Language-dependent expression of anxiety and depression symptoms in Japanese-English bilinguals

In the United States, there are persistent disparities in mental health services for linguistically and culturally minoritized groups. We examined whether bilinguals reported psychological symptoms differently when assessed across their two languages. Japanese-English bilinguals completed anxiety (STAI) and depression (BDI-II) symptom scales in Japanese and English, counterbalanced across two days. Bilinguals reported higher total anxiety scores, but not total depression scores, in first language Japanese than in second language English. Suicidal thoughts (BDI-II item #9) were rated higher in Japanese. Bicultural bilinguals who lived in balanced language environments had greater cross-linguistic differences in anxiety and depression symptoms compared to bilinguals who lived in Japanese-dominant environments. Bilinguals may express symptoms differently as a function of language, due to varying degrees of emotional reactivity across their first and second languages and associated cultural norms. We conclude that clinicians must consider multilingual assessments to implement equitable and effective mental health services.