Skip to main content

Advertisement

Log in

The phenomenon of somatization among community Chinese Americans

  • ORIGINAL PAPER
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Objective

The phenomenon of somatization was explored in relation to the experiences of acculturation, stress, support, and distress.

Methods

A representative community sample of 1,747 Chinese Americans (aged 18–65 years), selected by a multi-stage household sampling design, in the Los Angeles County was interviewed to tap their psychiatric diagnoses, symptomatology, level of acculturation, stress, and support.

Results

Across all indices, Chinese Americans’ level of somatic symptoms, impairment related to somatization, and percentage of meeting the Somatic Symptom Index 5/5 (SSI 5/5) criterion were comparable to those found in other populations. Length of residence in the U. S. and acculturation were not related to somatization. Regression analyses showed that anxiety, depression, gender, age, education, stressors, and support were significantly related to somatization, ps<0.05. Somatizers tended to perceive themselves with poor health and utilized both Western and indigenous Chinese medicine.

Conclusion

The importance of demographics, psychological distress, and stress was emphasized in the explanation of somatization tendencies among immigrant Chinese Americans. Somatization might be a stress response with regard to increased distress severity and psychosocial stressors rather than a cultural response to express psychological problems in somatic terms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Kleinman A (1980) The cultural construction of illness experience and behavior, 2: a model of somatization of dysphoric affects and affective disorders. In: Kleinman A (ed) Patients and healers in the context of culture: an exploration of the borderland between anthropology,medicine, and psychiatry. Berkeley: University of California Press; pp 146–178

  2. Mumford DB (1993) Somatization: A transcultural perspective. Int Rev Psychiatry 5(2–3):231–242

    Google Scholar 

  3. Chen D (1995) Cultural and psychological influences on mental health issues for Chinese Americans. In: Adler LL, Mukherji BR (eds) Spirit versus scalpel: traditional healing and modern psychotherapy. Westport, CN: Bergin & Garvey; pp 185–196

  4. Tabora B, Flaskerud JH (1994) Depression among Chinese Americans: a review of the literature. Issues in Mental Health Nursing 15(6):569–584

    CAS  PubMed  Google Scholar 

  5. Hong GK, Lee BS, Lorenzo MK (1995) Somatization in Chinese American clients: implications for psychotherapeutic services. J Contemporary Psychother 25(2):105–118

    Google Scholar 

  6. Chaplin SL (1997) Somatization. In: Tseng WS, Streltzer J (eds) Culture and psychopathology: a guide to clinical assessment. New York: Brunner/Mazel; pp 67–86

    Google Scholar 

  7. Cheung FM (1982) Psychological symptoms among Chinese in urban Hong Kong. Soc Sci Med 16:1339–1344

    CAS  PubMed  Google Scholar 

  8. Cheung FM, Lau BWK (1982) Situational variations of help-seeking behavior among Chinese patients. Compr Psychiatry 23(3):252–262

    CAS  PubMed  Google Scholar 

  9. Kleinman A, Kleinman J (1986) Somatization: the interconnections in Chinese society among culture, depressive experiences, and the meanings of pain. In: Kleinman A (ed) Social origins of distress and disease: depression, neurasthenia, and pain in modern China. New Haven: Yale University Press; pp 449–490

    Google Scholar 

  10. Kuo CL, Kavanagh KH (1994) Chinese perspectives on culture and mental health. Issues Ment Health Nurs 15(6):551–567

    CAS  PubMed  Google Scholar 

  11. Lin T (1982) Culture and psychiatry: a Chinese perspective. Aust N Z J Psychiatry 16(4):235–245

    CAS  PubMed  Google Scholar 

  12. Lin KM, Lau JKC, Yamamoto J, Zheng YP, Kim HS, Cho KH, Nakasaki G (1992) Hwa-byung: a community study of Korean Americans. J Nerv Ment Dis 180(6):386–391

