Abstract

Depression is a major public health concern and a leading cause of contributor to the global burden of disease worldwide. Although a growing body of culturally informed research has documented notable variations in the nature and meaning of depression, mainstream clinical psychology largely glosses over the role of culture. An exception is the well-established finding that people of Chinese cultural heritage tend to emphasize bodily disturbances and deemphasize psychological problems. Cultural variations in the perceived value of attending to one’s own emotional experiences, along with cultural-historical differences in the social and political consequences of expressing distress psychologically, have been evoked to explain why Chinese sufferers from depression tend towards more somatic and less psychological symptom reporting in contrast to those in ‘Western’ societies. Following China’s ideological shift towards economic development, increasing research evidence indicates noteworthy sociocultural changes in individualistic values and emotional expression norms in Chinese people. Shifting cultural meanings and practices, in turn, could have important implications for understanding depression in today’s China. As such, the current project sought to examine the cultural-historical shaping of depression in the Chinese cultural context.
Study 1 surveyed the current literature on the psychological consequences of China’s rapid modernization. Two themes, including a rising importance of individualism and an increasing but unevenly distributed prevalence of depression, emerged from this review. Study 2 examined urban and rural differences in depression and unpacked these group variations through the indirect effects of education and modernization values. As expected, rural patients reported higher levels of overall depressive symptoms and somatic symptoms of depression compared to their urban counterparts. In contrast, urban patients reported higher levels of psychological symptom emphasis, education, and modernization values. Endorsement of modernization values mediated the effects of group membership on depressive symptoms. Study 3 tested the temporal effect of depressive symptom presentation in three cohorts of Chinese patients. Over time, there was an increasing emphasis on psychological symptoms of depression while levels of somatic symptom reports were maintained. The findings of this research contribute to the existing literature on culture and mental health by demonstrating cultural variations of depression in different strata of Chinese society and highlighting the impact of historical change on culturally shaped expressions of depressive symptoms.