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 d eterminants of those characteristics, and explored implications of the find ings for the diagnosis and management of depression in China and for psychi atry in the West. Method: This paper reviews and interprets original studies and literature r eviews considering emotional distress, depression, neurasthenia, and somati zation in Chinese subjects. Results: Interpretation of the literature is complicated by the considerabl e heterogeneity among people described as "the Chinese" and by numerous fac tors 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. Despit e difficulties in interpreting the literature, the available data suggest t hat 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 influe nces on Chinese society and on the detection and identification of depressi on are likely to have modified the expression of depressive illness quite s harply since the early 1980s. Analyzing these changes may provide useful in sight into the evolution of the diagnosis of depression in Western and othe r cultures.