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Yang X, Li P, Liu GY, Shan D. Dysfunctional attitudes, social support, and adolescent depression. World J Psychiatry 2025; 15:100758. [DOI: 10.5498/wjp.v15.i4.100758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Revised: 01/13/2025] [Accepted: 01/24/2025] [Indexed: 03/25/2025] Open
Abstract
Adolescent depressive symptoms represent a significant public health concern, with negative life events and dysfunctional attitudes playing pivotal roles in their development. A cross-sectional study by Yu et al assessed the interplay between dysfunctional attitudes, social support, and depressive symptoms in 795 Chinese adolescents (49.9% male, mean age 15.2 ± 1.8 years, age range 11-18 years) from five middle schools in Shandong Province. Using the Dysfunctional Attitudes Scale, Adolescent Life Events Scale, Beck Depression Inventory, and Social Support Rating Scale, the study identified that dysfunctional attitudes, particularly over-autonomy and over-perfectionism, mediate the relationship between negative life events and depressive symptoms. Social support moderated this relationship, significantly reducing depressive symptoms. These findings underscore the need for preventive and therapeutic strategies targeting dysfunctional attitudes and enhancing social support to address adolescent depressive symptoms. In this article, we extend their findings to highlight the significance of culturally tailored interventions that incorporate familial and community dynamics in mitigating depressive symptoms, particularly in collectivist societies.
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Affiliation(s)
- Xi Yang
- Department of Pediatrics, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Peng Li
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing 100730, China
| | - Gui-Ying Liu
- Department of Pediatrics, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Dan Shan
- Clinical Science Institute, University Hospital Galway, Galway H91 YR71, Ireland
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Lüönd AM, Ayas G, Bachem R, Carranza-Neira J, Eberle DJ, Fares-Otero NE, Hashim M, Iqbal N, Jenkins D, Kamari Songhorabadi S, Ledermann K, Makhashvili N, Martin-Soelch C, Nebioğlu E, Oe M, Olayinka JN, Olff M, Picot L, Seedat S, Tandon T, Wadji DL, Womersley JS, Schnyder U, Sar V, Pfaltz MC, Ceylan D. Childhood Maltreatment and Somatic Symptoms in Adulthood: Establishing a New Research Pathway. Neuropsychobiology 2025; 84:113-120. [PMID: 39809241 DOI: 10.1159/000543438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 12/22/2024] [Indexed: 01/16/2025]
Abstract
BACKGROUND Somatic symptoms, such as chronic pain, fatigue, and gastrointestinal disturbances, are commonly reported in individuals with a history of childhood maltreatment (CM), which includes various forms of abuse and neglect experienced before age 18. Although CM is strongly associated with somatic symptoms, the specific relationships between CM subtypes and these symptoms, as well as the mechanisms connecting them, remain insufficiently understood. This review examines the complex interaction between CM and somatic symptoms, which often coexist with mental disorders and significantly impact quality of life and healthcare systems. SUMMARY Somatic symptoms, frequently a mix of "explained" and "unexplained" conditions, are associated with personal distress and pose diagnostic challenges. CM has been linked to these symptoms through neurobiological mechanisms, such as HPA axis dysregulation and allostatic load, while theoretical models emphasize the roles of hyperawareness, cultural factors, and vulnerability in symptom development. However, existing research often fails to account for specific CM subtypes, the full range of somatic symptoms, and cultural and situational factors, leading to inconsistencies in findings. KEY MESSAGES Bridging gaps in literature requires adopting the World Health Organization's CM subtype definitions and ICD-11 codes (MA00-MH2Y) to encompass a broader spectrum of somatic symptoms. Employing rigorous methodologies, such as systematic reviews and meta-analyses, is essential for advancing understanding. These approaches can enhance diagnostic accuracy, support tailored interventions, and promote a biopsychosocial framework for CM research, ultimately improving patient outcomes and alleviating societal burdens.
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Affiliation(s)
- Antonia M Lüönd
- Department of Adult Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Görkem Ayas
- Graduate School of Health Sciences, Koç University, Istanbul, Turkey
- Koç University Research Center for Translational Medicine (KUTTAM), Affective Laboratory, Istanbul, Turkey
| | - Rahel Bachem
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Julia Carranza-Neira
- Faculty of Health Sciences, School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru
| | - David J Eberle
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Natalia E Fares-Otero
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clínic, Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
- Fundació Clínic per a la Recerca Biomèdica (FCRB), Institut d'Investigacions, Biomèdiques August Pi i Sunyer (IDIBAPS), Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Barcelona, Spain
| | - Mohammad Hashim
- Department of Psychology, Jamia Millia Islamia, New Delhi, India
| | - Naved Iqbal
- Department of Psychology, Jamia Millia Islamia, New Delhi, India
| | - Dan Jenkins
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Katharina Ledermann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nino Makhashvili
- Faculty of Business, Technology, and Education, Ilia State University, Tbilisi, Georgia
| | | | | | - Misari Oe
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan
| | - Juliet N Olayinka
- Neuropharmacology Unit, Department of Pharmacology and Therapeutics, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Miranda Olff
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
- Department of Psychiatry and Amsterdam Public Health, Amsterdam University Medical Center Location University of Amsterdam, Amsterdam, The Netherlands
| | - Laura Picot
- Department of Neuroscience, University of Caen, Caen, France
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council, Stellenbosch University Genomics of Brain Disorders Extramural Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tanya Tandon
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Dany L Wadji
- Department of Educational and Counselling Psychology, McGill University, Montreal, Québec, Canada
| | - Jacqueline S Womersley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council, Stellenbosch University Genomics of Brain Disorders Extramural Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ulrich Schnyder
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Vedat Sar
- Graduate School of Health Sciences, Koç University, Istanbul, Turkey
- Department of Psychiatry, School of Medicine and Koç University Hospital, Koç University, Istanbul, Turkey
| | - Monique C Pfaltz
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Deniz Ceylan
- Graduate School of Health Sciences, Koç University, Istanbul, Turkey
- Koç University Research Center for Translational Medicine (KUTTAM), Affective Laboratory, Istanbul, Turkey
- Department of Psychiatry, School of Medicine and Koç University Hospital, Koç University, Istanbul, Turkey
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Kwegyir Tsiboe A, Raghuraman S, Marshall TC. Caught between two worlds: mental health literacy and stigma among bicultural youth. Int J Qual Stud Health Well-being 2024; 19:2321644. [PMID: 38431901 PMCID: PMC10911255 DOI: 10.1080/17482631.2024.2321644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 02/18/2024] [Indexed: 03/05/2024] Open
Abstract
PURPOSE Bicultural youths are at higher risk of mental health problems and are less likely to utilize mental health services, yet our knowledge of their mental health literacy and help-seeking behaviours remains limited. METHODS To fill this gap, the current study explored bicultural youths' mental health literacy and stigma by conducting semi-structured interviews with 14 Canadian university students in 2021. RESULTS Our analysis revealed that bicultural youths may be torn between two worlds: intergenerational tensions between participants assimilated into individualistic Canadian culture and their more collectivist parents meant that they had different cultural perceptions of mental health literacy and stigma. While being caught between these two worlds may be detrimental for bicultural youth, our results also suggested that a trans-cultural factor-celebrities' mental health journeys-may promote help-seeking behaviour across participants. Furthermore, our study speaks to the ways that unprecedented events such as the COVID-19 pandemic impact mental health literacy among bicultural youth. Our findings might be used by university mental health services to encourage help-seeking among bicultural students. CONCLUSION The acculturation of mental health literacy, stigma, and associated intergenerational differences needs to be considered by university wellness services.
