AccScience Publishing / JCBP / Online First / DOI: 10.36922/JCBP025100019
Submit to JCBP
Cite this article
3
Download
70
Views
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
ORIGINAL RESEARCH ARTICLE

Cross-cultural insights into psychosomatic symptoms, depression, and anxiety: A comparative study of China and Pakistan

S. Mudasser Shah1,2 ,  Chand Taneja3,4 ,  Chenguang Jiang2 ,  Wei Xu2 ,  Sun Taipeng2 ,  Chen Gang2 ,  Tianyu Wang2 ,  Wenhao Jiang2* ,  Yonggui Yuan2,5*
Show Less
1 Department of Psychology, Institute of Developmental Psychology, Beijing Normal University, Beijing, China
2 Department of Psychosomatics and Psychiatry, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
3 Department of Psychology and Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
4 Department of Neuropsychology Program, Queen Alexandra Center for Children’s Health, Victoria, British Columbia, Canada
5 Department of Psychosomatics and Psychiatry, Zhongda Hospital, School of Medicine, Jiangsu Provincial Key Laboratory of Brain Sciences and Medicine, Southeast University, Nanjing, Jiangsu, China
JCBP, 025100019 https://doi.org/10.36922/JCBP025100019
Received: 6 March 2025 | Revised: 9 April 2025 | Accepted: 4 June 2025 | Published online: 9 July 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Download PDF
Cite
XML
Abstract

Psychosomatic refers to an illness in which stress causes or exacerbates physical symptoms, and it may occur in transient or along with more acute mood disorders. The current study aimed to enhance understanding of the prevalence and cultural factors affecting psychosomatic symptoms, depression, and anxiety in China and Pakistan. A comparative cross-cultural study was conducted using a non-probability sampling technique. A total of 1633 samples were collected, including 598 healthy controls (300 from China and 298 from Pakistan) and 1035 patients (521 from China and 514 from Pakistan). Three assessment tools were utilized: Psychosomatic symptom scale (PSSS), patient health questionnaire-9, and generalized anxiety disorder-7. There were significant differences in the symptoms of patients and control groups with psychosomatic symptoms, depression, and anxiety in both countries. Post hoc testing revealed that Pakistani patients with mood disorders reported more psychosomatic symptoms than Chinese patients (p<0.001), whereas the Chinese control group had more psychosomatic symptoms than the Pakistani control group (p=0.001). Analysis of PSSS ratings in Chinese patients demonstrated a strong correlation between “depressed mood” and “loss of interest.” Pakistani PSSS displayed strong correlations on the somatic subscale and psychological subscale. In the present study, Pakistani patients exhibited higher levels of psychosomatic complaints, depression, and anxiety compared to Chinese patients. Notably, network analysis reveals that Pakistani patients displayed more physical symptoms, whereas Chinese patients experienced more psychological symptoms.

Keywords
Psychosomatics
Depression
Anxiety
Cross-cultural
China
Pakistan
Network analysis
Funding
None.
Conflict of interest
Yonggui Yuan is the Editor-in-Chief and Wenhao Jiang is the Associate Editor of this journal, but were not in any way involved in the editorial and peer-review process conducted for this paper, directly or indirectly. Separately, other authors declared that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.
References
  1. Bauer AM, Bonilla P, Grover MW, Meyer F, Riselli C, White L. The role of psychosomatic medicine in global health care. Curr Psychiatry Rep. 2011;13(1):10-17. doi: 10.1007/s11920-010-0162-2

 

  1. Andreas S, Schulz H, Volkert J, et al. Incidence and risk factors of mental disorders in the elderly: The European MentDis_ ICF65+ study. Aust N Z J Psychiatry. 2022;56(5):551-559. doi: 10.1177/00048674211025711

 

  1. Fischbein JE. Psychosomatics: A current overview. Int J Psychoanalysis. 2011;92(1):197-219. doi: 10.1111/j.1745-8315.2010.00389.x

 

  1. Barsky AJ, Borus JF. Functional somatic syndromes. Ann Intern Med. 1999;130(11):910-921. doi: 10.7326/0003-4819-130-11-199906010-00016

