ArticleLiterature Review

Depression in Cultural Context: "Chinese Somatization," Revisited

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

We have presented a view of culture and mental health that builds on work in cultural psychiatry, anthropology, and cultural psychology, and applied it to research on culture and depression. In particular, we have returned to the well-known topic of Chinese somatization. A culture–mind–brain approach to these questions helps us think about them in a way that points toward new research. We have applied this approach to thinking about a single set of questions, relevant to a single (DSM-based) diagnosis, in a single cultural group. The potential, however, is to rethink how we conceptualize mental health in ways consistent with cultural psychiatry’s general perspective over the past several decades, while incorporating rather than rejecting the many recent advances in brain and behavior sciences. In so doing, we gain a more expanded and nuanced view of the global landscape of mental health, accompanied by a more expanded and nuanced view of individual patients.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... It has been reported that culture may shape the presentation of depression and anxiety symptoms (22). For instance, Asian individuals with depression and anxiety tend to overemphasize somatic symptoms, such as excessive fatigue and headache (23). They also tend to believe that negative emotions have cognitive and motivational utility and are less likely to engage in hedonic emotion regulation (24). ...
... Furthermore, whereas Western studies have generally identified one class with almost no symptoms of depression and anxiety (20,21), here even the healthiest class (Class 4) in our study showed moderate probability of endorsing symptoms in terms of sleep and eating problems and fatigue. This is perhaps explained by the observation that Eastern individuals tend to emphasize somatic symptoms (23). Among subjects with high depressive symptoms (Class 1 and 2), onethird (Class 1) also showed high anxiety symptoms, which is generally consistent with previous reports that among individuals with depression, roughly half suffer from anxiety (6). ...
... In Asia, the common value of "conformity to norms, emotional self-control, collectivism, family recognition through achievement" [(48), p. 941] is strong and any deviation from the common value is considered inappropriate. As a result, people are afraid of being labeled "weak character" and while reporting depressed mood, they tend to in the meantime emphasize somatic and anxiety symptoms (23). ...
Article
Full-text available
Background Given the high comorbidity and shared risk factors between depression and anxiety, whether they represent theoretically distinct disease entities or are just characteristics of a common negative affect dimension remains debated. Employing a data-driven and person-centered approach, the present study aims to identify meaningful and discrete symptom patterns of the occurrence of depression and anxiety. Methods Using data from an adult sample from the Japanese general population (n = 403, including 184 females, age = 42.28 ± 11.87 years), we applied latent class analysis to identify distinct symptom patterns of depression (PHQ-9) and anxiety (STAI Y1). To empirically validate the derived class memberships, we tested the association between the derived classes and personal profiles including childhood experiences, life events, and personality traits. Results The best-fitting solution had four distinct symptom patterns or classes. Whereas both Class 1 and 2 had high depression, Class 1 showed high anxiety due to high anxiety-present symptoms (e.g., “I feel nervous”) while Class 2 showed moderate anxiety due to few anxiety-absent symptoms (e.g., “I feel calm”). Class 3 manifested mild anxiety symptoms due to lacking responses on anxiety-absent items. Class 4 manifested the least depressive and anxiety-present symptoms as well as the most anxiety-absent symptoms. Importantly, whereas both Class 1 and 2 had higher childhood neglect and reduced reward responsiveness, etc. compared to Class 4 (i.e., the most healthy class), only Class 1 had greater negative affect and reported more negative life events. Conclusions To our knowledge, this is the first latent class analysis that examined the symptom patterns of depression and anxiety in Asian subjects. The classes we identified have distinct features that confirm their unique patterns of symptom endorsement. Our findings may provide insights into the etiology of depression, anxiety, and their comorbidity.
... Lifetime comorbidity between any mood disorder and generalized anxiety disorder has been found globally to be high (63%) (Kessler et al., 2005). Nevertheless, international epidemiologic studies have found vastly different prevalence rates for psychiatric disorders (Andrade et al., 2003;Ryder and Chentsova-Dutton, 2012;Weissman et al., 1996) and US national epidemiological surveys have found that the prevalence of mood and anxiety disorders vary by sex and race/ethnicity (Martin, 2003;Merikangas et al., 2010;Pigott, 2003;Riolo et al., 2005). While considerable attention has been given to identifying the prevalence of mental disorders internationally and across subpopulations, we are unaware of studies that have examined the subtypes of depression and anxiety symptomatology across sex and race/ethnic groups. ...
... In this vein, cultural syndromes, such as ataque de nervios (i.e., attack of nerves), reported amongst Hispanic individuals, consist of symptoms across different diagnostic categories and benefit from culturally sensitive interventions (Dura-Vila and Hodes, 2012;Lizardi et al., 2009). Similarly, Chinese somatization has been coined to represent the differences in the manifestation of depressive symptoms among Chinese as compared to a more Western experience of psychological distress (Ryder and Chentsova-Dutton, 2012). Regarding sex, differences in the prevalence of depression and anxiety between men and women are well-documented, however the literature offers competing explanations for the determinants of the differences in prevalence and manifestation (Altemus et al., 2014;Hill and Needham, 2013;Kwon et al., 2012;Maeng and Milad, 2015). ...
... In particular, individuals of Hispanic, Asian, and Native American descent may have stronger intergenerational cultural identities than non-Hispanic White-and Black-identified Americans. Moreover, how cultures are taught to exhibit symptoms and explain them may contribute to how individuals interpret and manifest symptoms (Ryder and Chentsova-Dutton, 2012). For example, variations in the tendency for externally oriented thinking has been found to explain the manifestation of somatic versus psychological depressive symptoms (Ryder et al., 2008;Ryder and Chentsova-Dutton, 2012). ...
... Collectivism refers to prioritizing the values and ideals of the ingroup over personal goals for the purpose of preserving ingroup harmony, interdependence, security, conformity, and tradition (Schwartz, 1990). Because of the desire to maintain social harmony, save face, and uphold the family reputation in collectivist cultures, people might engage in somatization rather than psychologization of mental health problems (Markus & Kitayama, 1991;Ryder & Chentsova-Dutton, 2012). This means that they might focus on somatic aspects of a mental health complaint like poor appetite or not sleeping instead of psychological symptoms like low mood and lack of motivation-thereby side-stepping any potential mental health stigma. ...
... This qualitative study is among the few that have explored the role of culture and its influence on MHL and stigma among bicultural youths in Canada. It answers the call from other researchers who have suggested that culture plays a critical role in MHL, but there is a research gap that needs filling, especially among individuals from more collectivist heritage cultures (Altweck et al., 2015;Ryder & Chentsova-Dutton, 2012;Wang et al., 2019). Understanding these important cultural influences is critical to improving the cultural sensitivity of programmes in the future, such as university mental health services. ...
Article
Full-text available
Purpose Bicultural youths are at higher risk of mental health problems and are less likely to utilize mental health services, yet our knowledge of their mental health literacy and help-seeking behaviours remains limited. Methods To fill this gap, the current study explored bicultural youths’ mental health literacy and stigma by conducting semi-structured interviews with 14 Canadian university students in 2021. Results Our analysis revealed that bicultural youths may be torn between two worlds: intergenerational tensions between participants assimilated into individualistic Canadian culture and their more collectivist parents meant that they had different cultural perceptions of mental health literacy and stigma. While being caught between these two worlds may be detrimental for bicultural youth, our results also suggested that a trans-cultural factor—celebrities’ mental health journeys—may promote help-seeking behaviour across participants. Furthermore, our study speaks to the ways that unprecedented events such as the COVID-19 pandemic impact mental health literacy among bicultural youth. Our findings might be used by university mental health services to encourage help-seeking among bicultural students. Conclusion The acculturation of mental health literacy, stigma, and associated intergenerational differences needs to be considered by university wellness services.
... Several meta-reviews on mental health service utilization among Asians suggest that Asians are less likely to directly admit problems concerning their psychological well-being. Instead, they are more likely to seek help with somatic symptoms associated with these abnormalities [14][15][16]. Due to a complex cultural context, individuals of Asian descent tend to exhibit heightened concerns about the stigma attached to mental disorders [17][18][19][20]. In Asian culture, there exists a close and intricate connection between the mind and the body [19]. ...
... For relieving somatic symptoms related to mental distress, CAM treatments have a rapid effect and should be encouraged, although these treatments might not address the source of the mental illness directly. On the other hand, health care providers should be aware that Asians might not address mental health issues beyond somatic symptoms [14][15][16] and should help them to evaluate the root of their mental health problems more thoroughly. CAM service providers should also be encouraged to refer clients to mental health specialists when necessary. ...
Article
Full-text available
After the onset of the COVID-19 pandemic in 2020, Asian Americans in the United States have experienced a surge in anti-Asian crimes, leading to heightened psychological distress among this community. Consequently, the mental well-being of Asian Americans demands greater attention than ever. Regrettably, Asians tend to underutilize or delayed mental health care treatments. This study examines the conventional and alternative mental health service utilization among Asians in the United States according to their English proficiency. From the 2015–2018 National Survey on Drug Use and Health, this study examined 3,424 self-identified non-Hispanic Asians aged 18–64 with Kessler score of at least 5. Stratified bivariate analysis and multivariable logistic regression analysis were conducted. Regardless of English proficiency, Asians did not utilize alternative mental health service more than conventional mental health service. However, those with limited English proficiency consistently utilize care less than those with English proficiency. Need factors, such as mental distress severity and self-rated health status, were significant factors associated with their mental health service utilization. English proficiency remains a structural factor in preventing Asians from utilizing mental health services regardless of the nature of services. Due to the COVID-19 pandemic, more Asians have been experiencing mental distress. This study demonstrates a particular need for mental health services that are culturally specific and Asian language friendly.
... Some evidence suggests that patients are more readily able to identify somatic changes, including subtle changes, before impacts on mood or social life (Suls & Howren, 2012), and that physicians may prioritize those somatic complaints (Thomas-MacLean & Stoppard, 2004). Somatization is also especially relevant for non-white patients and supports the idea that depression manifests differently for different cultural or racial groups (Lewis-Fernandez et al., 2005;Ryder & Chentsova-Dutton, 2012). This may also contribute to the underdiagnosis of depression if the typical symptoms of depression for some populations do not fit the DSM criteria. ...
... For instance, new research suggests that some groups may experience predominant weight and appetite-related symptoms, while others experience physical agitation, and others may manifest more traditional symptoms like worthlessness (Goodmann et al., 2021). Others may even have emotional suppression (Ryder & Chentsova-Dutton, 2012) and close off. This lack of emotional expression and stoicism may be misinterpreted by providers as a cultural norm rather than a manifestation and symptom of depression. ...
Article
Full-text available
Depression is one of the most common mental health concerns in the USA. Critical to the treatment of depression is the identification of depressive symptoms by individuals and the professionals from whom individuals seek treatment. Symptom identification is made challenging by the diversity of depression symptoms experienced by those who struggle with the disease. The purpose of this study was to examine manifestations of depression as presented in a naturalistic textual forum, Twitter. By using the hashtag “#depressionsucks,” the authors examined the things that posters tweeted about that were relevant to experiences of depression in a sample of 169 unique tweets collected over a 4-week period using nCapture. The results of this study demonstrate the nuanced lived experience of Twitter users who experience depression and their public discussion of their depressive symptoms and experiences. The symptoms ranged from acute depression to a mindset of wanting to get better and to support others. These results show the wide range of manifestations of depression and give further insight into how social media can be used to understand lived experiences of those struggling with mental health.
... For example, the cultural phenomenon of presenting somatisationwhich refers to the tendency for some cultures to emphasise somatic symptoms (e.g., headache) when presenting with a mental disorder (e.g., depression) has been explained using the theory of cultural scripts. According to this theory, different cultures have different scripts (i.e., normative assumptions around a set of symptoms and syndromes) that guide subjective experience by directing us to what is meaningful (Bruner, 1990;Ryder & Chentsova-Dutton, 2012;Zhou et al., 2016). For example, Chinese somatisation, which refers to the specific form of presenting somatisation observed in Chinese individuals with depression, can be understood as a cultural script for depression. ...
... According to this script, traditional Chinese values involve a worldview in which somatic symptoms are understood as much less socially problematic than psychological symptoms (e.g., depressed mood), where communication about psychosocial distress is discouraged, and that these values shape symptom experience (Ryder & Chentsova-Dutton, 2012;Zhou et al., 2016). ...
