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Depression in Cultural Context: "Chinese Somatization," Revisited
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.
... 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). ...
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). ...
... Most extensive research on somatization was conducted with Chinese people both in China and in North America. Chinese somatization is now a key finding of research on culture and psychopathology (Ryder et al., 2011Ryder et al., , 2012). The attention of researchers was first drawn to the somatization of depression due to the extremely low rates of depression in China based on data from systematic large-scale epidemiological surveys. ...
... East Asians' tendency to emphasize somatic symptoms rather than emotional states in their communication can be understood in relation to their cultural norms for expressing emotions (Cheung, 1986;Kleinman, 1986;Ryder et al., 2012). Notably, paying attention to and maintaining social harmony is particularly crucial for East Asians who tend to endorse the interdependent model of self. ...
... Given East Asian cultural norms of emotional expression and seeking social support, the emphasis on somatic symptoms may be an effective strategy for securing social support and health resources in these cultural contexts (Cheung, 1986;Kleinman, 1986;Ryder et al., 2012). It is possible that the somatic scripts of communicating distress have been formed through socialization to reflect culture-specific incentives (D'Andrade, 1984;Kirmayer and Sartorius, 2007). ...
Previous research has documented that Asians tend to somatize negative experiences to a greater degree than Westerners. It is posited that somatization may be a more functional communication strategy in Korean than American context. We examined the effects of somatization in communications of distress among participants from the US and Korea. We predicted that the communicative benefits of somatic words used in distress narratives would depend on the cultural contexts. In Study 1, we found that Korean participants used more somatic words to communicate distress than US participants. Among Korean participants, but not US participants, use of somatic words predicted perceived effectiveness of the communication and expectations of positive reactions (e.g., empathy) from others. In Study 2, we found that when presented with distress narratives of others, Koreans (but not Americans) showed more sympathy in response to narratives using somatic words than narratives using emotional words. These findings suggest that cultural differences in use of somatization may reflect differential effectiveness of somatization in communicating distress across cultural contexts.
... 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). ...
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). ...
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.
... In späteren Arbeiten wurde repliziert, dass Menschen chinesischer Herkunft eine Tendenz zur Betonung somatischer im Vergleich zu psychologischen Symptomen bei Depression zeigten (Parker, Cheah & Roy, 2001). In der Folge etablierte sich die erneut etwas dichotomisierende Beschreibung einer spezifi schen kulturellen Formung von Depression mit chinesischer Somatisierung in der östlichen und Psychologisierung in der westlichen Hemisphäre, die jedoch zunehmend diff erenzierter und kritischer betrachtet wird (Ryder & Chentsova-Dutton, 2012;Ryder et al., 2008). Bei Menschen südasiatischer Herkunft im Großbritannien zeigte eine vergleichende Studie, dass vor allem bei erstmaligen Kontakten häufi ger somatische Symptome einer Depression präsentiert wurden (Gater et al., 2009). ...
... So konnte eine ebenfalls in Berlin durchgeführte Studie im Vergleich stationär behandelter türkischer Mig-rant_innen mit Depression zu einem gematchten deutschen Sample deutscher Patient_innen zwar höhere somatische und vegetative Syndromskalenwerte, jedoch keine Unterschiede hinsichtlich depressiver Syndromskalenwerte anhand der entsprechenden AMDP Skalen zeigen (Diefenbacher & Heim, 1994). Auch neuere Diskussionen fokussieren auf ein soziosomatisches und kontextabhängiges Verständnis, wobei insbesondere in chinesischen Samples zwar eine vermehrte somatische Aufmerksamkeit bei Depression, jedoch ebenso häufi g eine depressive Stimmung berichtet wurde (Dere et al., 2013;Ryder & Chentsova-Dutton, 2012). So kann in ostasiatischen Kulturen ein besonderer Wert in der Vermeidung von interpersonellen Konfl ikten durch Bescheidenheit in der Kommunikation und Vermeidung starker Emotionen liegen, der mit häufi geren verbal körperbezogenen Ausdrucksformen assoziiert sein kann (Kim, Atkinson & Umemoto, 2001). ...