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Affiliation(s)
| | - Shruthi Raghuraman
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Canada
| | - Tara C. Marshall
- Department of Health, Aging & Society, McMaster University, Hamilton, Canada
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Zeng X. Somatized or stigma? Causal attributions and emotional responses in shaping social distance towards people with mental illness, China. Heliyon 2024; 10:e32985. [PMID: 39021942 PMCID: PMC11252714 DOI: 10.1016/j.heliyon.2024.e32985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/08/2024] [Accepted: 06/12/2024] [Indexed: 07/20/2024] Open
Abstract
Background Mental illness in China has traditionally been attributed to physical factors and somatization tendencies, which seldom result in stigma. How has this perception changed after decades of social change? Methods Based on the Chinese General Social Survey database in 2011, this study constructed a structural equation model to analyze the effects of causal attribution and emotional responses on social distance. The causal attributions include dangerousness, controllability, and responsibility. And the emotional responses encompass negative affect, traditional prejudice, treatment carryover, and exclusionary sentiments. In addition, higher scores indicating greater social distance, whereas a low score reflected stronger emotional responses or a greater degree of internal attribution. Results The results reported a high level of social distance towards people with mental illness. These findings indicated that emotional responses have a direct impact on social distance. Specifically, when negative affect, traditional prejudice, and exclusionary sentiments increase by one standard deviation, the social distance decreases by 0.497, 0.178, and 0.073 standard deviation, respectively. Conversely, as the level of treatment carryover rises, social distance increases by 0.087. Meanwhile, the causal attribution only exerts a significant indirect effect on social distance by the function of emotional causal responses. Conclusion The results indicated that the public attributes mental illnesses like depression primarily to psychological issues rather than somatic ones. It suggested widespread stereotypes and public stigma towards people with mental illness in China, as well as an arduous task in anti-stigma. In addition, a targeted way to address public stigma lies in changing the stereotype of people with mental illness.
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Affiliation(s)
- Xiangming Zeng
- Department of Public Management, Law School, Wenzhou University, China
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Chang Z, Bodnar S. The Effects of Dust Storms on People Living in Beijing: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:835. [PMID: 39063412 PMCID: PMC11276360 DOI: 10.3390/ijerph21070835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/22/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024]
Abstract
Dust storms, which are common aversive occurrences in northern China, result from high winds, dry soil or dust, and soil surface disturbance. Exposure to dust storms, regardless of duration, can induce varying mental and physical distress levels. Recognizing the urgency of comprehending the impact of dust storms on residents and the scarcity of information on their effects on the indigenous civilians there, this study aims to address this gap by qualitatively sampling 29 participants from Beijing, a typical city in northern China. The current study seeks to gain insights into residents' dust storm experiences and explore their perspectives on effective coping mechanisms. The findings align with existing knowledge regarding the mental and physical repercussions of dust storms while identifying some emerging patterns of coping mechanisms already employed by residents in Beijing. Concerns regarding mental well-being, either directly influenced by the environmental conditions or indirectly stemming from disruptions to life routines on a broader scale, persistently dominate people's perceptions of dust storms. New themes emerged following the step-by-step exploration of feelings and coping mechanisms. This study aims to enlighten the public about the ramifications of the dust storms in Beijing and advocate for essential policy support.
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Affiliation(s)
- Zhaohe Chang
- Teachers College, Columbia University, New York, NY 10027, USA;
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Yu L, Chen C. Symptom patterns of comorbid depression and anxiety among older adults in China and their predictors. Psych J 2024; 13:494-511. [PMID: 38268089 PMCID: PMC11169763 DOI: 10.1002/pchj.729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/08/2023] [Indexed: 01/26/2024]
Abstract
Comorbid depression and anxiety causes serious psychological and physiological damage for older people. This study aimed to identify heterogeneous classes of comorbid depression and anxiety (CDA) among older people in China and to ascertain predictors of latent class membership. Cross-sectional data of 10,919 cases were extracted from the Chinese Longitudinal Healthy Longevity Survey. Latent profile analysis (LPA) was used to identify symptom patterns of comorbid depression (measured by the 10-item Center for Epidemiologic Studies Depression Scale) and anxiety (measured by the Generalized Anxiety Disorder 7-item Scale). Multinomial logistic regressions following bivariate analyses were used to explore the relationship between the derived classes and individual- and social-level factors. Four patterns of CDA were identified: low symptoms of depression and anxiety (30.52%; n = 3333), mild depression only (53.26%; n = 5815), moderate depression and anxiety (13.82%; n = 1509), and severe depression and anxiety (2.40%; n = 262). Older people who are male, suffer from multimorbidity, and lack a healthy lifestyle are more likely to have problematic symptom profiles. While intimate relationships with partners and children significantly predicted CDA patterns, the effects of sibling relationships, daily life, and emotional support from the community were insignificant. LPA identified four distinct CDA patterns among a representative sample of older Chinese people. While restless sleep, lack of positive emotions, uselessness, and weak concentration are salient across all profiles, "difficult to relax" is prominent in profiles high in anxiety. In addition to individual-level variables, social-level factors, especially intimate relationships with partners and children rather than general links to siblings or the community, have unneglectable impacts on whether and to what extent older Chinese adults suffer from CDA in the cultural context of relationism, patriarchy, and filial piety.
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Affiliation(s)
- Lingling Yu
- Department of Philosophy and ScienceSoutheast University at NanjingNanjingChina
| | - Chuqian Chen
- Department of Medical HumanitiesSoutheast University at NanjingNanjingChina
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Kuerban A, Seo JY. Conventional or Alternative Mental Health Service Utilization According to English Proficiency Among Asians in the United States. J Immigr Minor Health 2024; 26:91-100. [PMID: 37676448 DOI: 10.1007/s10903-023-01538-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 09/08/2023]
Abstract
After the onset of the COVID-19 pandemic in 2020, Asian Americans in the United States have experienced a surge in anti-Asian crimes, leading to heightened psychological distress among this community. Consequently, the mental well-being of Asian Americans demands greater attention than ever. Regrettably, Asians tend to underutilize or delayed mental health care treatments. This study examines the conventional and alternative mental health service utilization among Asians in the United States according to their English proficiency. From the 2015-2018 National Survey on Drug Use and Health, this study examined 3,424 self-identified non-Hispanic Asians aged 18-64 with Kessler score of at least 5. Stratified bivariate analysis and multivariable logistic regression analysis were conducted. Regardless of English proficiency, Asians did not utilize alternative mental health service more than conventional mental health service. However, those with limited English proficiency consistently utilize care less than those with English proficiency. Need factors, such as mental distress severity and self-rated health status, were significant factors associated with their mental health service utilization. English proficiency remains a structural factor in preventing Asians from utilizing mental health services regardless of the nature of services. Due to the COVID-19 pandemic, more Asians have been experiencing mental distress. This study demonstrates a particular need for mental health services that are culturally specific and Asian language friendly.
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Affiliation(s)
- Aliya Kuerban
- Barbara Hagan School of Nursing & Health Sciences, Molloy University, Rockville Centre, New York, USA.
| | - Jin Young Seo
- Hunter-Bellevue School of Nursing Hunter College, CUNY, New York, NY, USA
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Lam MI, Chen P, Zhang Q, Sha S, An FR, Su Z, Cheung T, Ungvari GS, Ng CH, Xiang YT, Feng Y. Prevalence of COVID-19 fear and its association with quality of life and network structure among Chinese mental health professionals after ending China's dynamic zero-COVID policy: a national survey. Front Public Health 2023; 11:1280688. [PMID: 37965522 PMCID: PMC10642929 DOI: 10.3389/fpubh.2023.1280688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Background China recorded a massive COVID-19 pandemic wave after ending its Dynamic Zero-COVID Policy on January 8, 2023. As a result, mental health professionals (MHPs) experienced negative mental health consequences, including an increased level of fear related to COVID-19. This study aimed to explore the prevalence and correlates of COVID-19 fear among MHPs following the end of the Policy, and its association with quality of life (QoL) from a network analysis perspective. Methods A cross-sectional national study was conducted across China. The correlates of COVID-19 fear were examined using both univariate and multivariate analyses. An analysis of covariance (ANCOVA) was conducted to determine the relationship between fear of COVID-19 and QoL. Central symptoms were identified using network analysis through the "Expected Influence" of the network model while specific symptoms directly correlated with QoL were identified through the "flow function." Results A total of 10,647 Chinese MHPs were included. The overall prevalence of COVID-19 fear (FCV-19S total score ≥ 16) was 60.8% (95% CI = 59.9-61.8%). The binary logistic regression analysis found that MHPs with fear of COVID-19 were more likely to be married (OR = 1.198; p < 0.001) and having COVID-19 infection (OR = 1.235; p = 0.005) and quarantine experience (OR = 1.189; p < 0.001). Having better economic status (good vs. poor: OR = 0.479; p < 0.001; fair vs. poor: OR = 0.646; p < 0.001) and health status (good vs. poor: OR = 0.410; p < 0.001; fair vs. poor: OR = 0.617; p < 0.001) were significantly associated with a lower risk of COVID-19 fear. The ANCOVA showed that MHPs with fear of COVID-19 had lower QoL [F = 228.0, p < 0.001]. "Palpitation when thinking about COVID-19" was the most central symptom in the COVID-19 fear network model, while "Uncomfortable thinking about COVID-19" had the strongest negative association with QoL (average edge weight = -0.048). Conclusion This study found a high prevalence of COVID-19 fear among Chinese MHPs following the end of China's Dynamic Zero-COVID Policy. Developing effective prevention and intervention measures that target the central symptoms as well as symptoms correlated with QoL in our network structure would be important to address COVID-19 fear and improve QoL.
