Cultural variation in temporal associations among somatic complaints, anxiety, and depressive symptoms in adolescence

Abstract Objective Different domains of internalizing symptoms (somatic complaints, anxiety, depression) often occur concurrently, suggesting that they may share common etiology. In longitudinal analyses of internalizing symptoms among youth, anxiety is often found to precede depression. However, relatively few studies have also assessed how somatic problems, the third symptom domain, are involved in longitudinal patterns of internalizing symptoms. In addition, temporal relations among internalizing symptom domains may vary by cultural group as somatic symptoms are posited to be a more culturally-normative way of communicating or experiencing distress in non-Western, interdependent cultures. Thus, the present study examined longitudinal relations among these three internalizing symptom domains in three ethnocultural adolescent samples. Methods 304 European American, 420 Vietnamese American, and 717 Vietnamese adolescents' self-reported internalizing symptoms (somatic, anxiety, depressive) were assessed at three timepoints spaced 3 months apart using multigroup cross-lagged path models. Results Anxiety symptoms consistently predicted increases in depressive symptoms in European American adolescents. In contrast, among Vietnamese and Vietnamese American adolescents, the most consistent relation was somatic symptoms predicting increases in anxiety. Anxiety and depressive symptoms bidirectionally predicted each other among the Vietnamese and Vietnamese American adolescents. Conclusions Cultural differences were evident in the temporal course of internalizing symptoms. The pattern of results have implications for culturally relevant early intervention targets, during a developmental period of risk for internalizing disorders.