Culture and Depression: New data may help doctors more accurately diagnose patients

    TORONTO, July 15 /CNW/ - The expectation that East-Asian people emphasize
physical symptoms of depression (e.g. headaches, poor appetite or aches/pains
in the body) is widely acknowledged, yet the few available empirical studies
report mixed data on this issue. A new study from the Centre for Addiction and
Mental Health (CAMH) debunks this cultural myth, and offers clinicians
valuable insight to into cultural context when assessing a patient, leading to
more accurate diagnosis.
    Lead by CAMH Clinical Research Director Dr. R. Michael Bagby, in
collaboration with Dr. Andrew Ryder, Concordia University, Steven Heine,
University of British Columbia and a number of collaborators from Second
Xiangya Hospital of Central South University, People's Republic of China, this
study recruited more than 200 participants, half from an outpatient clinic in
China, and half from a clinical research department outpatient clinic at CAMH,
and tested two central hypotheses: 1. East-Asian participants will emphasize
somatic or physical symptoms of depression more than North American
participants, and 2. North American participants would emphasize psychological
symptoms of depression (e.g. report feeling sad, crying spells, or a loss of
self-confidence) more than East-Asian participants. Dr. Bagby and his team
also wanted to examine the role stigma and alexithymia (difficulty using words
to describe emotions) play in how each culture presented and expressed
depression symptoms.
    This rigorous work is one of only a few studies to address these
questions with a direct cross-cultural comparison of clinical patients. Also,
it is the only study to use three assessment tools (spontaneous report of
problems during unstructured discussion with doctor; clinician-rated symptoms
in a structured clinical interview; and a symptom rating scale in
questionnaire form) translated into both English and Chinese (Mandarin) and
modified to address cross-cultural differences.
    As Dr. Bagby explains, "the onset of depression triggers a biological
response that takes place within a specific social context, resulting in a
cascade of somatic and psychological experiences that are interpreted through
a particular cultural lens. Careful translation and adaptation of our
assessment tools helped us clarify if different approaches lead to different
symptom profiles and conclusions about patients."
    Overall, the data demonstrate a consistently greater level of
psychological symptom reporting in the North American sample, regardless of
assessment tool. This suggests a tendency for Western cultures to emphasize
psychological symptoms of depression (psychologization), rather than a
tendency for those from East-Asian cultures to emphasize physical symptoms
    East-Asian participants did report a significantly higher level of
somatic symptoms when reporting through the spontaneous interview and
structured clinical interview. Also, these participants reported higher levels
of stigma and alexithymia. A refined examination of this link revealed that
the observed cross-cultural differences in somatic symptom scores relates, in
part, to cultural differences in internally versus externally oriented
thinking. This suggests that people who do not frequently focus on their
internal emotional state are more likely to notice somatic symptoms.
    While this data may help clinicians be more aware of how culture can
impact how people talk about their illness, this data does not constitute a
norm for depression worldwide. More work should be done to understand the
interaction of biology, culture and individual differences in predicting
variations in how people present symptoms of depression.

    To view a brief interview with Dr. Michael Bagby, Please visit:

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<a href="">ckgrounders/vnr_drbagby_15jul2008.html</a>

    The Centre for Addiction and Mental Health (CAMH) is Canada's largest
mental health and addiction teaching hospital, as well as one of the world's
leading research centres in the area of addiction and mental health. CAMH
combines clinical care, research, education, policy development and health
promotion to transform the lives of people affected by mental health and
addiction issues.

    CAMH is fully affiliated with the University of Toronto, and is a Pan
American Health Organization/World Health Organization Collaborating Centre.

For further information:

For further information: To arrange interviews please contact Michael
Torres, Media Relations, CAMH at (416) 595-6015

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