 

  1. Gatchel RJ. Comorbidity of chronic pain and mental health disorders: The biopsychosocial perspective. Am Psychol. 2004;59(8):795-805. doi: 10.1037/0003-066X.59.8.795

 

  1. Engel GL. The need for a new medical model: A challenge for biomedicine. Science (New York). 1977;196(4286):129-136. doi: 10.1126/science.847460

 

  1. Dimsdale JE. Psychological stress and cardiovascular disease. J Am Coll Cardiol. 2008;51(13):1237-1246. doi: 10.1016/j.jacc.2007.12.024

 

  1. Morton L, Elliott A, Thomas R, Cleland J, Deary V, Burton C. Developmental study of treatment fidelity, safety and acceptability of a Symptoms Clinic intervention delivered by General Practitioners to patients with multiple medically unexplained symptoms. J Psychosom Res. 2026;84:37-43. doi: 10.1016/j.jpsychores.2016.03.008

 

  1. Cosma A, Stevens G, Martin G, et al. Cross-national time trends in adolescent mental well-being from 2002 to 2018 and the explanatory role of schoolwork pressure. J Adolesc Health. 2020;66(6S):S50-S58. doi: 10.1016/j.jadohealth.2020.02.010

 

  1. Joustra ML, Janssens KAM, Schenk HM, Rosmalen JGM. The four week time frame for somatic symptom questionnaires reflects subjective symptom burden best. J Psychosom Res. 2018;104:16-21. doi: 10.1016/j.jpsychores.2017.11.006

 

  1. Yue Y, Li L, Liu R, et al. The dynamic changes of psychosomatic symptoms in three waves of COVID-19 outbreak and fatigue caused by enduring pandemic in China. J Affect Disord. 2023;331:17-24. doi: 10.1016/j.jad.2023.03.032

 

  1. Fava GA, Sonino N. Psychosomatic medicine. Int J Clin Pract. 2010;64(8):1155-1161. doi: 10.1111/j.1742-1241.2009.02266.x

 

  1. Wise TN. Psychosomatic medicine: An approach needed now more than ever. Int J Clin Pract. 2010;64(8):999-1001. doi: 10.1111/j.1742-1241.2009.02268.x

 

  1. Kelley KW, Peng YP, Liu Q, et al. Psychoneuroimmunology goes East: Development of the PNIRSChina affiliate and its expansion into PNIRSAsia-Pacific. Brain Behav. Immun. 2020;88:75-87. doi: 10.1016/j.bbi.2020.04.026

 

  1. Ahmed TA, Rana MH, Tipu HN, Ahmed D, Bashir MM. Suppression of humoral immune response due to psychological stress in survivors of large scale natural disaster. Pak J Pathol. 2008;19(3):78-81.

 

  1. Hyde MK, Chambers SK, Shum DID, Dunn J. Psycho-oncology assessment in Chinese populations: A systematic review of quality of life and psychosocial measures. Eur J Cancer. 2016;25(5):691-718. doi: 10.1111/ecc.12367

 

  1. Saleem A, Khan AM, Ali SM, Abbasi AN. Filling the void: The need for psycho-oncology multidisciplinary tumour boards in hospitals across Pakistan. Int J Cancer Res Ther. 2023;8(4):170-171.

 

  1. Tang TR, Wang M, Li H, et al. Untreated depression and anxiety in patients with common skin diseases: A cross-sectional study in China. Front Psychol. 2023;14:1150998. doi: 10.3389/fpsyg.2023.1150998

 

  1. Iftikhar U, Jafferany M, Khawaja AR. Awareness and knowledge toward psychodermatology in South Asia: A Pakistani perspective. Int J Dermatol. 2020;59(6):e219-e221. doi: 10.1111/ijd.14756

 

  1. Jawwad G, Anjum AF, Rasul A, et al. Role of exercise in modulating neuroendocrine response to psychological stress. Age (years). 2021;30:6.