Thesis
Full-text available
Traditionally, psychiatric syndromes have formed the primary target of explanation in psychopathology research. However, these syndromes have been significantly criticised for their conceptual weakness and lack of validity. Ultimately, this limits our ability to create valid explanations of these categories; if the target is invalid then our explanations will suffer as a consequence. Using depression as extended example, this doctoral thesis explores the theoretical and methodological challenges associated with classifying and explaining mental disorders, and develops an alternative explanatory approach and associated methodology for advancing our understanding of mental disorders-the Phenomena Detection Method (PDM; Clack & Ward, 2020; Ward & Clack, 2019). This theoretical thesis begins by evaluating the current approaches to defining, classifying, and explaining mental disorders like depression, and explores the methodological and theoretical challenges with building theories of them. Next, in moving forward, I argue that the explanatory target in psychopathology research should shift from arbitrary syndromes to the central symptoms and signs of mental disorders. By conceptualising the symptoms of a disorder as clinical phenomena, and by adopting epistemic model pluralism as an explanatory strategy, we can build multi-faceted explanations of the processes and factors that constitute a disorder's core symptoms. This core theoretical and methodological work is then followed by the development of the PDM. Unique in the field of psychopathology, the PDM links different phases of the inquiry process to provide a methodology for conceptualising the symptoms of psychopathology and for constructing multi-level models of the pathological processes that comprise them. Next, I apply the PDM to the two core symptoms of depression-anhedonia and depressed mood-as an illustrative example of the advantages of this approach. This includes providing a more secure relationship between the pathology of depression and its phenotypic presentation, as well as greater insight into the relationship between underlying biological and psychological processes, and behavioural dysfunction. Next, I evaluate the PDM in comparison to existing metatheoretical approaches in the field and make some suggestions for future development. Finally, I conclude with a summary of the main contributions of this thesis. Considering the issues with current diagnostic categories, simply continuing to build explanations of syndromes is not a fruitful way forward. Rather, the complexity of mental disorders suggests we need to represent their key psychopathological phenomena or symptoms at different levels or aspects using multiple models. This thesis provides the metatheoretical and methodological foundations for this to successfully occur.
... [DSM-IV]; American Psychiatric Association [APA], 1994) such as headache and back pain. Recently, several researchers (e.g., Choi et al., 2016;Ryder & Chentsova-Dutton, 2012) suggested that Asians tend to express their psychological distress to excessive stress with somatic rather than psychological symptoms due to social stigma associated with expression of mental illness problems and concerns about possible loss of harmonious interpersonal relationships. Thus, somatization may be considered as effective coping strategies to secure social support and health resources in Asian cultures (Ryder & Chentsova-Dutton, 2012). ...
... Recently, several researchers (e.g., Choi et al., 2016;Ryder & Chentsova-Dutton, 2012) suggested that Asians tend to express their psychological distress to excessive stress with somatic rather than psychological symptoms due to social stigma associated with expression of mental illness problems and concerns about possible loss of harmonious interpersonal relationships. Thus, somatization may be considered as effective coping strategies to secure social support and health resources in Asian cultures (Ryder & Chentsova-Dutton, 2012). ...
Article
Full-text available
Somatization is known to be more prevalent in Asian than in Western populations. Using a South Korean adolescent and young adult twin sample ( N = 1754; 367 monozygotic male, 173 dizygotic male, 681 monozygotic female, 274 dizygotic female and 259 opposite-sex dizygotic twins), the present study aimed to estimate heritability of somatization and to determine common genetic and environmental influences on somatization and hwabyung (HB: anger syndrome). Twins completed self-report questionnaires of the HB symptoms scale and the somatization scale via a telephone interview. The results of the general sex-limitation model showed that 43% (95% CI [36, 50]) of the total variance of somatization was attributable to additive genetic factors, with the remaining variance, 57% (95% CI [50, 64]), being due to individual-specific environmental influences, including measurement error. These estimates were not significantly different between the two sexes. The phenotypic correlation between HB and somatization was .53 ( p < .001). The bivariate model-fitting analyses revealed that the genetic correlation between the two symptoms was .68 (95% CI [.59, .77]), while the individual-specific environmental correlation, including correlated measurement error, was .41 (95% CI [.34, .48]). Of the additive genetic factors of 43% that influence somatization, approximately half (20%) were associated with those related to HB, with the remainder being due to genes unique to somatization. A substantial part (48%) of individual environmental variance in somatization was unrelated to HB; only 9% of the environmental variance was shared with HB. Our findings suggest that HB and somatization have shared genetic etiology, but environmental factors that precipitate the development of HB and somatization may be largely independent from each other.
... This aspect warrants circumspect examination in subsequent studies to understand how the interplay between the body and mind contributes to this sensation. This unique feeling that appeared from the responses of Beijing residents also seems to resonate with the "Chinese Somatization" theory, which portrays various manifestations of depression symptoms cross-culturally [24]. More specifically, Chinese individuals have been observed to express somatic experiences rather than give direct descriptions of their psychological state when asked about their mental well-being. ...
Article
Full-text available
Dust storms, which are common aversive occurrences in northern China, result from high winds, dry soil or dust, and soil surface disturbance. Exposure to dust storms, regardless of duration, can induce varying mental and physical distress levels. Recognizing the urgency of comprehending the impact of dust storms on residents and the scarcity of information on their effects on the indigenous civilians there, this study aims to address this gap by qualitatively sampling 29 participants from Beijing, a typical city in northern China. The current study seeks to gain insights into residents’ dust storm experiences and explore their perspectives on effective coping mechanisms. The findings align with existing knowledge regarding the mental and physical repercussions of dust storms while identifying some emerging patterns of coping mechanisms already employed by residents in Beijing. Concerns regarding mental well-being, either directly influenced by the environmental conditions or indirectly stemming from disruptions to life routines on a broader scale, persistently dominate people’s perceptions of dust storms. New themes emerged following the step-by-step exploration of feelings and coping mechanisms. This study aims to enlighten the public about the ramifications of the dust storms in Beijing and advocate for essential policy support.
... In addition, this study depicts that the stigmas towards persons with mental illness in China have widened over the past decades of years. In the past, people with mental illness in China were attributed to physical problems and were shaped by the prevailing trend of somatization [21][22][23][24][25], which is seen as curable. As a result, few stigmas are evident [28,25,20]. ...
Article
Full-text available
Background Mental illness in China has traditionally been attributed to physical factors and somatization tendencies, which seldom result in stigma. How has this perception changed after decades of social change? Methods Based on the Chinese General Social Survey database in 2011, this study constructed a structural equation model to analyze the effects of causal attribution and emotional responses on social distance. The causal attributions include dangerousness, controllability, and responsibility. And the emotional responses encompass negative affect, traditional prejudice, treatment carryover, and exclusionary sentiments. In addition, higher scores indicating greater social distance, whereas a low score reflected stronger emotional responses or a greater degree of internal attribution. Results The results reported a high level of social distance towards people with mental illness. These findings indicated that emotional responses have a direct impact on social distance. Specifically, when negative affect, traditional prejudice, and exclusionary sentiments increase by one standard deviation, the social distance decreases by 0.497, 0.178, and 0.073 standard deviation, respectively. Conversely, as the level of treatment carryover rises, social distance increases by 0.087. Meanwhile, the causal attribution only exerts a significant indirect effect on social distance by the function of emotional causal responses. Conclusion The results indicated that the public attributes mental illnesses like depression primarily to psychological issues rather than somatic ones. It suggested widespread stereotypes and public stigma towards people with mental illness in China, as well as an arduous task in anti-stigma. In addition, a targeted way to address public stigma lies in changing the stereotype of people with mental illness.
... Moreover, our sample was lacking in racial and gender diversity. Past research has consistently shown that prevalence rates for mood disorders vary widely among different demographic groups (Andrade et al., 2003;Ryder & Chentsova-Dutton, 2012;Weissman et al., 1996). For example, the prevalence of mood disorders varies substantially across different racial and ethnic groups (Rudenstine & Espinosa, 2018;Watkins et al., 2015), and women are more likely than men to experience both depression (Bebbington, 1996;Kessler et al., 1994;Noble, 2005;Sprock & Yoder, 1997;Wolk & Weissman, 1995) and anxiety symptomology (Angst & Dobler-Mikola, 1985;Bruce et al., 2005;Pigott, 2003). ...
Article
Full-text available
Several theories suggest that mood disorders, like depression and anxiety, involve relatively systematic biases in how one imagines and predicts their future feelings. Here, we examine whether affective forecasting errors for mildly evocative, everyday emotional events are associated with differences in depression, anxiety, and somatic symptom severity in a non-clinical sample drawn from the general population. Participants read descriptions of 20 affective pictures which varied in terms of their normative valence (pleasantness/unpleasantness) and arousal (activation/deactivation). Based on the provided descriptions, participants rated their predicted emotional reaction to each picture. One week later, rated their experienced emotion in response to viewing each picture. Depression, anxiety, and somatic symptom severity were assessed using self-report questionnaires. Results revealed that those with greater anxiety or depression symptom severity, but not greater somatic symptom severity, had increased error in predicting their negative emotions for normatively positive future events (e.g., viewing pictures of stereotypically pleasant animals). Supplemental analyses revealed that individuals with greater depression symptom severity tended to over-predict their future negative feelings, while individuals with greater anxiety symptom severity made more errors in general (i.e., they both over- and under-predicted future negative emotions). These findings suggest that biases in predicting one’s future affective feelings, particularly one’s future negative feelings, may play a role in mood disorder symptom severity, and highlight potential differences in how emotional predictions may be biased for those with greater depression and/or anxiety symptomology.
... These symptoms commonly occur among elderly individuals and are associated with lower physical and psychological health and life satisfaction, as well as with higher mortality (Gu et al., 2016. Moreover, given that sleep problems were present in the "most healthy" group in the Japanese sample (Lei et al., 2022) but not in the "low or no symptoms" group in the English sample (Curran et al., 2022), the tendency of individuals from Eastern cultures to focus on somatic symptoms was demonstrated (Ryder & Chentsova-Dutton, 2012). Meanwhile, it is worth noting that "difficult to relax" was the core symptom of anxiety, which is consistent with findings from exploratory graph analysis (Moriana et al., 2022). ...
Article
Full-text available
Comorbid depression and anxiety causes serious psychological and physiological damage for older people. This study aimed to identify heterogeneous classes of comorbid depression and anxiety (CDA) among older people in China and to ascertain predictors of latent class membership. Cross‐sectional data of 10,919 cases were extracted from the Chinese Longitudinal Healthy Longevity Survey. Latent profile analysis (LPA) was used to identify symptom patterns of comorbid depression (measured by the 10‐item Center for Epidemiologic Studies Depression Scale) and anxiety (measured by the Generalized Anxiety Disorder 7‐item Scale). Multinomial logistic regressions following bivariate analyses were used to explore the relationship between the derived classes and individual‐ and social‐level factors. Four patterns of CDA were identified: low symptoms of depression and anxiety (30.52%; n = 3333), mild depression only (53.26%; n = 5815), moderate depression and anxiety (13.82%; n = 1509), and severe depression and anxiety (2.40%; n = 262). Older people who are male, suffer from multimorbidity, and lack a healthy lifestyle are more likely to have problematic symptom profiles. While intimate relationships with partners and children significantly predicted CDA patterns, the effects of sibling relationships, daily life, and emotional support from the community were insignificant. LPA identified four distinct CDA patterns among a representative sample of older Chinese people. While restless sleep, lack of positive emotions, uselessness, and weak concentration are salient across all profiles, “difficult to relax” is prominent in profiles high in anxiety. In addition to individual‐level variables, social‐level factors, especially intimate relationships with partners and children rather than general links to siblings or the community, have unneglectable impacts on whether and to what extent older Chinese adults suffer from CDA in the cultural context of relationism, patriarchy, and filial piety.
... Adolescents, in particular, are more likely to somaticize their mental health issues rather than directly addressing them [39]. This tendency is further corroborated by qualitative research that examines the stress and coping strategies of adolescents in a Chinese population, where avoidance of direct confrontation with mental health issues is common, and somatization can be a culturally embedded response to distress [62][63][64]. ...
Article
Full-text available
Background Anxiety and depression often co-occur during adolescence, but the associations between symptoms of these two disorders in this developmental period are not yet fully understood. Network analysis provides a valuable approach to uncover meaningful associations among symptoms and offers insights for prevention and intervention strategies. This study aimed to investigate symptom-level associations between anxiety and depression using network analysis and to identify core symptoms, bridge symptoms, and differences in network structure across different stages of adolescence. Methods The cross-sectional study was conducted in March 2022 in Shenzhen, China. Participants completed the Generalized Anxiety Disorder Scale-7 and Patient Health Questionnaire Depression Scale, along with demographic questionnaires assessing age and gender. Chinese adolescents aged 10 to 17 who were in Grades 5 or 6 of elementary school, Grades 1 or 2 of middle school, or Grades 1 or 2 of high school, and who could comprehensively understand and read Chinese were recruited as participants. Students in Grade 3 of middle and high schools were excluded due to their upcoming high school or college entrance examinations. Based on age, participants were categorized into early, middle, and late developmental stages of adolescence. Results “Loss of control” was among the most central symptoms in the comorbidity network throughout all three developmental stages; “excessive worry” and “anhedonia” emerged as the core symptoms in early adolescence, and “restlessness” as the core symptom in late adolescence. “Anhedonia,” “sad mood,” and “fatigue” were identified as bridge symptoms between anxiety and depression across all three developmental stages of adolescence. The global strength of the network in middle adolescence was significantly higher compared to the other two stages. Conclusion These findings highlight the core and bridge symptoms that require special attention and intervention at each stage of adolescence. Moreover, significantly higher network connectivity in middle adolescence suggests this is a critical period for intervention to prevent the development of comorbid mental disorders.