Abstract: Studies in the general population have reported inconclusive results regarding higher rates of somatization in migrants compared to native populations. Overall, cross-cultural studies show, that patients in East-Asia with major depressive episodes report fewer psychological and more often somatic symptoms. Since mental health care utilization of Vietnamese migrants in Germany has been low, comparative studies on symptom presentation and somatization for depressed Vietnamese patients are lacking. The Patient Health Questionnaire (PHQ) is an internationally available, valid and easy to use self-report instrument for assessing common psychiatric disorders. Recent studies have shown that cross-cultural comparisons between migrants and native-German populations of PHQ mean values, severity and PHQ single items are possible.
In this study 66 female Vietnamese and 83 female German outpatients were assessed for symptoms of depression (PHQ-9) and somatic symptoms (PHQ-15), using the Vietnamese- or German language versions of the PHQ respectively. Differences in PHQ-9 and PHQ-15 total score, severity of depression and somatization and single item differences were analyzed using either MANOVAs or chi-square-tests. For both groups, PHQ-9 and PHQ-15 scales showed good internal consistency. Vietnamese outpatients reported depressive symptoms at similar severity levels as German outpatients matched for age and school education, but had a higher total score of somatic symptoms and a higher proportion of severe somatization according to PHQ-15. Since the differences in somatic symptoms was driven by a subset of PHQ-15 items, primary care physicians should keep in mind that somatic complains including headaches, chest pain, and pain in arms, legs, or joints, dizziness or fainting could be indicative of somatic symptoms of depression in female Vietnamese patients. However, increased awareness and emphasis on self-reported somatic symptoms did not reflect a minimization of PHQ-9 symptoms of depression in female Vietnamese patients.
Keywords: Vietnamese migrants, depression, somatization, somatic symptom presentation, Patient Health Questionnaire, PHQ-9, PHQ-15,
... 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. ...
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). ...
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. ...
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. ...
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. ...
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. ...
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]. ...
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). ...
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. ...
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. ...
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.
... 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. ...
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. ...
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). ...
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. ...
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. ...
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. ...
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. ...
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
... Chinese somatization has been described in China, Hong Kong and Taiwan, as well as among Chinese immigrants to Western nations (Ryder, Ban, & Chentsova-Dutton, 2011;Ryder et al., 2008). Ryder and Chentsova-Dutton (2012) proposed a model of Chinese somatization to understand the cultural context of depression. In this study, socio-cultural factors are hypothesized to partially account for the phenomenon of using 'psychosomatics' rather than 'psychiatry' in clinic names in Taiwan, while the effects of changing names need further investigation. ...
Background:
Relabeling has been proposed as a strategy to reduce the stigma associated with mental illnesses. Previous studies have shown that changing the names of psychiatry clinics has led to reduced feelings of being stigmatized among patients. In Taiwan, terms other than 'psychiatry' (in Chinese, jīng shén kē) are more commonly used in the names of psychiatry clinics. The term 'psychosomatic clinics' is widely used instead.
Aims:
This study investigated the characteristics of psychiatry clinic names in order to better understand the role of clinic names in primary care settings.
Methods:
Relevant data were extracted from an open database maintained by the government of Taiwan. These data included the names of community psychiatry clinics and hospital-based psychiatry clinics, population size and the degree of urbanization in the area served by each clinic.
Results:
At the time of this study, there were 254 community psychiatry clinics and 190 hospital-based psychiatry clinics in Taiwan. Only 18.9% of the community clinic names included the term 'psychiatry'. Additionally, 14.6% of community clinic names and 28.4% of hospital-based clinic names included the term 'psychosomatics'. The regions in which clinics without 'psychiatry' in their names were located had significantly larger populations and higher levels of urbanization than the regions in which clinics with 'psychiatry' in their names were located.
Conclusion:
A low prevalence of the term 'psychiatry' in community psychiatry clinic names was found in Taiwan. The stigma associated with psychiatry and other socio-cultural factors are hypothesized to explain this phenomenon.
... Previous demonstrations have focused on cultural variation in somatic versus affective presentations of youth distress (B. Weiss, Tram, Weisz, Rescorla, & Achenbach, 2009); however, the role of mental health stigma in shaping somatic presentations across cultures is not well established (Ryder & Chentsova-Dutton, 2012). ...
Objective:
This study examined predictors of stigma attitudes toward common youth emotional behavioral problems to test the hypothesis that interdependent cultural values would be associated with differential stigma towards externalizing versus internalizing disorders. Furthermore, we examined whether problem-specific stigma attitudes would predict adolescent's own self-reported manifestations of distress.