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Affiliation(s)
- Mei Ieng Lam
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China
- Kiang Wu Nursing College of Macau, Macao, Macao SAR, China
| | - Pan Chen
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Taipa, Macao SAR, China
| | - Qinge Zhang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Sha Sha
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Feng-Rong An
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Gabor S. Ungvari
- Section of Psychiatry, University of Notre Dame Australia, Fremantle, WA, Australia
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Chee H. Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VIC, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Taipa, Macao SAR, China
| | - Yuan Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
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Hennemann S, Killikelly C, Hyland P, Maercker A, Witthöft M. Somatic symptom distress and ICD-11 prolonged grief in a large intercultural sample. Eur J Psychotraumatol 2023; 14:2254584. [PMID: 37767693 PMCID: PMC10540649 DOI: 10.1080/20008066.2023.2254584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/12/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Grief is a multi-faceted experience including emotional, social, and physical reactions. Research in ICD-11 prolonged grief disorder (PGD) in different cultural contexts has revealed different or potentially missing grief symptoms that may be relevant.Objective: This study thus aimed to explore the prevalence of somatic symptom distress and its associations with grief and negative affect in a culturally diverse sample of bereaved individuals with symptoms of PGD.Methods: Based on cross-sectional survey data from the Measurement and Assessment of Grief (MAGIC) project, this study included 1337 participants (mean age 23.79 yrs, 76.1% female) from three regions (USA: 62.3%, Turkey/Iran: 24.2%, Cyprus/Greece: 13.5%), who experienced a loss of a significant other. Associations between somatic symptom distress (Somatic Symptom Scale, SSS-8), symptoms of PGD (International Prolonged Grief Disorder Scale, IPGDS-33), anxiety (Generalized Anxiety Disorder Questionnaire, GAD-7), depression (Patient Health Questionnaire, PHQ-9) as well as demographic and loss related characteristics were investigated. Three hundred and thirteen participants (23.4%) scored above the proposed cut-off for clinically severe PGD.Results: 'High' or 'very high' levels of somatic symptom distress were more frequent in a possible PGD group (58.2%), than in a non-PGD group (22.4%), p < .001, as divided per cut-off in the IPGDS. In a multiple regression analysis, PGD symptoms were significantly but weakly associated with somatic symptom distress (β = 0.08, p < .001) beyond demographics, loss-related variables, and negative affect. Negative affect (anxiety and depression) mediated the relationship of PGD symptoms with somatic symptom distress and the indirect effect explained 58% of the variance.Conclusions: High levels of somatic symptom distress can be observed in a substantial proportion of bereaved across cultures. Our findings suggest that PGD is related to somatic symptom distress partly and indirectly through facets of negative affect.
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Affiliation(s)
- Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Clare Killikelly
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
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Yik M, Chen CZ. Unraveling Chinese talk about emotion. Front Psychol 2023; 14:1157863. [PMID: 37655199 PMCID: PMC10467276 DOI: 10.3389/fpsyg.2023.1157863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/14/2023] [Indexed: 09/02/2023] Open
Abstract
Research in cross-cultural psychiatry has asserted that Chinese people have a higher tendency to report somatic symptoms of their psychological distress than people with a European ethnic background. However, recent studies have reached inconsistent conclusions and most have confounded language use with culture in their study designs. Focusing on the varying degrees of orientation to Chinese culture, the present study examined the words freely listed by two Chinese groups of university students (mainland Chinese and Hong Kong Chinese) when describing their illness experience. Words were categorized into somatic, emotion, and somatic-emotion clusters. Overall, the Chinese participants were more willing to talk about their emotions than their somatic symptoms in an anonymous survey. The enculturated mainland Chinese participants-who reported greater Chinese cultural identity-used significantly more emotion words but fewer somatic-emotion words than the Hong Kong Chinese participants. No group differences were found in somatic words. In contrast to previous findings, the current study failed to find support for the relationship between orientation to Chinese culture and somatic symptom reporting when controlling for language use.
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Chan HCY, Lo HHM. Effects of the original zentangle method on older adults with depressive symptoms a randomized waitlist-controlled trial. CURRENT PSYCHOLOGY 2023:1-13. [PMID: 37359601 PMCID: PMC10161183 DOI: 10.1007/s12144-023-04536-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 06/28/2023]
Abstract
Objectives: Depressive symptoms are common among older adults and many of them did not seek for professional help. Although Zentangle has been widely implemented in service centers for older adults in many societies, very limited empirical study has been conducted on the effects of this method. This study aims to evaluate the effects of Zentangle on community-dwelling older adults with depressive symptoms. Methods: A randomised waitlist-controlled trial of Zentangle was conducted. Forty-six community-dwelling older adults with mild to moderate depression were recruited and randomly assigned to a six session Zentangle group or a waitlist control group. The effects were examined by comparing the participants who received a six-week Zentangle intervention with those in the waitlist control group. Patient Health Questionnaire (PHQ-9), Self-compassion Scale - Short form (SCS-SF) and other mental health outcomes were assessed at baseline, post-intervention and six-week follow-up. Results: Repeated measure ANOVA revealed significant Time x Group effects for depression (F (2, 88) = 21.29, p < .001) and self-compassion (F (2, 88) = 18.50, p < .001) with a large net effect size. Six-week follow-up indicated that such improvements were sustained. Conclusion: This study provides preliminary support that the Zentangle programme is an effective alternative treatment approach for older adults with mild to moderate depression. The original Zentangle method can reduce depressive symptoms and cultivate self-compassion. Further research is necessary to expand our understanding of the underlying mechanisms of how the original Zentangle method works. Trial registration: ISRCTN66410347. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-023-04536-x.
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Affiliation(s)
- Henri Chun-Yiu Chan
- Department of Childcare, Elderly and Community Services, Institute of Vocational Education, Hung Hom, Hong Kong
| | - Herman Hay-Ming Lo
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Cui L, Wang Y, Cao L, Wu Z, Peng D, Chen J, Yang H, Rong H, Liu T, Fang Y. Age of onset for major depressive disorder and its association with symptomatology. J Affect Disord 2023; 320:682-690. [PMID: 36183820 DOI: 10.1016/j.jad.2022.09.096] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/31/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Lvchun Cui
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Yun Wang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Lan Cao
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Zhiguo Wu
- Department of Psychiatry and Psychology, Shanghai Deji Hospital affiliated to Qingdao University, Shanghai 200331, China
| | - Daihui Peng
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Jun Chen
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Haichen Yang
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen 518020, China
| | - Han Rong
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen 518020, China
| | - Tiebang Liu
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen 518020, China
| | - Yiru Fang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai 200031, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai 201108, China.
