Cultural variation in temporal associations among somatic complaints, anxiety, and depressive symptoms in adolescence
Open accessAbstract
Objective: Different domains of internalizing symptoms (somatic, anxiety, depressive) often occur concurrently, suggesting that they may share common etiology. In longitudinal analyses of internalizing among youth, anxiety is often found to precede depression. However, relatively few studies have also assessed how somatic problems, the third symptom domain, are involved in longitudinal patterns of internalizing. In addition, temporal relations among internalizing symptom domains may vary by cultural group as somatic symptoms are posited to be a more culturally-normative way of communicating or experiencing distress in non-Western, interdependent cultures. Thus, the present study examined longitudinal relations among these three internalizing symptom domains in three ethnocultural adolescent samples. Methods: 304 European American, 420 Vietnamese American, and 717 Vietnamese adolescents’ self-reported internalizing symptoms (somatic, anxiety, depressive) were assessed at three time points, spaced three months apart, using multigroup cross-lagged path analysis. Results: Anxiety symptoms consistently predicted increases in depressive symptoms in European American adolescents. In contrast, for Vietnamese and Vietnamese American adolescents, the most consistent relation was with somatic complaints predicting increases in anxiety. Anxiety and depressive symptoms bidirectionally predicted each other among the Vietnamese and Vietnamese American adolescents. Conclusions: Cultural group differences were evident in the temporal course of internalizing symptoms. The pattern of results have implications for culturally relevant intervention targets, during a developmental period of risk for internalizing disorders.
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CBT reduces both panic frequency and sleep-related anxiety in PD, supported by multiple RCTs and meta-analyses.
“CBT directly targets the cognitive distortions and catastrophic thinking that sustain panic symptoms, and remains one of the most extensively validated interventions for PD, supported by multiple RCTs and meta-analyses demonstrating efficacy in reducing both panic frequency and sleep-related anxiety [108-110].”
From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [110]
The Introduction discusses associations among somatic complaints, anxiety, and depression, while Methods > Analysis describes a longitudinal analysis of adolescent symptoms (page numbers not provided). Searches for CBT, panic frequency, sleep-related anxiety, and treatment trials found no passage addressing the claimed efficacy in panic disorder. (LLM, conf=0.78)
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Mao, B., Kanjanarat, P., Wongpakaran, T., Permsuwan, U., & O’Donnell, R. R. (2023) · Healthcare · doi:10.3390/healthcare11152174 · Cited by 7 · see citing works
“Notably, somatic symptoms are culturally sensitive [75,76], and many emotional expressions in the Chinese language fail to make a clear distinction between physical symptoms and psychological distress [77].”
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“Also, cultural context might change the importance of somatic symptoms in the interaction between anxiety and depression (Escovar et al., 2018; Kim et al., 2019; Park & Kim, 2020).”
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“For instance, the observed medium correlation between somatic symptoms and wellbeing might be contextualized within the broader literature, which suggests that somatic symptoms can manifest independently of subjective wellbeing levels due to cultural, psychosocial, or physiological factors (46).”
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“This fi nding supports the well-established literature on the stability of somatic symptom levels across childhood and adolescence (Janssens et al., 2010; Kim et al., 2019).”
Yoon, H., Lee, E., Hwang, S.-T., Hong, S.-H., & Kim, J. (2022) · The Korean Journal of Clinical Psychology · doi:10.15842/kjcp.2022.41.2.001 · Cited by 3 · see citing works
Self-citationMorujão, C., & Leite, Â. M. T. (2023) · Philosophical Psychology · doi:10.1080/09515089.2023.2241498 · Cited by 3 · see citing works
“J. H. Kim et al. (2019) considered that the way patients communicate somatic symptoms is the result of specific local culture influences, as they are considered a more culturally normative way to communicate or experience pain compared Malaysian Chinese and Euro-Australian depressed outpatients.”
Leadership and Faculty Burnout in Allied Healthcare Education: A Scoping Review
Sreedharan, J. K., & Alqahtani, A. (2025) · Healthcare · doi:10.3390/healthcare13212810 · Cited by 2 · see citing works
“Several studies examined interaction effects between personality traits and contextual factors, with preliminary evidence suggesting that certain personality traits may buffer negative effects of challenging work environments [32].”
Kil, H., Longpré, C., & Mageau, G. A. (2023) · Development and Psychopathology · doi:10.1017/s095457942300007x · Cited by 2 · see citing works
“In particular, DP may manifest differently in children of Asian American backgrounds given that individuals from these groups have been shown to experience heightened somatization problems (Kim et al., 2019; Ryder et al., 2008).”
Stigma Surrounding Depression in Different Cultures
Atif, S., & Sajid, A. (2024) · Allied Medical Research Journal · doi:10.59564/amrj/02.01/026 · Cited by 2 · see citing works
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“These criteria do not account for the variability of the construct and its presentations across cultures, such as increased somatic complaints in some depressed populations (Kim et al., 2019).”
Somatic signals of depression in Asian American college and community sample: ROC curve analysis
Suh, H. N. (2025) · Counselling Psychology Quarterly · doi:10.1080/09515070.2025.2517064 · Cited by 1 · see citing works
“…a belief that is deeply embedded within the Asian cultures (Lee et al., 2007), the strong relationship between somatic symptoms and depression has been well observed among Asians and Asian Americans (e.g. Akutsu & Chu, 2006; J. H. Kim et al., 2020; Mak & Zane, 2004; Novick et al., 2013).”
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FACTORS INFLUENCING DEPRESSIVE DISORDERS OF ADOLESCENTS IN VIETNAM
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“, investigated cultural differences in the temporal relationships between somatic complaints, anxiety, and depressive symptoms in adolescents [60].”
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- Authors
- Kim, J. H. J., Tsai, W., Kodish, T., Trung, L. T., Lau, A. S., & Weiss, B.
- Affiliations
- University of California, Los Angeles (US)
- New York University (US)
- Vanderbilt University (US)
- Corresponding author
- Kim, Jacqueline H.J.
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2019-09
- Volume
- 124
- Pages
- 109763
- ISSN
- 0022-3999 (ISSN-L)
- PMC
- PMC6709866
- OpenAlex
- W2954863263
- Semantic Scholar
- 9635ca2338087a80f1cbe60a706bf272d2d8b12d
- Cited by
- 38
- References
- 69
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 6 · 2023: 6 · 2022: 8 · 2021: 5 · 2020: 1
- FWCI
- 4.08
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- University of California, Los Angeles (5 T32 MH015750)
- Asian American Studies Center, University of California Los Angeles
- National Institute of Mental Health (5 T32 MH015750, R01 MH077697)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- somatic symptoms, anxiety symptoms, depressive symptoms, internalizing problems, adolescents, cultural variation, temporal association, European American adolescents, interdependent culture, emotion regulation, emotional expression
- MeSH terms
- Medically Unexplained Symptoms, Adolescent, Anxiety, Culture, Depression, Female, Humans, Male, Self Report
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