    CAS  PubMed  Google Scholar 

  13. Escobar JI (1987) Cross-cultural aspects of the somatization trait. Hosp Comm Psychiatry 38(2):174–180

    CAS  Google Scholar 

  14. Kellner R (1990) Somatization: theories and research. J Nerv Ment Dis 178(3):150–160

    CAS  PubMed  Google Scholar 

  15. Simon G, VonKorff M, Piccinelli M, Fullerton C, Ormel J (1999) An international study of the relation between somatic symptoms and depression. N Engl J Med 341(18):1329–1335

    CAS  PubMed  Google Scholar 

  16. Cheung FM, Lau BWK, Waldmann E (1980–1981) Somatization among Chinese depressives in general practice. Int J Psychiatry Med 10(4):361–374

    Google Scholar 

  17. Cheung F (1982) Somatization among Chinese: a critique. Bull Hong Kong Psychol Soc 8:27–35

    Google Scholar 

  18. Moore LJ, Boehnlein JK (1991) Posttraumatic stress disorder, depression, and somatic symptoms in US Mien patients. J Nerv Ment Dis 179(12):728–733

    CAS  PubMed  Google Scholar 

  19. Simon GE, VonKorff M (1991) Somatization and psychiatric disorder in the NIMH Epidemiologic Catchment Area study. Am J Psychiatry 148(11):1494–1500

    CAS  PubMed  Google Scholar 

  20. Canino IA, Rubio-Stipec M, Canino G, Escobar JI (1992) Functional somatic symptoms: a cross-ethnic comparison. Am J Orthopsychiatry 62(4):605–612

    CAS  PubMed  Google Scholar 

  21. Escobar JI, Burnam A, Karno M, Forsythe A, Golding JM (1987) Somatization in the community. Arch Gen Psychiatry 44:713–718

    CAS  PubMed  Google Scholar 

  22. Ritsner M, Ponizovsky A, Kurs R, Modai I (2000) Somatization in an immigrant population in Israel: a community survey of prevalence, risk factors, and help-seeking behavior. Am J Psychiatry 157(3):385–392

    CAS  PubMed  Google Scholar 

  23. Hoover CR (1999) Somatization disorders. In: Kramer EJ, Ivey SL,Ying YW (eds) Immigrant women’s health: problems and solutions. San Francisco: Jossey-Bass; pp 233–241

    Google Scholar 

  24. Gureje O, Simon GE, Ustsun TB, Goldberg DP (1997) Somatization in cross-cultural perspective: a World Health Organization study in primary care. Am J Psychiatry 154(7):989–995

    CAS  PubMed  Google Scholar 

  25. Kirmayer LJ, Robbins JM (1991) Three forms of somatization in primary care: prevalence, co-occurrence, and sociodemographic characteristics. J Nerv Ment Dis 179(11):647–655

    CAS  PubMed  Google Scholar 

  26. Rief W, Heuser J, Mayrhuber E, Stelzer I, Hiller W, Fichter MM (1996) The classification of multiple somatoform symptoms. J Nerv Ment Dis 184(11):680–687

    CAS  PubMed  Google Scholar 

  27. Escobar JI, Rubio-Stipec M, Canino G, Karno M (1989) Somatic symptom index (SSI): a new and abridged somatization construct: prevalence and epidemiological correlates in two large community samples. J Nerv Ment Dis 177(2):140–146

    CAS  PubMed  Google Scholar 

  28. Escobar JI, Canino G (1989) Unexplained physical complaints: psychopathology and epidemiological correlates. Br J Psychiatry 154(Suppl 4):24–27

    Google Scholar 

  29. Hiller W, Rief W, Fichter MM (1995) Further evidence for a broader concept of somatization disorder using the somatic symptom index. Psychosomatics 36(3):285–294

    CAS  PubMed  Google Scholar 

  30. Takeuchi DT, Chung TC, Lin K, Shen H, Kurasaki K, Chun C, Sue S (1998) Life-time and twelve-month prevalence rates of major depressive episodes and dysthymia among Chinese Americans in Los Angeles. Am J Psychiatry 155(10):1407–1414

    CAS  PubMed  Google Scholar 

  31. Cuellar I, Harris LC, Jasso R (1980) An acculturation scale for Mexican American normal and clinical populations. Hispanic J Behav Sci 2(3):199–217

