Interoception, somatic symptoms, and somatization tendency in Chinese individuals with subsyndromal depression: A follow-up study

Abstract

Interoception refers to the sensation and perception of internal bodily sensations, and may be related to depressive symptoms. Schemata concerning the body vary across different cultures and may influence interoception and symptom presentations of depression. This study explored the relationship between interoception, depressive symptoms, and schema of somatic focus in Chinese people with subsyndromal depression. Thirty-nine individuals with subsyndromal depression (SD) and 40 healthy controls (HCs) were assessed at baseline and after 3 months. Participants completed the self-report questionnaires for assessing interoceptive sensibility, somatic and psychological symptoms of depression, and somatization tendency. They also completed the heartbeat perception behavioral task for estimating interoceptive accuracy. The results showed that both the SD and the HC groups showed similar interoceptive accuracy, although the SD group showed heightened interoceptive sensibility. The discrepancy between interoceptive sensibility and interoceptive accuracy is termed the interoceptive trait prediction error (ITPE). The ITPE was positive in SD participants but was negative in HCs. In the entire sample, interoceptive sensibility and the ITPE were correlated with somatic symptoms rather than with psychological symptoms of depression. Interoceptive sensibility partially mediated the relationship between somatization tendency and somatic symptoms, after controlling for psychological symptoms of depression. These results remained stable after 3 months. The shortcomings of the present study were a lack of clinical interview to ascertain diagnosis and a short follow-up duration. In conclusion, our study suggests that altered interoception occurs in subsyndromal depression. Interoception is related to somatic symptoms of depression. The schema of body was related to depressive symptoms, partially through interoception, in Chinese people with subsyndromal depression.

Keywords

Interoception / schema of somatic focus / somatic symptoms / subsyndromal depression

References

[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.

[2] Cabrera, A., Kolacz, J., Pailhez, G., Bulbena-Cabre, A., Bulbena, A., & Porges, S. W. (2018). Assessing body awareness and autonomic reactivity: Factor structure and psychometric properties of the body perception questionnaire-short form (BPQ-SF). International Journal of Methods in Psychiatric Research, 27(2), e1596.

[3] Cheng, T. A., & Williams, P. (1986). The design and development of a screening questionnaire (CHQ) for use in community studies of mental disorders in Taiwan. Psychological Medicine, 16(2), 415–422.

[4] Chentsova-Dutton, Y. E., & Dzokoto, V. (2014). Listen to your heart: The cultural shaping of interoceptive awareness and accuracy. Emotion, 14(4), 666–678.

[5] Cheung, F. M., Cheung, S. F., & Leung, F. (2008). Clinical utility of the cross-cultural (Chinese) personality assessment inventory (CPAI–2) in the assessment of substance use disorders among Chinese men. Psychological Assessment, 20(2), 103–113.

[6] Craig, A. D. (2002). How do you feel? Interoception: The sense of the physiological condition of the body. Nature Reviews Neuroscience, 3(8), 655–666.

[7] Dunn, B. D., Dalgleish, T., Ogilvie, A. D., & Lawrence, A. D. (2007). Heartbeat perception in depression. Behaviour Research and Therapy, 45(8), 1921–1930.

[8] Dzokoto, V. A. (2010). Different ways of feeling: Emotion and somatic awareness in Ghanaians and euro-Americans. Journal of Social, Evolutionary and Cultural Psychology, 4(2), 68–78.

[9] Eggart, M., Lange, A., Binser, M. J., Queri, S., & Müller-Oerlinghausen, B. (2019). Major depressive disorder is associated with impaired interoceptive accuracy: A systematic review. Brain Sciences, 9(6), 131.

[10] Eggart, M., & Valdés-Stauber, J. (2021). Can changes in multidimensional self-reported interoception be considered as outcome predictors in severely depressed patients? A moderation and mediation analysis. Journal of Psychosomatic Research, 141, 110331.

[11] Ewing, D. L., Manassei, M., Gould van Praag, C., Philippides, A. O., Critchley, H. D., & Garfinkel, S. N. (2017). Sleep and the heart: Interoceptive differences linked to poor experiential sleep quality in anxiety and depression. Biological Psychology, 127, 163–172.

[12] Fissler, M., Winnebeck, E., Schroeter, T., Gummersbach, M., Huntenburg, J. M., Gaertner, M., & Barnhofer, T. (2016). An investigation of the effects of brief mindfulness training on self-reported interoceptive awareness, the ability to decenter, and their role in the reduction of depressive symptoms. Mindfulness, 7(5), 1170–1181.

[13] Furman, D. J., Waugh, C. E., Bhattacharjee, K., Thompson, R. J., & Gotlib, I. H. (2013). Interoceptive awareness, positive affect, and decision making in major depressive disorder. Journal of Affective Disorders, 151(2), 780–785.

[14] Garfinkel, S. N., Seth, A. K., Barrett, A. B., Suzuki, K., & Critchley, H. D. (2015). Knowing your own heart: Distinguishing interoceptive accuracy from interoceptive awareness. Biological Psychology, 104, 65–74.

[15] Garfinkel, S. N., Tiley, C., O’Keeffe, S., Harrison, N. A., Seth, A. K., & Critchley, H. D. (2016). Discrepancies between dimensions of interoception in autism: Implications for emotion and anxiety. Biological Psychology, 114, 117–126.

