Cross-cultural comparison of somatic-depressive symptom networks in Chinese and Rwandan adolescents: network analysis study

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Background Adolescent depression often presents with somatic complaints, and its clinical manifestation is strongly shaped by cultural context. In non-western districts, psychological distress is frequently expressed through physical symptoms; a tendency that, combined with mental health stigma and culturally influenced health beliefs, complicates accurate detection, diagnosis and treatment. Standardised diagnostic tools developed in Western populations may overlook culturally specific symptom patterns, contributing to under-recognition and inadequate care. Despite the global impact of adolescent depression, cross-cultural symptom-level studies remain limited, hindering the development of culturally responsive mental health strategies. Aims This study aims to compare somatic-depressive symptom networks in Chinese and Rwandan adolescents using symptom-level network analysis, to identify culturally distinct central and bridge symptoms, and to assess structural differences between symptom networks across groups. Method A cross-sectional sample of 3830 adolescents (China: n = 2017, mean age 15.35 ± 1.56; Rwanda: n = 1813, mean age 15.80 ± 1.90) completed culturally adapted versions of the Patient Health Questionnaires for somatic symptoms (PHQ-15) and depression (PHQ-9). Gaussian Graphical Models were estimated in R to construct symptom networks. Centrality measures (expected influence and bridge expected influence) were used to identify influential symptoms within each group. Network Comparison Tests were conducted to examine differences in global strength and network structure, and bootstrapping was employed to assess network stability. Results Depressive symptoms were more prevalent among Rwandan adolescents (54.6%) than among Chinese adolescents (29.2%), whereas somatic symptoms were more commonly reported by Chinese participants (71.0% v . 64.0%). Low energy and sleep problems emerged as key bridge symptoms in both groups. Cultural differences were observed in central symptoms: psychomotor impairment and chest pain were central symptoms in Rwanda, whereas dizziness and headaches were central in China. Network structure differed significantly between groups ( S = 0.99, p < 0.05), with culturally specific symptom connections. Conclusions The findings revealed distinct central and bridge symptoms in Chinese and Rwandan adolescents, reflecting culturally patterned architectures of symptom expression and distress reporting. These results highlight the need for culturally adapted screening tools and symptom-level interventions that target culture-specific symptoms to improve adolescent mental health care globally.

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