 

  1. Jafar TH, Jehan I, de Silva HA, et al. Multicomponent intervention versus usual care for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: Study protocol for a cluster randomized controlled trial. Trials. 2017;18(1):272. doi: 10.1186/s13063-017-2018-0

 

  1. Henningsen P. Management of somatic symptom disorder. Dialogues Clin Neurosci. 2018;20:(1):23-31. doi: 10.31887/DCNS.2018.20.1/phenningsen

 

  1. Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005;62(8):903-910. doi: 10.1001/archpsyc.62.8.903

 

  1. Donnay A, Ziem G. Prevalence and overlap of chronic fatigue syndrome and fibromyalgia syndrome among 100 new patients with multiple chemical sensitivity syndrome. J Chronic Fatigue Syndr. 1999;5(3-4):71-80.

 

  1. Keefer L, Palsson OS, Pandolfino JE. Best practice update: Incorporating psychogastroenterology into management of digestive disorders. Gastroenterology. 2018;154(5):1249-1257. doi: 10.1053/j.gastro.2018.01.045

 

  1. Miller MC. Available from: https://www.cfr.org/article/ how-china-and-pakistan-forged-close-ties [Last accessed on 2025 Apr 08].

 

  1. Khan MZU, Khan MM. China-Pakistan economic corridor: Opportunities and challenges. Strat Stud. 2019;39(2):67-82.

 

  1. Shah SM, Jahangir M, Xu W, Yuan Y. Reliability and validity of the Urdu version of psychosomatic symptoms scale in Pakistani patients. Front Psychol. 2022;13:861859. doi: 10.3389/fpsyg.2022.861859

 

  1. Li L, Peng T, Liu R, et al. Development of the psychosomatic symptom scale (PSSS) and assessment of its reliability and validity in general hospital patients in China. Gen Hosp Psych. 2020;64:1-8. doi: 10.1016/j.genhosppsych.2020.01.008

 

  1. Wang W, Bian Q, Zhao Y, et al. Reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-9) in the general population. Gen Hosp Psych. 2024;36(5):539-544. doi: 10.1016/j.genhosppsych.2014.05.021

 

  1. Ahmad S, Hussain S, Akhtar F, Shah FS. Urdu translation and validation of PHQ-9, a reliable identification, severity and treatment outcome tool for depression. J Pak Med. Assoc. 2018;68(8):1166-1170.

 

  1. Williams N. The GAD-7 questionnaire. Occup Med. 2014;64(3):224-224.

 

  1. Zeng QZ, He YL, Liu, H, et al. Reliability and validity of Chinese version of the Generalized Anxiety Disorder 7-item (GAD-7) scale in screening anxiety disorders in outpatients from traditional Chinese internal department. Chin Ment Health J. 2013;27(3):163-168.

 

  1. Ahmad S, Hussain S, Shah FS, Akhtar F. Urdu translation and validation of GAD-7: A screening and rating tool for anxiety symptoms in primary health care. J Pak Med Assoc. 2017;67(10):1536-1540.

 

  1. Borsboom D. A network theory of mental disorders. World Psychiatry. 2017;16(1):5-13. doi: 10.1002/wps.20375

 

  1. Heeren A, Jones PJ, McNally RJ. Mapping network connectivity among symptoms of social anxiety and comorbid depression in people with social anxiety disorder. J Affect Dis. 2018;228:75-82. doi: 10.1016/j.jad.2017.12.003

 

  1. Epskamp S, Borsboom D, Fried EI. Estimating psychological networks and their accuracy: A tutorial paper. Behav Res Methods. 2018;50(1):195-212. doi: 10.3758/s13428-017-0862-1

 

  1. Pan H, Liu Q. Difference of depression between widowed and non-widowed older people in China: A network analysis approach. J Affect Disord. 2021;280(Pt B):68-76. doi: 10.1016/j.jad.2020.11.058

 

  1. Wang Y, Hu Z, Feng Y, Wilson A, Chen R. Changes in network centrality of psychopathology symptoms between the COVID-19 outbreak and after peak. Mol Psychiatry. 2020;25(12):3140-3149. doi: 10.1038/s41380-020-00881-6

 

