporting of emotional experiences may be shaped by local standards of interpretation of such symptoms as evidence of maladaptation and therefore their reporting as important symptoms.…”

Psychiatric Disorders Differently Correlate with Physical Self-Rated Health across Ethnic Groups

“…Minority populations that have low access, trust and high stigma toward mental health care systems may express and perceive their mental and emotional symptoms as due to physical health problem [ 18 ]. This somatization may be one of the mechanisms that explain the lower mental health care utilization of ethnic minorities [ 34 ]. Due to higher somatization, we can expect the association between psychiatric disorders and physical SRH to be stronger in ethnic minority groups.…”

A Randomized Controlled Trial on the Comparative Effectiveness of Mindfulness-Based Cognitive Therapy and Health Qigong-Based Cognitive Therapy Among Chinese People With Mood Disorders

“…Moreover, the somatization tendency [52] as espoused in Chinese culture may also explain the greater effect of HQCT on mood change. Essentially, there is strong "holism" ideation in Chinese culture.…”