... HPs were twice more likely to experience somatic symptoms if they were fearful of returning home due to the risk of infecting their family members (83). Somatic symptoms, sometimes referred to as somatization, are psychological defense mechanisms against the recognition or expression of psychological distress (i.e., fear) (97), particularly in cultures where psychiatric disorders are highly stigmatized (98,99). Signs of somatization, such as palpation and sleep difficulty, may suggest that individuals have irrational fears associated with COVID-19 that should be addressed (46). ...
Article
Full-text available
Background China recorded a massive COVID-19 pandemic wave after ending its Dynamic Zero-COVID Policy on January 8, 2023. As a result, mental health professionals (MHPs) experienced negative mental health consequences, including an increased level of fear related to COVID-19. This study aimed to explore the prevalence and correlates of COVID-19 fear among MHPs following the end of the Policy, and its association with quality of life (QoL) from a network analysis perspective. Methods A cross-sectional national study was conducted across China. The correlates of COVID-19 fear were examined using both univariate and multivariate analyses. An analysis of covariance (ANCOVA) was conducted to determine the relationship between fear of COVID-19 and QoL. Central symptoms were identified using network analysis through the “Expected Influence” of the network model while specific symptoms directly correlated with QoL were identified through the “flow function.” Results A total of 10,647 Chinese MHPs were included. The overall prevalence of COVID-19 fear (FCV-19S total score ≥ 16) was 60.8% (95% CI = 59.9–61.8%). The binary logistic regression analysis found that MHPs with fear of COVID-19 were more likely to be married (OR = 1.198; p < 0.001) and having COVID-19 infection (OR = 1.235; p = 0.005) and quarantine experience (OR = 1.189; p < 0.001). Having better economic status (good vs. poor: OR = 0.479; p < 0.001; fair vs. poor: OR = 0.646; p < 0.001) and health status (good vs. poor: OR = 0.410; p < 0.001; fair vs. poor: OR = 0.617; p < 0.001) were significantly associated with a lower risk of COVID-19 fear. The ANCOVA showed that MHPs with fear of COVID-19 had lower QoL [F = 228.0, p < 0.001]. “Palpitation when thinking about COVID-19” was the most central symptom in the COVID-19 fear network model, while “Uncomfortable thinking about COVID-19” had the strongest negative association with QoL (average edge weight = −0.048). Conclusion This study found a high prevalence of COVID-19 fear among Chinese MHPs following the end of China’s Dynamic Zero-COVID Policy. Developing effective prevention and intervention measures that target the central symptoms as well as symptoms correlated with QoL in our network structure would be important to address COVID-19 fear and improve QoL.
... The low prevalence rates of depression may be partly due to the difficulties in defining and diagnosing depression in Chinese culture. In a seminal study, Kleinman (1982; see also Lee, 1999) found that neurasthenia, which emphasizes somatic symptoms such as fatigue, insomnia, and muscle pain, was a frequently used diagnosis in China (Ryder and Chentsova-Dutton, 2012). Kleinman found that Chinese patients diagnosed with neurasthenia could be re-diagnosed as having some level of depression using the Diagnostic and Statistical Manual of Mental Disorders III. ...
Article
Full-text available
Research in cross-cultural psychiatry has asserted that Chinese people have a higher tendency to report somatic symptoms of their psychological distress than people with a European ethnic background. However, recent studies have reached inconsistent conclusions and most have confounded language use with culture in their study designs. Focusing on the varying degrees of orientation to Chinese culture, the present study examined the words freely listed by two Chinese groups of university students (mainland Chinese and Hong Kong Chinese) when describing their illness experience. Words were categorized into somatic, emotion, and somatic–emotion clusters. Overall, the Chinese participants were more willing to talk about their emotions than their somatic symptoms in an anonymous survey. The enculturated mainland Chinese participants—who reported greater Chinese cultural identity—used significantly more emotion words but fewer somatic–emotion words than the Hong Kong Chinese participants. No group differences were found in somatic words. In contrast to previous findings, the current study failed to find support for the relationship between orientation to Chinese culture and somatic symptom reporting when controlling for language use.
... The nonexpression of emotions may be identified as cultural defence mechanisms, as they protect the individual against intrapsychic anxiety for disrupting interpersonal harmony and stability (Chung, 2006;Sun, 2013). Ryder and Chentsova-Dutton (2012) found that Chinese people with depression reported a higher level of suppressed emotions. Compared with Western counterparts, Chinese people with depression tend to report somatic complaints and are reluctant to report emotional distress (Dere et al., 2013). ...
Article
Full-text available
Unlabelled: Objectives: Depressive symptoms are common among older adults and many of them did not seek for professional help. Although Zentangle has been widely implemented in service centers for older adults in many societies, very limited empirical study has been conducted on the effects of this method. This study aims to evaluate the effects of Zentangle on community-dwelling older adults with depressive symptoms. Methods: A randomised waitlist-controlled trial of Zentangle was conducted. Forty-six community-dwelling older adults with mild to moderate depression were recruited and randomly assigned to a six session Zentangle group or a waitlist control group. The effects were examined by comparing the participants who received a six-week Zentangle intervention with those in the waitlist control group. Patient Health Questionnaire (PHQ-9), Self-compassion Scale - Short form (SCS-SF) and other mental health outcomes were assessed at baseline, post-intervention and six-week follow-up. Results: Repeated measure ANOVA revealed significant Time x Group effects for depression (F (2, 88) = 21.29, p < .001) and self-compassion (F (2, 88) = 18.50, p < .001) with a large net effect size. Six-week follow-up indicated that such improvements were sustained. Conclusion: This study provides preliminary support that the Zentangle programme is an effective alternative treatment approach for older adults with mild to moderate depression. The original Zentangle method can reduce depressive symptoms and cultivate self-compassion. Further research is necessary to expand our understanding of the underlying mechanisms of how the original Zentangle method works. Trial registration: ISRCTN66410347. Supplementary information: The online version contains supplementary material available at 10.1007/s12144-023-04536-x.
... When experiencing depression, Chinese patients tend to report more somatic symptoms, whereas Western patients endorse more psychological symptoms (Ryder et al., 2008;Ahmad et al., 2018). The "Chinese somatization" has been regarded as a culturally relevant phenomenon, as opposed to the "Western psychologization", probably due to stigma, self-attention, and externally oriented thinking (Ryder and Chentsova-Dutton, 2012). However, to the best of our knowledge, very few studies have investigated the effect of AOO on symptomatology of depression among Chinese patients. ...
Article
Background The age of onset (AOO) is a key factor for heterogeneity in major depressive disorder (MDD). Looking at the effect of AOO on symptomatology may improve clinical outcomes. This study aims to examine whether and how AOO affects symptomatology using a machine learning approach and latent profile analysis (LPA). Methods The study enrolled 915 participants diagnosed with MDD from eight hospitals across China. Depressive symptoms were assessed using the 17-item Hamilton Depression Rating Scale. The relationship between symptom profiles and AOO was explored using Random Forest. The effect of AOO on symptom clusters and subtypes was investigated using multiple linear regression and LPA. A continuous AOO indicator was used to conduct the analyses. Results Based on the Random Forest, symptom profiles were closely associated with AOO. The regression model showed that the severity of neurovegetative symptoms was positively associated with AOO (β = 0.18, p < 0.001), and the severity of cognitive-behavioral symptoms was negatively associated with AOO (β = −0.12, p < 0.001). LPA demonstrated that the subgroups characterized by suicide and guilt had earlier onset of depression. The subgroup with the lowest global severity of depression had the latest onset. Limitations AOO was recalled retrospectively. The relative scarcity of participants with childhood and adolescence onset depression. Conclusions AOO has an important impact on symptomatology. The findings may enhance clinical evaluations for MDD and assist clinicians in promoting earlier detection and individualized care in vulnerable individuals.
... In recent years, this model has partially and imperfectly merged with a biomedical model emphasizing physical causes, symptoms, and interventions, with decidedly mixed results for public attitudes toward mental disorder (Haslam and Kvaale, 2015). In China and India, models of depression emphasize a combination of moral and somatic causes, symptoms, and interventionsdwhere "somatic" may involve etiological beliefs from Chinese or Ayurvedic Medicine rather than "Western" biomedicine (Dere et al., 2013;Karasz, 2005;Pereira et al., 2007;Ryder and Chentsova-Dutton, 2012). A review of qualitative studies of depression covering 170 populations across six world regions identified symptoms reported both frequently and widely (e.g., depressed mood, fatigue) along with others that were only reported frequently in some cultural contexts (Haroz et al., 2017). ...
Chapter
Accounting for cultural context in psychological assessment is a challenging endeavor, but one that is essential if the clinician is to provide accurate diagnoses and proceed with effective treatment plans. This chapter aims to provide some clarity to clinicians and researchers regarding how culture should be understood and addressed in assessment settings. A conceptual account is provided of how psychopathology is shaped by culture so that the reader gains an appreciation for the essential role that culture plays in the development, experience and expression of psychopathology. The negative consequences of not accounting for culture when conducting clinical assessments are then highlighted through selected examples. Practical recommendations are then provided concerning how to conduct a psychological assessment that accounts for culture. These recommendations include how to conduct a culturally-informed clinical interview, how to select valid and reliable measurement instruments and interpret their scores, and how to develop treatment plans that take patients' cultural contexts into account.
... 12 However, somatic symptoms tend to be emphasized over emotional and cognitive symptoms. 13 Previous studies of US individuals of European descent have reported the absence of high-arousal positive emotions, such as excitement or enthusiasm, as a main feature of depression, while presentations in Chinese individuals emphasize the absence of low-arousal positive states, such as peacefulness. [14][15][16] Consequently, different items on depression scales tend to be useful markers of depression across populations and ethnic groups, [17][18][19] raising questions about what depression means and how best to assess it cross-culturally for research. ...
Article
Full-text available
Importance Most previous genome-wide association studies (GWAS) of depression have used data from individuals of European descent. This limits the understanding of the underlying biology of depression and raises questions about the transferability of findings between populations. Objective To investigate the genetics of depression among individuals of East Asian and European descent living in different geographic locations, and with different outcome definitions for depression. Design, Setting, and Participants Genome-wide association analyses followed by meta-analysis, which included data from 9 cohort and case-control data sets comprising individuals with depression and control individuals of East Asian descent. This study was conducted between January 2019 and May 2021. Exposures Associations of genetic variants with depression risk were assessed using generalized linear mixed models and logistic regression. The results were combined across studies using fixed-effects meta-analyses. These were subsequently also meta-analyzed with the largest published GWAS for depression among individuals of European descent. Additional meta-analyses were carried out separately by outcome definition (clinical depression vs symptom-based depression) and region (East Asian countries vs Western countries) for East Asian ancestry cohorts. Main Outcomes and Measures Depression status was defined based on health records and self-report questionnaires. Results There were a total of 194 548 study participants (approximate mean age, 51.3 years; 62.8% women). Participants included 15 771 individuals with depression and 178 777 control individuals of East Asian descent. Five novel associations were identified, including 1 in the meta-analysis for broad depression among those of East Asian descent: rs4656484 (β = −0.018, SE = 0.003, P = 4.43x10⁻⁸) at 1q24.1. Another locus at 7p21.2 was associated in a meta-analysis restricted to geographically East Asian studies (β = 0.028, SE = 0.005, P = 6.48x10⁻⁹ for rs10240457). The lead variants of these 2 novel loci were not associated with depression risk in European ancestry cohorts (β = −0.003, SE = 0.005, P = .53 for rs4656484 and β = −0.005, SE = 0.004, P = .28 for rs10240457). Only 11% of depression loci previously identified in individuals of European descent reached nominal significance levels in the individuals of East Asian descent. The transancestry genetic correlation between cohorts of East Asian and European descent for clinical depression was r = 0.413 (SE = 0.159). Clinical depression risk was negatively genetically correlated with body mass index in individuals of East Asian descent (r = −0.212, SE = 0.084), contrary to findings for individuals of European descent. Conclusions and Relevance These results support caution against generalizing findings about depression risk factors across populations and highlight the need to increase the ancestral and geographic diversity of samples with consistent phenotyping.
