Anxiety symptom presentations in Han Chinese and Euro-Canadian outpatients: is distress always somatized in China?

Background: Cultural variations in the relative emphasis on somatic versus psychological symptoms of distress are a common topic in cultural psychopathology. The most well-known example involves people of Chinese heritage, who are found to emphasize somatic symptoms in presenting depression as compared with people of Western European heritage. It remains unknown whether a similar cultural difference is found for anxiety disorders.

Methods: Euro-Canadian (n=79) and Han Chinese (n=154) psychiatric outpatients with clinically significant concerns about both depression and anxiety were selected from a larger dataset based on their responses to a structured interview. They also completed two self-report questionnaires assessing somatization of depression and anxiety.

Results: As expected, Chinese participants reported a greater tendency to emphasize somatic symptoms of depression, as compared to the Euro-Canadians. Contrary to expectations, the tendency to emphasize somatic symptoms of anxiety was higher among the Euro-Canadians as compared to the Chinese participants.

Limitations: Characteristics of our participants limit the generalizability of our findings. The current study is preliminary and requires replication.

Conclusions: Despite the exploratory nature of this study, the results suggest that the popular notion of 'Chinese somatization' should not be over-generalized. Our findings also imply that there may be important differences in the cultural understanding of depression and anxiety in both Chinese and 'Western' contexts. Future studies should seek to unpack potential cultural explanations for why Euro-Canadian outpatients may emphasize somatic symptoms in the presentation of anxiety to a greater degree than Chinese outpatients.