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13
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Lin C, Glynn NW, Gmelin T, Wei YC, Chen YL, Huang CM, Shyu YC, Chen CK. Validation of the Traditional Chinese Version of the Pittsburgh Fatigability Scale for Older Adults. Clin Gerontol 2022; 45:606-618. [PMID: 33934690 PMCID: PMC10155380 DOI: 10.1080/07317115.2021.1914258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Chemin Lin
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Nancy W Glynn
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Theresa Gmelin
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yi-Chia Wei
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.,Department of Neurology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Liang Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Ken Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
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14
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Lei H, Chen C, Hagiwara K, Kusumi I, Tanabe H, Inoue T, Nakagawa S. Symptom Patterns of the Occurrence of Depression and Anxiety in a Japanese General Adult Population Sample: A Latent Class Analysis. Front Psychiatry 2022; 13:808918. [PMID: 35211043 PMCID: PMC8861440 DOI: 10.3389/fpsyt.2022.808918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Huijie Lei
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Chong Chen
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kosuke Hagiwara
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hajime Tanabe
- Faculty of Humanities and Social Sciences, Shizuoka University, Shizuoka, Japan
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Shin Nakagawa
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
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15
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Nguyen MH, Lanca JC, Hahn E, von Poser A, Heyken E, Wingenfeld K, Burian R, Diefenbacher A, Ta TMT. Migration-related emotional distress among Vietnamese psychiatric patients in Germany: An interdisciplinary, mixed methods study. Transcult Psychiatry 2021; 58:772-788. [PMID: 32389070 DOI: 10.1177/1363461520920329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Culture and socialization influence how individuals perceive and express emotional distress. Research therefore, must consider the context to capture individual experiences. However, the majority of studies on factors associated with emotional distress among migrants use quantitative approaches, limiting an in-depth understanding. This study investigates emic themes of emotional distress among Vietnamese migrants by integrating anthropological and psychiatric approaches. The mixed methods study first quantified differences in reported themes of distress between Vietnamese (n = 104) and German (n = 104) patients, who utilized two psychiatric outpatient clinics in Berlin, Germany. Based on these differences, ethnographic interviews were conducted with 20 Vietnamese patients. In the quantitative part, differences in frequency of reported distress between Vietnamese and German patients indicate cultural and migration-related issues among Vietnamese migrants, such as the upbringing of children in a transcultural context. In the qualitative part, interviews with Vietnamese patients elicited contextualizing information and additional themes of distress. Besides commonly expressed socioeconomic themes, such as work and finances, we identified affectively charged themes concerning roles toward partnership and children. A central emic theme is expressed as "moments of speechlessness," which go beyond a lack of language proficiency and challenge patients in different spheres of life. Migration entails complex affective dynamics, determined by a specific migratory and post-migratory context. Within this context, norms and values determine which themes of distress patients articulate openly. Therefore, an interdisciplinary, mixed-methods approach can yield a contextualized understanding of emotional distress and the complex nature of migration.
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Affiliation(s)
- Main Huong Nguyen
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin
| | | | - Eric Hahn
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin.,Department of Psychiatry, Evangelical Hospital Königin Elisabeth Herzberge, Berlin
| | - Anita von Poser
- Institute of Social- and Cultural Anthropology, Freie Universität Berlin
| | - Edda Heyken
- Institute of Social- and Cultural Anthropology, Freie Universität Berlin
| | - Katja Wingenfeld
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin
| | - Ronald Burian
- Department of Psychiatry, Evangelical Hospital Königin Elisabeth Herzberge, Berlin
| | - Albert Diefenbacher
- Department of Psychiatry, Evangelical Hospital Königin Elisabeth Herzberge, Berlin
| | - Thi Minh Tam Ta
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin.,Berlin Institute of Health
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16
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Giannakopoulou O, Lin K, Meng X, Su MH, Kuo PH, Peterson RE, Awasthi S, Moscati A, Coleman JRI, Bass N, Millwood IY, Chen Y, Chen Z, Chen HC, Lu ML, Huang MC, Chen CH, Stahl EA, Loos RJF, Mullins N, Ursano RJ, Kessler RC, Stein MB, Sen S, Scott LJ, Burmeister M, Fang Y, Tyrrell J, Jiang Y, Tian C, McIntosh AM, Ripke S, Dunn EC, Kendler KS, Walters RG, Lewis CM, Kuchenbaecker K. The Genetic Architecture of Depression in Individuals of East Asian Ancestry: A Genome-Wide Association Study. JAMA Psychiatry 2021; 78:1258-1269. [PMID: 34586374 PMCID: PMC8482304 DOI: 10.1001/jamapsychiatry.2021.2099] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Olga Giannakopoulou
- Division of Psychiatry, University College of London, London, United Kingdom
| | - Kuang Lin
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Xiangrui Meng
- Division of Psychiatry, University College of London, London, United Kingdom
| | - Mei-Hsin Su
- Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Po-Hsiu Kuo
- Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Roseann E. Peterson
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - Swapnil Awasthi
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Berlin, Germany
| | - Arden Moscati
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jonathan R. I. Coleman
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, King’s College London, London, United Kingdom
| | - Nick Bass
- Division of Psychiatry, University College of London, London, United Kingdom
| | - Iona Y. Millwood
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- MRC Population Health Research Unit, University of Oxford, Oxford, United Kingdom
| | - Yiping Chen
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- MRC Population Health Research Unit, University of Oxford, Oxford, United Kingdom
| | - Zhengming Chen
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- MRC Population Health Research Unit, University of Oxford, Oxford, United Kingdom
| | - Hsi-Chung Chen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan-Fang Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ming-Chyi Huang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei, Taiwan
| | - Chun-Hsin Chen
- Department of Psychiatry, Wan-Fang Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Eli A. Stahl
- The Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ruth J. F. Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Niamh Mullins
- The Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert J. Ursano
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | | | - Srijan Sen
- Michigan Neuroscience Institute, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Laura J. Scott
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Margit Burmeister
- Molecular & Behavioral Neuroscience Institute, Department of Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, Michigan
| | - Yu Fang
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan
| | - Jess Tyrrell
- University of Exeter Medical School, University of Exeter, The RILD Building, RD&E Hospital, Exeter, United Kingdom
| | | | | | - Andrew M. McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Stephan Ripke
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Berlin, Germany
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Erin C. Dunn
- Harvard Medical School, Boston, Massachusetts
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - Robin G. Walters
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- MRC Population Health Research Unit, University of Oxford, Oxford, United Kingdom
| | - Cathryn M. Lewis
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, King’s College London, London, United Kingdom
| | - Karoline Kuchenbaecker
- Division of Psychiatry, University College of London, London, United Kingdom
- UCL Genetics Institute, University College of London, London, United Kingdom
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17
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The effect of academic performance, individualistic and collectivistic orientation on Chinese youth’s adjustment. SOCIAL PSYCHOLOGY OF EDUCATION 2021. [DOI: 10.1007/s11218-021-09650-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Guo J, Kong D, Fang L, Zhu Y, Zhang B. Depressive symptoms and health service utilization among Chinese middle-aged and older adults: a national population-based longitudinal survey. Int J Ment Health Syst 2021; 15:2. [PMID: 33407726 PMCID: PMC7788883 DOI: 10.1186/s13033-020-00421-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/21/2020] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Jing Guo
- Center for Health Policy and Technology Evaluation, Department of Health Policy and Management, School of Public Health, Peking University, Beijing, P. R. China
| | - Dexia Kong
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, Piscataway, NJ, USA.
| | - Liming Fang
- School of Insurance and Economics, University of International Business and Economics, Beijing, P. R. China
| | - Yingxue Zhu
- School of Sociology, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Bo Zhang
- Department of Neurology and ICCTR Biostatistics and Research Design Center, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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19
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Huang Y, Shen L, Huang J, Xu X, Wang Y, Jin H. Efficacy and Safety of tDCS and tACS in Treatment of Major Depressive Disorder: A Randomized, Double-Blind, Factorial Placebo-Controlled Study Design. Neuropsychiatr Dis Treat 2021; 17:1459-1468. [PMID: 34012266 PMCID: PMC8128494 DOI: 10.2147/ndt.s295945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/27/2021] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
- Yuxin Huang
- Department of Outpatient, Shanghai Mental Health Center, Shanghai, People's Republic of China
| | - Linjie Shen
- Department of Outpatient, Shanghai Mental Health Center, Shanghai, People's Republic of China
| | - Jia Huang
- Department of Outpatient, Shanghai Mental Health Center, Shanghai, People's Republic of China
| | - Xianrong Xu
- School of Public Health, Hangzhou Normal University, Hnagzhou, Zhejiang Province, People's Republic of China
| | - Yong Wang
- Department of Outpatient, Shanghai Mental Health Center, Shanghai, People's Republic of China
| | - Hua Jin
- Department of Outpatient, Shanghai Mental Health Center, Shanghai, People's Republic of China
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20
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Van Der Feltz-Cornelis CM, Varley D, Allgar VL, de Beurs E. Workplace Stress, Presenteeism, Absenteeism, and Resilience Amongst University Staff and Students in the COVID-19 Lockdown. Front Psychiatry 2020; 11:588803. [PMID: 33329135 PMCID: PMC7728738 DOI: 10.3389/fpsyt.2020.588803] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/26/2020] [Indexed: 01/26/2023] Open
Abstract
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.
