A new study provides objective analysis of how symptoms of depression may be different among various cultures.
According to background information in the article, the expectation that East-Asian people emphasize physical symptoms of depression (e.g. headaches, poor appetite or aches/pains in the body) is widely acknowledged. However, researchers from the Centre for Addiction and Mental Health (CAMH) debunk this cultural myth.
Furthermore, the research findings offer clinicians valuable insight into cultural context when assessing a patient for depression, leading to more accurate diagnosis.
Lead by CAMH Clinical Research Director Dr. R. Michael Bagby, and a number of collaborators from Second Xiangya Hospital of Central South University, People’s Republic of China, more than 200 participants, half from an outpatient clinic in China, and half from a clinical research department outpatient clinic at CAMH were tested on two central hypotheses.
Investigators first investigated the premise that East-Asian participants emphasize somatic or physical symptoms of depression more than North American participants; then, that North American participants would emphasize psychological symptoms of depression (e.g. report feeling sad, crying spells, or a loss of self-confidence) more than East-Asian participants.
This rigorous work is one of only a few studies to address these questions with a direct cross-cultural comparison of clinical patients.
Also, it is the only study to use three assessment tools (spontaneous report of problems during unstructured discussion with doctor; clinician-rated symptoms in a structured clinical interview; and a symptom rating scale in questionnaire form) translated into both English and Chinese (Mandarin) and modified to address cross-cultural differences.
As Dr. Bagby explains, “the onset of depression triggers a biological response that takes place within a specific social context, resulting in a cascade of somatic and psychological experiences that are interpreted through a particular cultural lens. Careful translation and adaptation of our assessment tools helped us clarify if different approaches lead to different symptom profiles and conclusions about patients.”
Overall, the data demonstrate a consistently greater level of psychological symptom reporting in the North American sample, regardless of assessment tool.
This suggests a tendency for Western cultures to emphasize psychological symptoms of depression (psychologization), rather than a tendency for those from East-Asian cultures to emphasize physical symptoms (somatization).
East-Asian participants did report a significantly higher level of somatic symptoms when reporting through the spontaneous interview and structured clinical interview. Also, these participants reported higher levels of stigma and alexithymia.
A refined examination of this link revealed that the observed cross-cultural differences in somatic symptom scores relates, in part, to cultural differences in internally versus externally oriented thinking.
This suggests that people who do not frequently focus on their internal emotional state are more likely to notice somatic symptoms.
While this data may help clinicians be more aware of how culture can impact how people talk about their illness, this data does not constitute a norm for depression worldwide.
Investigators conclude that additional investigation is necessary on how the interaction of biology, culture and individual differences predict variations in how people present symptoms of depression.