(PS4-69) The Impact of Language on Psychological Assessment in Japanese-English Bilinguals

Abstract Text: Disparities in mental health services for linguistically and culturally minoritized groups persist. The present study examined how bilinguals use each of their languages to express psychological distress (i.e., language-dependent symptom expression) in assessment of anxiety and depression.

One hundred and twenty Japanese-English bilinguals (Mage = 54.52, SDage = 10.08, age range = 40–90 years; Medu = 16.79, SDedu = 3.50) completed the State Trait Anxiety Inventory (STAI; Spielberger et al., 1970) and Beck Depression Inventory (BDI-II; Beck et al., 1996) in their first (L1) and second languages (L2). The language of assessment (L1 Japanese and L2 English) was counterbalanced across two consecutive days. Within-subject data were analyzed using multilevel modeling to account for nesting and order effects as covariates.

Bilinguals rated anxiety symptoms (ß = -2.40, SE = 0.80, p = .004), cognitive symptoms of depression (ß = -0.69, SE = 0.26, p = .009), and suicidal thoughts (ß = -0.12, SE = 0.04, p = .007) higher in L1 Japanese than in L2 English. In addition, years spent in varying language contexts (“balanced” vs. “Japanese-dominant”) moderated bilingual effects on depression symptoms. Specifically, bicultural bilinguals who lived in balanced language environments had greater cross-linguistic differences in depression scores compared to monocultural bilinguals who lived in Japanese-dominant environments (ß = -1.25, SE = 0.58, p = 0.03).

One mechanism may be that emotional symptoms are muted in L2 because cognitive processing is less automatic and more effortful, particularly under the conditions of anxiety or depressive mood. Another mechanism that may explain the cross-linguistic differences is cultural frame switching (Hong et al., 2000; Markus & Kitayama, 2010), where use of different languages prime or activate distinct cultural expressions of symptoms. Qualitative examples from risk assessment interviews with Japanese-English bilinguals are provided as additional evidence to illustrate participants’ difficulty communicating feelings in L2, cultural expressions of distress (including suicidal thoughts), and multicultural identities.

To conclude, the present findings provide evidence for language-dependent symptom expression in bilinguals. By integrating psycholinguistic approaches to mental health assessments, the study highlights the limits of English-only symptom rating scales and illustrates the important role of language environments for multilingual patients. Clinical researchers and practitioners must prioritize a patient-centered approach, in which bilinguals are able to draw on their diverse linguistic and cultural repertoires for full assessment of symptoms.