[16] Goldberg, D. P. (1972). The detection of psychiatric illness by questionnaire (Maudsley monograph 21). Oxford University Press.

[17] Goldberg, D. P., & Williams, P. (1988). A user’s guide to the general health questionnaire. NFER-NELSON.

[18] Harshaw, C. (2015). Interoceptive dysfunction: Toward an integrated framework for understanding somatic and affective disturbance in depression. Psychological Bulletin, 141(2), 311–363.

[19] Khalsa, S. S., Adolphs, R., Cameron, O. G., Critchley, H. D., Davenport, P. W., Feinstein, J. S., Feusner, J. D., Garfinkel, S. N., Lane, R. D., Mehling, W. E., Meuret, A. E., Nemeroff, C. B., Oppenheimer, S., Petzschner, F. H., Pollatos, O., Rhudy, J. L., Schramm, L. P., Simmons, W. K., Stein, M. B., … Interoception Summit 2016 participants. (2018). Interoception and mental health: A roadmap. Biological Psychiatry. Cognitive Neuroscience and Neuroimaging, 3(6), 501–513.

[20] Khalsa, S. S., & Lapidus, R. C. (2016). Can interoception improve the pragmatic search for biomarkers in psychiatry. Frontiers in Psychiatry, 7, 121.

[21] Kirmayer, L. J., & Robbins, J. M. (1991). Introduction: Concepts of somatization. In L. J. Kirmayer & J. M. Robbins (Eds.), Current concepts of somatization: Research and clinical perspectives (pp. 1–19). American Psychiatric Press.

[22] Kleinman, A. (1982). Neurasthenia and depression: A study of somatization and culture in China. Culture, Medicine, and Psychiatry, 6(2), 117–190.

[23] Kleinman, A. (1986). Social origins of disease and distress: Depression, neurasthenia, and pain in modern China. Yale University Press.

[24] Ma-Kellams, C., Blascovich, J., & McCall, C. (2012). Culture and the body: East—West differences in visceral perception. Journal of Personality and Social Psychology, 102(4), 718–728.

[25] Parker, G., Cheah, Y. C., & Roy, K. (2001). Do the Chinese somatize depression? A cross-cultural study. Social Psychiatry and Psychiatric Epidemiology, 36(6), 287–293.

[26] Paulus, M. P., & Stein, M. B. (2010). Interoception in anxiety and depression. Brain Structure & Function, 214(5–6), 451–463.

[27] Porges, S. (1993). Body perception questionnaire. In Laboratory of Developmental Assessment. University of Maryland.

[28] Ryder, A. G., Doucerain, M. M., Zhou, B., Dere, J., Jurcik, T., & Zhou, X. (2021). On dynamic contexts and unstable categories: Steps toward a cultural-clinical psychology. In M. J. Gelfand, C. Chiu, & Y. Hong (Eds.), Handbook of advances in culture and psychology (pp. 195–243). Oxford University Press.

[29] Ryder, A. G., Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S. J., & Bagby, R. M. (2008). The cultural shaping of depression: Somatic symptoms in China, psychological symptoms in North America? Journal of Abnormal Psychology, 117(2), 300–313.

[30] Schandry, R. (1981). Heart beat perception and emotional experience. Psychophysiology, 18(4), 483–488.

[31] Simon, G. E., VonKorff, M., Piccinelli, M., Fullerton, C., & Ormel, J. (1999). An international study of the relation between somatic symptoms and depression. The New England Journal of Medicine, 341(18), 1329–1335.

[32] Solano López, A. L., & Moore, S. (2019). Dimensions of body-awareness and depressed mood and anxiety. Western Journal of Nursing Research, 41(6), 834–853.

[33] Terhaar, J., Viola, F. C., Bär, K.-J., & Debener, S. (2012). Heartbeat evoked potentials mirror altered body perception in depressed patients. Clinical Neurophysiology, 123(10), 1950–1957.

[34] Wang, N., Ren, F., & Zhou, X. (2020). Factor structure and psychometric properties of the body perception questionnaire-short form (BPQ-SF) among Chinese college students. Frontiers in Psychology, 11, 1355.

[35] Wiebking, C., Bauer, A., de Greck, M., Duncan, N. W., Tempelmann, C., & Northoff, G. (2010). Abnormal body perception and neural activity in the insula in depression: An fMRI study of the depressed “material me”. The World Journal of Biological Psychiatry, 11(3), 538–549.

[36] Zhang, M. (1998). Handbook of rating scales in psychiatry. Hunan Science and Technology Publishing House.

[37] Zhao, D., Wu, Z., Zhang, H., Mellor, D., Ding, L., Wu, H., Wu, C., Huang, J., Hong, W., Peng, D., & Fang, Y. (2018). Somatic symptoms vary in major depressive disorder in China. Comprehensive Psychiatry, 87, 32–37.

[38] Zhou, X., Peng, Y., Zhu, X., Yao, S., Dere, J., Chentsova-Dutton, Y. E., & Ryder, A. G. (2016). From culture to symptom: Testing a structural model of “Chinese somatization”. Transcultural Psychiatry, 53(1), 3–23.

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