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Affiliation(s)
| | - D. Varley
- Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
| | - Victoria L. Allgar
- Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Edwin de Beurs
- Social and Behavioral Sciences, Psychology Department, Leiden University, Leiden, Netherlands
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21
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Cheung HN, Williams JM, Chan SWY. A cultural validation of the Chinese version of multidimensional depression assessment scale (MDAS) in clinically depressed patients in Inner Mongolia. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-01107-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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de la Torre-Luque A, Ojagbemi A, Caballero FF, Lara E, Moreno-Agostino D, Bello T, Olaya B, Haro JM, Gureje O, Ayuso-Mateos JL. Cross-cultural comparison of symptom networks in late-life major depressive disorder: Yoruba Africans and the Spanish Population. Int J Geriatr Psychiatry 2020; 35:1060-1068. [PMID: 32394534 DOI: 10.1002/gps.5329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND The concept of European psychologisation 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. J Am Geriatr Soc 68:-, 2020.
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Affiliation(s)
- Alejandro de la Torre-Luque
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain.,Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
| | - Akin Ojagbemi
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Francisco F Caballero
- Department of Preventive Medicine, Public Health, and Microbiology, Universidad Autónoma de Madrid, Madrid, Spain.,Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Elvira Lara
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain.,Department of Psychiatry, Universidad Autonoma de Madrid, Madrid, Spain
| | | | - Toyin Bello
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.,WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, University of Ibadan, Ibadan, Nigeria
| | - Beatriz Olaya
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.,Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Josep M Haro
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.,Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.,WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, University of Ibadan, Ibadan, Nigeria.,Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Jose L Ayuso-Mateos
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain.,Department of Psychiatry, Universidad Autonoma de Madrid, Madrid, Spain
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Canna M, Seligman R. Dealing with the unknown. Functional neurological disorder (FND) and the conversion of cultural meaning. Soc Sci Med 2019; 246:112725. [PMID: 31911360 DOI: 10.1016/j.socscimed.2019.112725] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 12/22/2022]
Abstract
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.
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24
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Kam W, Zhang ZJ, Bäärnhielm S. Traditional Chinese Medicine Explanatory Models of Depressive Disorders: A Qualitative Study. Cult Med Psychiatry 2019; 43:387-403. [PMID: 30963358 DOI: 10.1007/s11013-019-09628-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Wan Kam
- Transcultural Centre, North Stockholm Psychiatric Clinic, Stockholm, Sweden
| | - Zhang-Jin Zhang
- The University of Hong Kong School of Chinese Medicine, 10 Sassoon Road, Pokfulam, Hong Kong, China
| | - Sofie Bäärnhielm
- Transcultural Centre, North Stockholm Psychiatric Clinic, Stockholm, Sweden. .,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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25
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Kim JHJ, Tsai W, Kodish T, Trung LT, Lau AS, Weiss B. Cultural variation in temporal associations among somatic complaints, anxiety, and depressive symptoms in adolescence. J Psychosom Res 2019; 124:109763. [PMID: 31443807 PMCID: PMC6709866 DOI: 10.1016/j.jpsychores.2019.109763] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 05/20/2019] [Accepted: 07/05/2019] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Jacqueline H J Kim
- Department of Psychology, University of California, Los Angeles, United States of America.
| | - William Tsai
- Department of Applied Psychology, New York University, United States of America
| | - Tamar Kodish
- Department of Psychology, University of California, Los Angeles, United States of America
| | - Lam T Trung
- Danang Psychiatric Hospital, Danang, Vietnam
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, United States of America
| | - Bahr Weiss
- Department of Psychology and Human Development, Vanderbilt University, United States of America
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Ahmad F, Maule C, Wang J, Fung WLA. Symptoms and Experience of Depression Among Chinese Communities in the West: A Scoping Review. Harv Rev Psychiatry 2019; 26:340-351. [PMID: 30407233 DOI: 10.1097/hrp.0000000000000202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Farah Ahmad
- From York University (Dr. Ahmad); North York General Hospital, Toronto (Drs. Ahmad and Fung, Mss. Maule and Wang); Department of Psychiatry, University of Toronto (Dr. Fung); Tyndale University College (Dr. Fung)
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Shared Genetic Etiology of Hwabyung (Anger Syndrome) and Somatization Symptoms in South Korean Adolescent and Young Adult Twins. Twin Res Hum Genet 2019; 22:114-119. [PMID: 31006417 DOI: 10.1017/thg.2019.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Kalibatseva Z, Leong FTL. Cultural Factors, Depressive and Somatic Symptoms Among Chinese American and European American College Students. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2018. [DOI: 10.1177/0022022118803181] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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More than a feeling: A unified view of stress measurement for population science. Front Neuroendocrinol 2018; 49:146-169. [PMID: 29551356 PMCID: PMC6345505 DOI: 10.1016/j.yfrne.2018.03.001] [Citation(s) in RCA: 507] [Impact Index Per Article: 72.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/01/2018] [Accepted: 03/14/2018] [Indexed: 12/16/2022]
Abstract
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 alone have 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.
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30
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Stone L. Disease prestige and the hierarchy of suffering. Med J Aust 2018; 208:60-62. [DOI: 10.5694/mja17.00503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022]
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Leonhart R, de Vroege L, Zhang L, Liu Y, Dong Z, Schaefert R, Nolte S, Fischer F, Fritzsche K, van der Feltz-Cornelis CM. Comparison of the Factor Structure of the Patient Health Questionnaire for Somatic Symptoms (PHQ-15) in Germany, the Netherlands, and China. A Transcultural Structural Equation Modeling (SEM) Study. Front Psychiatry 2018; 9:240. [PMID: 29997528 PMCID: PMC6028697 DOI: 10.3389/fpsyt.2018.00240] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/17/2018] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Rainer Leonhart
- Department Social Psychology and Methodology, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Lars de Vroege
- Clinical Centre of Excellence for Body Mind and Health, GGz Breburg, Tilburg, Netherlands.,Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Lan Zhang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yang Liu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Zaiquan Dong
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Rainer Schaefert
- Division of Internal Medicine, Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.,Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Sandra Nolte
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Burwood, VIC, Australia
| | - Felix Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Christina M van der Feltz-Cornelis
- Clinical Centre of Excellence for Body Mind and Health, GGz Breburg, Tilburg, Netherlands.,Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
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Jeon SW, Han C, Ko YH, Yoon SY, Pae CU, Choi J, Park YC, Kim JW, Yoon HK, Ko SD, Patkar AA, Zimmerman M. Measurement-based Treatment of Residual Symptoms Using Clinically Useful Depression Outcome Scale: Korean Validation Study. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2017; 15:28-34. [PMID: 28138107 PMCID: PMC5290726 DOI: 10.9758/cpn.2017.15.1.28] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- Sang Won Jeon
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Changsu Han
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Young-Hoon Ko
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Seo Young Yoon
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Chi-Un Pae
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joonho Choi
- Department of Psychiatry, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Yong Chon Park
- Department of Psychiatry, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jong-Woo Kim
- Department of Psychiatry, Kyung Hee University College of Medicine, Seoul, Korea
| | - Ho-Kyoung Yoon
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Seung-Duk Ko
- Department of Health Management, Hyupsung University, Hwaseong, Korea
| | - Ashwin A Patkar
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI, USA
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Xiong N, Wei J, Fritzsche K, Leonhart R, Hong X, Li T, Jiang J, Zhu L, Tian G, Zhao X, Zhang L, Schaefert R. Psychological and somatic distress in Chinese outpatients at general hospitals: a cross-sectional study. Ann Gen Psychiatry 2017; 16:35. [PMID: 29075308 PMCID: PMC5644179 DOI: 10.1186/s12991-017-0158-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/05/2017] [Indexed: 02/05/2023] Open
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 < .001). Patients with psychological distress alone and mixed distress were significantly younger and with lower monthly family income, while the proportion of female patients (80.9%) was highest in the somatic distress group. Patients with mixed distress had the most negative cognitive and behavioral characteristics [highest health anxiety (5.0 ± 1.9), lowest sense of coherence (35.5 ± 10.0), the worst doctor-patient relationship from both patients' (36.0 ± 7.3) and doctors' perspectives (23.3 ± 7.0)], as well as most impaired quality of life (41.6 ± 7.4 and 31.9 ± 10.3). In addition, compared with patients with somatic distress alone, those with psychological distress alone had lower sense of coherence, worse doctor-patient relationship, and more impaired mental quality of life, but less doctor visits. Discriminant analysis showed that gender, mental quality of life, health anxiety, sense of coherence, and frequent doctor visits were significant indicators in identifying patients with different distress patterns. CONCLUSIONS Our study found that (1) psychological distress was not rare in the Chinese general hospital outpatients, especially in those with high somatic distress; (2) patients with psychological distress alone sought less help from doctors, despite their severe psychosocial impairment; and (3) gender, health anxiety, sense of coherence, mental quality of life, and frequent doctor visits could help to identify different distress patterns.