Method:
1224 Vietnamese American and European American adolescents completed measures of social distance stigma attitudes in response to vignettes depicting youth with internalizing (depression, social anxiety, somatization) and externalizing (alcohol use, aggressive behaviors, delinquency) disorders. A subset of 676 youth also provided self-reports on their own adjustment prospectively over six months.
Results:
Measurement models revealed clear separation of negatively correlated factors assessing stigma toward externalizing versus internalizing problems. Values related to family interdependence were significantly associated with greater tolerance of internalizing disorders and lower tolerance of externalizing disorders. Stigma towards internalizing disorders was associated with lower concurrent self-reported internalizing symptoms, whereas stigma towards externalizing symptoms was associated with lower concurrent externalizing symptoms and greater decreases in externalizing symptoms over time.
Conclusions:
The results of the study suggest that stigma attitudes are differentiated by problem type and may represent one cultural factor shaping distress manifestations.
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.
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.
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.
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.
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.
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.
Cambridge Core - Health and Clinical Psychology - Alexithymia - edited by Olivier Luminet
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.
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.
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
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.
Zurück in Berlin nimmt Felix Kontakt zu Annalena auf, er vermisst sie und will sich mit ihr über die interkulturellen Differenzen austauschen. Doch sie berichtet von einer Depression, die sie seit ihrer Rückkehr aus China quält. Und auch dabei wird deutlich: kulturelle Differenzen gibt es sogar in der Wahrnehmung und Interpretation einer solchen Beeinträchtigung.
This article examines two forms of the medicalization of worry in an outpatient psychiatric clinic in Ho Chi Minh City, Vietnam. Biomedical psychiatrists understand patients' symptoms as manifestations of the excessive worry associated with generalized anxiety disorder (GAD). Drawing on an ethnopsychology of emotion that reflects increasingly popular models of neoliberal selfhood, they encourage patients to frame psychic distress in terms of private feelings to address the conditions in their lives that lead to chronic anxiety. However, most patients attribute their symptoms to neurasthenia instead of GAD. Differences between doctors and patients' explanatory models are not just rooted in their understandings of illness but also in their respective conceptualizations of worry in terms of emotion and sentiment. Patients with neurasthenia reject doctors' attempts to psychologize distress and maintain a model of worry that supports a sense of moral selfhood based on notions of obligation and sacrifice. This article is protected by copyright. All rights reserved.
Mainland China has undergone profound changes dating back to the nineteenth century, including a contemporary period of rapid modernization that began in the 1980s. The result has been dramatic social, cultural, and economic shifts impacting the daily lives of Chinese people. In this paper, we explore the psychological implications of sociocultural transformation in China, emphasizing two central themes. First, rising individualism: findings from social and developmental psychology suggest that China’s rapid development has been accompanied by ever-increasing adherence to individualistic values. Second, rising rates of depression: findings from psychiatric epidemiology point to increasing prevalence of depression over this same time period, particularly in rural settings. We argue that links between sociocultural and psychological shifts in China can be usefully studied through a cultural psychology lens, emphasizing the mutual constitution of culture, mind, and brain. In particular, we note that the link between social change, individualism, and rising mental illness deserves careful attention. Our review suggests that shifting values and socialization practices shape emotion norms of concealment and display, with implications for depressive symptom presentation. The challenge comes with interpretation. Increasing prevalence rates of depression may indeed be a general response to the rapidity of sociocultural change, or a specific consequence of rising individualism—but may also result from increasingly ‘Western’ patterns of symptom presentation, or improvements in diagnostic practice. We conclude by considering the challenges posed to standard universal models of psychological phenomena.
