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Somatic Symptoms of Depression and Anxiety in the Western Pacific Region: Questions and Answers

Published online by Cambridge University Press:  07 November 2014

David M. Clarke
Dr. David M. Clarke, MBBS, PhD, FRANZCP, is professor in the Department of Psychological and Behavioural Medicine at Monash Medical Centre in Melbourne. Dr. Clarke is a consultant to Wyeth.
Ahmad Hatim
Ahmad Hatim, MBBS, MPM, is associate professor at, the University of Malaya in Kuala Lumpur. Dr. Hatim is a consultant to Janssen-Cilag, Lundbeck, and Servier; is on the advisory board of AstraZeneca, Janssen-Cilag, and Wyeth; and has received honoraria from Eli Lilly, GlaxoSmithKline, Johnson & Johnson, and Pfizer.
Brian Ho
Brian Ho, FRCPsych, MPM, MBBS, is associate professor of psychiatry at, Universiti Putra Malaysia in Kuala Lumpur. Dr. Ho is a consultant to and/or on the advisory boards of Janssen-Cilag and Wyeth; and has received honoraria from AstraZeneca and Lundbeck.
Jiyang Pan
Jiyang Pan, MD, is professor of psychiatry and chairman of the Department of Psychiatry in, the First Affiliated Hospital of Jinan University in Guangzhou. Dr. Pan is a consultant to GlaxoSmithKline, Johnson & Johnson, and Wyeth.
Chee Ng
Chee Ng, MBBS, MMed, MD, FRANZCP, is associate professor in the Department of Psychiatry at, the University of Melbourne. Dr. Ng is a consultant to and on the advisory boards of Eli Lilly and Wyeth; and has received honoraria from Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen-Cilag, and Wyeth.
Kang-Seob Oh
Kang-Seob Oh, MD, PhD, is department director of the Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan UniversityDr. Oh reports no affiliation with or relevant financial interest in any organization that may pose of conflict of interest.
Wu Wenyuan
Wu Wenyuan, MD, is professor in the Department of Psychiatry at, Tongji Univiversity in Shanghai. Dr. Wu reports no affiliation with or relevant financial interest in any organization that may pose of conflict of interest.
Mak Ki-Yan
Mak Ki-Yan, MBBS, DPM, MHA, MD, FRCPsych, is honorary professor in the Department of Psychiatry at, the University of Hong Kong. Dr. Mak reports no affiliation with or relevant financial interest in any organization that may pose of conflict of interest.


It is a commonly held belief among mental health care providers that patients from the Western Pacific region with major depressive disorder (MDD) and anxiety disorders disproportionately present with somatic symptoms as opposed to emotional symptoms. Cultural norms, such as the stigma associated with psychiatric disorders, may lead members of this population to ignore the emotional aspects of these disorders or deny the presence of psychological symptoms. Empirical support is provided by the lower prevalence of these disorders in some Western Pacific nations in relation to the rest of the world. For example, MDD rates in India (9%), Japan (2%), China (2% to 4%), Malaysia (8%) and Australia (3%) are generally lower than rates in the United States (16%) and worldwide (10%). These discrepancies may be the result of missed diagnoses. Misdiagnosis is related to the increased somatization of MDD symptoms in these populations. As defined by the WHO, the Western Pacific region consists of 37 countries with a total population of 1.8 billion people (1.3 billion in China alone) with diverse cultural backgrounds and demographic profiles, which makes the issue of cultural effects on MDD diagnosis more complex.

Patients with MDD or anxiety disorders worldwide often present with somatic symptoms, which frequently accompany psychological symptoms. For example, in a recent report of pooled data from Canada, scores on the Somatic Symptoms Inventory, the 17-item Hamilton Rating Scale for Depression (HAM-D17), and the Hamilton Rating Scale for Anxiety (HAM-A) were used to evaluate the association between somatic symptoms and MDD. Of the 2,191 patients randomly enrolled in the study, 78% reported moderate-to-severe fatigue and weakness. Painful physical symptoms commonly occur in patients with anxiety disorders as well. In a European study, painful physical symptoms were reported by 28% of those without anxiety disorders and 45% of those with anxiety disorders.

Research Article
Copyright © Cambridge University Press 2009

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