Understanding Cultural Influences on Depression by Analyzing a Measure of Its Constituent Symptoms

To examine the different understandings of depression between Chinese and Americans, we employed confirmatory factor analysis, multidimensional scaling, and hierarchical cluster analysis of the symptom measure provided by the Center for Epidemiologic Studies-Depression Scale (CES-D). The present study revealed a different center-periphery scatter pattern of the twenty items of the CES-D in the two cultural groups, such that Chinese made a clearer discrimination between the affective/interpersonal and somatic items, while Americans conflated such items. Moreover, Chinese tended to further separate somatic symptoms into two subdivisions: subjective symptoms and objective symptoms. These results demonstrate that the conceptual organization of the symptoms characterizing depression is culture-related, suggesting culturally appropriate modifications in its clinical practice.