Somatization and depression among former Soviet immigrants.

Abstract: This study investigated the prevalence of pure and overlapping forms of somatization and depression in a sample of former Soviet immigrants and whether pure somatization or pure depression could be differentiated using the study variables. Study respondents completed a demographic questionnaire, the Demands of Immigration Scale, and the Symptom Checklist 90R. Respondents were classified as (a) neither depressed nor somatic, (b) only somatic, (c) only depressed, or (d) both depressed and somatic. Univariate analyses and logistical regression were used to compare these four groups and to predict the likelihood of being only depressed or only somatic. The four groups differed in terms of immigration demands, age, education, employment, and years in the U.S. A logistic regression analysis was able to classify 75% of the participants as only somatic or only depressed on the basis of certain demographic characteristics. Age, being unemployed and not looking for work, and not having a college education increased the risk of being somatic rather than depressed. Key Words: Immigration; Former Soviets; Depression; Somatization Somatization pertains to illness pictures in which bodily symptoms are overly dominant and either without a clear organic basis or out of proportion to discernible disease. Displaced psychosocial distress is implicit in the term somatization (Fabrega, 1990; Kirmayer, 1984; Kirmayer, Robbins, & Paris, 1994). In comparison with most other psychiatric diagnoses, a greater degree of inference is required for the diagnosis of somatization (Kirmayer, 1984). Research findings document that many immigrants (particularly those from developing countries, from rural areas, with refugee status, and with low education) manifest their distress over immigration difficulties through somatization (Allodi & Rojas, 1985; Crandell & Dohrenwend, 1967; Katon, Kleinman, & Rosen, 1982; Lin, Carter, & Kleinman, 1985; Lin, Ihle, & Tazuma, 1985; Mirdal, 1984; Moitoza, 1982). Some research studies have also identified recent immigrants or those who are less acculturated or more behaviorally ethnic as more likely to somaticize than their more acculturated counterparts (Angel & Guarnaccia, 1989; Katon et al., 1982; Lin, Carter et al., 1985). Somatization among immigrants is a diagnostic and research challenge for a number of reasons. First, somatization is a help seeking behavior shaped by cultural norms and beliefs, such as local idioms of distress, the health care systems people are socialized in, and the stigma of mental illness (Guarnaccia, Good, & Kleinman, 1990; Kirmayer et al., 1994; Ying, 1990). Therefore, presumed somatic tendencies among certain groups may be artifactual: People may hold a psychological conceptualization of their difficulties but may communicate somatic symptoms to health care providers because this is viewed as appropriate patient behavior (Kawanishi, 1992; Kirmayer et al., 1994; Ying, 1990). Second, somatic symptoms may be misinterpreted as psychophysiological when, in fact, they reflect the actual physical disease status (Angel & Guarnaccia, 1989; Kirmayer, 1984). Therefore, the common practice of conducting research or using clinical anecdotes from primary health care settings confounds cultural patterns of help seeking, actual physical health status, and somatization (Goldberg & Huxley, 1992; Kirmayer et al., 1994; Ying, 1990). Lastly, even when the diagnosis of somatization is accurate, another diagnostic challenge involves determining the type of underlying psychiatric disorder (Katon et al., 1982; Kirmayer, 1984). For instance, Kirmayer and Robbins (1991) found that the majority of patients who sought primary care for somatic complaints were clinically depressed. Even so, they cautioned that somatization is not a unitary construct but potentially encompasses a number of nonoverlapping psychiatric conditions. The challenge of diagnosing somatization is particularly relevant for former Soviet immigrants. …