International Journal of Intercultural Relations 89 (2022) 90–99

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International Journal of Intercultural Relations

journal homepage: www.elsevier.com/locate/ijintrel

Cultural values, shame and guilt, and expressive suppression as

predictors of depression
Lina Liw a, *, Ayse Ciftci b, Taewon Kim c
a
Healing Tree Clinic, South Korea
b
Department of Educational Studies, Purdue University, USA
c
Psychological, Health, & Learning Science, University of Houston, USA

A R T I C L E I N F O A B S T R A C T

Keywords: We need to consider culturally relevant factors to understand depression among individuals with
Cultural Values Asian background. Based on Matsuoto, Yoo, and Nakagawa (2008)’s framework on cultural
Shame values and emotion regulation, the current study tested our proposed model to understand the
Guilt
roles of cultural values (i.e., Asian values, European American values), culturally relevant
Expressive suppression
Depression
emotional experiences (i.e., shame proneness and guilt proneness), and expressive suppression in
explaining depression among 181 Asian American and 161 Asian international students. The
model tests revealed that Asian values positively related to shame proneness, and European
American values positively related to guilt proneness. Shame and guilt proneness were positively
and negatively associated with suppression, which in turn positively related to depression. The
findings extended the current literature on the relation between culture and emotion regulation
by addressing how cultural values and culturally relevant emotions (i.e., shame and guilt) play
roles in explaining suppression in relation to depression. We discussed future implications for
research and practice with Asian American or Asian international students with depression.

Cultural Values, Shame and Guilt, and Expressive Suppression as Predictors of Depression is one of the most common types of
psychological distress that is associated with impairment in social, occupational, or other functioning (American Psychiatric Associ­
ation, 2013; Lim et al., 2018). Specifically, studies show that depression relates to poorer academic and work performance (Harvey
et al., 2011; Hysenbegasi, Hass, & Rowland, 2005), relationship satisfaction instability (Whitton & Whisman, 2010), suicidal thoughts
(Farabaugh et al., 2012), and high risk for mortality and morbidity (Farrokhi, Abedi, Beyene, Kurdyak, & Jassal, 2014). Among
different cultural groups, individuals from Asian cultures are at higher risk for depression (Young et al., 2010). Although prevalences of
depression among people from Asian cultures vary in different studies, scholars point out that depression tends to be less detected and
treated among individuals with Asian cultural backgrounds (Alegria et al., 2008; Kalibatseva & Leong, 2011). Considering the lack of
seeking and receiving treatment of the population (Kalibatseva & Leong, 2011) and the serious consequences of depression, under­
standing its etiology, phenomenology, and treatment for people with Asian background needs to be further investigated in a culturally
relevant way.
One of the factors that influences depression is expressive suppression (hereafter suppression) which is a type of emotion regulation
(Gross & Levenson, 1993). Although current literature shows the maladaptive consequences of suppression, its impact for individuals
from Asian cultures was inconsistent (Butler, Lee, & Gross, 2007; Cheung & Park, 2010). Further, only a few studies in suppression

* Correspondence to: Department of Educational Studies, Purdue University, West Lafayette, IN, 47907, USA.
E-mail address: linaliw2020@gmail.com (L. Liw).

https://doi.org/10.1016/j.ijintrel.2022.05.005
Received 5 March 2020; Received in revised form 29 April 2022; Accepted 14 May 2022
Available online 13 June 2022
0147-1767/© 2022 Published by Elsevier Ltd.
L. Liw et al. International Journal of Intercultural Relations 89 (2022) 90–99

have focused on individuals from cultures other than Western-European cultures (Wei et al., 2013), and few studies, if any, used
culturally relevant constructs in relation to suppression and depression. Thus, in this study, we aimed to test a) the relationship be­
tween suppression and depression and b) the model in which cultural values (i.e., Asian values and European American values) explain
suppression via culturally relevant emotional experiences (i.e., shame proneness, guilt proneness) in predicting depression among
individuals from Asian cultural backgrounds.
We will use Matsumoto et al. (2008) functional view of the relationship between cultural values and emotion regulation as a
theoretical framework (please see Fig. 1). According to this model, emotion regulation derives from cultural values which are formed
by meaning and the information system of the culture. The model posits that there are two types of values that are particularly relevant
to emotion regulation: values related to emotions (i.e., guidelines for ideal emotions) and values related to interpersonal relationships
(i.e., guidelines for interpersonal relationship styles). These values create and facilitate norms regarding emotion regulation such as
what type of emotions are acceptable and how the emotions should be expressed. To extend the model to understand the role of
suppression as emotion regulation, we suggest that cultural values create not only social norms regarding emotion regulation but also
unique patterns of emotional experiences among cultural groups. In sum, we expect that cultural values predict culturally relevant
emotions (i.e., shame and guilt) which are associated with suppression and that those emotions and suppression predict levels of
depression.