    Google Scholar 

  32. Burnam MA, Hough RL, Karno M, Escobar JI, Telles CA (1987) Acculturation and lifetime prevalence of psychiatric disorders among Mexican Americans in Los Angeles. J Health Soc Behav 28:89–102

    CAS  PubMed  Google Scholar 

  33. Szapocznik J, Scopetta MA, Aranalde M, Kurtines W (1987) Theory and measurement of acculturation. Interamerican J Psychol 12:113–130

    Google Scholar 

  34. Derogatis LR (1978) SCL-90: administration, scoring, & procedures manual for the (revised) version and other instruments of the psychopathology rating scale series. Towson, MD: John Hopkins University School of Medicine

  35. Derogatis LR, Cleary PA (1977) Confirmation of the dimensional structure of the SCL-90: a study in construct validation. J Clin Psychol 33(4):981–989

    Google Scholar 

  36. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen H, Kendler KS (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry 51:8–19

    CAS  PubMed  Google Scholar 

  37. Robins LN, Wing J, Wittchen HU, Helzer JE (1998) The Composite International Diagnostic Interview: an epidemiological instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry 45:1069–1077

    Google Scholar 

  38. Wittchen HU, Robins LN, Cottler LB, Sartorius N, Burke JD, Regier D (1991) Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The multicentre WHO/ADAMHA field trials. Br J Psychiatry 159:645–653

    CAS  PubMed  Google Scholar 

  39. Holmes TH, Rahe RH (1967) The social readjustment rating scale. J Psychosom Res 11:213–218

    Article  CAS  PubMed  Google Scholar 

  40. Grant I, Sweetwood H, Gerst MS, Yager J (1978) Scaling procedures in life events research. J Psychosom Res 22(6):525–530

    Google Scholar 

  41. Lei H, Skinner HA (1980) A psychometric study of life events and social readjustment. J Psychosom Res 24(2):57–65

    CAS  PubMed  Google Scholar 

  42. Kanner AD, Coyne JC, Schaefer C, Lazarus R (1981) Comparison of two modes of stress measurements: daily hassles and uplifts versus major life events. J Behav Med 4:1–39

    CAS  PubMed  Google Scholar 

  43. Turner RJ, Frankel G, Levin DM (1983) Social support: conceptualizations, measurement, and implications for mental health. In: Greenley JR, Simmons RG (eds) Research in community and mental health. vol 3. Greenwich: JAI Press; pp 67–111

  44. Simon G, Gater R, Kisely S, Piccinelli M (1996) Somatic symptoms of distress: an international primary care study. Psychosom Med 58(5):481–488

    CAS  PubMed  Google Scholar 

  45. Katon W, Lin E, VonKorff M, Russo J, Lipscomb P, Bush T (1991) Somatization: a spectrum of severity. Am J Psychiatry 148(1):34–40

    CAS  PubMed  Google Scholar 

  46. Rief W, Hessel A, Braehler E (2001) Somatization symptoms and hypochondriacal features in the general population. Psychosom Med 63:595–602

    CAS  PubMed  Google Scholar 

  47. Piccinelli M, Simon G (1997) Gender and cross-cultural differences in somatic symptoms associated with emotional distress. An international study in primary care. Psychol Med 27(2):433–444

    CAS  PubMed  Google Scholar 

  48. Kisely S, Goldberg D, Simon G (1997) A comparison between somatic symptoms with and without clear organic cause: results of an international study. Psychol Med 27(5):1011–1019

    CAS  PubMed  Google Scholar 

  49. Farooq S, Gahir MS, Okyere E, Sheikh AJ, Oyebode F (1995) Somatization: a transcultural study. J Psychosom Res 39(7):883–888

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Winnie W. S. Mak Ph.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mak, W.W.S., Zane, N.W.S. The phenomenon of somatization among community Chinese Americans. Soc Psychiatry Psychiatr Epidemiol 39, 967–974 (2004). https://doi.org/10.1007/s00127-004-0827-4

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-004-0827-4

Key words

Navigation