Still Chinese somatization? A cross-cultural and cross-temporal analysis of depressive symptoms in Chinese and Canadian outpatients

A well-established finding in the field of culture and depression research is that patients of Chinese cultural heritage tend to emphasize somatic symptoms of depression over psychological symptoms. However, with massive economic and social demographic shifts, China has undergone rapid sociocultural changes, which can have enormous implications for mental health in general and depression specifically. In this study, we asked the question whether Chinese patients would still predominantly present somatic symptoms of depression over psychological symptoms over time.
To this end, we have two samples of Euro-Canadian and three samples of Chinese psychiatric outpatients that were collected between 2002 and 2016. All participants answered the same symptoms questionnaires, which yielded indices of overall depressive symptom severity, somatic symptom reporting, and psychological symptom reporting.
Our recent samples of Chinese patients (2009 and 2016) reported greater overall symptom severity compared to those recruited in 2002. There was no significant change in somatic symptom reporting in Chinese patients over time. However, recent Chinese cohorts consistently reported significantly greater levels of psychological symptoms across methods of analysis. Moreover, the strength of cross-cultural differences in symptom presentation decreased over time, such that recent Chinese cohorts did not differ significantly in psychological symptom reporting from their EuroCanadian counterparts.
Our finding of continued somatic symptom presentation suggests that an increasing exposure to Western model of illness does not necessarily come at the expense of culturally familiar ways of expressing distress. Meanwhile, rising psychologization illustrates the power of globalization and its impact on shaping symptom presentation of psychopathology.