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Affiliation(s)
- Nana Xiong
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730 People's Republic of China
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730 People's Republic of China
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Freiburg, Freiburg, Germany
| | - Rainer Leonhart
- Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Xia Hong
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730 People's Republic of China
| | - Tao Li
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730 People's Republic of China
| | - Jing Jiang
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730 People's Republic of China
| | - Liming Zhu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Guoqing Tian
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xudong Zhao
- Department of Psychosomatic Medicine, Dongfang Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lan Zhang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Rainer Schaefert
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Huang V, Beshai S, Yu M. The effects of the gender-culture interaction on self-reports of depressive symptoms: cross-cultural study among Egyptians and Canadians. PeerJ 2016; 4:e2783. [PMID: 27957403 PMCID: PMC5147018 DOI: 10.7717/peerj.2783] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/10/2016] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Vivian Huang
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Shadi Beshai
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Mabel Yu
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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35
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Dai YX, Chen MH, Chen TJ. Low prevalence of the use of the Chinese term for 'psychiatry' in the names of community psychiatry clinics: A nationwide study in Taiwan. Int J Soc Psychiatry 2016; 62:601-607. [PMID: 27444635 DOI: 10.1177/0020764016660994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Ying-Xiu Dai
- 1 Department of Family Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan, R.O.C
| | - Mu-Hong Chen
- 2 Department of Psychiatry, Taipei Veterans General Hospital, Taipei City, Taiwan, R.O.C
| | - Tzeng-Ji Chen
- 1 Department of Family Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan, R.O.C.,3 School of Medicine, National Yang-Ming University, Taipei City, Taiwan, R.O.C
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36
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Chang MXL, Jetten J, Cruwys T, Haslam C. Cultural Identity and the Expression of Depression: A Social Identity Perspective. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2016. [DOI: 10.1002/casp.2291] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
| | - Jolanda Jetten
- School of Psychology; The University of Queensland; Brisbane Queensland Australia
| | - Tegan Cruwys
- School of Psychology; The University of Queensland; Brisbane Queensland Australia
| | - Catherine Haslam
- School of Psychology; The University of Queensland; Brisbane Queensland Australia
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37
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Lau AS, Guo S, Tsai W, Nguyen DJ, Nguyen HT, Ngo V, Weiss B. Adolescents' stigma attitudes toward internalizing and externalizing disorders: Cultural influences and implications for distress manifestations. Clin Psychol Sci 2016; 4:704-717. [PMID: 28090404 PMCID: PMC5228599 DOI: 10.1177/2167702616646314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
| | - Sisi Guo
- University of California, Los Angeles
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38
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Tran AL. Neurasthenia, Generalized Anxiety Disorder, and the Medicalization of Worry in a Vietnamese Psychiatric Hospital. Med Anthropol Q 2016; 31:198-217. [DOI: 10.1111/maq.12297] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Allen L. Tran
- Department of Sociology and Anthropology; Bucknell University
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39
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Sun J, Ryder AG. The Chinese Experience of Rapid Modernization: Sociocultural Changes, Psychological Consequences? Front Psychol 2016; 7:477. [PMID: 27092093 PMCID: PMC4820454 DOI: 10.3389/fpsyg.2016.00477] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 03/17/2016] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Jiahong Sun
- Culture, Health, and Personality Lab, Centre for Clinical Research in Health and Department of Psychology, Concordia University Montreal, QC, Canada
| | - Andrew G Ryder
- Culture, Health, and Personality Lab, Centre for Clinical Research in Health and Department of Psychology, Concordia UniversityMontreal, QC, Canada; Culture and Mental Health Research Unit, Jewish General HospitalMontreal, QC, Canada
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40
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Choi E, Chentsova-Dutton Y, Parrott WG. The Effectiveness of Somatization in Communicating Distress in Korean and American Cultural Contexts. Front Psychol 2016; 7:383. [PMID: 27047414 PMCID: PMC4803738 DOI: 10.3389/fpsyg.2016.00383] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 03/03/2016] [Indexed: 12/03/2022] Open
Abstract
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.
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Affiliation(s)
- Eunsoo Choi
- Japanese Society for the Promotion Fellowship, Kokoro Research Center, Kyoto University Kyoto, Japan
| | | | - W Gerrod Parrott
- Department of Psychology, Georgetown University, Washington DC, USA
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41
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Zhou X, Peng Y, Zhu X, Yao S, Dere J, Chentsova-Dutton YE, Ryder AG. From culture to symptom: Testing a structural model of "Chinese somatization". Transcult Psychiatry 2016; 53:3-23. [PMID: 26076689 DOI: 10.1177/1363461515589708] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
"Chinese somatization" has been frequently discussed over the past three decades of cultural psychiatry, and has more recently been demonstrated in cross-national comparisons. Empirical studies of potential explanations are lacking, however. Ryder and Chentsova-Dutton (2012) proposed that Chinese somatization can be understood as a cultural script for depression, noting that the literature is divided on whether this script primarily involves felt bodily experience or a stigma-avoiding communication strategy. Two samples from Hunan province, China-one of undergraduate students (n = 213) and one of depressed psychiatric outpatients (n = 281)-completed the same set of self-report questionnaires, including a somatization questionnaire developed in Chinese. Confirmatory factor analysis demonstrated that Chinese somatization could be understood as two correlated factors: one focusing on the experience and expression of distress, the other on its conceptualization and communication. Structural equation modeling demonstrated that traditional Chinese cultural values are associated with both of these factors, but only bodily experience is associated with somatic depressive symptoms. This study takes a first step towards directly evaluating explanations for Chinese somatization, pointing the way to future multimethod investigations of this cultural script.
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42
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Lo BCY, Zhao Y, Kwok AWY, Chan W, Chan CKY. Evaluation of the Psychometric Properties of the Asian Adolescent Depression Scale and Construction of a Short Form: An Item Response Theory Analysis. Assessment 2015; 24:660-676. [PMID: 26603116 DOI: 10.1177/1073191115614393] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study applied item response theory to examine the psychometric properties of the Asian Adolescent Depression Scale and to construct a short form among 1,084 teenagers recruited from secondary schools in Hong Kong. Findings suggested that some items of the full form reflected higher levels of severity and were more discriminating than others, and the Asian Adolescent Depression Scale was useful in measuring a broad range of depressive severity in community youths. Differential item functioning emerged in several items where females reported higher depressive severity than males. In the short form construction, preliminary validation suggested that, relative to the 20-item full form, our derived short form offered significantly greater diagnostic performance and stronger discriminatory ability in differentiating depressed and nondepressed groups, and simultaneously maintained adequate measurement precision with a reduced response burden in assessing depression in the Asian adolescents. Cultural variance in depressive symptomatology and clinical implications are discussed.
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Affiliation(s)
| | - Yue Zhao
- 1 The University of Hong Kong, Hong Kong SAR
| | | | - Wai Chan
- 3 The Chinese University of Hong Kong, Hong Kong SAR
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Chentsova-Dutton YE, Choi E, Ryder AG, Reyes J. "I felt sad and did not enjoy life": Cultural context and the associations between anhedonia, depressed mood, and momentary emotions. Transcult Psychiatry 2015; 52:616-35. [PMID: 25603917 DOI: 10.1177/1363461514565850] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The meanings of "anhedonia" and "depressed mood," the cardinal emotional symptoms of major depression, may be shaped by cultural norms regarding pleasure and sadness. Thirty-two European Americans, 26 Hispanic Americans, 33 Asian Americans, and 20 Russian Americans provided reports of (a) depressive symptoms, (b) momentary emotions and pleasure, and (c) global subjective well-being. Momentary reports were collected over 10 days using handheld personal digital assistants. Reports of anhedonia were associated with heightened levels of momentary low arousal negative emotions (e.g., sadness), whereas reports of depressed mood were associated with dampened levels of momentary positive emotions (e.g., happiness). Symptoms of anhedonia and depressed mood interacted in their associations with momentary pleasure. In addition, the associations of anhedonia and depressed mood with positive emotions and life satisfaction differed across cultural groups. Specifically, these symptoms were associated with dampened positive emotions in the Asian American group only. Additionally, anhedonia was associated with dampened global life satisfaction in the European American group only. These results suggest that reports of anhedonia and depressed mood cannot be interpreted at face value as specific and culture-free indicators of emotional deficits. Instead, they appear to signal changes in the balance of positive and negative emotions, with the exact nature of these signals shaped at least in part by cultural context. This conclusion has important consequences for the clinical interpretation of depressive symptoms in multicultural societies.