Cultural values, expressive suppression, and depression

Suppression is a form of emotion regulation which can be defined as, “conscious inhibition of one’s own emotionally expressive
behavior while emotionally aroused” (Gross & Levenson, 1993, p. 970). There is an increasing interest in understanding how culture
plays a role in suppression. Research indicates that Asian values are positively associated with suppression and European American
values are negatively associated with suppression (Matsumoto, Yoo, & Nakagawa, 2008; Wei et al., 2013). Wei et al. (2013) found that
people from collectivistic cultures tend to be more likely to suppress their emotions compared to those from individualistic cultures,
and they attributed the results to values of interpersonal harmony in collectivistic cultures. Another study showed that power distance,
embeddedness, hierarchy, and long-term orientation are positively correlated with suppression while individualism, affective au­
tonomy, and egalitarianism are negatively correlated with suppression (Matsumoto et al., 2008). The results indicate that cultural
dimensions which are close to Asian values (e.g., power distance, hierarchy) have positive relationships with suppression, and cultural
dimensions which are close to Western-European values (e.g., affective autonomy, egalitarianism) have negative relationships with
suppression. To consolidate these results and to test the functional view of the relationship between cultural values and emotion
regulation (Matsumoto et al., 2008), we will examine the relationship between cultural values (i.e., Asian and European American
values) and suppression.
Suppression is related to negative consequences because it does not involve reducing negative emotional experiences, it consumes
cognitive resources and limits social performance, and it creates discrepancies between one’s inner and outer experiences that lead to
negative feelings about the self and disturb interpersonal interactions (Higgins, 1987; John & Gross, 2004). Therefore, suppression is
associated with maladaptive outcomes such as symptomatic activation, psychological symptoms, poor social outcomes, and higher
levels of depressive symptoms (Butler et al., 2003, 2007; Gross & John, 2003; Gross, 1998; John & Gross, 2004).
The findings about the relationship between suppression and negative outcomes are not consistent for individuals who hold Asian
values (Butler et al., 2007; Soto, Perez, Kim, Lee, & Minnick, 2011). For instance, while suppression has a positive correlation with
depressive mood and a negative correlation with life satisfaction for European Americans, these relationships did not appear for Hong
Kong Chinese participants (Soto et al., 2011). Similarly, habitual emotional suppression had positive association with negative
emotions for Americans with high levels of Western-European values; however, those relationships were reduced for individuals with
high levels of Asian values (Butler et al., 2007). Butler et al. (2007) claimed that cultural values that individuals hold moderate the
relations between suppression and negative consequences in psychological and interpersonal functioning. They asserted that sup­
pression does not cause adverse consequences for individuals with Asian values because Asian values encourage people to restrain their
emotion (i.e., suppression) for interpersonal harmony.
Other researchers, however, have found that suppression may have a negative impact on psychological outcomes for people with
Asian values as it does for people with Western-European values (Cheung & Park, 2010; Park et al., 2011). For instance, Park and

Fig. 1. Final structural model with standardized regression coefficients. Note: Errors are not shown. *p < .05, **p < .01, ***p < .001.

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colleagues (2011) found that an interdependent self-construal is related to emotional suppression, which in turn, predicts higher levels
of social anxiety among Asian American college students. Similarly, Cheung and Park (2010) found that anger suppression is associated
with depressive symptoms in the college student population, regardless of their race and degree of interdependent self-construal. These
inconsistent results suggest the need for further research on examining whether expressive suppression predicts depression among
individuals with Asian cultural values.