... Several possible reasons for these links may be proposed. According to Ryder and Chentsova-Dutton (2012), individualism is related to a self-focused thinking style (e.g., rumination). As such, a stronger individualistic orientation might result in more self-focused negative thinking in response to stress (rather than seeking emotional support) which might create a risk for depression. ...
Article
Full-text available
Collectivism remains a dominant force in the Chinese society and schooling is a process to instill collectivistic values in the students, although there has been a noticeable increase in individualistic orientation among Chinese youth. Because China’s meritocratic educational system endorses high individualism to enhance academic competitiveness and performance, the Chinese educational system is contradictorily both collectivistic and individualistic. Within meritocratic educational systems, academic performance influences students’ psychosocial adjustment. However, the role of students’ individualistic orientation and collectivistic orientation on their psychosocial adjustment and the role of them on the link between academic performance and psychosocial adjustment are not well understood. To address this issue, we obtained survey data from 1003 6–12th grade Chinese students on their academic performance, individualistic orientation, collectivistic orientation, and psychosocial adjustment (i.e., self-esteem, anxiety symptoms, depression symptoms, peer relations, and parent–child relationship quality). Results showed the students’ academic performance scores predicted scores for all five psychosocial adjustment subscales in expected directions; higher collectivistic orientation scores predicted lower depression scores, higher parent–child relationship quality scores and peer relation scores, while higher individualistic orientation scores predicted higher self-esteem scores and higher depression scores. Finally, the influence of academic performance on anxiety symptoms was moderated by the students’ individualistic orientation.
... 39 It should be noted that depression symptoms vary from cultures and requires various treatment approaches, for example, somatization is more severe and common in China. [61][62][63] It is necessary to provide more evidence of tDCS and tACS treating MDD in the cultural context of China. ...
Article
Full-text available
Background Transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) are regarded as promising antidepressant treatments. Objective To compare the efficacy and safety of tDCS, tACS, escitalopram, and placebo/sham stimulation controls. Design Randomized, parallel, double-blind, placebo-controlled study. Methods Sample sizes were calculated based on data from previous similar studies. Eligible non-treatment-resistant-depressive outpatient subjects with moderate-to-severe depression (HRDS ≥17) are randomized to receive (1) tDCS + placebo; (2) tACS + placebo; (3) escitalopram + placebo; or (4) sham stimulation + placebo. The intensity of electricity is 2 mA, lasting for 30 minutes over two consecutive working days (10 sessions in total). The medication lasts for 6 weeks. The primary outcome measure was the response rates within 6 weeks (week 6 is also the endpoint of the study), and secondary outcome measures included changes in other clinical measurements. Safety and acceptability are measured by adverse event rates and dropout rates. Exploring outcome consist of the performance of cognitive battery as well as neurophysiology results. Conclusion To the best of our knowledge, the present study is the first double-blind controlled study comparing tDCS, tACS, and clinically used antidepressants, which will provide further evidence for their efficacy and safety in possible clinical applications.
... Notably, Chinese individuals have the tendency to use somatization in expressing suppressed mental distress (Mak & Zane, 2004). This phenomenon is particularly evident in depressed patients (Ryder & Chentsova-Dutton, 2012), which may explain our findings that the TC-PFS Physical subscale had the best model fit indexes in LLD. In our sample, those with LLD reported greater fatigability compared to MCI and CN groups; with 80.0% reporting greater physical fatigability and 82.9% greater mental fatigability. ...
Article
Full-text available
Objectives: The Pittsburgh Fatigability Scale (PFS) is a self-administered 10-item tool to measure physical and mental fatigability in older adults. The aim of the current study was to validate the psychometric properties of the traditional Chinese version of PFS (TC-PFS). Methods: We recruited 114 community-dwellingolder adults, where 35 were diagnosed with late-life depression (LLD), 26 with mild cognitive impairment (MCI), and 53 were cognitively normal (CN) from a larger community study of older adults. Statistical analyses were done separately for TC-PFS Physical and Mental subscales. Factor analysis was used for reliability, Cronbach’s alpha for internal consistency, Pearson’s correlation for construct validity, and group comparison for discriminative validity. Results: Factor analysis revealed a two-factor structure for both the TC-PFS Physical and Mental subscales with high reliability (α = 0.89 and 0.89, respectively). Patients with LLD had the highest PFS scores, with 80.0% and 82.9% classified as having greater physical and mental fatigability. For concurrent validity, we found moderate associations with the vitality and physical functioning subscales of the 36-Item Short Form Health Survey. For convergent validity, TC-PFS showed moderate association with emotional-related psychometrics, particularly for the Physical subscale in those with LLD. In contrast, TC-PFS Mental subscale showed correlations with cognitive function, particularly in the MCI group. Conclusions: Our results indicate that the TC-PFS is a valid instrument to measure perceived physical and mental fatigability in older Taiwanese adults. Clinical implications: Perceived fatigability reflects the underlying physical, mental or cognitive function in older adults with or without depression.
... First, mental health service infrastructure in mainland China is less developed than in many Western countries [10]. Second, among Chinese adults depression and depressive symptoms are often expressed in somatic symptoms, such as insomnia and chest pain [11]. As a result, Chinese middle-aged and older adults in mainland China are likely to have help-seeking behaviors that are culturally informed and distinct from their counterparts in, for example, the United States, where the mental health system is more established [12]. ...
Article
Full-text available
Objectives This study aimed to (1) examine the cross-sectional and longitudinal relationships between depressive symptoms and health services utilization among Chinese middle-aged and older adults; and (2) evaluate whether there exists a rural–urban difference in such relationships. Methods Data was obtained from China Health and Retirement Longitudinal Study (CHARLS) in 2013 and 2015, a nationally representative survey of 13,551 adults aged 45 years and above in China. Results Depressive symptoms were positively associated with a greater likelihood of outpatient and inpatient health services utilization. This association was consistent across rural and urban settings, indicating the robustness of such findings across geographic areas. Conclusions Findings indicate that depressive symptoms are significantly associated with both in-patient and out-patient health service utilization among Chinese adults. Screening for depressive symptoms needs to be incorporated in these care settings in China.
... The literature suggests that there may be cultural differences in how Chinese people communicate distress, compared to, for example, people from western culture. Chinese people have been suggested to report physical symptoms rather than psychological symptoms such as depression (51,52) and anxiety (53), and this tendency might originate from the way people showing psychological distress were treated during the Cultural Revolution (54,55). Also, more in general, stigma related to mental disorders might play a role in the tendency to under-report psychological distress (56). ...
Article
Full-text available
Background: This study explored how the COVID-19 outbreak and arrangements such as remote working and furlough affect work or study stress levels and functioning in staff and students at the University of York, UK. Methods: An invitation to participate in an online survey was sent to all University of York staff and students in May-June 2020. We measured stress levels [VAS-scale, Perceived Stress Questionnaire (PSQ)], mental health [anxiety (GAD-7), depression (PHQ-9)], physical health (PHQ-15, chronic medical conditions checklist), presenteeism, and absenteeism levels (iPCQ). We explored demographic and other characteristics as factors which may contribute to resilience and vulnerability for the impact of COVID-19 on stress. Results: One thousand and fifty five staff and nine hundred and twenty five students completed the survey. Ninety-eight per cent of staff and seventy-eight per cent of students worked or studied remotely. 7% of staff and 10% of students reported sickness absence. 26% of staff and 40% of the students experienced presenteeism. 22–24% of staff reported clinical-level anxiety and depression scores, and 37.2 and 46.5% of students. Staff experienced high stress levels due to COVID-19 (66.2%, labeled vulnerable) and 33.8% experienced low stress levels (labeled resilient). Students were 71.7% resilient vs. 28.3% non-resilient. Predictors of vulnerability in staff were having children [OR = 2.23; CI (95) = 1.63–3.04] and social isolation [OR = 1.97; CI (95) = 1.39–2.79] and in students, being female [OR = 1.62; CI (95) = 1.14–2.28], having children [OR = 2.04; CI (95) = 1.11–3.72], and social isolation [OR = 1.78; CI (95) = 1.25–2.52]. Resilience was predicted by exercise in staff [OR = 0.83; CI (95) = 0.73–0.94] and in students [OR = 0.85; CI (95) = 0.75–0.97]. Discussion: University staff and students reported high psychological distress, presenteeism and absenteeism. However, 33.8% of staff and 71.7% of the students were resilient. Amongst others, female gender, having children, and having to self-isolate contributed to vulnerability. Exercise contributed to resilience. Conclusion: Resilience occurred much more often in students than in staff, although psychological distress was much higher in students. This suggests that predictors of resilience may differ from psychological distress per se. Hence, interventions to improve resilience should not only address psychological distress but may also address other factors.
... In the current study, cognitive symptoms such as difficulty in planning things and taking care of oneself as well as the interpersonal symptom of a decrease in activities were conceptualised as physical difficulties or brain function issues, so they emerged in the same factor. Somatisation could be related to a lack of attention to emotional life that is shaped by cultural values (Ryder and Chentsova-Dutton 2012) or to insufficient emotional expression skills that result in the physical expression of psychological distress (Zhang et al. 2012). It may be that the depressed inpatients in this study had been made aware of the affective and cognitive symptoms in previous assessments as part of their routine clinical care and thus tended to provide the 'correct' answers on the depression scales by emphasising the affective element of depression. ...
Article
Full-text available
Depression symptoms and assessment in China are influenced by unique cultural values of collectivism and by social-political factors specific to China. This study validated the Chinese version of the 52-item Multidimensional Depression Assessment Scale (MDAS) with clinically depressed patients in Inner Mongolia. The study sought to examine the psychometric properties of the MDAS and understand the construct of depression in a specific collectivistic cultural context using a scale with comprehensive dimensions of depressive symptoms in the emotional, cognitive, somatic and interpersonal domains. A total of 171 clinically depressed participants in Inner Mongolia completed the Chinese versions of the MDAS and the Beck Depressive Inventory (BDI). The reliability and validity of the MDAS were tested, and an exploratory factor analysis (EFA) was conducted on the MDAS to examine the underlying structure of the measure. The MDAS and BDI were compared in terms of sensitivity and reactivity on the basis of the cut-off value of BDI. The Chinese-MDAS was found to have good psychometric properties, including high Cronbach’s alphas for the total scale and for each subscale (0.90–0.97), indicating good reliability, as well as a high and significant correlation with the BDI (r = 0.72; p < .001), suggesting good validity. The factor analysis indicated the emergence of a salient factor of interpersonal symptoms in Chinese depressed patients, suggesting the importance of interpersonal symptoms in Chinese depressed individuals. A cut-off value of 118.5 with high sensitivity and specificity was found on the MDAS based on the cut-off value of the BDI. The Chinese-MDAS demonstrated good psychometric properties among depressed individuals in Inner Mongolia. This study paves the way for the measure’s further development and cultural adaptation in a Chinese depressed population.
... One of the best-known examples of cultural variation in psychopathology is the notion of differential somatic symptom reporting by non-European populations. 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, somatization 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. ...
Article
Background The concept of European psychologization of depression versus somatisation in non‐European populations has been the basis of several studies of cultural psychopathology in the general population. Little is currently known about cross‐cultural differences and similarities in late‐life depression symptom reporting. We cross‐culturally compared symptom reporting in the context of Major Depressive Disorder (MDD) among community‐dwelling older adults from Spain and Nigeria. Methods We relied on data from two household multistage probability samples comprising 3,715 persons aged 65 years or older in the Spanish and Nigerian populations. All participants underwent assessments for MDD using the World Mental Health Survey version of the Composite International Diagnostic Interview. Cross‐cultural comparison of broad somatic and psychological categories as well as relationship and influence of individual symptoms were analysed using the Symptom Network Analysis approach. Results Current MDD was diagnosed in 232 and 195 older persons from Spain and Nigeria, respectively. The symptom network of the two samples were invariant in terms of global strength, S(GSPAIN, GNIGERIA) = 7.56, p = .06, with psychological and somatic symptoms demonstrating centrality in both countries. However, country‐specific relationships and influence of individual symptoms were found in the network structure of both samples, M(GSPAIN, GNIGERIA) = 2.95, p < .01. Conclusion Broad somatic and psychological symptoms categories contributed to the structural network of older Africans and their peers from the Spanish population. Variations in the relationship and influence of individual symptoms suggests that the functional and ‘communicative’ role of individual symptoms may be differentiated by context specific imperatives.
... Models of the cultural variability of illness, such as the biopsychosocial model, the culture-mind-brain model (Ryder and Chentsova-Dutton, 2012) as well as the model of cultural syndromes proposed by Hinton et al. (2012), acknowledge the role of society in the development of illness. Drawing on such theoretical models, this article takes a step further in detailing the processes through which socially acquired models are relevant for the therapeutic practice both inside and outside of the clinic. ...