The title of this chapter evokes the common ground between anthropology and psychiatry, and by extension suggests Edward Sapir’s (1932) enduringly astute essay on this topic, written already eighty years ago, as a starting point for defining a cultural phenomenology of psychiatric illness. Sapir was a close collaborator of Harry Stack Sullivan, based in part on the concordance of Sullivan’s interpersonal psychiatry and Sapir’s anthropological understanding that the locus of culture is in the interaction of specific individuals. Sapir begins by observing that cultural anthropology emphasizes the group and its traditions, and the testimony of discrete individuals is of interest only insofar as they can be assumed typical of their community. Despite the presence in ethnography of "a kaleidoscopic picture of varying degrees of generality" from the broadly shared to the idiosyncratic, the individual note creates "disquieting interruptions to the impersonality of his [the anthropologist’s] thinking" (1932, p. 230). Psychiatry’s concern for individual pathology tends to be dominated by a need to magnify the biological approach in order to maintain legitimacy in the medical profession, even though "attempts to explain a morbid suspiciousness of one’s companions or delusion as to one’s status in society by some organically definable weakness of the nervous system or of the functioning of endocrine glands may be no more to the point than to explain the habit of swearing by the absence of a few teeth or by a poorly shaped mouth" (1932, p. 232). Psychiatric morbidity is "not a morbidity of organic segments or even organic functions but of experience itself," and it is unrealistic to "assume that ll experience is but the mechanical sum of physiological processes lodged in isolated individuals" (1932, p. 232). Sapir’s argument, perhaps ironically, is that anthropology and psychiatry most fruitfully overlap precisely at their respective blind spots: he individual for anthropology, experience for psychiatry. Culture as "superorganic" or abstracted from individual experience is a deterrent to "the more dynamic study of… cultural patterns because these cannot be disconnected from those organizations of ideas and feelings which constitute the individual" (1932, p. 233).
What do psychiatrists encounter when they encounter psychopathological experience in their patients? How should we interpret such experiences? In this chapter, we contrast a checklist approach to diagnosis, which is standard today and which treats psychiatric symptoms and signs (i.e., "the psychiatric object", Marková & Berrios, 2009; see also Chapter 2, this volume) as readily operationalizable object-like entities, with a nonstandard phenomenological approach that emphasizes the importance of a specific kind of interpretive interview. The descriptive methods of today’s psychiatry perpetuate what has been called psychiatry’s "problem of description" (Spitzer, 1988) because these methods are not adequately tailored to the ontological nature of the "psychiatric object." The psychiatric object is typically portrayed as an objective, thinglike entity, unproblematically graspable as it exists "in itself" through a behaviorist third-person perspective and as being indicative of a specific and modular physiological dysfunction. We will propose a different epistemological approach, considering the nature of mental disorders to be primarily constituted by the patient’s anomalies of experience, expression, and existence that typically involve suffering and dysfunction (Parnas, Sass, & Zahavi, 2013). Introduction: Is There a Problem in Contemporary Psychiatry?. More than thirty years ago, psychiatry, attempting to match somatic medicine in its scientific-biological foundations, underwent an "operational revolution," introducing criteria-based diagnoses and "operational definitions" of such criteria (American Psychiatric Association [APA], 1980). The operational project radically abridged, simplified, and condensed the then existing corpus of clinical knowledge into diagnostic manuals accessible to the grand publique because they are written in lay language and stripped of theoretical and psychopathological reflection. These manuals have long been the main source of clinical knowledge for psychiatrists in training (Andreasen, 2007). Moreover, it is assumed that a structured interview, that is, an interview in which a psychiatrist asks the patient a series of preformulated questions in a fixed sequence, is an adequate methodology for obtaining psychodiagnostic information. We will argue that this is a mistaken assumption.
The descriptions of psychiatric disorders in DSM-5 (APA, 2013) represent only some of the diverse forms of clinical presentations worldwide and throughout history. Cultural variation may help explain why current DSM diagnoses only partially map onto their putative biological substrates at the genetic or neurocircuitry level. It is more likely that these biological domains constitute dimensional vulnerability factors that pattern disorder expression more generally (e.g., mood dysregulation), and that specific syndromes arise from the interaction of this general vulnerability with other contextual factors, including culturally patterned illness expressions. This hypothesis raises several questions: How can research on cultural variation help elucidate the full range of underlying mechanisms that culminate in a given illness prototype? What cultural-contextual information can help clarify the relationship between related but diverse presentations of psychopathology? How can cultural variation be included in a universalistic nosology, such as DSM-5? This chapter presents a model of interdisciplinary triangulation that suggests how combining findings from sociocultural contextual analysis, neurobiological substrates of mental illness, and psychological dimensions can identify the substrates of illness phenomenology. The model will first be illustrated through an example of research on language, and then applied to a cultural syndrome included in the DSM-5 Appendix: ataque de nervios (attack of nerves). The chapter concludes by discussing how this model helped the DSM-5 revision process and by suggesting areas for future research. Psychopathology is experienced, expressed, and interpreted around the world with considerable cultural variation. To date, no blueprint exists that can untangle the contributions to this variation from neurobiological, psychological, and cultural levels of analysis (Kendler, 2008). As a result, classification systems of psychopathology rely almost exclusively on phenomenological description - in its simplest sense of that which is apparent to an external observer (Andreasen, 2007; Hyman, 2010) and with only the barest attention to other aspects of illness phenomenology, such as the sufferer’s own subjective description of lived experience and an accounting of the sociocultural environment that helps pattern illness expression (Csordas, Chapter 5, this volume; Heidegger, 1962 /1927; Merleau-Ponty, 1996 /1945; Parnas & Gallagher, Chapter 3, this volume).