Shame and guilt proneness, suppression, and depression

Shame and guilt fit well into the functional model to explain the relationship between cultural values and emotion regulation
(Matsumoto et al., 2008). Shame and guilt proneness are effective means of social control to maintain social order (Bedford & Hwang,
2003) and they may influence the use of suppression differently in different cultures. Shame and guilt are the moral emotions that
people experience when individuals violate social values or norms (Haidt, 2003). Even though shame and guilt are used inter­
changeably, shame is about the self and guilt concerns behavior (Lewis, 1971; Tangney & Dearing, 2002). Shame represents negative
appraisals and feelings toward the entire self, not specific behavior, when one violates social or moral norms. In the state of shame,
people reject themselves, experiencing a sense of smallness, inadequacy, and worthlessness. People may experience guilt when they
violate moral values or social norms (Freud, 1961; Lazarus, 1991), particularly when those violations lead to negative consequences to
others such as harm, loss, or distress (Hoffman, 1982). In contrast to shame, individuals experiencing guilt have negative appraisals
and affects toward their behaviors. Guilt is related to remorse which leads individuals to recompense and reconcile in constructive
ways (Tangney, 1998).
People may be prone to experiencing shame or guilt depending on whether their cultural values facilitate or inhibit these emotions.
Literature addresses cultural variances in experiences of shame and guilt (Anolli & Pascucci, 2005; Bedford & Hwang, 2003; Sznycer
et al., 2012; Wallbott & Scherer, 1995). Historically, Benedict (1947) described Japanese culture as a shame culture and the U.S.
culture as a guilt culture. According to Bedford and Hwang (2003), shame and guilt are mechanisms of social control in Asian and
Western cultures, respectively. In addition, literature showed that individuals from Asian cultures are prone to experience shame and
tend to react more intensely to shame (Anolli & Pascucci, 2005; Bedford & Hwang, 2003; Sznycer et al., 2012), while people from
Western cultures are prone to experience guilt and tend to react more intensely to guilt (Anolli & Pascucci, 2005; Bedford & Hwang,
2003). In addition, research showed that “closed” cultures, which hold high values in collectivism, power distance, and uncertainty
avoidance, induce shame experiences (Wallbott & Scherer, 1995). On the contrary, “open” cultures, which hold high values in
individualism and low values in power distance and uncertainty avoidance, lead predominant guilt experience. In open cultures,
people tend to experience shame in a similar way as they experience guilt or even turn shame experiences into guilt experiences
(Wallbott & Scherer, 1995).
Shame and guilt proneness are expected to predict the use of suppression because shame and guilt are self-conscious emotions
which involve in self-regulation of behaviors (Beer, Heerey, Keltner, Scabini, & Knight, 2003). Previous studies reported that shame is
associated with suppression (Lanteigne, Flynn, Eastabrook, & Hollenstein, 2014; Velotti, Garofalo, Bottazzi, & Caretti, 2017). Further,
literature indicates that the association of shame and psychological distress is mediated by emotional suppression (Velotti et al., 2017).
The results are interpreted as feelings of shame may increase difficulty in emotional regulation which could lead to psychological
distress. Even though current literature does not directly address the relationship between guilt proneness and suppression, literature
indicates that guilt is associated with approach motivation and active engagement rather than social inhibition (Amodio, Devine, &
Harmon-Jones, 2007; Baumeister, Stillwell, & Heatherton, 1995; Tangney & Dearing, 2002). Thus, it is expected that individuals prone
to experiencing guilt may suppress their emotions less frequently, which will relate to lower levels of depression.

Current study

In the current literature on expressive suppression and depression, research on cultural differences and cultural considerations is
limited. In this study, therefore, we aim to test the relationships among cultural values, culturally relevant emotions, suppression, and
depression for individuals with Asian cultures. First, we examined whether there is a positive relationship between suppression and
depression among the population. Second, we examined how cultural values relate to suppression via culturally relevant emotions in
predicting depression based on Matsumoto et al. (2008) functional view of the relationship between cultural values and emotion
regulation. More specifically, we hypothesized that Asian values and European American values would predict shame and guilt
proneness respectively. Then, we expected that shame would positively and guilt negatively predict suppression, which in turn
positively relates to depression. Based on previous literature, it is expected that shame and guilt proneness mediate the association of
cultural values and suppression, and that suppression mediates shame and guilt proneness and depression.

Method

Participants

A total of 426 undergraduate and graduate students who identify themselves either as Asian American or Asian international
students at a large Midwest university responded initially for the current study. Eighty four participants were removed due to a sig­
nificant amount of missing data or failure to meet the qualifications of the study, resulting in a sample of 342 participants. The final
sample consisted of 181 Asian American students and 161 Asian international students. The age of participants ranged from 18 to 42

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(M = 22.90, SD = 3.93). The participants consisted of 176 undergraduate students (52 first years, 41 sophomores, 43 juniors, and 40
seniors) and 166 graduate students. Among Asian international students, the duration of stay in the U.S. ranged from 6 months to 15
years (M=39.29, SD = 36.46). Their regions of origin included India, Japan, Bangladesh, South Korea, China, Hong Kong, Pakistan,
Indonesia, Taiwan, Kazakhstan, Singapore, Malaysia, Saudia Arabia, Thailand, Sri Lanka, Nepal, and Vietnam.