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Affiliation(s)
| | | | - Andrew G Ryder
- Concordia UniversityJewish General Hospital, Montreal, Canada
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44
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Lee S, Leung CM, Kwok KP, Lam Ng K. A community-based study of the relationship between somatic and psychological distress in Hong Kong. Transcult Psychiatry 2015; 52:594-615. [PMID: 25665587 DOI: 10.1177/1363461515569756] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Although the predominantly somatic presentation of distress has been used to explain low rates of emotional illnesses and health service use in Chinese communities, this concept of somatization has not been examined by concurrently studying the profile of somatically and psychologically distressed Chinese individuals. A random population-based sample of 3014 adults underwent a structured telephone interview that examined their sociodemographic characteristics, somatic distress (Patient Health Questionnaire-15, PHQ-15), non-specific psychological distress (Kessler Scale-6, K6), health service use, and functional impairment. Four groups of individuals identified by PHQ-15 and K6 cut-off scores were compared. Results showed that PHQ-15 and K6 scores were positively correlated. The large majority of respondents (85.9%) reported both somatic and psychological distress. The proportions of Low Distress Group, Somatically Distressed Group, Psychologically Distressed Group, and Mixed Distress Group were 69.2%, 5.0%, 15.8%, and 10.0%, respectively. Specific age range, male gender, greater family income, higher education level, and retirement were associated with decreased odds of somatic and/or psychological distress. Although psychological distress best predicted impairment, somatic distress best predicted health service use. Mixed distress predicted most impairment and health service use. Thus, psychological distress and somatic distress commonly coexist across Chinese sociodemographic groups. This speaks against the conventional notion of somatization and is consistent with recent findings of a higher prevalence of emotional illnesses in Chinese people. That psychologically distressed individuals are more impaired but less inclined to seek help than somatically distressed individuals may partly explain low levels of help-seeking for mental disorders found in epidemiological studies.
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Affiliation(s)
- Sing Lee
- The Chinese University of Hong Kong
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45
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Zhou X, Min S, Sun J, Kim SJ, Ahn JS, Peng Y, Noh S, Ryder AG. Extending a structural model of somatization to South Koreans: Cultural values, somatization tendency, and the presentation of depressive symptoms. J Affect Disord 2015; 176:151-4. [PMID: 25721611 DOI: 10.1016/j.jad.2015.01.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 01/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Somatization refers to the tendency to emphasize somatic symptoms when experiencing a psychiatric disturbance. This tendency has been widely reported in patients from East Asian cultural contexts suffering from depression. Recent research in two Chinese samples have demonstrated that the local cultural script for depression, involving two aspects-the experience and expression of distress (EED) and conceptualization and communication of distress (CCD)-can be evoked to help explain somatization. Given the beliefs and practices broadly shared across Chinese and South Korean cultural contexts, the current study seeks to replicate this explanatory model in South Koreans. METHODS Our sample included 209 psychiatric outpatients from Seoul and Wonju, South Korea. Self-report questionnaires were used to assess somatization tendency, adherence to traditional values, and psychological and somatic symptoms of depression. RESULTS Results from SEM showed that the EED and CCD factors of somatization tendency were differently associated with cultural values and somatic symptoms, replicating our previous findings in Chinese outpatients. LIMITATIONS The reliance on a brief self-report measure of somatization tendency, not originally designed to assess separate EED and CCD factors, highlights the need for measurement tools for the assessment of cultural scripts in cross-cultural depression research. CONCLUSIONS The replication of the Chinese structural model of somatization in South Korea lends empirical support to the view that somatization can be understood as the consequence of specific cultural scripts. These scripts involve the experience and expression of distress as well as culturally meaningful ways in which this distress is conceptualized and communicated to others.
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Affiliation(s)
- Xiaolu Zhou
- Department of Management, Education College, Shanghai Normal University, 100 Guilin Rd., Shanghai 200234, China.
| | - Seongho Min
- Yonsei University Wonju School of Medicine, Republic of Korea
| | | | - Se Joo Kim
- Yonsei University College of Medicine, Republic of Korea
| | - Joung-Sook Ahn
- Yonsei University Wonju School of Medicine, Republic of Korea
| | | | - Samuel Noh
- Centre for Addiction and Mental Health and University of Toronto, Canada
| | - Andrew G Ryder
- Concordia University and Jewish General Hospital, Canada.
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Chen JA, Hung GCL, Parkin S, Fava M, Yeung AS. Illness beliefs of Chinese American immigrants with major depressive disorder in a primary care setting. Asian J Psychiatr 2015; 13:16-22. [PMID: 25563074 PMCID: PMC4390427 DOI: 10.1016/j.ajp.2014.12.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 11/21/2014] [Accepted: 12/14/2014] [Indexed: 11/16/2022]
Abstract
Underutilization of mental health services in the U.S. is compounded among racial/ethnic minorities, especially Chinese Americans. Culturally based illness beliefs influence help-seeking behavior and may provide insights into strategies for increasing utilization rates among vulnerable populations. This is the first large descriptive study of depressed Chinese American immigrant patients' illness beliefs using a standardized instrument. 190 depressed Chinese immigrants seeking primary care at South Cove Community Health Center completed the Explanatory Model Interview Catalogue, which probes different dimensions of illness beliefs: chief complaint, labeling of illness, stigma perception, causal attributions, and help-seeking patterns. Responses were sorted into categories by independent raters and results compared to an earlier study at the same site and using the same instrument. Contrary to prior findings that depressed Chinese individuals tend to present with primarily somatic symptoms, subjects were more likely to report chief complaints and illness labels related to depressed mood than physical symptoms. Nearly half reported they would conceal the name of their problem from others. Mean stigma levels were significantly higher than in the previous study. Most subjects identified psychological stress as the most likely cause of their problem. Chinese immigrants' illness beliefs were notable for psychological explanations regarding their symptoms, possibly reflecting increased acceptance of Western biomedical frameworks, in accordance with recent research. However, reported stigma regarding these symptoms also increased. As Asian American immigrant populations increasingly accept psychological models of depression, stigma may become an increasingly important target for addressing disparities in mental health service utilization.
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Affiliation(s)
- Justin A Chen
- Massachusetts General Hospital, Depression Clinical and Research Program, 1 Bowdoin Square 6th Floor, Boston, MA 02114, United States; South Cove Community Health Center, Department of Behavioral Health, 885 Washington St., Boston, MA 02111, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States.
| | - Galen Chin-Lun Hung
- Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States; Department of Addiction Medicine, Taipei City Psychiatric Center, Taipei City Hospital, Taiwan.
| | - Susannah Parkin
- Massachusetts General Hospital, Depression Clinical and Research Program, 1 Bowdoin Square 6th Floor, Boston, MA 02114, United States.
| | - Maurizio Fava
- Massachusetts General Hospital, Depression Clinical and Research Program, 1 Bowdoin Square 6th Floor, Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States.
| | - Albert S Yeung
- Massachusetts General Hospital, Depression Clinical and Research Program, 1 Bowdoin Square 6th Floor, Boston, MA 02114, United States; South Cove Community Health Center, Department of Behavioral Health, 885 Washington St., Boston, MA 02111, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States.