Article
Full-text available
Functional Neurological Disorder (FND), otherwise known as Conversion Disorder, is characterized by abnormal sensory or motor symptoms that are determined to be "incompatible" with neurological disease. FND patients are a challenge for contemporary medicine. They experience high levels of distress, disability, and social isolation, yet a large proportion of those treated do not get better. Patients with FNDs are often misdiagnosed and suffer from stigma, dysfunctional medical encounters and scarcity of adequate treatments. In this paper we argue that an anthropological understanding of these phenomena is needed for improving diagnosis and therapies. We argue that cultural meaning is pivotal in the development of FND on three levels. 1) The embodiment of cultural models, as shared representations and beliefs about illnesses shape the manifestation of symptoms and the meanings of sensations; 2) The socialization of personal trauma and chronic stress, as the way in which individuals are socially primed to cope or to reframe personal trauma and chronic stress affects bodily symptoms; 3) Moral judgment, as stigma and ethical evaluations of symptoms impact coping abilities and resilience. In particular, we focus on the disorder known as PNES (Psychogenic-Non-Epileptic Seizure) to show how cultural meaning co-determines the development of such seizures. We introduce the notion of interoceptive affordances to account for the cultural scaffolding of patients' bodily experiences. Finally, we suggest that effective treatments of FND must act upon meaning in all of its aspects, and treatment adequacy must be assessed according to the cultural diversity of patients.
... On the other hand, the same cultural influences may shape the actual experience of internalizing distress. Daily living and enacting of cultural scripts may influence cognitive perceptions as well as biology, so that somatic symptoms are generated and amplified to be prominently experienced when distressed [31]. To the extent that somatic symptoms limit daily functioning [32][33][34], individuals with interdependent values may become distressed if they feel they are burdening others or failing in their social roles. ...
Article
Objective: Different domains of internalizing symptoms (somatic, anxiety, depressive) often occur concurrently, suggesting that they may share common etiology. In longitudinal analyses of internalizing among youth, anxiety is often found to precede depression. However, relatively few studies have also assessed how somatic problems, the third symptom domain, are involved in longitudinal patterns of internalizing. In addition, temporal relations among internalizing symptom domains may vary by cultural group as somatic symptoms are posited to be a more culturally-normative way of communicating or experiencing distress in non-Western, interdependent cultures. Thus, the present study examined longitudinal relations among these three internalizing symptom domains in three ethnocultural adolescent samples. Methods: 304 European American, 420 Vietnamese American, and 717 Vietnamese adolescents' self-reported internalizing symptoms (somatic, anxiety, depressive) were assessed at three time points, spaced three months apart, using multigroup cross-lagged path analysis. Results: Anxiety symptoms consistently predicted increases in depressive symptoms in European American adolescents. In contrast, for Vietnamese and Vietnamese American adolescents, the most consistent relation was with somatic complaints predicting increases in anxiety. Anxiety and depressive symptoms bidirectionally predicted each other among the Vietnamese and Vietnamese American adolescents. Conclusions: Cultural group differences were evident in the temporal course of internalizing symptoms. The pattern of results have implications for culturally relevant intervention targets, during a developmental period of risk for internalizing disorders. Keywords: Asian, Somatic, Internalizing, Adolescents, Depressive, Culture
... Three dominant schools of thought evolved: somatosensory amplification, denial of psychological stress, and a strategic emphasis on accessing resources or avoiding stigma by changing the context for, and perception of, what would otherwise be psychic symptoms. In 2012, Ryder and Chentsova-Dutton 14 critiqued the amplification and denial approaches for their mind-body dualism, Western-based emphasis on independent self-construal, and pathologizing of Chinese culture. They argued for applying a culture-mind-body perspective, wherein people attend and react to particular experiences in culturally based ways. ...
Article
Despite the increasing presence of Chinese communities in the West, their experiences of depression and the variations in symptoms or presentation are not well understood. Using Arksey and O'Malley's methodical framework, we conducted a scoping review of the published literature, using electronic databases MEDLINE and PsycINFO, and searched for articles published since 1999. Out of 1177 articles identified, 21 met the inclusion criteria. Thematic synthesis revealed valuable scholarly work on (1) depression rates, migration, and contextual determinants, (2) causation beliefs and help seeking, (3) acculturation and symptoms, (4) presenting symptoms and somatization, and (5) culturally sensitive assessment and care. Overall, this review has identified the importance of contextual determinants in the development of depression, low rates of seeking of professional help, subtle variations in somatization, and knowledge gaps in culturally sensitive care. The findings suggest that, rather than treating migration as a cause of mental distress, the accompanying conditions and events need to be further examined and addressed as potential risk or protective factors. Subtle variations in somatization are also evident, and future scholarly work should examine the notion of cultural scripts-namely, that people attend and react to particular experiences in culturally based ways. For this reason (among others), practice models need to develop strategies for culturally sensitive care, such as co-construction of illness narratives and finding common ground. Given the stigma of mental illness and the low level of seeking professional help, the role of primary care should be expanded. Further studies investigating mental health issues beyond depression are also warranted in the studied community.
... Thus, cultural scripts (66) shape the ways in which people attend and react to particular experiences marked as important in some way. In some cases, pathological loops can form, where attention to a particular symptom can accentuate its severity and give rise to related symptoms' (65). ...
Article
Full-text available
Background: Persistent somatic symptoms are associated with psychological distress, impaired function, and medical help-seeking behavior. The Patient Health Questionnaire (PHQ)-15 is used as a screening instrument for somatization and as a monitoring instrument for somatic symptom severity. A bifactorial model has been described, with one general factor and four orthogonal specific symptom factors. The objective of the present study was to assess and to clarify the factor structure of the PHQ-15 within and between different countries in Western Europe and China. Method: Cross-sectional secondary data analysis performed in three patient data samples from two Western European countries (Germany N = 2,517, the Netherlands N = 456) and from China (N = 1,329). Confirmatory factor analyses (CFA), and structural equation modeling (SEM) analysis were performed. Results: The general factor is found in every sample. However, although the outcomes of the PHQ-15 estimate severity of somatic symptoms in different facets, these subscales may have different meanings in the European and Chinese setting. Replication of the factorial structure was possible in the German and Dutch datasets but not in the dataset from China. For the Chinese dataset, a bifactorial model with a different structure for the cardiopulmonary factor is suggested. The PHQ-15 could discern somatization from anxiety and depression within the three samples. Conclusion: The PHQ-15 is a valid questionnaire that can discern somatization from anxiety and depression within different cultures like Europe or China. It can be fitted to a bifactorial model for categorical data, however, the model can only be recommended for use of the general factor. Application of the orthogonal subscales in non-European samples is not corroborated by the results. The differences cannot be ascribed to differences in health care settings or by differences in concomitant depression or anxiety but instead, a cultural factor involving concepts of disease may play a role in this as they may play a role in the translation of the questionnaire. Further research is needed to explore this, and replication studies are needed regarding the factorial structure of the PHQ-15 in China.
... There are also cultural factors influencing the expression of feelings of distress, where they are experienced more in the body than in psychological terms, such as the somatization of depression in China (Ryder and Chentsova-Dutton, 2012) or among immigrants with low social resources (Lin et al., 1985). Thus, it is possible that in some cultural groups and circumstances, self-reports of somatic experiences that are outcomes of stressor exposure, such as pain or sleep disturbances, or somatic health symptoms such as headaches or stomachaches, may serve as better indicators of responses to stressor exposure than direct assessments of feelings or thoughts. ...
Article
Full-text available
Stress can influence health throughout the lifespan, yet there is little agreement about what types and aspects of stress matter most for human health and disease. This is in part because "stress" is not a monolithic concept but rather, an emergent process that involves interactions between individual and environmental factors, historical and current events, allostatic states, and psychological and physiological reactivity. Many of these processes has alone been labeled as "stress." Stress science would be further advanced if researchers adopted a common conceptual model that incorporates epidemiological, affective, and psychophysiological perspectives, with more precise language for describing stress measures. We articulate an integrative working model, highlighting how stressor exposures across the life course influence habitual responding and stress reactivity, and how health behaviors interact with stress. We offer a Stress Typology articulating timescales for stress measurement - acute, event-based, daily, and chronic-- and more precise language for dimensions of stress measurement.
... Recent findings suggest that culture plays an important role in symptom presentation (e.g., Dere et al., 2013). For example, since the Chinese culture encourages a focus away from internal experiences (e.g., emotions) and towards concrete details of the external world, Chinese patients may perceive somatic symptoms as more salient than cognitive symptoms (Ryder & Chentsova-Dutton, 2012). In this regard, somatization is a culturally shaped style for expressing distress. ...
Article
Full-text available
Purpose Research in depression has revealed differences in the way depressed individuals across cultures report their symptoms. This literature also points to possible differences in symptom reporting patterns between men and women. Using data from a larger dataset (Beshai et al. 2016), the current study examined whether non-depressed and depressed Egyptian and Canadian men and women differed in their self-report of the various domains of the Beck Depression Inventory –II (BDI-II). Method We recruited a total of 131 depressed and non-depressed participants from both Egypt ( n = 29 depressed; n = 29 non-depressed) and Canada ( n = 35 depressed; n = 38 non-depressed). Depression status was ascertained using a structured interview. All participants were asked to complete the BDI-II along with other self-report measures of depression. BDI-II items were divided into two subscales in accordance with Dozois, Dobson & Ahnberg (1998) factor analysis: cognitive-affective and somatic-vegetative subscales. Results We found a significant three-way interaction effect on the cognitive-affective ( F (1,121) = 9.51, p = .003) and main effect of depression status on somatic-vegetative subscales ( F (1,121) = 42.80, p < .001). Post hoc analyses revealed that depressed Egyptian men reported lower scores on the cognitive-affective subscale of the BDI-II compared to their depressed Canadian male counterparts. Conclusions These results suggest that males across cultures may differentially report cognitive symptoms of depression. These results also suggest that clinicians and clinical scientists need to further examine the interaction effect of culture and gender when investigating self-reported symptoms of depression.
... [41][42][43][44] These latter factors contribute to variation in the prevalence of depression and suicidal behaviour across different cultural contexts. [45][46][47] There is evidence that cultural factors influence the cultural variation in the prevalence of depression. Cultural differences in stress, standards of living, unemployment, stigma and reporting bias are among those factors. ...
Article
Full-text available
Objectives To examine depression and suicidal behaviour and associated factors in a sample of medical students in Portugal. Methods We conducted a cross-sectional study design of 456 native Portuguese medical students from the 4th and 5th year at the University of Lisbon. Participants answered a self-report survey including questions on demographic and clinical variables. Statistical analyses were conducted using the chi-square test, with a Monte Carlo simulation when appropriate. Results Depression among medical students was 6.1% (n=28) and suicidal behaviour 3.9% (n=18). Higher depression scores were noted in female medical students (χ²=4.870,df=2,p=0.027), students who lived alone (χ²=8.491,df=3,p=0.037), those with poor physical health (χ²=48.269,df=2,p<0.001), with poor economic status (χ²=8.579,df=2,p=0.014), students with a psychiatric diagnosis (χ²=44.846,df=1,p=0.009), students with a family history of psychiatric disorders (χ²=5.284,df=1,p=0.022) and students with high levels of anxiety (χ²=104.8, df=3, p<0.001). Depression scores were also higher in students with suicidal ideation (χ²=85.0,df=1,p<0.001), suicidal plan (χ²=47.9,df=1,p<0.001) and suicidal attempt (χ²=19.2,df=1,p<0.001). Suicidal behaviour was higher in medical students who lived alone (χ²=16.936,df=3,p=0.001), who had poor physical health (χ²=18,929,df=2,p=0.001), poor economic status (χ²=9.181,df=2,p=0.01), who are/were in psychopharmacology treatment (χ²=30.108,df =1,p<0.001), and who had high alcohol use (χ²=7.547,df=2,p=0.023), severe depression (χ²=88.875,df=3,p<0.001) and high anxiety levels (χ²=50.343,df=3,p<0.001). The results also revealed that there were no differences between students in the 4th and 5th years of medical school regarding rate of depression and suicidal behaviour. Conclusions Since depression and suicidal behaviour are mental health problems affecting a significant proportion of medical students, medical schools should implement programs that promote mental health wellness, physical health and economic status between other factors.
... In the case of somatization, responses were coded for emphasis, rather than exclusive presentation of one set of symptoms, on a 3-point scale. This is because many researchers have argued that the experience of depression includes both somatic and psychological symptoms for Chinese and Westerners, albeit differentially, and it is rare for individuals in either group to solely report one set of symptoms (somatic or psychological; Mak and Zane, 2004;Ryder and Chentsova-Dutton, 2012). A code of 3 was assigned when the response indicated a greater expression or elaboration of somatic symptoms, or when the overarching theme of the response reflected a focus on bodily irregularity (e.g. ...