Procedures

We sent out a survey request via email to students at a large Midwest university. When students agreed to participate in the survey,
they were directed to the survey website and completed the 15–20 min survey at their convenience. Survey questionnaires were in
English and began with an informed consent form. Participants were asked to complete a set of questionnaires that include de­
mographic information, cultural background, cultural values, emotional suppression, shame and guilt proneness, and depression.
Upon completion of the questionnaire, the participants had an opportunity to be entered into a drawing for a gift card.

Measures

Demographics and cultural background

Participants were asked to respond to demographic questions. Questions included participants’ age, academic standing, cultural
background, and whether they were domestic students or international students (i.e., Asian American or Asian international students).
For international students, their home countries and duration of their stay in the U.S. were requested.

Cultural values

Participants’ cultural values were assessed using items taken from the Asian Values Scale (AVS; Kim, Atkinson, & Yang, 1999) and
from the European American Values Scale for Asian Americans (EAVS-AA; Wolfe, Yang, Wong, & Atkinson, 2001). The AVS is a
36-item scale that measures adherence to Asian cultural values such as conformity to norms, collectivism, and emotional self-control
(Kim et al., 1999). Sample items include “The worst thing one can do is bring disgrace to one’s family reputation” and “One should not
make waves.” The EAVS-AA is an 18-item scale that assesses adherence to European cultural values such as independence, autonomy,
and flexibility to norms. Sample items are: “Sometimes, it is necessary for the government to stifle individual development (reversed
code)” and “I’m confident in my ability to handle most things.” Participants responded on a 7-point Likert scale (1 = strongly disagree to
7 = strongly agree) for both scales.
Following Butler et al. (2007) method, we used 10 items of each of AVS and EAVS-AA that maximally distinguished Asian and
European Americans (Kim et al., 1999; Wolfe et al., 2001), in order to reduce participants’ burden. In Butler et al., (2007) study, Asian
Americans reported higher levels of Asian values than European Americans while European Americans reported higher levels of
EAVS-AA than Asian Americans. The items were shown reliable in the previous study (α = 0.69 for AVS and α = 0.63 for EAVS-AA;
Butler et al., 2007) and reliability in the current study was.65 for AVS and.62 for EAVS-AA.

Emotional suppression

Emotional suppression was measured by the Emotion Regulation Questionnaire (ERQ) that assesses how individuals control their
emotion (Gross & John, 2003). We used the suppression subscale that consisted of 4 items. Sample items include “I control my
emotions by not expressing them” and “When I am feeling negative emotions, I make sure not to express them.” Participants responded
on a 7-point Likert scale (1 = strongly disagree to 7 = strongly agree). Convergent validity was established by expected relationships with
other scales, such as Inauthenticity (Gross & John, 1998), the Venting subscale from COPE (Carver, Scheier, & Weintraub, 1989), and
the Negative Mood Regulation scale (Catanzaro & Mearns, 1990). Discriminant validity was confirmed by correlations with the Big
Five Inventory (John & Srivastava, 1999) and cognitive ability (Gross & John, 2003). Cronbach’s alpha in the previous study was.73
(Gross & John, 2003) and in the current study,.82.

Guilt and shame proneness

Participants’ guilt proneness and shame proneness were measured by the Test of Self-Conscious Affect 3–Short Version (TOSCA
3–Short Version; Tangney & Dearing, 2002). The TOSCA 3–Short Version provides 11 negative scenarios participants can encounter in
their daily lives and asks them to imagine they are in those situations. The scale measures shame-proneness, guilt-proneness, exter­
nalization, detachment/unconcern, and pride. In the current study, we used only items that assess shame and guilt proneness. Par­
ticipants responded how likely they would be to react in presented ways. An example scenario includes “While playing around, you
throw a ball and it hits your friend in the face," and an example response is ”You would feel inadequate that you could not even throw a
ball” (shame) and “You would apologize and make sure your friend feels better” (guilt). Participants responded to each response on a
5-point Likert scale (1 = not likely to 5 = very likely). Cronbach’s alpha in the previous study ranged.77 to.88 for shame and.70 to.83 for
guilt (Tangney & Dearing, 2002). Cronbach’s alpha in the current study was.75 for shame and.78 for guilt.

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Depression

Depression was measured by the Center for Epidemiological Studies Depression scale (CES-D; Radloff, 1977). The CES-D is a
20-item self-report instrument that measures the current level of depressive symptoms in the general population. Participants were
asked to indicate the frequency of occurrence of depressive symptoms, and items focus on affective aspects (e.g., “I was bothered by
things that usually don’t bother me” or “I felt lonely”). Participants responded on a 4-point Likert scale, which ranges from “rarely or
none of the time (less than 1 day)” to “most or all of the time (5–7 days).” Total scores range from 0 to 60, and a higher score indicates
severe depressive symptoms. Construct validity of the CES-D was established by correlations of the scale with clinical ratings of
depression and other self-report scales, such as Bradburn Affect Balance (Bradburn, 1969; Randloff, 1977). Internal consistency in a
previous study was high as indicated by a Cronbach’s alpha of.84 to.90 (Radloff, 1977). Cronbach’s alpha in the present study was.91.

