Towards a Cultural-Clinical Psychology

A Social Media Study of Portrayals of Bipolar Disorders on YouTube: Content and Thematic Analyses

BACKGROUND

Individuals with mental disorders frequently use YouTube to express themselves, reach an audience, or as a means of understanding their condition. Testimonies posted on YouTube provide longer and richer perspectives than the short posts found on other social media platforms. Research focusing on the depiction of mental disorders on YouTube is blossoming. Bipolar disorders (BDs) are disabling mood disorders. The diagnosis of any mental disorder, and more so BD, is often a life-changing event. However, no published study has investigated the portrayal of diagnoses of BD on YouTube.

OBJECTIVE

This study aims to investigate the portrayals of BDs on YouTube, focusing on the diagnosis narratives and their accompanying narrative context, in particular, reports of personal experiences and reactions.

METHODS

We performed a manual content analysis of 39 testimonies (women: n=24, 62%) depicting BDs and their diagnosis by individuals with BD. We also performed a thematic analysis of the corpus relying upon a deductive and inductive approach.

RESULTS

Our manual content analysis revealed that portrayals included the disclosure of diagnoses of BD-I (as per both coders' agreement: 10 testimonies) and BD-II (11 testimonies) to a similar extent. The reactions to the diagnosis were mostly negative (8 testimonies), followed by positive (5 testimonies), while fewer portrayals indicated a denial of the condition (4 testimonies). Several portrayals made mention of issues in the areas of money and accommodation (15 testimonies), profession and education (13 testimonies), and relationships (20 testimonies). Medication (31 testimonies) and psychotherapy (23 testimonies) were often mentioned as part of treatment for BD, most generally in positive terms. The 8 themes emerging from the thematic analysis were: "reactions on diagnosis, treatment, and health care professionals' expertise," "trial and error in medication," "positive effects of BD," "disability, stigma, and shame," "loss," "family planning and genetics," "identity change (psychological and physical)," and "human social relationships."

CONCLUSIONS

Overall, our results underline the complexity and richness of the depiction of the diagnosis of BD and its narrative context, and highlight the importance of the moment of the diagnosis, medication, and psychotherapy. Our study emphasizes the need for further exploration of the impact of social media on mental health awareness.

Sociocultural Implications in the Development of Early Maladaptive Schemas in Adolescents Belonging to Sexual and Gender Minorities

Culture is a central theme across various theories and disciplines, influencing behavior and self-perception through interactions within social groups, families, and legal systems. This influence extends to the general population and particularly impacts sexual and gender minorities (SGMs), resulting in minority stress that contributes to mental health issues and the development of Early Maladaptive Schemas (EMSs). Adolescents within these groups face typical developmental stressors-such as hormonal changes and societal pressures-compounded by prejudice, increasing their vulnerability to depression, anxiety, stress, substance abuse, and eating disorders. Despite these challenges, Schema Therapy (ST) lacks comprehensive studies on the sociocultural aspects influencing EMS acquisition in SGM adolescents. This theoretical review aims to fill this gap by exploring the impact of society and culture on EMS development within SGM adolescents. We recognize the broad spectrum of cultural influences and emphasize the importance of cultural sensitivity and diversity. This review specifically addresses how societal and cultural dynamics impact SGM individuals, acknowledging that while ethnic or other cultural factors are not the focus of this paper, they merit future research. This manuscript will discuss central topics and their impact on LGBTQIA+ youth, including (1) the background (definition of culture, lack of studies on ST focusing on culture, and studies on adverse psychological outcomes), (2) minority stress theory and prejudice against sexual and gender diversity (distal and proximal stressors and sociocultural aspects), (3) EMSs and unmet emotional needs, (4) ST affirmative strategies (working with schema modes, imagery rescripting, chair work, and photo techniques), and (5) final considerations (limitations and research agenda).

Research breakdowns: A constructive critique of research practice involving grief, trauma and displaced people

Impactful research on refugee mental health is urgently needed. To mitigate the growing refugee crisis, researchers and clinicians seek to better understand the relationship between trauma, grief and post-migration factors with the aim of bringing better awareness, more resources and improved support for these communities and individuals living in host countries. As much as this is our intention, the prevailing research methods, that is, online anonymous questionnaires, used to engage refugees in mental health research are increasingly outdated and lack inclusivity and representation. With this perspective piece, we would like to highlight a growing crisis in global mental health research; the predominance of a Global North-centric approach and methodology. We use our recent research challenges and breakdowns as a learning example and possible opportunity to rebuild our research practice in a more ethical and equitable way.

A new approach to cultural scripts of trauma sequelae assessment: The sample case of Switzerland

BACKGROUND

The novel concept of cultural scripts of trauma sequelae captures culture-specific expressions of posttraumatic distress (e.g., cognitive, emotional, interpersonal, psychosomatic changes) and their temporal associations. Cultural scripts of trauma sequelae complement pan-cultural (etic) diagnoses, such as posttraumatic stress disorder (PTSD) and Complex PTSD, as well as the cultural syndromes concept.

