Jessica Dere

Cross-Cultural Examination of Measurement Invariance of the Beck Depression Inventory-II

Given substantial rates of major depressive disorder among college and university students, as well as the growing cultural diversity on many campuses, establishing the cross-cultural validity of relevant assessment tools is important. In the current investigation, we examined the Beck Depression Inventory-Second Edition (BDI-II; Beck, Steer, & Brown, 1996) among Chinese-heritage (n = 933) and European-heritage (n = 933) undergraduates in North America. The investigation integrated 3 distinct lines of inquiry: (a) the literature on cultural variation in depressive symptom reporting between people of Chinese and Western heritage; (b) recent developments regarding the factor structure of the BDI-II; and (c) the application of advanced statistical techniques to the issue of cross-cultural measurement invariance. A bifactor model was found to represent the optimal factor structure of the BDI-II. Multigroup confirmatory factor analysis showed that the BDI-II had strong measurement invariance across both culture and gender. In group comparisons with latent and observed variables, Chinese-heritage students scored higher than European-heritage students on cognitive symptoms of depression. This finding deviates from the commonly held view that those of Chinese heritage somatize depression. These findings hold implications for the study and use of the BDI-II, highlight the value of advanced statistical techniques such as multigroup confirmatory factor analysis, and offer methodological lessons for cross-cultural psychopathology research more broadly.

Unpacking Cultural Differences in Alexithymia The Role of Cultural Values Among Euro-Canadian and Chinese-Canadian Students

The current study provides a cultural examination of alexithymia, a multifaceted personality construct that refers to a general deficit in the ability to identify and describe emotional states, and that has been linked to a number of psychiatric illnesses. Though this construct has been critiqued as heavily rooted in “Western” norms of emotional expression, it has not received much empirical attention from a cultural perspective. Recently, Ryder et al. (2008) found that higher levels of alexithymia among Chinese versus Euro-Canadian outpatients were explained by group differences in one component of alexithymia, externally oriented thinking (EOT); they proposed that Chinese cultural contexts may encourage EOT due to a greater emphasis on social relationships and interpersonal harmony rather than inner emotional experience. The current study examined the hypothesis that EOT is more strongly shaped by cultural values than are two other components of alexithymia, difficulty identifying feelings (DIF) and difficulty describing feelings (DDF). Euro-Canadian (n = 271) and Chinese-Canadian (n = 237) undergraduates completed measures of alexithymia and cultural values. Chinese-Canadians showed higher levels of EOT than Euro-Canadians (p < .001). EOT, and not DIF or DDF, was predicted by Modernization and Euro-American values in both groups. Furthermore, cultural values mediated the effect of group membership on levels of EOT. These results suggest that cultural differences in alexithymia may be explained by culturally based variations in the importance placed on emotions, rather than deficits in emotional processing. The study also raises questions about the measurement and meaning of EOT, particularly from a cross-cultural perspective.

The cultural shaping of alexithymia: values and externally oriented thinking in a Chinese clinical sample.

OBJECTIVE Alexithymia is a multi-faceted personality construct characterized by difficulties in identifying and describing emotional states. Originally based on observations of American psychosomatic patients, the construct is now studied in a variety of cultural contexts. However, few studies have critically examined alexithymia from a cultural perspective. Dere et al. [1] recently found support for the hypothesis that one alexithymia component - externally oriented thinking (EOT) - is linked to cultural values, among Euro-Canadian and Chinese-Canadian students. The current study examines this association in a Chinese clinical sample. METHODS Outpatients presenting at three hospital-based psychology clinics in Hunan province, China (N=268) completed a structured clinical interview and self-report measures of alexithymia and cultural values. All participants endorsed clinically significant levels of depressed mood, anhedonia, and/or fatigue. RESULTS As expected, EOT was negatively predicted by Modernization and Euro-American values. Two other alexithymia components, difficulty identifying feelings and difficulty describing feelings, were unrelated to cultural values. CONCLUSION These findings suggest that cultural variations in the importance placed on emotional experience must be taken into account in cross-cultural alexithymia research. Such studies should also consider separately the specific components of alexithymia; failure to do so can lead to overestimation of alexithymia in groups where scores are driven by culturally-promoted EOT.

From culture to symptom: Testing a structural model of “Chinese somatization”

“Chinese somatization” has been frequently discussed over the past three decades of cultural psychiatry, and has more recently been demonstrated in cross-national comparisons. Empirical studies of potential explanations are lacking, however. Ryder and Chentsova-Dutton (2012) proposed that Chinese somatization can be understood as a cultural script for depression, noting that the literature is divided on whether this script primarily involves felt bodily experience or a stigma-avoiding communication strategy. Two samples from Hunan province, China—one of undergraduate students (n = 213) and one of depressed psychiatric outpatients (n = 281)—completed the same set of self-report questionnaires, including a somatization questionnaire developed in Chinese. Confirmatory factor analysis demonstrated that Chinese somatization could be understood as two correlated factors: one focusing on the experience and expression of distress, the other on its conceptualization and communication. Structural equation modeling demonstrated that traditional Chinese cultural values are associated with both of these factors, but only bodily experience is associated with somatic depressive symptoms. This study takes a first step towards directly evaluating explanations for Chinese somatization, pointing the way to future multimethod investigations of this cultural script.

Personality disorders in Asians: Summary, and a call for cultural research

Epidemiological studies show relatively low rates of personality disorder (PD) in Asian-origin samples, but these low rates may result from a lack of understanding about what constitutes PD in Asian cultural contexts. Research on etiology, assessment, and treatment has rarely been extended to incorporate ways in which culture might shape PDs in general, let alone among Asians in particular. PDs did not officially change in DSM-5, but an alternative dimensional system may help link the Asian PD literature to non-clinical personality research. Personality and culture are deeply intertwined, and the research literature on Asian PDs - and on PDs more generally - would benefit greatly from more research unpacking the cultural mechanisms of variation.

Book Review: Miguel E. Gallardo & Brian W. McNeill (Eds.), Intersections of Multiple Identities: A Casebook of Evidence-based Practices with Diverse Populations. New York: Routledge, 2009. 363 pp. US

Dietrich, A. (2003). Functional neuroanatomy of altered states of consciousness: The transient hypofrontality hypothesis. Consciousness and Cognition, 12, 231–256. Hines, T. (1988). Pseudoscience and the paranormal. A critical examination of the evidence (2nd ed.). New York, NY: Prometheus Books. Ward, C. A. (Ed.) (1989). Altered states of consciousness and mental health: A cross-cultural perspective. London, UK: Sage.