Results

Preliminary analyses

To conduct primary analyses, we evaluated statistical assumptions for regression and structural equation modeling. Regarding
univariate normality, visually inspected histograms and boxplots showed normal distributions. Levels of skewness values ranged from
− 0.93 to.64 and kurtosis ranged from − 0.52–0.91, indicating all variables were normally distributed (Byrne, 2010). In order to
examine outliers, we evaluated standardized deviations of each variable, and identified no outliers with absolute values greater than 3.
We checked homoscedasticity and linearity by scatterplots and did not find nonlinear relationships. In order to examine multivariate
outliers, we evaluated Mahalanobis Distance and four outliers were identified. These cases appeared to be in a predictable range of
responses and thus, we left them in the following analysis. To examine multicollinearity and singularity, we checked correlations
among variables and there were no correlations greater than.90. In addition, we examined variation inflation factors and did not find
evidence for multicollinearity and singularity issues (Menard, 1995). There was only one missing datum. Given that it is an extremely
small portion of the total data, we replaced it with the mean.
To examine whether suppression and depression have positive associations among people with Asian values, we tested correlations
among the variables. The results showed that suppression and depression were significantly correlated (r = 0.23, p < .001).

Model testing

To evaluate this model, we used structural equation modeling with maximum likelihood in AMOS 24.0. We used indices of fit that
minimized the likelihood of Type 1 and Type II errors (Hu & Bentler, 1999), including the χ2 test, the root mean squared residual
(SRMR), the comparative fit index (CFI), and the root mean square error of approximation (RMSEA). Specifically, we referred to
conventional model fit statistics, including CFA greater than.95, RMSEA ranging from.06 to.08 with a maximum upper bound of the
90%, and SRMR less than.10 (Browne & Cudeck, 1993; Hu & Bentler, 1999; Kline, 2005). In terms of creating parcels, parceling data is
statistically beneficial, such as providing reduced levels of skewness and kurtosis, higher reliability, more precise parameter estimates,
and better model fit (Bandalos & Finney, 2001; Dow, Wong, Jackson, & Leitch, 2008; Little, Cunningham, Shahar, & Widaman, 2002).
Therefore, we created three or four parcels each for measures with eleven or more items (i.e., Asian values, European American values,
guilt, shame, and depression). Because all noted variables were unidimensional constructs, which is appropriate for creating parcels,
we proceeded to create parcels (Dow et al., 2008). Specifically, we followed item-to-construct balancing procedures (Little et al.,
2002). First, we conducted an exploratory factor analysis on each measure and restricted them to one factor. Then, we assigned items
to parcels in countervailing order based on the size of the factor loading to balance parcels with approximately equivalent factor
loadings. For the latent construct that consisted of measures with four items (i.e., suppression), each of the four items was used as an
indicator for its corresponding latent variable.

Measurement model

To evaluate the hypothesized models, we firstly tested a measurement model of the six latent constructs to ensure that latent

Table 1
Descriptive Statistics and Factor Correlations among Study Variables.
1 2 3 4 5 6

1. Asian values –
2. European American values -0.33*** –
3. Guilt -0.16* .63*** –
4. Shame .37*** -0.12 .35*** –
5. Suppression .34*** -0.13 -0.05 .22*** –
6. Depression .18** -0.21** -0.05 .45*** .25*** –
Mean 36.20 52.77 46.17 34.57 16.32 20.08
Standard Deviation 8.45 7.35 5.88 7.22 5.68 12.31

Note. * p < .05, ** p < .01.

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constructs were measured adequately with items and parcels. The measurement model had good fit to the data, χ2 (155) = 332.396,
p < .001, CFI = 0.94, RMSEA = 0.06, 90% CI [0.05, 0.07], and SRMR = 0.07, and all indicators loaded onto their respective factors at
coefficients of.49 or higher. Specifically, depression was significantly and positively associated with Asian values (0.18), suppression
(0.25), and shame (0.45) but significantly and negatively associated with European American values (− 0.21). Additionally, Asian
values were significantly and positively related to suppression (0.34) and shame (0.37) but significantly and negatively related to
European American values (− 0.33) and guilt (− 0.16). European American values were significantly and positively related to guilt
(0.63). Shame was significantly and positively related to guilt (0.35) and suppression (0.22). Table 1 displays the factor correlations,
raw means, and standard deviations among study variables.