Introduction In this chapter, we propose a model to describe the various ways in which biological mechanisms of anxiety and their psychological correlates are embedded in, shape, and are shaped by particular cultural contexts. Our approach focuses on a set of processes, including attentional looping, catastrophic cognitions, and interpretive biases, and uses several versions of our "multiplex model" in order to illustrate the profound effects of culture on panic attacks, panic disorder, worry/generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), anxiety symptoms, and somatization more generally. In doing so, we illustrate how local conceptualizations of the body alter the experience of somatic and panic-related symptoms. Our illustrations come mainly from research and clinical work with traumatized Cambodian refugees. The multiplex models illustrate the importance of a dimensional approach to psychopathology - such as catastrophic cognitions, panic, somatic sensations, trauma associations, biology of trauma (e.g., amygdala reactivity) - in line with NIMH’s RDoC initiative (Morris & Cuthbert, 2012; Sanislow et al., 2010; see also Kirmayer & Crafa, 2014, for critique); the models also provide insights into how a biocultural phenomenology of mental disorders may be advanced. More specifically, the multiplex models demonstrate how certain somatic symptoms may be subject to "bioattentional" looping, a positive feedback effect whereby interpretation of the symptoms in terms of the local ethnophysiology, ethnopsychology, and ethnospirituality may "loop back" and amplify their physiological effects, creating a vicious circle (for a review, see Hinton & Good, 2009; Hinton & Hinton, 2002; Hinton, Hinton, Eng, & Choung, 2012; Hinton & Kirmayer, 2013; Kirmayer & Blake, 2009; Kirmayer & Sartorius, 2007). As conceptualized in the multiplex models, trauma associations and metaphor associations also may play a role in the generation and escalation of the somatic symptoms and general distress. Furthermore, the multiplex models are nested in that they involve core processes embedded within the matrices of other processes, including coping, treatment, and interpersonal contexts (e.g., Kleinman & Becker, 1998), what we refer here to as sociocultural pragmatics. Altogether, the models demonstrate how anxiety ontologies can vary greatly across cultures, with important implications for assessment and treatment.
After a two-centuries-long alliance with medicine, psychiatry (its structure, objects, language, and praxis) remains as opaque as ever. Explaining why this is the case should be the task of the epistemology of psychiatry (EP). Surprisingly enough, until recently psychiatry lacked an epistemology to explore the nature and legitimacy of psychiatric knowledge. Instead, its problems have been addressed in part by the general epistemology of medicine (Berrios, 2006; Wulff, Pedersen, & Rosenberg, 1986) and in part by work in the philosophy of psychiatry, which began to appear after World War II (see, e.g., Blanc, 1998; Griffiths, 1994; Kehrer, 1951;Lanteri-Laura, 1963; Lewis, 1967; Natanson, 1969; Palem, 2010; Palmer, 1952; Reznek, 1991; Siegler & Osmond, 1974; Spiegelberg, 1972; Spitzer & Maher, 1990; Strauss, 1958; and others). In the hands of Anglo-American writers (such as Fulford, Thornton, & Graham, 2006; Radden, 2004) the philosophy of psychiatry has now become a voluminous industry. Given its bias in the direction of analytical philosophy, a great deal of this work has been openly justificatory of the neurosciences in general and of biological psychiatry in particular (Bolton & Hill, 2003; Kendler & Parnas, 2008; Murphy, 2006; more on this later). This predictable state of affairs throws into relief the urgent need for a dedicated epistemology that may act as an independent auditor of all psychiatric narratives, past and present, and that conceives of psychiatry as a sui generis discipline, broader than the conventional sciences, language-bound, and closely dependent on its historical period. This chapter will present a sketch of a new EP along these lines. We are using the concept of "EP" to refer to the discipline of examining the various sources of knowledge underlying psychiatry and its objects in order to further develop understanding concerning their nature and stability. Because we feel that philosophy of psychiatry, while pursuing a similar aim, is too constraining in its methods and sources of knowledge, we have adopted the broader term of "epistemology" to widen the field. Within EP, there will naturally be many approaches and ways of tackling the questions, but as far as the discipline is concerned we are talking about a single general epistemology rather than many epistemologies of psychiatry.
