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Somatic in the East, Psychological in the West?: A Clinically-Grounded Evaluation of Cross-Cultural Depression Symptoms in LLMs

Paper · 2026 · Shintaro Sakai, Jisun An, Migyeong Kang et al.

Summary

LLMs are increasingly used for mental-health tasks such as screening and supportive chat. It is unclear whether they reflect a well-replicated clinical observation. People in Western settings tend to report the emotional side of depression, while patients in many Eastern contexts more often describe bodily complaints. The authors build a clinically anchored test of this. A general-purpose model role-plays a depressed person from one of six countries, three Western and three Eastern. It then picks symptoms from a fixed DSM-5-derived checklist, where each item is labelled somatic or psychological and comes with a short definition. The setup varies how strongly culture is signalled in the instructions and which language the prompt is written in. With English prompts, the models mostly fail to show the expected East–West contrast. Prompting in major Eastern languages improves agreement in some configurations, which suggests that language partly activates cultural knowledge. Still, a stable symptom ranking that ignores culture dominates the outputs. This matters because models blind to cultural differences in how distress is expressed could misread users in mental-health tools.

Key points

  • The symptom inventory has 14 depression symptoms grounded in DSM-5 and drawn from Zhang et al.'s (2022) PsySym dataset. The somatic/psychological split follows Ryder et al. (2008).
  • The Western personas are American, Canadian and Australian. The Eastern personas are Japanese, Chinese and Indian, chosen to mirror countries studied in prior clinical work.
  • Two prompt styles were compared:
    • ICP, which gives only background cultural context.
    • ECP, which explicitly tells the model to consider the persona's culture.
  • The study tests two hypotheses:
    • H1: Western personas get more psychological symptoms and Eastern personas more somatic ones.
    • H2: Local-language prompts increase cultural alignment.
  • H1 is largely unsupported in English, and H2 holds only partially.
  • Two extra analyses confirm the weak alignment:
    • an inverse cultural attribution task, where the model picks which persona would more likely show a given symptom;
    • a symptom-level analysis.
  • Some models also behaved in highly deterministic ways.
  • The authors list several limitations:
    • binary East/West and somatic/psychological categories;
    • DSM-5's Western origins;
    • no distinction between typical and atypical somatic symptoms.

Our summary of the paper, in our own words — not its text. The work belongs to its authors; read it at the links above.

 Institutions

🎓Indiana University BloomingtonBloomington · United States37 works · 3,685 citations🎓Sungkyunkwan UniversitySuwon · South Korea9 works · 195 citations

 Fields, topics and concepts

📚 Shelves 3The field of science this work belongs to (OpenAlex fields).Psychology · 1,552 worksExperimental and Cognitive Psychology · 870 worksSocial Psychology · 306 works

🧭 Topics 1Research subjects and languages the work is about.Language models & pretraining · 3,320 works

Cite

Cite as Shintaro Sakai, Jisun An, Migyeong Kang and Haewoon Kwak. 2026. Somatic in the East, Psychological in the West?: A Clinically-Grounded Evaluation of Cross-Cultural Depression Symptoms in LLMs. Proceedings of the 4th Workshop on Cross-Cultural Considerations in NLP (C3NLP 2026).

The paper itself, not this page. BibTeX from the library's record of the work. DOI 10.18653/v1/2026.c3nlp-1.2

@inproceedings{sakai2026somatic,
  title = {{Somatic in the East, Psychological in the West?: A Clinically-Grounded Evaluation of Cross-Cultural Depression Symptoms in LLMs}},
  author = {Shintaro Sakai, Jisun An, Migyeong Kang and Haewoon Kwak},
  booktitle = {Proceedings of the 4th Workshop on Cross-Cultural Considerations in NLP (C3NLP 2026)},
  year = {2026},
  doi = {10.18653/v1/2026.c3nlp-1.2},
  url = {https://doi.org/10.18653/v1/2026.c3nlp-1.2}
}

References

5 references, 2 of them with a card of ours. ↗ leads to the work, «find» searches for one we have no id for yet.

  1. Nuredin Ali Abdelkadir, Charles Zhang, Ned Mayo, and Stevie Chancellor. 2024. Diverse perspectives, divergent models: Cross-cultural evaluation of depression detection on twitter. In Proceedings of the 2024 Conference of the North American Chapter of the Association for Computational Linguistics: Hu… find
  2. Badr AlKhamissi, Muhammad ElNokrashy, Mai Alkhamissi, and Mona Diab. 2024. Investigating Cultural Alignment of Large Language Models. In Proceedings of the 62nd Annual Meeting of the Association for Computational Linguistics (Volume 1: Long Papers), pages 12404–12422, Bangkok, Thailand. Association…
  3. Denise Saint Arnault, Shinji Sakamoto, and Aiko Moriwaki. 2006. Somatic and Depressive Symptoms in Female Japanese and American Students: A Preliminary Investigation. Transcultural psychiatry, 43(2):275–286. find
  4. American Psychiatric Association and 1 others. 2013. Diagnostic and statistical manual of mental disorders: DSM-5. American psychiatric association. find
  5. Jinze Bai, Shuai Bai, Yunfei Chu, Zeyu Cui, Kai Dang, Xiaodong Deng, Yang Fan, Wenbin Ge, Yu Han, Fei Huang, Binyuan Hui, Luo Ji, Mei Li, Junyang Lin, Runji Lin, Dayiheng Liu, Gao Liu, Chengqiang Lu, Keming Lu, and 29 others. 2023. Qwen Technical Report. Preprint, arXiv:2309.16609. \#\# Ethical Consid…

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