Structural model

The structural model tested relations among the study variables, with Asian values and European American values predicting
shame and guilt respectively, which in turn predicted depression via suppression. First, we tested a full mediation model that did not
include direct paths from both shame and guilt to depression. This model had acceptable fit, χ2 (163) = 396.692, p < .001, CFI = 0.92,
RMSEA = 0.07, 90% CI [0.06, 0.07], and SRMR = 0.10. Consistent with the hypotheses, Asian values positively predicted shame, and
European American values also positively predicted guilt. In addition, shame positively predicted suppression, whereas guilt nega­
tively predicted suppression. Further, suppression positively predicted depression.
To further test our hypothesized pathways, we added paths from shame and guilt to depression to test a partial mediation model.
This model had better fit to the data, χ2 (161) = 347.058, p < .001, CFI = 0.93, RMSEA = 0.06, 90% CI [0.05, 0.07], and SRMR = 0.08.
The full mediation model and the partial mediation model had a significant change in chi-square, χ2 (2) = 49.634, p < .01. Given the fit
statistics and a significant change in chi-square between the full mediation model and the partial mediation model, we retained the
partial mediation model, which supports our hypotheses. The retained model explains 25% of the variance in depression. Fig. 1 depicts
the final, structural model with standardized regression coefficients.

Alternative model

We tested an exploratory model by adding two paths of Asian values predicting guilt and European American values predicting
shame on our partial mediation model to explore further relations among these variables. This model had good fit to the data, χ2 (159)
= 346.570, p < .001, CFI = 0.93, RMSEA = 0.06, 90% CI [0.05, 0.07], and SRMR = .08. However, the difference in chi-square be­
tween the partial mediation model and the exploratory model was not significant, χ2 (2) = 0.488, p < .05. Therefore, we retained the
structural model for parsimony.

Indirect effects

We tested six indirect effects from Asian values and European American values to depression via shame and guilt and suppression.
Because AMOS does not calculate indirect effects for specific paths, we used RMediation that uses the distribution of the product of
coefficients method to create confidence interval estimates of indirect effects (Tofighi & MacKinnon, 2011). If 95% confidence in­
tervals do not include zero, the indirect effects are significant (Tofighi & MacKinnon, 2011). First, the indirect effect from Asian values
to suppression via shame, 95% CI [0.116, 0.421], was significant. Second, the indirect effect from Asian values to depression via
shame, 95% CI [0.093, 0.251], was significant. Third, the indirect effect from shame to depression via suppression, 95% CI [0.003,
0.07], was significant. Fourth, the indirect effect from European American values to suppression via guilt, 95% CI [− 0.476, − 0.048],
was significant. Fifth, the indirect effect from European American values to depression via guilt, 95% CI [− 0.211, − 0.045], was
significant. Finally, the indirect effect from guilt to depression via supression, 95% CI [− 0.067, 0], was also significant. These results
are consistent with our hypotheses that shame and guilt would mediate the relationship between cultural values and suppression and
that suppression would mediate the relationship between shame and guilt and depression.

Discussion

The aim of the present study was to test the proposed model of cultural values, shame and guilt proneness, suppression, and
depression. More specifically, based on Matsumoto et al. (2008) functional view of the relationship between cultural values and
emotion regulation, we tested if Asian and European American values predicted suppression via shame proneness and guilt proneness,
which in turn explain depression. First, the results showed that suppression significantly and positively related to depression.
Regarding the model test, when all variables were included in the model, the results supported all the hypotheses of the current study.
As expected, Asian values and European American values significantly and positively predicted shame and guilt proneness, respec­
tively. Then, shame proneness positively and guilt proneness negatively predicted suppression, which in turn positively related to
depression. Furthermore, all the indirect effects of the model were significant. The current study has implications for emotion regu­
lation theory, particularly how cultural values play a role in unique emotional experiences (i.e., shame and guilt, depression) in
relation to emotion regulation (i.e., suppression). This study also highlights the importance of considering cultural values and sup­
pression when working with clients with depression.
Our results showed the positive relation between suppression and depression among individuals who hold Asian values, as ex­
pected. The result corroborates the previous findings of a positive relation between suppression and psychological distress (Cheung &

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Park, 2010; Park et al., 2011). The result also rebuts the findings and claims that suppression does not have a positive relation with
psychological distress for people with Asian values because Asian values emphasize interpersonal harmony and encourage restraint in
their emotions to maintain interpersonal harmony (Soto et al., 2011). Scholars should not assume that cultural values or norms are
always harmless. Instead, some cultural norms may have a maladaptive function. For instance, theory and research suggests that
cultural norms for appearance significantly contribute to body dissatisfaction (Thompson, 1992; Thompson, Heinberg, Altabe, &
Tantleff-Dunn, 1999). Although emotional restraint is a cultural norm in Asian cultures (Butler et al., 2007), its consequences must be
considered based on how it relates to individuals’ well-being. Our results support the positive relation between suppression and
negative emotions, indicating that the relation may be a universal phenomenon. Further studies need to replicate the results to
corroborate the relations among different cultural groups. Particualrly, future studies may test causal relationships between sup­
pression and psychological distress among individuals with Asian background and address better ways to regulate their emotions
which are culturally appropriate.
To extend the functional view of the relationship between cultural values and emotion regulation (Matsumoto et al., 2008), we
suggested that Asian and European American values will predict the unique pattern of emotional experience (i.e., shame and guilt
proneness), which in turn relates to suppression. Consistent with our hypothesis, Asian values positively and European American
values negatively related to suppression via shame and guilt proneness, respectively. The results indicate that Asian values may
facilitate shame proneness, which may lead to frequent use of suppression while European American values may facilitate guilt
proneness, which could lead to less use of suppression. The finding corroborates previous research which showed that cultural di­
mensions that reflect Asian values positively related to suppression and cultural dimensions that reflect European American values
negatively related to suppression (Matsumoto et al., 2008; Wei et al., 2013). People with Asian values are taught and encouraged to
maintain interpersonal harmony (Bedford & Hwang, 2003) and thus, they may tend to suppress their emotions to avoid potential
ruptures of interpersonal harmony. In contrast, people with European American values are taught and encouraged to respect their own
freedom and personal rights (Bedford & Hwang, 2003) and thus, they may tend not to suppress their emotions, a practice accepted in
individualistic cultures.
The findings of the present study also support previous research on relations between cultural values and shame and guilt
proneness. Literature showed that individuals from Asian cultures are prone to experience shame and react more intensely to shame
(Anolli & Pascucci, 2005; Bedford & Hwang, 2003; Sznycer et al., 2012; Wallbott & Scherer, 1995), while individuals from Western
cultures are prone to experience guilt and tend to react more intensely to guilt (Anolli & Pascucci, 2005; Bedford & Hwang, 2003;
Wallbott & Scherer, 1995). Bedford and Hwang (2003) elucidated this pattern from a cultural perspective. In Western cultures, in­
dividuals are responsible for their own behaviors and they are expected to hold a sense of appropriate behaviors consistent with social
norms. Guilt emphasizes individual responsibility and functions as a method of social control. Thus, people from Western cultures are
more connected to the experience of guilt. In contrast, in Asian cultures, maintaining harmony is highly valued and individuals may
lose group status when judged by group members as not fulfilling group requirements (Bedford & Hwang, 2003). Individuals also tend
to judge their own failures in group requirements because they share the point of view of the group. Thus, people from Asian cultures
are likely to experience shame associated with revelations of failure or flaws in one’s identity.
Finally, shame positively and guilt negatively predicted depression via suppression, partially supporting our hypothesis. The results
indicate that individuals with shame proneness may have higher levels of depression partly from suppressing their emotions. In a
similar way, individuals with guilt proneness may experience lower levels of depression from being less likely to suppress their
emotions. The relations between shame and guilt proneness and depression are partially consistent with previous research in that
shame positively relates to depression while shame-free guilt does not (Kim, Thibodeau, & Jorgensen, 2011; Orth, Berking, & Bur­
khardt, 2006). Interestingly, the current study showed that guilt proneness negatively related to depression. Given that the current
study found a negative relation between guilt and depression which was not found in previous studies, future studies may further
explore this relationship. In regards to the relations between shame proneness and suppression, the results are consistent with previous
research which showed shame proneness was positively related to expressive suppression (Lanteigne et al., 2014; Velotti et al., 2017).
People who are prone to experiencing shame may be highly conscious about their inappropriate emotional expression and tend to
suppress their emotions, so as to not violate the social norms and be rejected by the group to which they belong. Regarding the relation
between guilt proneness and suppression, the results are aligned with the previous literature that indicated associations of guilt and
approach motivation and active engagement (Amodio et al., 2007; Baumeister et al., 1995; Tangney & Dearing, 2002). The current
results proved the negative relation between guilt and suppression. Individuals who are prone to experience guilt may tend to express
their emotions to actively improve social interactions, rather than suppress their emotion.
In sum, the findings illustrate the roles of cultural values, shame and guilt proneness, and suppression in explaining depression.
Specifically, individuals who hold high Asian values may be prone to experience shame, which influence them to suppress their
emotions, resulting in high levels of depression. Individuals who hold high European American values may be prone to experience
guilt, which influences them to not suppress their emotions, resulting lower levels of depression. The current study expanded the body
of literature by proving the mediating role of self-conscious emotions (i.e., shame and guilt) in the relation between cultural values and
suppression as well as the mediating role of suppression in the relation between self-conscious emotions and depression.

