近年来跨文化研究报告显示，相对与西方的抑郁症患者，中国抑郁症患者更倾向于报告自己的躯体症状。这种以更注重躯体症状的认知行为模式在别的精神疾病中也存在吗？比如焦虑。在全世界范围内，焦虑和抑郁是最常见的情绪障碍，它们之间也有很多关联。有报告显示60%-70%的重症抑郁病人也同时患有焦虑症。基于它们共病性，我们预计相类似的强调躯体症状的认知行为模式在焦虑症中也会存在。有研究表示，在中国，焦虑的病人更倾向于说明其心理症状，而欧洲和加拿大的同行却发现他们的病人在报告焦虑状态时更倾向于说明其躯体症状。为了进一步检验这个结果，我们想把中国的抑郁焦虑患者和加拿大的抑郁焦虑患者放在一起做一个混合研究，人群选取城市为中国长沙和加拿大蒙特利尔。我们将分别在这两座城市招募100-150名精神科门诊病人来完成问卷，并抽取其中的30名来做一个对抑郁和焦虑定义的深度访谈。第一步是通过抑郁和焦虑量表来评估症状变化。第二步是通过面对面的非结构性访谈去探究病人对他们自身疾病的解释和看法，尤其是想探寻在汉语语境中焦虑中被支持心理症状可能起到重要的亲社会功能。这个研究将会帮助我们更好的理解不同文化对于共同情绪障碍的解释。

Cross-cultural variations in the experience and reporting of emotional distress is a topic of substantial clinical and empirical interest.The most frequently cited example of such variation is the finding that people of Chinese heritage tend to emphasize somatic symptoms of depression. Recent cross-cultural studies supported the notion that Chinese psychiatric patients were more likely to report somatic symptoms in the presentation of depression, compared to their ‘Western’ counterparts (e.g., Ryder et al., 2008). However, can this pattern of somatic symptom reporting of depression be generalized to other psychiatric disorders, such as anxiety?. Anxiety and depression are among the most frequently experienced mental health problems worldwide, and there is a considerable association between them. For example, reports from North America and China showed that 60% to 70% of patients with lifetime major depression also has an anxiety disorder (Kessler et al., 2011; Shi et al., 2009). Given the frequent co-morbidity and symptom overlap of depression and anxiety disorders, we could expect that a similar pattern of somatic symptom emphasis can also be found with anxiety disorders. However, there is preliminary evidence from China suggesting that both somatic and psychological symptoms of anxiety are commonly reported. For example, Zhu and colleagues (2011) found that, contrary to expectation, Chinese psychiatric outpatients reported significantly higher levels of psychological symptoms of anxiety, including worry and obsessions, whereas their Euro-Canadian counterparts reported significantly higher levels of somatic symptoms of anxiety. In addition, Zhu and colleagues reported that anxiety about causing discomfort to others was strongly associated with psychological symptoms of social anxiety in Chinese patients (xiongzhao,zhu et al.,2014). These findings suggest that, in a predominantly interdependent sociocultural context, psychological symptoms of anxiety, such as worry about friends, are effective means of expressing concern about and sensitivity to others, thereby serving important prosocial functions in maintaining social harmony. . In order to further test these ideas, we are proposing a mixed method study of anxiety and depression in Chinese psychiatric outpatients from Changsha, Hunan province, China, and Canadian psychiatric outpatients from Montreal, Quebec, Canada. Our goal is to recruit approximately 100 to 150 psychiatric outpatients from each site for the questionnaires component, and invite 30 of them for an in-depth interview focused on explanations of anxiety and depression. The first objective is to examine symptom variations in the presentation of depression and generalized anxiety using questionnaires. In line with previous reports, we hypothesized that Chinese psychiatric patients who are primarily suffering from depression, compared to Canadian patients, will report higher levels of somatic symptoms compared to psychological symptoms. In contrast, we posited that Chinese patients who are primarily concerned with anxiety, compared to their Canadian counterparts, will report higher levels of psychological symptoms compared to somatic symptoms. The second objective is to explore patients’ causal explanations of their illnesses using unstructured face-to-face interview. Specifically, the current project seeks to test the idea that endorsing psychological symptoms of anxiety may serve important prosocial functions in the Chinese context. If so, patients with anxiety, compared to those with depression, would be more likely to explain their suffering in relation to their significant others, rather than as a result of personal failure. In summary, findings from this study will help us better understand the presentations of and explanations for common psychological distress in adults from Chinese and Canadian societies.

大量的证据表明，文化因素不仅影响着个体的社会行为准则，也影响着个体的病理心理。跨文化研究结果显示抑郁症的症状表现特征存在着文化差异（Ryder et al., 2008），相对与西方的抑郁症患者，中国抑郁症患者更倾向于报告自己的躯体症状，即中国的抑郁症患者更多地以躯体化的形式表现其抑郁情绪与不适。而近年来发现，这种以更关注躯体症状的认知行为模式存在于其他的精神疾病中。在全世界范围内，焦虑和抑郁是最常见的情绪障碍，而且两者高度共病，有报告显示60%-70%的重症抑郁病人也同时患有焦虑症。基于它们的高共病性，相类似的强调躯体症状的认知行为模式也可能存在于焦虑症患者中。来自中国的初步证据表明，焦虑病人会同时汇报自己的躯体症状和心理症状。朱熊兆教授和她的团队（2011）研究发现，精神心理门诊的患者会报告较高水平的焦虑，而且焦虑患者在生活中人际关系的不适与其社会焦虑水平密切相关。这些研究结果提示，在相互依赖的集体主义社会文化背景下，焦虑的心理状态比如担心，是表达对他人友好的有效手段，在维持社会和谐方面发挥着重要的亲社会功能。为了进一步检验在不同文化背景下的患者对抑郁和焦虑的表达是否存在上述差异，在我们与加拿大的合作研究中选取了以东方文化为代表的中国长沙的抑郁焦虑患者和以西方文化为代表的加拿大蒙特利尔的抑郁焦虑患者进行对照研究，以探究东西文化对抑郁焦虑症状表现特征的影响。目前我们已与加拿大Concordia大学Andrew G.Ryder教授的团队一起在继2003、2009年起合作研究的基础上，新完成中国抑郁焦虑患者（120名）以及加拿大抑郁焦虑患者（30名）的症状自我报告，问卷填写和临床结构性访谈资料的收集，以探索东西文化背景下抑郁焦虑患者的症状表现特征以及时代变迁对东西方化背景下抑郁焦虑患者症状表现特征的影响。本项目得到了中国国家自然科学基金委(NSFC)和加拿大魁北克健康研究基金(FRQS)共同资助，用于支持本研究的开展及中国和加拿大双方的研究人员短期（3个月）的交流互访，加拿大研究人员与中国研究人员已分别于2015年9月至12月和2016年9月至12月完成了三个月的学术互访，包括开展实验研究和学术交流等。本项目投入经费6.52万元，支出6.52万元，各项支出与预算符合。