Depression in the planet's largest ethnic group: the Chinese.

OBJECTIVE The authors reviewed the evidence for the claim that the Chinese tend to deny depression or express it somatically, examined the possible determinants of those characteristics, and explored implications of the findings for the diagnosis and management of depression in China and for psychiatry in the WEST: METHOD This paper reviews and interprets original studies and literature reviews considering emotional distress, depression, neurasthenia, and somatization in Chinese subjects. RESULTS Interpretation of the literature is complicated by the considerable heterogeneity among people described as "the Chinese" and by numerous factors affecting collection of data, including issues of illness definition, sampling, and case finding; differences in help-seeking behavior; idiomatic expression of emotional distress; and the stigma of mental illness. Despite difficulties in interpreting the literature, the available data suggest that the Chinese do tend to deny depression or express it somatically. CONCLUSIONS The existing evidence supports the hypothesis that the Chinese tend to deny depression or express it somatically. However, Western influences on Chinese society and on the detection and identification of depression are likely to have modified the expression of depressive illness quite sharply since the early 1980s. Analyzing these changes may provide useful insight into the evolution of the diagnosis of depression in Western and other cultures.

[1]  Tsung-Yi Lin.  Mental Disorders and Psychiatry in Chinese Culture: Characteristic Features and Major Issues , 1985 .

[2]  L. Kirmayer,et al.  Culture and Somatization: Clinical, Epidemiological, and Ethnographic Perspectives , 1998, Psychosomatic medicine.

[3]  David Healy,et al.  The Antidepressant Era , 1998 .

[4]  Sing Lee,et al.  Cultures in psychiatric nosology: The CCMD-2-R and International Classification of Mental Disorders , 1996, Culture, medicine and psychiatry.

[5]  Some Issues in the Diagnosis of Depression in China* , 1987 .

[6]  Sing Lee.  Estranged Bodies, Simulated Harmony, and Misplaced Cultures: Neurasthenia in Contemporary Chinese Society , 1998, Psychosomatic medicine.

[7]  The necessity of retaining the diagnostic concept of neurasthenia , 1989 .

[8]  G. Beard.  Neurasthenia, or Nervous Exhaustion , 1869 .

[9]  Michael Harris Bond,et al.  The social psychology of Chinese people. , 1986 .

[10]  T. Cheng.  Symptomatology of minor psychiatric morbidity: a crosscultural comparison , 1989, Psychological Medicine.

[11]  N. Sartorius,et al.  Mental illness in general health care : an international study , 1995 .

[12]  D. Wu.  Psychotherapy and Emotion in Traditional Chinese Medicine , 1982 .

[13]  Sing Lee.  The Vicissitudes of Neurasthenia in Chinese Societies: Where Will It Go From the ICD-10? , 1994 .

[14]  The diagnosis and phenomenology of neurasthenia a Shanghai study , 1989 .

[15]  D. Chan.  The Meaning of Depression: The Chinese Word Associations , 1990 .

[16]  A. Marsella,et al.  Ethnic Variations in the Expression of Depression , 1973 .

[17]  D. Takeuchi,et al.  An epidemiological study of neurasthenia in Chinese-Americans in Los Angeles. , 1997, Comprehensive psychiatry.

[18]  Arthur Kleinman,et al.  Chinese Culture and Mental Health , 1987, The Journal of Asian Studies.

[19]  A. Kleinman.  Depression, somatization and the "new cross-cultural psychiatry". , 1977, Social science & medicine.

[20]  A. Kleinman,et al.  Overview of Mental Disorders in Chinese Cultures: Review of Epidemiological and Clinical Studies , 1981 .

[21]  A. Kleinman.  Neurasthenia and depression: A study of somatization and culture in China , 1982, Culture, medicine and psychiatry.

[22]  Tsung-Yi Lin,et al.  Chinese societies and mental health , 1995 .

[23]  N. Lin,et al.  Measuring Depressive Symptomatology in China , 1989, The Journal of nervous and mental disease.

[24]  S. Sue,et al.  Lifetime and twelve-month prevalence rates of major depressive episodes and dysthymia among Chinese Americans in Los Angeles. , 1998, The American journal of psychiatry.

[25]  Comparative study of affective disorders in three Asian countries I. Differences in diagnostic classification , 1988, Acta psychiatrica Scandinavica.

[26]  A. Kleinman.  Social Origins Of Distress And Disease , 1986 .

[27]  L. Altshuler,et al.  Who seeks mental health care in China? Diagnoses of Chinese outpatients according to DSM-III criteria and the Chinese classification system. , 1988, The American journal of psychiatry.

[28]  Dan Zhang,et al.  Depression and Culture--A Chinese Perspective. , 1995 .

[29]  J. Orley,et al.  Somatization - a culture-bound or universal syndrome? , 1996 .

[30]  M M Weissman,et al.  Lifetime prevalence of specific psychiatric disorders in three sites. , 1984, Archives of general psychiatry.

[31]  B. W. Lau,et al.  Situational variations of help-seeking behavior among Chinese patients. , 1982, Comprehensive psychiatry.

[32]  V. Pearson,et al.  Goods on which one loses: women and mental health in China. , 1995, Social science & medicine.

[33]  Zheng Yanping,et al.  Styles of verbal expression of emotional and physical experiences: A study of depressed patients and normal controls in China , 1986 .

[34]  W. Tsoi.  Mental Health In Singapore and Its Relation to Chinese Culture , 1985 .

[35]  Sing Lee,et al.  Diagnosis Postponed: Shenjing Shuairuo and the Transformation of Psychiatry in Post-Mao China , 1999, Culture, medicine and psychiatry.

[36]  Arthur Kleinman,et al.  Culture, Illness, and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research , 1978 .

[37]  M. Weissman,et al.  Cross-national epidemiology of major depression and bipolar disorder. , 1996, JAMA.

[38]  R. Kessler,et al.  Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. , 1994, Archives of general psychiatry.

[39]  J. Murray,et al.  The Global Burden of Disease , 1996 .

[40]  B. Ng.  Qigong-Induced Mental Disorders: A Review , 1999, The Australian and New Zealand journal of psychiatry.

[41]  M. Bond.  Beyond the Chinese face : insights from psychology , 1991 .

[42]  Song Weizhen.  A Preliminary Study of the Character Traits of the Chinese , 1985 .

[43]  S. Sue,et al.  ASIAN AMERICANS IN THE COMMUNITY MENTAL HEALTH CARE SYSTEM , 1975 .

[44]  J. M. Xu.  Some issues in the diagnosis of depression in China. , 1987, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[45]  M. Zhang,et al.  The diagnosis and phenomenology of neurasthenia. A Shanghai study. , 1989, Culture, medicine and psychiatry.

[46]  H. Hwu,et al.  Prevalence of psychiatric disorders in Taiwan defined by the Chinese Diagnostic Interview Schedule , 1989, Acta psychiatrica Scandinavica.

[47]  H. Rin,et al.  Neurasthenia as nosological dilemma , 1989, Culture, medicine and psychiatry.

[48]  Sing Lee,et al.  Rethinking neurasthenia: The illness concepts of Shenjing Shuairuo among Chinese undergraduates in Hong Kong , 1995, Culture, medicine and psychiatry.