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47
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Guo F, Chen Z, Ren F. The latent structure of depression among Chinese: A taxometric analysis in a nationwide urban sample. Psych J 2014; 3:234-44. [DOI: 10.1002/pchj.72] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 08/27/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Fei Guo
- Key Laboratory of Mental Health; Institute of Psychology; Chinese Academy of Sciences; Beijing China
| | - Zhiyan Chen
- Key Laboratory of Mental Health; Institute of Psychology; Chinese Academy of Sciences; Beijing China
| | - Fen Ren
- Key Laboratory of Mental Health; Institute of Psychology; Chinese Academy of Sciences; Beijing China
- University of Chinese Academy of Sciences; Beijing China
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48
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Ma-Kellams C. Cross-cultural differences in somatic awareness and interoceptive accuracy: a review of the literature and directions for future research. Front Psychol 2014; 5:1379. [PMID: 25520688 PMCID: PMC4253951 DOI: 10.3389/fpsyg.2014.01379] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 11/11/2014] [Indexed: 01/19/2023] Open
Abstract
This review examines cross-cultural differences in interoception and the role of culturally bound epistemologies, historical traditions, and contemplative practices to assess four aspects of culture and interoception: (1) the extent to which members from Western and non-Western cultural groups exhibit differential levels of interoceptive accuracy and somatic awareness; (2) the mechanistic origins that can explain these cultural differences, (3) culturally bound behavioral practices that have been empirically shown to affect interoception, and (4) consequences for culturally bound psychopathologies. The following outlines the scope of the scientific review. Part 1 reviews studies on cultural variation in spontaneous somatic word use, linguistic expressions, traditional medical practices, and empirical laboratory studies to assess the evidence for cultural differences in somatic processes. Integration of these findings suggests a startling paradox: on the one hand, non-Western cultures consistently exhibit heightened somatic focus and awareness across a variety of contexts; on the other hand, non-Western cultures also exhibit less interoceptive accuracy in laboratory studies. Part 2 discusses the various mechanistic explanations that have been proposed to explain these cultural differences in somatic awareness and interoceptive accuracy, focusing on cultural schemas and epistemologies. Part 3 addresses the behavioral and contemplative practices that have been proposed as possible "interventions," or methods of cultivating bodily awareness and perceptual accuracy. Finally, Part 4 reviews the consequences of interoception for psychopathology, including somatization, body dysmorphia, eating disorders, and anxiety disorders.
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Kohrt BA, Rasmussen A, Kaiser BN, Haroz EE, Maharjan SM, Mutamba BB, de Jong JTVM, Hinton DE. Cultural concepts of distress and psychiatric disorders: literature review and research recommendations for global mental health epidemiology. Int J Epidemiol 2014; 43:365-406. [PMID: 24366490 PMCID: PMC3997373 DOI: 10.1093/ije/dyt227] [Citation(s) in RCA: 175] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Burgeoning global mental health endeavors have renewed debates about cultural applicability of psychiatric categories. This study's goal is to review strengths and limitations of literature comparing psychiatric categories with cultural concepts of distress (CCD) such as cultural syndromes, culture-bound syndromes, and idioms of distress. METHODS The Systematic Assessment of Quality in Observational Research (SAQOR) was adapted based on cultural psychiatry principles to develop a Cultural Psychiatry Epidemiology version (SAQOR-CPE), which was used to rate quality of quantitative studies comparing CCD and psychiatric categories. A meta-analysis was performed for each psychiatric category. RESULTS Forty-five studies met inclusion criteria, with 18 782 unique participants. Primary objectives of the studies included comparing CCD and psychiatric disorders (51%), assessing risk factors for CCD (18%) and instrument validation (16%). Only 27% of studies met SAQOR-CPE criteria for medium quality, with the remainder low or very low quality. Only 29% of studies employed representative samples, 53% used validated outcome measures, 44% included function assessments and 44% controlled for confounding. Meta-analyses for anxiety, depression, PTSD and somatization revealed high heterogeneity (I(2) > 75%). Only general psychological distress had low heterogeneity (I(2) = 8%) with a summary effect odds ratio of 5.39 (95% CI 4.71-6.17). Associations between CCD and psychiatric disorders were influenced by methodological issues, such as validation designs (β = 16.27, 95%CI 12.75-19.79) and use of CCD multi-item checklists (β = 6.10, 95%CI 1.89-10.31). Higher quality studies demonstrated weaker associations of CCD and psychiatric disorders. CONCLUSIONS Cultural concepts of distress are not inherently unamenable to epidemiological study. However, poor study quality impedes conceptual advancement and service application. With improved study design and reporting using guidelines such as the SAQOR-CPE, CCD research can enhance detection of mental health problems, reduce cultural biases in diagnostic criteria and increase cultural salience of intervention trial outcomes.
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Affiliation(s)
- Brandon A Kohrt
- Duke Global Health Institute, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA, Department of Psychology, Fordham University, New York, USA, Department of Anthropology, Department of Epidemiology, Emory University, Atlanta, GA, USA, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA, Department of Psychology, Tribhuvan University, Kirtipur, Nepal, Butabika National Referral Mental and Teaching Hospital, Kampala, Uganda, AISSR, University of Amsterdam, The Netherlands and Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew Rasmussen
- Duke Global Health Institute, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA, Department of Psychology, Fordham University, New York, USA, Department of Anthropology, Department of Epidemiology, Emory University, Atlanta, GA, USA, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA, Department of Psychology, Tribhuvan University, Kirtipur, Nepal, Butabika National Referral Mental and Teaching Hospital, Kampala, Uganda, AISSR, University of Amsterdam, The Netherlands and Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Bonnie N Kaiser
- Duke Global Health Institute, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA, Department of Psychology, Fordham University, New York, USA, Department of Anthropology, Department of Epidemiology, Emory University, Atlanta, GA, USA, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA, Department of Psychology, Tribhuvan University, Kirtipur, Nepal, Butabika National Referral Mental and Teaching Hospital, Kampala, Uganda, AISSR, University of Amsterdam, The Netherlands and Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Emily E Haroz
- Duke Global Health Institute, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA, Department of Psychology, Fordham University, New York, USA, Department of Anthropology, Department of Epidemiology, Emory University, Atlanta, GA, USA, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA, Department of Psychology, Tribhuvan University, Kirtipur, Nepal, Butabika National Referral Mental and Teaching Hospital, Kampala, Uganda, AISSR, University of Amsterdam, The Netherlands and Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sujen M Maharjan
- Duke Global Health Institute, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA, Department of Psychology, Fordham University, New York, USA, Department of Anthropology, Department of Epidemiology, Emory University, Atlanta, GA, USA, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA, Department of Psychology, Tribhuvan University, Kirtipur, Nepal, Butabika National Referral Mental and Teaching Hospital, Kampala, Uganda, AISSR, University of Amsterdam, The Netherlands and Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Byamah B Mutamba
- Duke Global Health Institute, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA, Department of Psychology, Fordham University, New York, USA, Department of Anthropology, Department of Epidemiology, Emory University, Atlanta, GA, USA, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA, Department of Psychology, Tribhuvan University, Kirtipur, Nepal, Butabika National Referral Mental and Teaching Hospital, Kampala, Uganda, AISSR, University of Amsterdam, The Netherlands and Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Joop TVM de Jong
- Duke Global Health Institute, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA, Department of Psychology, Fordham University, New York, USA, Department of Anthropology, Department of Epidemiology, Emory University, Atlanta, GA, USA, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA, Department of Psychology, Tribhuvan University, Kirtipur, Nepal, Butabika National Referral Mental and Teaching Hospital, Kampala, Uganda, AISSR, University of Amsterdam, The Netherlands and Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Devon E Hinton
- Duke Global Health Institute, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA, Department of Psychology, Fordham University, New York, USA, Department of Anthropology, Department of Epidemiology, Emory University, Atlanta, GA, USA, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA, Department of Psychology, Tribhuvan University, Kirtipur, Nepal, Butabika National Referral Mental and Teaching Hospital, Kampala, Uganda, AISSR, University of Amsterdam, The Netherlands and Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Dzokoto VA, Opare-Henaku A, Kpobi LA. Somatic Referencing and Psychologisation in Emotion Narratives: A USA–Ghana Comparison. PSYCHOLOGY AND DEVELOPING SOCIETIES 2013. [DOI: 10.1177/0971333613500875] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ameka (2002), Dzokoto and Okazaki (2006) and Guerts (2002) have observed a preponderance of somatic references in the communication of emotion in several spoken Ghanaian languages. This suggests that embodiment features prominently in Ghanaian cultural scripts of emotions. Unfortunately, the structure of English—Ghana’s official language due to its British colonial history—does not provide opportunities for somatic referencing in its emotion lexicon. How, then, do English-speaking Ghanaians express emotions, given the discrepancy between the cultural scripts and the structural limitations of the English emotion lexicon? To answer this question, 186 Ghanaian and181 American college students recalled what they considered one of their top ten most significant positive or negative emotional events, and indicated recalled physiological changes on a blank diagram of the human body. A subgroup of the larger sample provided written narratives about their most significant emotional event. Using thematic investigations and Linguistic Inquiry Word Count software, data analysis explored the nature of discourse about emotions in English, with particular focus on affective and embodied referents in the emotion narratives. Ghanaians reported fewer emotion words, but not more somatic words. The implications of the findings for somatisation are discussed.
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