Article
Full-text available
The present research interrogates the greater tendency for Chinese people to somaticize depression relative to Westerners. Drawing from a social identity perspective, three studies were conducted examining the role that cultural norms play in symptom expression. In an initial study, we confirmed greater somatization, minimization of distress and suppression of emotional expression among Chinese participants compared with Australians (Study 1). Asian normative expectations of collectivism moderated these effects such that somatization was higher among those who endorsed collectivism norms, but only among Chinese participants. Studies 2a and 2b found that only when Asian participants identified strongly with Asian culture did collectivism norms predict somatic symptoms. These findings have implications for practitioners working with people from Asian cultures, highlighting that it is not culture per se, but the endorsement of normative expectations in the context of strong identification with cultural groups that predicts which symptoms of depression are emphasized. Copyright
Chapter
Somatisation as an aspect of cultural variation in mental disorders has been widely studied. Less has been offered by way of explaining how culture influences presentation with somatic symptoms. Acknowledging the embodied experience of depression as a universal part of the disorder, a range of different bodily symptoms in depression are examined, including fatigue, lack of energy and perception of body as heavy and leaden. Situating these universal experiences within a cultural context with particular conceptions regarding health and illness, the higher emphasis on some of the somatic symptoms such as pain is accounted for. While the meaning and significance attached to somatic symptoms may be culturally determined, these nonetheless ought to be understood as instances of disturbances of embodiment, itself a universal part of experience of depression.
Article
Full-text available
This study aimed to examine trends in depressive disorders incidence and associations with age, period, and birth cohort across China, Japan, and South Korea between 1990 and 2019. Data were obtained from the Global Burden of Disease Study 2019. Age-period-cohort (APC) model was used to evaluate effects of age, period, and cohort on the depressive disorders incidence. From 1990 to 2019, the age-standardized incidence of depressive disorders increased by 6.4% in Japan and 9.1% in South Korea, while it decreased by 12.8% in China. The annual percentage change of incidence in China, Japan, and South Korea was -0.74%, 0.44%, and 0.58%, respectively. The local drifts were below 0 in those aged 5–49 years and above 0 in those aged 55–84 years in China, while they were no less than 0 in all age groups in Japan and South Korea. The longitudinal age curves of depressive disorders showed an N-shaped pattern across all three countries. Both period and cohort effects showed an overall increase in South Korea. In conclusion, older adults are at a higher risk of depressive disorders, and their incidence has increased over the last three decades across all the three East Asian countries. Immediate measures, including popularizing knowledge about depressive disorders, improving access to mental health services, and increasing investment in basic and applied research on depressive disorders, should be taken to prevent depressive disorders in older adults and to provide support for those with depressive disorders.
Article
Full-text available
This qualitative study examines the characteristics exhibited by Chinese patients with somatization symptoms during their treatment process, focusing on changes in illness interpretation and language use. A semi-structured in-depth interview was conducted with 10 patients receiving treatment in a clinical psychology department of a general hospital who reported somatic symptoms as their main complaint. The interview data were recorded and transcribed, and analyzed using interpretive phenomenological analysis. Two core themes emerged from the analysis: avoidance at the utterance level; and at the semantic level, power and contestation. Patients with somatization symptoms exhibit avoidance behaviors, and their experience of illness and the therapeutic process impact their discourse. Professionals should pay attention to patients’ own interpretations, cultural background and acceptance of the illness.
Article
Background: Grief is a multi-faceted experience including emotional, social, and physical reactions. Research in ICD-11 prolonged grief disorder (PGD) in different cultural contexts has revealed different or potentially missing grief symptoms that may be relevant. Objective: This study thus aimed to explore the prevalence of somatic symptom distress and its associations with grief and negative affect in a culturally diverse sample of bereaved individuals with symptoms of PGD. Methods: Based on cross-sectional survey data from the Measurement and Assessment of Grief (MAGIC) project, this study included 1337 participants (mean age 23.79 yrs, 76.1% female) from three regions (USA: 62.3%, Turkey/Iran: 24.2%, Cyprus/Greece: 13.5%), who experienced a loss of a significant other. Associations between somatic symptom distress (Somatic Symptom Scale, SSS-8), symptoms of PGD (International Prolonged Grief Disorder Scale, IPGDS-33), anxiety (Generalized Anxiety Disorder Questionnaire, GAD-7), depression (Patient Health Questionnaire, PHQ-9) as well as demographic and loss related characteristics were investigated. Three hundred and thirteen participants (23.4%) scored above the proposed cut-off for clinically severe PGD. Results: ‘High’ or ‘very high’ levels of somatic symptom distress were more frequent in a possible PGD group (58.2%), than in a non-PGD group (22.4%), p < .001, as divided per cut-off in the IPGDS. In a multiple regression analysis, PGD symptoms were significantly but weakly associated with somatic symptom distress (β = 0.08, p < .001) beyond demographics, loss-related variables, and negative affect. Negative affect (anxiety and depression) mediated the relationship of PGD symptoms with somatic symptom distress and the indirect effect explained 58% of the variance. Conclusions: High levels of somatic symptom distress can be observed in a substantial proportion of bereaved across cultures. Our findings suggest that PGD is related to somatic symptom distress partly and indirectly through facets of negative affect.
Chapter
Re-Visioning Psychiatry explores new theories and models from cultural psychiatry and psychology, philosophy, neuroscience and anthropology that clarify how mental health problems emerge in specific contexts and points toward future integration of these perspectives. Taken together, the contributions point to the need for fundamental shifts in psychiatric theory and practice: • Restoring phenomenology to its rightful place in research and practice • Advancing the social and cultural neuroscience of brain-person-environment systems over time and across social contexts • Understanding how self-awareness, interpersonal interactions, and larger social processes give rise to vicious circles that constitute mental health problems • Locating efforts to help and heal within the local and global social, economic, and political contexts that influence how we frame problems and imagine solutions. In advancing ecosystemic models of mental disorders, contributors challenge reductionistic models and culture-bound perspectives and highlight possibilities for a more transdisciplinary, integrated approach to research, mental health policy, and clinical practice.
Thesis
Full-text available
This thesis aims to give a critical investigation of Mindfulness-Based Cognitive Therapy (MBCT) from the perspective of Buddhist Psychology. Reasons for doing this include 1) the reconciliation of a program that is influenced by, but does not explicitly maintain a Buddhist model of consciousness, 2) to continue the dialogue between science and religion in the context of mindfulness, 3) to consider what direction MBCT is headed, and 4) to consider the effectiveness of MBCT as a long-term management tool for depression. Some of the philosophical issues troubling MBCT are of primary concern for this research. The three main philosophical concerns relate to ethics, the significance of ethics regarding Buddhist practice, and how ethics is side-stepped in secular mindfulness programs; ontology and how the reification of an unchanging self is philosophically problematic for mindfulness-based interventions; and epistemology especially regarding the gap between appearance and reality and what that means for depression caused by knowledge borne out of inaccurate thoughts. After interpreting the thirty verses of the Triṃśikā, MBCT will be reconsidered from the perspective of Yogâcāra Buddhism to supply it with a theoretical framework that can assist in addressing these concerns. This thesis concludes by suggesting two major areas where MBCT may be improved with the assistance of Yogâcāra teachings. The first is through a more active engagement with the analytical mind. Despite MBCTs primary aim to decrease ruminative thinking, discriminative thought is necessary to cultivate wisdom and reduce suffering. Secondly, the causes of depression are vast and include social and environmental grounds in addition to cognitive-based issues. By contrasting the MBCT program with the practices and theory of Yogâcāra, it is suggested that MBCTs philosophical framework can be refined leading to an even more effective means of preventing depression.
Article
Full-text available
Traditional Chinese medicine (TCM) is an alternative medical system utilised by many Chinese. However, the knowledge of TCM concepts of depression is limited amongst clinicians with training in Western biomedicine. The purpose of this study was to obtain a better understanding of the conceptualisation of depression from a group of TCM practitioners. Semi-structured interviews in Chinese were carried out with 10 TCM practitioners in Hong Kong. A case description of major depression disorder (MDD) was used as a basis. Interview texts were transcribed, translated and analysed using qualitative content analysis. Most informants identified the case as a depression pattern, a term that lacked clear definition and standardised criteria. The mechanism of disease for MDD symptoms were regarded to be liver-qi dysregulation and an imbalance of yin and yang. The TCM practitioners implemented individualised diagnosis, treatment, and a holistic concept without clear distinction between the mind and the body. This contrasted with the biomedical tradition of separating psychologisation and somatisation. The meanings given to the concept of depression did not correspond with current DSM or ICD definitions, and the TCM normativity can result in variations in explanatory models.
Article
Many elderly people are disturbed by insomnia. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition no longer considers insomnia as merely a symptom, secondary to medical and psychiatric problems, because insomnia has been found to cause depression, heart disease and accidents in older adults. Psychosocial treatment is preferable to pharmacological treatment in handling insomnia because of the lack of side effects. This study aims to examine the impact of group treatment on insomnia-stricken elderly people using cognitive-behavioural therapy (CBT) as well as strategies and skills learning and development (SSLD). These two approaches integrate well with each other. CBT modifies the dysfunctional beliefs and behaviours related to sleep, whilst SSLD enhances insomniacs’ awareness of their underlying needs. A mixed-methods research design revealed positive changes in night-time insomnia symptoms, daytime distress, dysfunctional beliefs about sleep, and depression. The suitability of the intervention model for Chinese elderly people is discussed.
Article
This study seeks to fill a gap in the existing empirical literature about the relationship between somatic and depressive symptoms and their associations with cultural factors among Chinese American and European American college students. In particular, the study examined how three culturally relevant psychological constructs, self-construal, loss of face, and emotion regulation, associate with depressive and somatic symptoms among Chinese American and European American college students and if they can explain possible group differences in depressive symptoms. The sample consisted of 204 Chinese American and 315 European American college students who completed an online survey. Based on multiple regression analyses, European American students reported higher levels of somatic symptoms on the Patient Health Questionnaire–15 (PHQ-15) than Chinese Americans. There was no initial group difference in depressive symptoms based on Center for Epidemiologic Studies–Depression Scale (CES-D) scores. Correlations between depressive and somatic symptoms, independent and interdependent self-construal, and cognitive reappraisal and independent self-construal were stronger for European Americans than Chinese Americans. Somatic symptoms, loss of face, and expressive suppression were positively associated with depressive symptoms, whereas independent self-construal and cognitive reappraisal were negatively associated with depressive symptoms for both groups. When controlling for gender and somatic symptoms, being Chinese American and male was significantly and positively associated with depressive symptoms measured with the CES-D. These ethnic and gender differences in depressive symptoms were explained by independent self-construal, loss of face, cognitive reappraisal, and expressive suppression. Clinical implications include the incorporation of specific culturally relevant constructs and avoidance of race-, ethnicity-, and gender-based stereotypes to reduce health disparities in depression treatment.
Article
Cambridge Core - Health and Clinical Psychology - Alexithymia - edited by Olivier Luminet
Chapter
Major depressive disorder (MDD) is a recognized and highly prevalent public health issue of worldwide importance. Estimates of prevalence of MDD vary across countries. In general, studies have found a higher prevalence of MDD in high-income countries compared to low- and middle-income countries. There may be methodological issues influencing these estimates, such as differences in symptom expression across cultures, which are modulated by constructs such as gender roles, social expectations, and acceptability of communicating affective states. International epidemiological studies attempting to address methodological challenges and other lines of evidence indicate that there may be substantive factors (differences in genetic vulnerability and environmental risk factors) playing a role on the prevalence estimate variations of MDD. Despite the inherent limitations of this mostly cross-sectional epidemiological data, it confirms MDD is a major public health concern across cultures, indicating associations of MDD with numerous adverse outcomes. Among these outcomes are elevated risks of other psychiatric and medical disorders, in addition to poor functional outcomes in areas such as education, employment status, financial success, teen childbearing, parent functioning, and marital stability. We hope that future epidemiological research will continue to take into account how MDD manifests across different cultures, drawing from work in transcultural psychiatry while designing cross-cultural studies. Investigating the worldwide prevalence of MDD and its associated features may contribute to the proper identification of environmental risk factors for this disorder, which may facilitate the identification of vulnerable individuals, who might benefit from targeted preventative strategies.
Book
Revisioning Psychiatry explores new theories and models from cultural psychiatry and psychology, philosophy, neuroscience, and anthropology that clarify how mental health problems emerge in specific contexts and points toward future integration of these perspectives. Taken together, the contributions point to the need for fundamental shifts in psychiatric theory and practice: • Restoring phenomenology to its rightful place in research and practice; • Advancing the social and cultural neuroscience of brain-person-environment systems over time and across social contexts; • Understanding how self-awareness, interpersonal interactions, and larger social processes give rise to vicious circles that constitute mental health problems; • Locating efforts to help and heal within the local and global social, economic, and political contexts that influence how we frame problems and imagine solutions. In advancing ecosystemic models of mental disorders, contributors challenge reductionistic models and culture-bound perspectives and highlight possibilities for a more transdisciplinary, integrated approach to research, mental health policy, and clinical practice.