  1. Bovier PA, Chamot E, Perneger TV. Perceived stress, internal resources, and social support as determinants of mental health among young adults. Qual Life Res. 2004;13(1):161-170. doi: 10.1023/B: QURE.0000015288.43768.e4

 

  1. Campbell KA, Madva EN, Villegas AC, et al. Non-cardiac chest pain: A review for the consultation-liaison psychiatrist. Psychosomatics. 2017;58(3):252-265. doi: 10.1016/j.psym.2016.12.003

 

  1. Patel V, Chisholm D, Parikh R, et al. Addressing the burden of mental, neurological, and substance use disorders: Key messages from Disease Control Priorities, 3rd edition. Lancet. 2016;387(10028):1672-1685. doi: 10.1016/S0140-6736(15)00390-6

 

  1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. Lancet. 2006;367(9524):1747-1757. doi: 10.1016/S0140-6736(06)68770-9

 

  1. Shi S. What will the development of psychiatry in China be in 10 years? Gen Psychiatry. 2019;32(2):e100025. doi: 10.1136/gpsych-2018-100025

 

  1. Jiang W, Zhang Y, Turner JA, Yuan Y. Editorial: Psychosomatic medicine in general hospitals: Cross- Disorder and interdisciplinary collaboration. Front Psychiatry. 2022;13:1099678. doi: 10.3389/fpsyt.2022.1099678

 

  1. Yuan Y, Wu A, Jiang W. Psychosomatic medicine in China. Psychother Psychosom. 2015;84(1):59-60. doi: 10.1159/000365420

 

  1. Biswas J, Gangadhar BN, Keshavan M. Cross cultural variations in psychiatrists’ perception of mental illness: A tool for teaching culture in psychiatry. Asia J Psychiatry. 2016;23:1-7. doi: 10.1016/j.ajp.2016.05.011

 

  1. Nguyen D, Bornheimer LA. Mental health service use types among Asian Americans with a psychiatric disorder: Considerations of culture and need. J Behav Health Serv Res. 2014;41(4):520-528. doi: 10.1007/s11414-013-9383-6

 

  1. USDHHS Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General; 2001.

 

  1. Helman CG. Culture, Health and Illness. 5th ed. London: Hodder Arnold; 2007.

 

  1. Hechanova R, Waelde L. the influence of culture on disaster mental health and psychosocial support interventions in Southeast Asia. Mental Health Relig Cult. 2017;20:31-44. doi: 10.1080/13674676.2017.1322048

 

  1. Shah SM, Sun T, Xu W, Jiang W, Yuan Y. The mental health of China and Pakistan, mental health laws and COVID-19 mental health policies: A comparative review. Gen Psychiatry. 2022;35(5):e100885. doi: 10.1136/gpsych-2022-100885

 

  1. Munawar K, Abdul Khaiyom JH, Bokharey IZ, Park MS, Choudhry FR. A systematic review of mental health literacy in Pakistan. Asia Pac Psychiatry. 2020;12(4):e12408. doi: 10.1111/appy.12408

 

  1. Sadiq F, Khan Q. Barriers and challenges to mental health care in Pakistan. Pak J Neurolog Sci. 2021;16:1-2.

 

  1. Sikander S. Pakistan. Lancet Psychiatry. 2020;7(10):845. doi: 10.1016/S2215-0366(20)30387-4

 

  1. Javed A, Khan MS, Nasar A, Alina, R. Mental healthcare in Pakistan. Taiwanese J Psychiatry. 2020;24(1):6-14. doi: 10.4103/TPSY.TPSY_8_20

 

  1. Gitlin MJ, Miklowitz DJ. The difficult lives of individuals with bipolar disorder: A review of functional outcomes and their implications for treatment. J Affect Disord. 2017;209: 147-154. doi: 10.1016/j.jad.2016.11.021

 

  1. Miziou S, Tsitsipa E, Moysidou S, et al. Psychosocial treatment and interventions for bipolar disorder: A systematic review. Ann Gen Psychiatry. 2015;14:19. doi: 10.1186/s12991-015-0057-z

 

  1. Liang D, Mays VM, Hwang WC. Integrated mental health services in China: challenges and planning for the future. Health Policy Plan. 2018;33(1):107-122. doi: 10.1093/heapol/czx137

 

  1. Zhang X, Zhang X, Chen X. Happiness in the air: How does a dirty sky affect mental health and subjective well-being? J Environ Econom Manag. 2017;85:81-94. doi: 10.1016/j.jeem.2017.04.001

 

  1. Liu W, Alt M, Pittsinger R. The role of the Social Class Worldview Model in the assessment, diagnosis, and treatment of mental and physical health. In: Handbook of Multicultural Mental Health: Assessment and Treatment of Diverse Populations. 2nd ed. United States: Academic Press; 2023. p. 111-125.

