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, yet the few available empirical studies report mixed data on this issue.
A new study from the Centre for Addiction and Mental Health (CAMH) debunks this cultural myth, and offers clinicians valuable insight to into cultural context when assessing a patient, leading to more accurate diagnosis.
Lead by CAMH Clinical Research Director Dr. R. Michael Bagby, in collaboration with Dr. Andrew Ryder, Concordia University, Steven Heine, University of British Columbia and a number of collaborators from Second Xiangya Hospital of Central South University, People's Republic of China, this study recruited more than 200 participants, half from an outpatient clinic in China, and half from a clinical research department outpatient clinic at CAMH, and tested two central hypotheses: 1. East-Asian participants will emphasize somatic or physical symptoms of depression more than North American participants, and 2. 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. Dr. Bagby and his team also wanted to examine the role stigma and alexithymia (difficulty using words to describe emotions) play in how each culture presented and expressed depression symptoms.
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."