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Chinese Depression and Acculturation Continued...

As a result of these differences, the Chinese conception of depression is likely to integrate the body, psyche, and social relationship, while the American conception is likely to differentiate these. In addition, Chinese people tend to minimize positive self-concept and positive affect, while Americans admire a positive sense of self and open expression of positive emotion.

As most Chinese Americans are either immigrants or children of immigrants, it is likely that, by and large, their conception of self and depression would reflect an integration of body, psyche, and social relationships, with minimization of positive affect. This hypothesis was tested in a community sample of 360 Chinese American adults. The participants varied greatly in educational level, ranging from no formal schooling to postgraduate education. In addition, the sample included a large number of immigrants (76%) and recent arrivals (25% have been in the US for less than 5 years). Using the Center for Epidemiologic Studies-Depression Scale (CES-D), three factors were identified: depressed affect/vegetative signs, positive affect, and interpersonal/vegetative/ depressed. Notably, two of these factors were conceptually mixed, suggesting that Chinese Americans, on the whole, may continue to hold a body-mind and self-other integrated conception of depression, consistent with Chinese cultural views and values.

The Chinese American population is a heterogeneous one, of course, and with acculturation, a more differentiated conception of depression, approximating that of white Americans, may emerge. A study assessing the conception of depression in 353 bicultural Chinese American college students (64% were immigrants) using the CES-D identified five conceptually pure factors of depression: depressed affect, positive affect, somatic/retarded, interpersonal, and somatic. The Chinese American college students' conception of depression were more similar to that of white American adults than to the Chinese American community. Two confirmatory factor analyses provided empirical support that the Chinese Americans students had a better fit with white Americans' differentiated conception than the Chinese American general community sample's integrated view.

As Chinese Americans vary in their conception of depression, careful assessment of the client's problem conceptualization prior to embarking on psychological intervention is recommended. Clients with an integrated conception may prefer an intervention that concurrently addresses psychological, physical, and interpersonal distress. This may include problem-solving oriented and supportive psychotherapy, the practice of chi-gong and tai-chi, and consultation with practitioners of traditional Chinese medicine. In contrast, clients with a differentiated conception of depression may require less modification of traditional psychotherapy techniques. Still, it has been noted that even acculturated Chinese American clients (e.g., those with American college and postgraduate education) in insight-oriented psychotherapy attend to their social relationships significantly more than white Americans, suggesting the persistence of a collectivistic sense of self. Clearly, more research is needed to identify means for increasing therapy effectiveness with even acculturated Chinese Americans.

Excerpted from Yu-Wen Ying (2000), "The Conception of Depression in Chinese Americans," in K. S. Kurasaki, S. Okazaki, and S. Sue (eds.), Asian American Mental Health: Assessment Theories and Methods, Kluwer Academic Publishers.