 

  1. Augsberger A, Yeung A, Dougher M, Hahm HC. Factors influencing the underutilization of mental health services among Asian American women with a history of depression and suicide. BMC Health Serv Res. 2015;15:542. doi: 10.1186/s12913-015-1191-7

 

  1. Saw A, Yi SS, Ðoàn LN, et al. Improving Asian American health during the syndemic of COVID-19 and racism. EClinicalMedicine. 2022;45:101313. doi: 10.1016/j.eclinm.2022.101313

 

  1. Lee J, Howard JT. Increased self-reported mental health problems among Asian-Americans during the COVID-19 pandemic in the United States: Evidence from a nationally representative database. J Racial Ethn Health Dispar. 2023;10(5):2344-2353. doi: 10.1007/s40615-022-01414-3

 

  1. AAPI. COVID-19 Needs Assessment Project; 2023. Available from: https://www.aapicovidneeds.org/mentalhealth [Last accessed on 2024 Dec 23].

 

  1. Huang JT, Krupenkin M, Rothschild D, Lee Cunningham J. The cost of anti-Asian racism during the COVID-19 pandemic. Nat Hum Behav.2023;7(5):682-695. doi: 10.1038/s41562-022-01493-6

 

  1. Corrigan PW. Mental health stigma as social attribution: Implications for research methods and attitude change. Clin Psychol Sci Pract. 2000;7(1):48-67. doi: 10.1093/clipsy/7.1.48

 

  1. Corrigan P. How stigma interferes with mental health care. Am Psychol. 2004;59(7):614-625. doi: 10.1037/0003-066X.59.7.614

 

  1. Leong FT, Lau AS. Barriers to providing effective mental health services to Asian Americans. Mental Health Serv Res. 2001;3(4):201-214. doi: 10.1023/a:1013177014788

 

  1. Eisenberg D, Downs MF, Golberstein E, Zivin K. Stigma and help seeking for mental health among college students. Med Care Res Rev. 2009;66(5):522-541. doi: 10.1177/1077558709335173

 

  1. Griffiths KM, Nakane Y, Christensen H, Yoshioka K, Jorm AF, Nakane H. Stigma in response to mental disorders: A comparison of Australia and Japan. BMC Psychiatry. 2006;6:21. doi: 10.1186/1471-244X-6-21

 

  1. Gee CB, Khera GS, Poblete AT, Kim B, Buchwach SY. Barriers to mental health service use in Asian American and European American college students. Asian Am J Psychol. 2020;11(2):98107. doi: 10.1037/aap0000178

 

  1. Loya F, Reddy R, Hinshaw SP. Mental illness stigma as a mediator of differences in Caucasian and South Asian college students’ attitudes toward psychological counseling. J Couns Psychol. 2010;57(4):484-490. doi: 10.1037/a0021113

 

  1. Yang LH, Phelan JC, Link BG. Stigma and beliefs of efficacy towards traditional Chinese medicine and Western psychiatric treatment among Chinese Americans. Cult Divers Ethnic Minor Psychol. 2008;14(1):10-18. doi: 10.1037/1099-9809.14.1.10

 

  1. David EJR. Cultural mistrust and mental health help-seeking attitudes among Filipino Americans. Asian Am J Psychol. 2020;1(1):57-66. doi: 10.1037/a0018814
Next article in this issue
Share
Back to top
Journal of Clinical and Basic Psychosomatics, Electronic ISSN: 2972-4414 Print ISSN: 3060-8562, Published by AccScience Publishing
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept