Interpretation of symptom presentation and distress. A Southeast Asian refugee example.

Symptom expression or the manifestation of distress is greatly influenced by one's cultural background. This exploratory study investigated symptom presentation of distress among a community sample of Vietnamese, Chinese-Vietnamese, Cambodian, and Lao refugees. The study examined whether or not the Western-designed distress measure used in the study was culturally sensitive enough to accurately capture culturally framed expressions of distress. The results of the factor analyses showed that the four Southeast Asian refugee groups did not express distress in three separate factors as devised in the original measure. Instead, a single robust factor emerged. The single factor comprised items from the depression, anxiety, somatic, and psychosocial dysfunction subscales. The items that made up the single factor strongly resemble the construct for the diagnosis of neurasthenia. Researchers have found neurasthenia to be a culturally sanctioned Asian cultural idiom of distress. The findings strongly suggested that this Southeast Asian refugee population expressed distress in a pattern of symptoms more consistent with Asian nosology. The clinical and research implications of the results of this exploratory study are also discussed.