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The finding that people of Chinese heritage tend to emphasize somatic rather than psychological symptoms of depression has frequently been discussed in the culture and mental health literature since the 1970s. Recent studies have confirmed that Chinese samples report more somatic and fewer psychological depression symptoms compared to “Western” samples. The question remains, however, as to whether or not these effects are attributable to variation in all the constituent symptoms or to a subset. If the latter, there is the additional possibility that some symptoms might show a divergent pattern. Such findings would have implications for how cultural variations in symptom presentation are interpreted, and would also inform the cultural study of affective experiences more broadly. The current study addressed these issues in Chinese (n = 175) and Euro-Canadian (n = 107) psychiatric outpatients originally described by Ryder et al. (2008). Differential item functioning (DIF) was used to examine whether specific somatic and psychological symptoms diverged from the overall patterns of cultural variation. Chi-square analyses were used to examine atypical somatic symptoms (e.g., hypersomnia), previously neglected in this literature. No DIF was observed for the typical somatic symptoms, but Euro-Canadians reported greater levels of atypical somatic symptoms, and showed higher rates of atypical depression. DIF was observed for psychological symptoms—the Chinese reported high levels of “suppressed emotions” and “depressed mood,” relative to their overall psychological symptom reporting. Chinese outpatients also spontaneously reported “depressed mood” at similar levels as the Euro-Canadians, contrary to prevailing ideas about Chinese unwillingness to discuss depression. Overall, the findings provide a more nuanced picture of how culture shapes symptom presentation and point toward future studies designed to unpack cultural variation in narrower subsets of depressive symptoms.

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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