Article
Full-text available
Abstract Background Our study aimed (1) to describe the proportion of psychological distress among Chinese outpatients at general hospitals, (2) to compare cognitive and behavioral characteristics of patients with different distress patterns, and (3) to investigate the discriminant function of the analyzed variables in indicating the affinity towards the different distress patterns. Methods This multicenter cross-sectional study was conducted at ten outpatient departments at Chinese general hospitals. The somatic symptom severity scale (PHQ-15), the nine-item depression scale (PHQ-9), and the seven-item anxiety scale (GAD-7) were employed to classify patients in terms of four distress patterns. Results A total of 491 patients were enrolled. Among them, the proportion of patients with high psychological distress was significantly higher within those with high somatic distress (74.5% vs. 25.5%, p
Article
Full-text available
Objective This study was aimed at evaluating the diagnostic validity of the Korean version of the Clinically Useful Depression Outcome Scale (CUDOS) with varying follow-up in a typical clinical setting in multiple centers. Methods In total, 891 psychiatric outpatients were enrolled at the time of their intake appointment. Current diagnostic characteristics were examined using the Structured Clinical Interview for DSM-IV (41% major depressive disorder). The CUDOS was measured and compared with three clinician rating scales and four self-report scales. Results The CUDOS showed excellent results for internal consistency (Cronbach’s α, 0.91), test-retest reliability (patients at intake, r=0.81; depressed patients in ongoing treatment, r=0.89), and convergent and discriminant validity (measures of depression, r=0.80; measures of anxiety and somatization, r=0.42). The CUDOS had a high ability to discriminate between different levels of depression severity based on the rating of Clinical Global Impression for depression severity and the diagnostic classification of major depression, minor depression, and non-depression. The ability of the CUDOS to identify patients with major depression was high (area under the receiver operating characteristic curve=0.867). A score of 20 as the optimal cutoff point was suggested when screening for major depression using the CUDOS (sensitivity=89.9%, specificity=69.5%). The CUDOS was sensitive to change after antidepressant treatment: patients with greater improvement showed a greater decrease in CUDOS scores (p<0.001). Conclusion The results of this multi-site outpatient study found that the Korean version of the CUDOS is a very useful measurement for research and for clinical practice.
Article
Full-text available
This study compared depressive symptomatology among Chinese psychiatric outpatients versus the general Chinese population, and across 3 cultural groups—Chinese, Chinese American, and Caucasian American students—by use of the Center for Epidemiological Studies–Depression Scale (CES-D; L. S. Radloff, 1977) and the Chinese Depression Scale (N. Lin, 1989), translated from the CES-D. Results indicate that Chinese patients (n = 112) endorsed a higher proportion of somatic symptoms than nonpatients (n = 112). The intercultural comparison found that Chinese students (n = 98) had the lowest levels of somatic depressive symptom endorsement compared to both U.S. groups (n = 198). These findings seem to suggest that the tendency toward somatic symptom reporting is not any greater among Chinese populations but may be a function of having a mental illness or of help seeking in China.
Article
Full-text available
An evolved module for fear elicitation and fear learning with 4 characteristics is proposed. (a) The fear module is preferentially activated in aversive contexts by stimuli that are fear relevant in an evolutionary perspective. (b) Its activation to such stimuli is automatic. (c) It is relatively impenetrable to cognitive control. (d) It originates in a dedicated neural circuitry, centered on the amygdala. Evidence supporting these propositions is reviewed from conditioning studies, both in humans and in monkeys; illusory correlation studies; studies using unreportable stimuli; and studies from animal neuroscience. The fear module is assumed to mediate an emotional level of fear learning that is relatively independent and dissociable from cognitive learning of stimulus relationships.
Article
Full-text available
Within- and between-nations differences in norms for experiencing emotions were analyzed in a cross-cultural study with 1,846 respondents from 2 individualistic (United States, Australia) and 2 collectivistic (China, Taiwan) countries. A multigroup latent class analysis revealed that there were both universal and culture-specific types of norms for experiencing emotions. Moreover, strong intranational variability in norms for affect could be detected, particularly for collectivistic nations. Unexpectedly, individualistic nations were most uniform in norms, particularly with regard to pleasant affect. Individualistic and collectivistic nations differed most strongly in norms for self-reflective emotions (e.g., pride and guilt). Norms for emotions were related to emotional experiences within nations. Furthermore, there were strong national differences in reported emotional experiences, even when norms were held constant.
Article
Full-text available
The papers in this volume, a multidisciplinary collaboration of anthropologists, linguists, and psychologists, explore the ways in which cultural knowledge is organized and used in everyday language and understanding. Employing a variety of methods, which rely heavily on linguistic data, the authors offer analyses of domains of knowledge ranging across the physical, social, and psychological worlds, and reveal the importance of tacit, presupposed knowledge in the conduct of everyday life. The authors argue that cultural knowledge is organized in 'cultural models' - storylike chains of prototypical events that unfold in simplified worlds - and explore the nature and role of these models. They demonstrate that cultural knowledge may take either proposition-schematic or image-schematic form, each enabling the performance of different kinds of cognitive tasks. Metaphor and metonymy are shown to have special roles in the construction of cultural models. The authors also demonstrates that some widely applicable cultural models recur nested within other, more special-purpose models. Finally, it is shown that shared models play a critical role in thinking, allowing humans to master, remember, and use the vast amount of knowledge required in everyday life. This innovative collection will appeal to anthropologists, linguists, psychologists, philosophers, students of artificial intelligence, and other readers interested in the processes of everyday human understanding.
Article
Full-text available
We review the literature on interoception as it relates to depression and anxiety, with a focus on belief, and alliesthesia. The connection between increased but noisy afferent interoceptive input, self-referential and belief-based states, and top-down modulation of poorly predictive signals is integrated into a neuroanatomical and processing model for depression and anxiety. The advantage of this conceptualization is the ability to specifically examine the interface between basic interoception, self-referential belief-based states, and enhanced top-down modulation to attenuate poor predictability. We conclude that depression and anxiety are not simply interoceptive disorders but are altered interoceptive states as a consequence of noisily amplified self-referential interoceptive predictive belief states.
Article
Full-text available
Reviews the book, Critical Neuroscience: A Handbook of the Social and Cultural Contexts of Neuroscience by Suparna Choudhury and Jan Slaby (2011). A substantial book, it is made up of an introduction and 18 chapters, spread across five sections. It is a “critical” engagement with Neuroscience— a discipline claiming significant academic and economic capital which has rapidly infiltrated popular discourse and the media. As a “neurorevolution” it is a significant cultural phenomenon. Choudhury and Slaby define Critical Neuroscience (CN, my abbreviation) as seeking to work both within and without the parameters of Neuroscience, moving beyond uncritical embrace and outright rejection toward conceptual and pragmatic engagement. Emphasized is a concern with “what is actually happening” in Neuroscience (p. 3). Moving beyond rhetoric and utopian or gothic speculation, CN is construed as both an intimate and critical engagement. The book is, in part, a definitional exercise where the parameters of CN are tentatively or, often, boldly articulated. Choudhury and Slaby justifiably position Neuroscience as a significant, historically contingent, sociocultural, and ideologically embedded development. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Article
Full-text available
According to recent research, abnormal behavior appears normal to the extent it is understood. Cultural differences in frameworks for making sense of abnormality suggest there may be variations in this “reasoning fallacy.” In light of evidence that people from Western cultures psychologize abnormality to a greater extent than people from East Asian cultures, the effect of understanding on perceptions of abnormality was predicted to differ across cultures. Results of a cross-cultural questionnaire study indicated that understanding made behavior seem normal to European Australians (n = 51), consistent with the reasoning fallacy. For Singaporeans (n = 51), however, understanding did not influence the extent to which behavior was normalized and made abnormal behavior more stigmatizing. Cultural variations in the effect of understanding were attributed to the differential salience of deviance frameworks, which are grounded in culturally specific conceptions of the person.
Article
Full-text available
Intersubjective perceptions refer to shared perceptions of the psychological characteristics that are widespread within a culture. In this article, we propose the intersubjective approach as a new approach to understanding the role that culture plays in human behavior. In this approach, intersubjective perceptions, which are distinct from personal values and beliefs, mediate the effect of the ecology on individuals' responses and adaptations. We review evidence that attests to the validity and utility of the intersubjective approach in explicating culture's influence on human behaviors and discuss the implications of this approach for understanding the interaction between the individual, ecology, and culture; the nature of cultural competence; management of multicultural identities; cultural change; and measurement of culture. © The Author(s) 2010.
Article
Full-text available
Wertsch's 'mediated action' approach is complemented with a version of 'methodological individualism' (the preference/ constraint approach) which allows researchers to avoid the exclusive separation of mind and culture and to concentrate on specific forms of their mutuality. This version of 'methodological individualism' focuses attention on an active mental agent who makes culture and mind meet in the context of social practice.
Article
Full-text available
It is hypothesised that the empirical correlation between facial expression and affective experience varies as a function of the correlational design used to compute the coefficients. Predictions about the rank order of five designs were derived based on two assumptions. Female subjects were placed into one of three alcohol conditions (no ethanol, low dose, high dose) and were exposed to 30 slides containing jokes or cartoons. The degree of rated funniness and overt behaviour were intercorrelated using five different designs to analyse the same set of data. The results show that within-subject analyses yielded higher coefficients than between-subjects analyses. Aggregation of data increased the coefficients for within-subject analyses, but not for between-subject analyses. A cheerful mood was associated with hyper-expressiveness, i.e. the occurrence of smiling and laughter at relatively low levels of perceived funniness. It was demonstrated that low correlations between facial expression and affective experience may be based on several method artefacts.
Article
Full-text available
Cultural differences in daily emotions were investigated by administering emotion questionnaires four times a day throughout a one-week period. Respondents were American students, Japanese students living in the United States, and Japanese students living in Japan. Americans rated their emotional lives as more pleasant than did the Japanese groups. The dimension of emotional pleasantness (unpleasant-pleasant) was predicted better by interdependent than independent concerns in the Japanese groups, but this was not the case in the American group where the variance predicted by interdependent and independent concerns did not significantly differ. It is argued that cultural differences in the concerns most strongly associated with pleasantness are related to differences in ideals, norms, and practices of what it means to be a person. Cultural differences in the concerns are assumed to implicate differences in the nature of emotional experience.
Article
Full-text available
Although the Chinese have been exposed to Western psychotherapies since the 1950s, the practice of counseling is a relatively new phenomenon. In this article, we trace the development of counsel- ing in China, examine its cultural and practical relevance, and review recent advances in training and practice. Although heavily influenced by Western models, contemporary Chinese approaches to counseling reflect the philosophical traditions, cultural history, and indigenous help-seeking practices of a rapidly modernizing society. The increasing popularization of psychotherapy in China is analyzed in the context of the changing social and economic climate and the crises and opportunities that accompany Chinese life in the 21st century. The past 50 years have witnessed China's remarkable transformation from a poor agricultural society into an emerging industrial power. With the open- ing-and-reform policies initiated in the 1980s, China has officially reentered the global fray, experimenting with Western ideas, markets, and institutions, including Western-style counseling and psychotherapy. In this article, we trace the development of counseling in China, examine its cultural and practical relevance, and review recent advances in training and practice. The techniques of counseling and psychotherapy have found a home in China. However, their Western cultural origins have created problems in translation, not the least of which is their literal translation into the Chinese language. The Chinese use two terms to refer to what may be generally described as talk therapy: xinli zixun (i.e., psychological counseling or con- sulting) and xinli zhiliao (i.e., psychotherapy). However, the cross-cultural correspondence of these constructs remains unclear. In practice, xinli zixun encompasses a variety of counseling services, including informal supportive
Article
Full-text available
People in different cultures have strikingly different construals of the self, of others, and of the interdependence of the 2. These construals can influence, and in many cases determine, the very nature of individual experience, including cognition, emotion, and motivation. Many Asian cultures have distinct conceptions of individuality that insist on the fundamental relatedness of individuals to each other. The emphasis is on attending to others, fitting in, and harmonious interdependence with them. American culture neither assumes nor values such an overt connectedness among individuals. In contrast, individuals seek to maintain their independence from others by attending to the self and by discovering and expressing their unique inner attributes. As proposed herein, these construals are even more powerful than previously imagined. Theories of the self from both psychology and anthropology are integrated to define in detail the difference between a construal of the self as independent and a construal of the self as interdependent. Each of these divergent construals should have a set of specific consequences for cognition, emotion, and motivation; these consequences are proposed and relevant empirical literature is reviewed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Full-text available
[speculate] about the [uniqueness and universality of the] emotions of the Chinese / [review] writings on Chinese emotions that are available / [delineate] the components rather that constitute an emotional episode / specifically . . . consider the situational antecedents of emotion, its cognitive antecedents, the facial and vocal expression of emotion, the physiological or somatic component, emotional behaviour in a social context, and the influence of emotion on subsequent cognitive performance / [discuss] the indigenous Chinese conceptualization of emotion indigenous Chinese conception of emotion [emotion lexicon, hypercognition and hypocognition of emotion, metaphors, Chinese writings] (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Full-text available
The study of culture and related concerns, such as ethnicity and race, in American psychology are examined. First, the conceptual confusion and ways in which culture, ethnicity, and race are used as explanatory factors for intergroup differences in psychological phenomena are discussed. Second, ways in which to study culture in mainstream psychology and to enhance hypothesis testing and theory in cross-cultural psychology are illustrated. Finally, the importance of examining sociocultural variables and considering theory in ethnic minority research is addressed. In general, it is proposed that by including theory, conceptualizing, and measuring cultural and related variables, mainstream, cross-cultural, and ethnic research can advance the understanding of culture in psychology as well as the generality of principles and the cultural sensitivity of applications. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Book
Research shows that between birth and early adulthood the brain requires sensory stimulation to develop physically. The nature of the stimulation shapes the connections among neurons that create the neuronal networks necessary for thought and behavior. By changing the cultural environment, each generation shapes the brains of the next. By early adulthood, the neuroplasticity of the brain is greatly reduced, and this leads to a fundamental shift in the relationship between the individual and the environment: during the first part of life, the brain and mind shape themselves to the major recurring features of their environment; by early adulthood, the individual attempts to make the environment conform to the established internal structures of the brain and mind. In Brain and Culture, Bruce Wexler explores the social implications of the close and changing neurobiological relationship between the individual and the environment, with particular attention to the difficulties individuals face in adulthood when the environment changes beyond their ability to maintain the fit between existing internal structure and external reality. These difficulties are evident in bereavement, the meeting of different cultures, the experience of immigrants (in which children of immigrant families are more successful than their parents at the necessary internal transformations), and the phenomenon of interethnic violence. Integrating recent neurobiological research with major experimental findings in cognitive and developmental psychology—with illuminating references to psychoanalysis, literature, anthropology, history, and politics—Wexler presents a wealth of detail to support his arguments. The groundbreaking connections he makes allow for reconceptualization of the effect of cultural change on the brain and provide a new biological base from which to consider such social issues as "culture wars" and ethnic violence. Bradford Books imprint
Article
This article reviews cultural variations in the clinical presentation of depression and anxiety. Culture-specific symptoms may lead to underrecognition or misidentification of psychological distress. Contrary to the claim that non-Westerners are prone to somatize their distress, recent research confirms that somatization is ubiquitous. Somatic symptoms serve as cultural idioms of distress in many ethnocultural groups and, if misinterpreted by the clinician, may lead to unnecessary diagnostic procedures or inappropriate treatment. Clinicians must learn to decode the meaning of somatic and dissociative symptoms, which are not simply indices of disease or disorder but part of a language of distress with interpersonal and wider social meanings. Implications of these findings for the recognition and treatment of depressive disorders among culturally diverse populations in primary care and mental health settings are discussed.
Article
Recent work in cognitive psychology and social cognition bears heavily on concerns of sociologists of culture. Cognitive research confirms views of culture as fragmented; clarifies the roles of institutions and agency; and illuminates supra-individual aspects of culture. Individuals experience culture as disparate bits of information and as schematic structures that organize that information. Culture carried by institutions, networks, and social movements diffuses, activates, and selects among available schemata. Implications for the study of identity, collective memory, social classification, and logics of action are developed.
Article
Some of the most innovative and provocative work on the emotions and illness is occurring in cross-cultural research on depression. Culture and Depression presents the work of anthropologists, psychiatrists, and psychologists who examine the controversies, agreements, and conceptual and methodological problems that arise in the course of such research. A book of enormous depth and breadth of discussion, Culture and Depression enriches the cross-cultural study of emotions and mental illness and leads it in new directions. It commences with a historical study followed by a series of anthropological accounts that examine the problems that arise when depression is assessed in other cultures. This is a work of impressive scholarship which demonstrates that anthropological approaches to affect and illness raise central questions for psychiatry and psychology, and that cross-cultural studies of depression raise equally provocative questions for anthropology.
Article
Humans are a cultural species, and the study of human psychology benefits from attention to cultural influences. Cultural psychology's contributions to psychological science can largely be divided according to the two different stages of scientific inquiry. Stage 1 research seeks cultural differences and establishes the boundaries of psychological phenomena. Stage 2 research seeks underlying mechanisms of those cultural differences. The literatures regarding these two distinct stages are reviewed, and various methods for conducting Stage 2 research are discussed. The implications of culture-blind and multicultural psychologies for society and intergroup relations are also discussed. © 2006 Association for Psychological Science.
Article
We examined the hypothesis that muscle contractions in the face influence subjective emotional experience. Previously, researchers have been critical of experiments designed to test this facial feedback hypothesis, particularly in terms of methodological problems that may lead to demand characteristics. In an effort to surmount these methodological problems Strack, Martin, and Stepper (1988) developed an experimental procedure whereby subjects were induced to contract facial muscles involved in the production of an emotional pattern, without being asked to actually simulate an emotion. Specifically, subjects were required to hold a pen in their teeth, which unobtrusively creates a contraction of the zygomaticus major muscles, the muscles involved in the production of a human smile. This manipulation minimises the likelihood that subjects are able to interpret their zygomaticus contractions as representing a particular emotion, thereby preventing subjects from determining the purpose of the experiment. Strack et al. (1988) found support for the facial feedback hypothesis applied to pleasant affect, in that subjects in the pen-in-teeth condition rated humorous cartoons as being funnier than subjects in the control condition (in which zygomaticus contractions were inhibited). The present study represents an extension of this nonobtrusive methodology to an investigation of the facial feedback of unpleasant affect. Consistent with the Strack et al. procedure, we wanted to have subjects furrow their brow without actually instructing them to do so and without asking them to produce any emotional facial pattern at all. This was achieved by attaching two golf tees to the subject's brow region (just above the inside comer of each eye) and then instructing them to touch the tips of the golf tees together as part of a “divided-attention” experiment. Touching the tips of the golf tees together could only be achieved by a contraction of the corrugator supercilii muscles, the muscles involved in the production of a sad emotional facial pattern. Subjects reported significantly more sadness in response to aversive photographs while touching the tips of the golf tees together than under conditions which inhibited corrugator contractions. These results provide evidence, using a new and unobtrusive manipulation, that facial feedback operates for unpleasant affect to a degree similar to that previously found for pleasant affect.
Article
This article argues that the current popularity of culture in psychology is likely to continue in the future if the conception of the person that psychologists adopt includes culture as an integral part of human nature. This thesis is illustrated in a brief historical account. Although the current discourse in psychology is marked by a metatheoretical tension between natural and cultural science approaches to mind, a consensus is emerging that assumes a materialist (or physicalist) ontology, a Darwinian evolutionism, and cultural-historical embeddedness of psychological processes and their development in social context. In this emerging consensus, culture is conceptualized as a species-specific property of Homo sapiens, which transmits information not only genetically across generations, but also symbolically between and within generations. Culture is thus integral to the ongoing process of tool use and symbol manipulation. Contemporary issues in the culture-mind relation are discussed against this common background.
Article
Research has demonstrated that certain genotypes are expressed phenotypically in different forms depending on the social environment. To examine sensitivity to cultural norms regarding emotion regulation, we explored the expression of the oxytocin receptor polymorphism (OXTR) rs53576, a gene previously related to socioemotional sensitivity, in conjunction with cultural norms. Emotional suppression is normative in East Asian cultures but not in American culture. Consequently, we predicted an interaction of Culture and OXTR in emotional suppression. Korean and American participants completed assessments of emotion regulation and were genotyped for OXTR. We found the predicted interaction: Among Americans, those with the GG genotype reported using emotional suppression less than those with the AA genotype, whereas Koreans showed the opposite pattern. These findings suggest that OXTR rs53576 is sensitive to input from cultural norms regarding emotion regulation. These findings also indicate that culture is a moderator that shapes behavioral outcomes associated with OXTR genotypes.
Article
The current study provides a cultural examination of alexithymia, a multifaceted personality construct that refers to a general deficit in the ability to identify and describe emotional states, and that has been linked to a number of psychiatric illnesses. Though this construct has been critiqued as heavily rooted in “Western” norms of emotional expression, it has not received much empirical attention from a cultural perspective. Recently, Ryder et al. (2008) found that higher levels of alexithymia among Chinese versus Euro-Canadian outpatients were explained by group differences in one component of alexithymia, externally oriented thinking (EOT); they proposed that Chinese cultural contexts may encourage EOT due to a greater emphasis on social relationships and interpersonal harmony rather than inner emotional experience. The current study examined the hypothesis that EOT is more strongly shaped by cultural values than are two other components of alexithymia, difficulty identifying feelings (DIF) and difficulty describing feelings (DDF). Euro-Canadian (n = 271) and Chinese-Canadian (n = 237) undergraduates completed measures of alexithymia and cultural values. Chinese-Canadians showed higher levels of EOT than Euro-Canadians (p < .001). EOT, and not DIF or DDF, was predicted by Modernization and Euro-American values in both groups. Furthermore, cultural values mediated the effect of group membership on levels of EOT. These results suggest that cultural differences in alexithymia may be explained by culturally based variations in the importance placed on emotions, rather than deficits in emotional processing. The study also raises questions about the measurement and meaning of EOT, particularly from a cross-cultural perspective.
Article
Recent work in cognitive psychology and social cognition bears heavily on concerns of sociologists of culture. Cognitive research confirms views of culture as fragmented; clarifies the roles of institutions and agency; and illuminates supra-individual aspects of culture. Individuals experience culture as disparate bits of information and as schematic structures that organize that information. Culture carried by institutions, networks, and social movements diffuses, activates, and selects among available schemata. Implications for the study of identity, collective memory, social classification, and logics of action are developed.
Article
This opening article outlines some key themes of an evolutionary approach to psychopathology, and explores possible implications for cognitive therapy. Evolutionary psychology suggests that many of our mental mechanisms are designed to promote survival and reproduction, not happiness, or even mental health, as such. This article focuses on the concept of evolved strategies and their phenotypic expressions, to fit specific niches. It suggests that evolved strategies and their phenotypic expressions partly operate through two psychobiological systems, called the defense and safeness systems, which detect and respond to threats and punishments, and safeness and potential rewards, respectively. Various cognitive schemas, rules and automatic thoughts, especially those linked to psychopathology, are often products of the linkages in strategies as coded in defense and safeness systems. The latter part of the article gives a brief exploration of the view that self-to-self relationships (self-evaluations and "self-talk") evolved from social cognitions and behavior. Negative self-evaluations, self-criticism, and self-attacking are viewed as internalized interactions between a hostile, dominant part of self, and an appeasing, subordinate part of self. One way of undermining this interaction is to introduce the notion of compassion for the self. A brief consideration is given to the development of "compassionate mind" in work with shame-prone people as expressed in high self-criticalness and/or self-hating. Throughout the text the main problems addressed are those of the more chronic, emotional difficulties often associated with some degree of what is called personality disorder.
Article
Presents a review of the literature on patterns of intelligence, rigidity and age, tolerance of ambiguity, creativity, extremity ratings, and inductive vs deductive reasoning in obsessional neurosis or obsessional personality. A theory of obsessional thinking based on G. H. Kelly's theory of personality constructs is presented, and suggestions for therapy are noted. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
[discuss] the interplay between the Chinese culture and the abnormal or maladaptive patterns of behaviour and experience that are encountered among the Chinese people / [asks] in what ways are these behaviour patterns similar to, and different from, the expressions of maladaptation in other parts of the world encompasses the available information on the manifestations of maladaptation in the several socio-political settings in which the Chinese people live: mainland China, Taiwan, Hong Kong, Singapore, and the worldwide Chinese diaspora / the available research approaches can be grouped under 3 general headings: clinical observations that are based on naturalistic descriptions of psychiatric symptoms, often gathered on a case-by-case basis in a treatment context; epidemiological data which involve a psychiatric census of all cases of the disorder in their catchment area; and comparisons of groups or samples of psychiatric patients across 2 or more culture settings, conducted in the optimal case on appropriate and representative samples with equivalent measures somatization in China: a major avenue for experiencing psychic distress / depression in China: its experience and importance / suicide / anxiety: a little-investigated topic / schizophrenia: the scope of cultural factors / epidemiological research: a bird's-eye view of psychopathology / alcoholism: a limited but growing problem / psychological disorders in children and adolescents: a variety of leads / emic disorders of the Chinese: the case of koro (PsycINFO Database Record (c) 2012 APA, all rights reserved)