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"What Keeps Them Up at Night": A Cross-Cultural NLP Analysis of Psychological Distress Among Family Caregivers of Older Adults in Chinese and English-Speaking Online Communities
ABSTRACT
Background:
Cross-cultural comparisons of caregiver psychological distress rely heavily on standardized scales, which struggle to capture the culturally specific dimensions of distress that emerge spontaneously.
Objective:
To identify and compare the thematic patterns and emotional characteristics of psychological distress expressed by family caregivers of older adults in Chinese- and English-speaking online communities, and to explore cross-cultural similarities and differences to inform the development of culturally sensitive caregiver support strategies.
Methods:
We conducted a retrospective computational text analysis of 13,996 caregiver posts (2020–2024) from Reddit (8,762 English) and Zhihu, Douban, and Baidu Tieba (5,234 Chinese). BERTopic modeling was applied to each corpus, sentiment polarity and emotion were classified using manually validated pre-trained models, cross-cultural topics were aligned through bilingual mapping and multilingual semantic similarity, and multidimensional comparisons used chi-square, Mann-Whitney U, and Levene's tests.
Results:
Ten English and nine Chinese topics were consolidated into 10 conceptual domains. Emotional exhaustion showed similar proportions (17.0% vs. 15.9%, P = 0.58) and the highest semantic correspondence (0.78), making it the most cross-culturally stable domain. Structurally, English posts concentrated on secondary stressors (45.3%), whereas Chinese posts formed independent cultural-context themes (filial obligation and only-child status, 25.5%) absent in English. Chinese-unique themes included moral guilt (13.8%) and somatization (7.9%); English-unique themes included loss of self and identity crisis (5.7%). Across shared domains, English posts leaned toward anger and Chinese toward fear. Chinese posts showed a marginally higher mean distress level and lower variance in expressed distress; both between-corpus differences were small in magnitude despite statistical significance in this large sample.
Conclusions:
Emotional exhaustion is a cross-culturally stable core dilemma, but its structural focus varies by culture: Chinese caregivers' distress is driven directly by cultural-moral norms and may surface as physical symptoms, whereas Western caregivers focus on role erosion and navigating systemic resources. These findings suggest the Pearlin Stress Process Model needs to reassess the hierarchical positioning of cultural factors in cross-cultural applications, and that screening and interventions for Chinese caregivers should incorporate physical indicators and reframe support within a filial-piety framework. Clinical Trial: None
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