Introduction Every year more than eight hundred thousand people die by suicide, and more than twenty times that number attempt suicide (World Health Organization [WHO], 2014). In addition to the confusion and pain generated by the loss of a beloved family member or friend, suicide has major consequences for society. The WHO estimates the actual burden of suicide to be twenty million life-years and predicts that, by 2020, suicide could be responsible for 2.4 percent of the total burden of disease (WHO, 2006). These statistics not only clearly show the importance suicide has on society but also highlight our inability to properly implement prevention strategies. Suicide represents the extreme of a behavioral continuum comprising different forms and severities of self-injurious behaviors (van Heeringen, 2001). It is generally assumed that suicide is a complex behavior resulting from the interaction of different distal and proximal risk factors. Distal risk factors such as familial history of suicide, genetic and epigenetic factors, early life adversity, and personality traits confer vulnerability to suicide, while proximal risk factors like psychopathology, recent life events, hopelessness, and acute substance intoxication are better understood as precipitants of the suicidal crisis. The presence of comorbid major depressive disorder (MDD) and substance abuse are among the strongest proximal risk factors. Indeed, studies suggest that 50 to 70 percent of suicide completers die during an episode of MDD (Arsenault-Lapierre, Kim, & Turecki, 2004; Cavanagh, Carson, Sharpe, & Lawrie, 2003), although most individuals who are affected by MDD and other mood disorders will not die by suicide (F. Angst, Stassen, Clayton, & Angst, 2002; J. Angst, Angst, & Stassen, 1999; J. Angst, Degonda, & Ernst, 1992; Blair-West, Cantor, Mellsop, & Eyeson-Annan, 1999). Age and other sociodemographic factors such as educational level, employment, and income moderate the impact of proximal factors on suicide risk (Brezo, Paris, Tremblay, et al., 2007; Brezo, Paris, & Turecki, 2006; van den Bos, Harteveld, & Stoop, 2009). Among risk factors influencing suicide more distally are personality traits and familial history of suicidal behavior, both considered strong predictors of suicide (Hawton & van Heeringen, 2009; Suominen et al., 2004).
Introduction A few short weeks before the long-awaited publication of DSM-5, Thomas Insel, director of the National Institute of Mental Health (NIMH), stated that the manual suffers from a "lack of validity" (Insel, 2013). To remedy this problem, he envisaged a new direction for psychiatry whereby clinicians and researchers classify disorders based on underlying neurobiological causes rather than on highly variable symptoms. The anticipation of DSM-5 and professional efforts surrounding it generated unprecedented questioning from both consumers and practitioners. The public, advocacy groups, and even senior members of the psychiatric community raised questions, not only regarding decisions to include or exclude specific types of problems from the revised manual but also concerning the scientific foundation of the whole enterprise. Many of these criticisms were based on recognizing the limited advances that have been made in the biological understanding and treatment of mental disorders. Psychiatry aims to link behavioral science to underlying mechanisms, using the techniques of neuroscience. Yet decades of work on cognitive, molecular, and systems neuroscience have taught most scientists a lesson in humility: despite an enormous investment in research with an emphasis on the neural correlates of typical and atypical behavioral "phenotypes," breakthroughs are sorely lacking. In spite of the global efforts and the accumulation of a large body of findings, the lack of clinical advances has undermined many working assumptions concerning the neurobiological basis of psychiatric distress. The genetic and neuroimaging revolutions - which seemed poised to elucidate and ultimately explain conditions categorized as psychopathologies and psychiatric disorders - have produced modest results that speak only obliquely to the vast, complex dynamics revealed by behavioral science. Many scholars are disillusioned with imaging studies of the living human brain, and further recognize that genetic polymorphisms putatively appearing to increase risk of schizophrenia in one person may actually predispose another to bipolar disorder (Bilder, 2011). Furthermore, some scientists argue that the therapeutic effects of drugs that comprise the backbone of modern psychiatry - antidepressants and atypical antipsychotics - are largely indistinguishable from placebos in common clinical situations (Raz & Harris, in press). These findings challenge the extent to which the study of pharmaceutical drugs contributes to our understanding of psychological conditions.
