t is a commonly held notion by anthropologists and psychologists that mood disorders areembedded in Western culture and may not apply as well to people of non-Western culturalbackgrounds

t is a commonly held notion by anthropologists and psychologists that mood disorders areembedded in Western culture and may not apply as well to people of non-Western culturalbackgrounds (e.g.,Kleinman, 1988;Ryder et al., 2008). TheDiagnostic and Statistical Manualof Mental Disorders-Fifth Edition(DSM-5;American Psychiatric Association, 2013) states that“culture provides interpretive frameworks that shape the experience and expression of thesymptoms, signs, and behaviors that are criteria for diagnosis” (p. 14). In support of this, pastresearch has demonstrated that participants of Asian background are more likely thanparticipants of European background to express depression in somatic terms (Yen, Robins, &Lin, 2000;Yeung & Chang, 2002). Examples of somatic symptoms include fatigue,gastrointestinal problems, headache, and pain. There are many descriptions and theoreticaldiscussions of somatization in people of Asian origin (Kleinman, 1982;Parker, Gladstone, &Chee, 2001;Ryder et al., 2008).A recent literature review, however, reveals only limited evidence that people of Asianbackground are more likely than others to report somatic symptoms (Uebelacker, Strong,Weinstock, & Miller, 2009). On the one hand, some clinical studies suggest that, for example,Chinese American patients are more likely to endorse somatic symptoms than EuropeanAmerican patients (e.g.,Huang, Chung, Kroenke, Delucchi, & Spitzer, 2006), and that depressedMalaysian Chinese outpatients are more likely than depressed Australian White outpatients toendorse a somatic symptom as the primary complaint (Parker, Cheah, & Roy, 2001). However,the findings across studies, especially those using community samples, have not been robust orconsistent (Uebelacker et al., 2009).International community studies also do not find increased somatization among Asianparticipants.Weiss, Tram, Weisz, Rescorla, and Achenbach (2009)compared symptoms ofdepression in Thai and American children and adolescents from a community sample and foundthat the Thai and American groups endorsed similar levels of somatic (and psychological)symptoms (effect size of the mean contrasts = 0.00, CI [−.05∼.05]). WhenKadir and Bifulco(2010)examined a community sample of Malaysian women, they found that both somatic andpsychological symptoms of depression were expressed by these participants. Although this studywas qualitative in nature, it is consistent with other community-based studies (e.g.,Cheng, 1989;Cheung, 1982) that suggest that the high prevalence of somatization in people of Asianbackground is not likely observed in community samples.Similarly, Ryder and his research team also suggest that there may be little difference betweenAsian origin and European origin adults in the presentation of somatic symptoms. They arguethat the difference is in people of Asian background endorsing fewer psychological symptomsthan people of European background. In their study of outpatients,Ryder and colleagues (2008)found that Chinese participants endorsed a significantly higher level of somatic symptoms thanEuropean Canadian participants on two of the three depression measures. The Chineseparticipants also endorsed a significantly lower level of psychological symptoms than theEuropean Canadian participants on all three depression measures. The effect sizes forpsychological symptoms were larger and more consistently significant than the effect sizes forsomatic symptoms. Therefore, the authors argued that the “truly distinctive cross-culturalfeature” in the expression of depression for people of Asian background may be their reportingof fewer psychological symptoms than people of European background 

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