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Somatization is the expression of physical symptoms in the absence of medically explained physical illness. As a disproportionate response to psychosocial distress, somatization is usually correlated with depression. According to the idiom of distress hypothesis, the association of somatization and mental health is mitigated when somatizing indirectly expresses, and is understood by others as, emotional distress. Theory and data suggest that collectivistic societies such as South Korea (S.K.), unlike individualistic societies like the U.S. (U.S.), employ an idiom of distress. Multiple measures of physical and mental health were administered to a random sample of S.K. (n=220) and U.S. (n=215) adults. Measurement structures of physical health and mental health were comparable between samples. Individuals in both samples somatized the same number of symptoms, although the U.S. adults expressed those symptoms more frequently. Findings supported the idiom of distress hypothesis. Bivariate and multivariate analyses revealed that the relationship of somatization with mental health depends on culture. Also, the disparity in mental health was greatest and favored the U.S. adults at low levels of somatization, but the disparity in mental health between countries disappeared as somatization increased. [Copyright &y& Elsevier]