Introduction to the Problem WHO [World Health Organization] is making a simple statement: mental health - neglected for far too long - is crucial to the well-being of individuals, societies and countries and must be universally regarded in a new light. (WHO, 2001, p. ix) WHO has received an increasing number of requests from countries for assistance and country-specific action. The need for - and relevance of - an economic perspective in planning, provision, and assessment of services, and for scaling up care for MNS [Mental, Neurological and Substance use] disorders is another reason to revise the focus of the mental health strategy. Moreover, a comprehensive programme for action can inspire stakeholders and accelerate progress by bringing together partners with a common purpose. (WHO Mental Health Gap Action Programme, 2008, p. 9) How does a term such as "global mental health" become a normative object of medical and epidemiological evaluation and estimation to the degree that remedial strategies can be deployed toward its improvement? When WHO reports that, worldwide, "Depression is the leading cause of disability as measured by YLDs [years lost due to disability]" and that "by the year 2020, depression is projected to reach 2nd place of the ranking of DALYs [disability adjusted life years] calculated for all ages, both sexes," how does WHO wish us to understand the object so as to act on it? We move closer to the intended object with the WHO estimate that the treatment gap for mental, neurological, and substance abuse disorders is greater than 75 percent (Barbui et al., 2010), and through comorbidities is linked further, as cause and consequence, to primary health concerns in those locales (Prince et al., 2007, p. 1). The opening quote from WHO frames their engagement with global mental health as a response to pleas for help from low- and middle-income countries (LMICs). In a podcast interview of three of the founders of the new global mental health movement, including Shekhar Saxena, coordinator for mental health at WHO, Graham Thornicroft estimated that every year a quarter of all adults will have a mental illness, with a lifetime prevalence of 50 percent.
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.
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.
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)
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.
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.
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.
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.
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.
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
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)
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)
Varieties of Critical NeuroscienceLocating Nervous SystemsUncovering Looping EffectsThe Rhetorical Appeal of Neuroscience in PsychiatryThe Willful BrainSpectral SelvesConclusion
AcknowledgementsReferences
Considerable evidence suggests that ethnic Chinese families in Canada are reluctant to seek psychiatric treatment for a relative with mental illness. The following hypotheses were investigated: (a) longer delay in seeking treatment among Chinese versus Euro-Canadians; (b) greater burden among Chinese versus Euro-Canadians; and (c) more negative conceptions of mental illness among Chinese versus Euro-Canadians. The sample consisted of 18 Chinese Canadians and 36 Euro-Canadians experi-encing a first episode of psychosis; each participant recruited a parent or sibling who responded to measures of perceived family burden and attitudes toward mental illness. Results confirmed all three hypotheses. Chinese care-givers were particularly more likely to endorse the practice of keeping mental illness a secret from others, as well as withdrawal from individuals with mental illness. These findings suggest that Chinese caregivers were more affected by the stigma of mental illness than were Euro-Canadian caregivers.
This review evaluates four facial feedback hypotheses, each proposing a certain relation between the face and emotions. It addresses criticisms of the data, considers implications for emotional and social processes, and advises directions for future research. The current data support the following: Facial actions are sensitive to social context, yet correspond to the affective dimension of emotions; matches with specific emotions are unlikely. They modulate ongoing emotions, and initiate them. These two claims have received substantially improved support, in part due to studies controlling for effects of experimental demand and task difficulty. Facial action may influence the occurrence of specific emotions, not simply their valence and intensity. Facial action is not necessary for emotions. There are multiple and nonmutually exclusive plausible mechanisms for facial effects on emotions. Future work must focus on determining the relative contributions of these mechanisms, and the parameters of their effects on emotions.