Clinical implications

The current study showed that people with high Asian values have higher levels of depression and the relationship is mediated by
shame proneness and frequent use of suppression. Clinicians who work with clients presenting with depression concerns and holding
Asian values may need to attend to whether the clients suppress their emotions due to a tendency to experience shame. If this is the

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case, clinicians need to encourage clients to express their emotions appropriately. This will help clients experience emotional
authenticity and communicate with others more effectively. In this process, clinicians should be aware of the importance of cultural
values that clients hold, and explore clients’ inner experiences in relation to their cultural values and norms, in order to empower
clients to express their emotions in a culturally appropriate way.
There are some aspects that clinicians need to consider when applying the results of this study. First, clinicians need to be cognizant
of cultural biases and not to pathologize cultural phenomena. Although shame proneness relates to suppression which is associated
with depression, there are positive roles that shame plays in certain cultures (Bedford & Hwang, 2003). Further, even though some
causal relations among the variables of the current study maybe plausible, the results of the study do not imply causal relations.
Specifically, the findings do not indicate that Asian cultures lead to shame nor does shame cause suppression, which results in
depression. Rather, clinicians should facilitate clients’ process based on their cultural values, shame and guilt proneness, and sup­
pression in relation to depressive symptoms and help clients understand how these factors function in their unique situations.
Additionally, clinicians need to attend to differences between expressive suppression and quietness, shyness, or being introverted
which tend to be shown among people with Asian backgrounds. Again, clinicians should not perpetuate stereotypes or pathologize
unique cultural traits and tendencies among Asian populations.

Limitations

There are some limitations of the present study, which will suggest areas for future study. First, the measurements used in the study
are not culturally sensitive instruments. Although the measurements are used among individuals with Asian background (e.g., Wei,
Heppner, Ku, & Liao, 2010), it does not guarantee those measurements capture the culturally specific aspects of the constructs. For
instance, the CES-D (Radloff, 1977) has been widely used to assess depressive symptoms among different ethnic groups, including
Asians and Asian Americans (e.g., Wei et al., 2010). Scholars have pointed out the different manifestation of depression among cultural
groups and emphasized attending to the culture-specific aspects of depression (Kalibatseva & Leong, 2011; Marsella, 2003). However,
the CES-D (Radloff, 1977) does not necessarily reflect culturally unique manifestation of depression for those with Asian background.
Thus, future studies need to replicate the current study, using culturally sensitive measurements to integrate the unique experiences
among people with Asian cultures.
Second, the current study used the suppression subscale of the ERQ (Gross & John, 2003) to measure expressive suppression. The
scale does not assess the intensity of emotions people suppress. In addition, the subscale consists of only 4 items, and there is only one
item that assesses suppression of positive and negative emotions. Thus, we were not able to examine the different functions of sup­
pression of positive versus negative emotions in a latent model. To establish better psychometrics, it is recommended that researchers
assess a series of items that reflects the construct, instead of a single item (Gardner, Cummings, Dunham, & Pierce, 1998). To un­
derstand the role of suppression in a more comprehensive way, we recommend future studies to develop a suppression scale that
assesses suppression while integrating valence and intensity of emotions.
Third, the study was conducted in the U.S. among Asian Americans and Asian international students, and thus, the results of the
present study should not be generalized to entire Asian populations. Asian Americans and Asian international students hold Asian
values at different levels their varying states of acculturation (Berry, 2005). Their levels of Asian values, European American values,
shame and guilt, and suppression and their interactions can be different from people residing in Asian countries. Thus, the implications
of the current study will apply to those who live in the U.S. and utilize the U.S. health system and health care providers. To extend the
applicability of the model, future studies may replicate the results in other populations, including Asians living in Asian countries.
Lastly, the current study is based on the categorical views on shame and guilt in relation to cultures. However, there are discussions
and differing views regarding definitions and the conceptualization of shame and guilt, and different menifestations of shame and guilt
across cultures which can be related to measurement issues (Young et al., 2019). Thus, readers need to be informed that the current
study is designed and the data is analyzed based on the particular tradition in shame and guilt literature.

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