Somatic in the East, Psychological in the West?: Investigating Clinically-Grounded Cross-Cultural Depression Symptom Expression in LLMs

ACL ARR 2025 July Submission405 Authors

Abstract: Prior clinical psychology research shows that Western individuals with depression tend to report psychological symptoms, while Eastern individuals report somatic ones. We test whether Large Language Models (LLMs), which are increasingly used in mental health, reproduce these cultural patterns by prompting them with Western or Eastern personas. Results show that LLMs largely fail to replicate the patterns when prompted in English, though prompting in major Eastern languages (i.e., Chinese, Japanese, and Hindi) improves alignment in several configurations. Our analysis pinpoints two key reasons for this failure: the models' low sensitivity to cultural personas and a strong, culturally invariant symptom hierarchy that overrides cultural cues. These findings reveal that while prompt language is important, current general-purpose LLMs lack the robust, culture-aware capabilities essential for safe and effective mental health applications.

Paper Type: Long

Research Area: Ethics, Bias, and Fairness

Research Area Keywords: model bias/fairness evaluation, ethical considerations in NLP applications

Contribution Types: Model analysis & interpretability

Languages Studied: English, Japanese, Chinese, Hindi

Submission Number: 405