Participants included 46 European American, 33 Asian American, 91 Japanese, 160 Indian, and 80 Hispanic students (N = 416). Discrete emotions, as well as pleasant and unpleasant emotions, were assessed: (a) with global self-report measures,
(b) using an experience-sampling method for 1 week, and (c) by asking participants to recall their emotions from the experience
sampling week. Cultural differences emerged for nearly all measures. The inclusion of indigenous emotions in India and Japan
did not alter the conclusions substantially, although pride showed a pattern across cultures that differed from the other
positive emotions. In all five cultural groups and for both pleasant and unpleasant emotions, global reports of emotion predicted
retrospective recall even after controlling for reports made during the experience sampling period, suggesting that individuals’
general conceptions of their emotional lives influenced their memories of emotions. Cultural differences emerged in the degree
to which recall of frequency of emotion was related to experience sampling reports of intensity of emotions. Despite the memory
bias, the three methods led to similar conclusions about the relative position of the groups.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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)
[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)
Shorter's fascinating history of psychologically induced illness shows how patients throughout the modern era have manifested physical symptoms corresponding to the current models of disease espoused by physicians, as well as to the cultural shifts and tensions in the larger society. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In this book I have attempted to provide a transcultural perspective on psychiatry in order to question the unspoken assumptions that form the background to this branch of medicine. To this end, the nature of psychiatric symptoms and conditions is examined in a variety of cultures (Part I), leading inevitably to the question of what may be considered mentally abnormal and whether an absolute standard of abnormality can be determined. Cultural influences on the form taken by psychiatric disorders are explored, particularly the effect that language has on the expression of emotional distress.
In Part II, the issue of variation in the frequency of psychiatric conditions throughout the world is tackled in order to seek out clues to their origins.
Part III is devoted to a description of traditional methods of healing the psychiatric patient, and these are compared with Western scientific medicine, revealing more similarities than differences. In Part IV, studies of the course taken by psychiatric illnesses in different cultures are reviewed and some surprising findings encountered.
Finally, in Part V, the psychiatric problems of migrants are considered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study examined age and gender differences in internalizing and externalizing behavioral problems in a large sample of Chinese children aged 6-15 (N=4472). The Chinese Child Behavior Checklist (CBCL) and Teacher Report Form (TRF) were used to assess these problems. Results showed that boys were scored higher than girls on externalizing problems by both parents and teachers, while girls were rated higher than boys on somatic problems by teachers. Parent reported externalizing problems tended to decline with age but there was no age effect on internalizing problems except slight increases with age on somatic problems. Older children tended to have higher scores than younger children on anxious and somatic problems as reported by teachers, while aggressive problems showed quadratic association with age, declining until age 10 and thereafter increasing. Parents and teachers tended to report more consistently with boys on externalizing problems but less consistently with boys on anxious and somatic syndromes. Directions for future research were provided.
With a starting point in John Abela's groundbreaking developmental psychopathology research on adolescent depression in China, we aimed to review the state of the literature on Chinese depression across the lifespan. We began with Dr. Abela's published studies relevant to depression in China and our own research with adults before turning to the reference lists of these articles to find additional sources. Then we conducted literature searches using PsycINFO and PubMed to find other relevant studies published between April 2001 and April 20111.
Abela , J. R. Z. ,
Stolow , D. ,
Mineka , S. ,
Yao , S. ,
Zhu , X. , &
Hankin , B. L. ( 2011 ). Cognitive vulnerabilities to depressive symptoms in adolescents in urban and rural Hunan, China: A multiwave longitudinal study . Journal of Abnormal Psychology , 120 , 765 – 778 . [CrossRef], [PubMed], [Web of Science ®]View all references. There are two distinct literatures on depression in China. Developmental psychopathology research has emphasized adolescent samples and cognitive models of causation; cultural-clinical psychology and cultural psychiatry research have emphasized adult samples and the meanings associated with emotions, symptoms, and syndromes. Both approaches to the study of depression in China have yielded important findings but have also highlighted issues that could be better addressed by incorporating the other approach. Beyond depression in China, the psychological study of culture and mental health more generally would benefit from greater exchange between developmental psychopathology and cultural-clinical psychology.