OBJECTIVE

This study aimed to develop the cultural scripts of trauma inventory (CSTI) for German-speaking Switzerland and to explore temporal associations of script elements.

METHOD

Five semi-structured focus groups were conducted with psychotraumatologists (n = 8) and Swiss trauma survivors (n = 7). The interview schedule included open questions about different domains of potential posttraumatic changes (emotions, cognitions, worldviews, interpersonal relationships, body-related experiences, behavior, and growth). Data were analyzed using qualitative content analysis.

RESULTS

The Swiss CSTI includes 57 emic elements that represent salient trauma sequelae (30 conformed with a theoretically derived item pool, 27 were newly phrased). Temporal script associations were visualized in a network, whereby self-deprecation, the urge to function and overcompensate, and the urge to hide and endure suffering had the highest number of connections.

CONCLUSION

While many posttraumatic changes identified in the present work seem to mirror pan-cultural phenomena represented in the Complex PTSD concept (e.g., self-deprecation), others (e.g., urge to function and perform, urge to hide and endure suffering) may be prominently related to Swiss culture with its value orientations. Knowledge about cultural scripts of trauma sequelae may provide a culture-specific framework that can help to understand individual experiences of distress and enable mental health practitioners to administer culturally sensitive interventions. Pending further validation, the Swiss CSTI bears the potential to advance culture-sensitive assessment of trauma sequelae.

Annual Research Review: Puberty and the development of anhedonia - considering childhood adversity and inflammation

Anhedonia, or diminished pleasure and motivation, is a symptom of severe mental illness (e.g., depressive disorder, bipolar disorder, schizophrenia) that emerges during adolescence. Anhedonia is a pernicious symptom that is related to social impairments, treatment resistance, and suicide. As the mechanisms of anhedonia are postulated to include the frontostriatal circuitry and the dopamine neuromodulatory system, the development and plasticity of these systems during the vulnerable period of adolescence, as well as their sensitivity to pubertal hormones, suggest that pubertal maturation could play a role in the development of anhedonia. This review takes a developmental perspective, considering the possibility that anhedonia emerges in the context of pubertal maturation and adolescent development, with childhood adversity and chronic inflammation influencing neural reward systems to accelerate anhedonia's progression. Here, we review the relevant extant literature on the components of this model and suggest directions for future research.

What Comes First, Acculturation or Adjustment? A Longitudinal Investigation of Integration Versus Mental Resources Hypotheses

A focal point in the acculturation literature is the so-called "integration hypothesis," whereby integration (high mainstream cultural engagement and heritage cultural maintenance) is associated with higher psychosocial adjustment, compared to other strategies. Yet, the vast majority of this literature is cross-sectional, raising questions about how best to understand associations between integration and adjustment. Does greater integration lead to greater psychosocial adjustment, as proposed by the integration hypothesis? Or is it the other way around, with more adjustment leading to greater integration, consistent with what we name the "mental resources hypothesis?" This study tests these 2 competing hypotheses in a 4-wave longitudinal study of 278 international students in their first weeks and months in Canada. The results replicate well-documented cross-sectional acculturation-adjustment associations. They also show that baseline adjustment is prospectively associated with later integration and mainstream acculturation, but not vice versa, supporting the mental resources hypothesis but not the integration hypothesis.

The cultural supplement: A new method for assessing culturally relevant prolonged grief disorder symptoms

Background

The new diagnosis of prolonged grief disorder (PGD) is both an opportunity and a challenge for researchers, clinicians, and bereaved individuals. The latest definition of PGD includes a refreshing and novel feature: the cultural caveat, i.e., clinicians must determine that the grief presentation is more severe and of longer duration than would be expected by an individual’s culture and context. Currently, there are no guidelines on how to operationalize the cultural caveat in mental health care settings.

Method

To respond to this important demand we have developed, piloted, and tested the cultural supplement module of the International Prolonged Grief Disorder scale (IPGDS). The cultural supplement aims to provide clinicians with a catalogue of culturally relevant symptoms of grief that indicate probable PGD alongside a simple framework for cultural adaptation for use in specific clinical settings.

Results

In this short report we outline the rationale and aim of the cultural supplement and provide a summary of our latest validation studies of the IPGDS with bereaved German-speaking, Chinese and Swiss migrant individuals. We also provide a step-by-step framework for adaptation of the cultural supplement that clinicians and researchers may use when working with different cultural groups.

Conclusion

To date, this is the first PGD questionnaire based on the ICD-11, and the first to include a cultural supplement that can be adapted to different contexts and groups. This cultural supplement will provide clinicians and researchers an easy-to-use assessment tool with the aim to improve the global applicability of the ICD-11 PGD definition.

Cross-cultural comparison of depressive symptoms on the Beck Depression Inventory-II, across six population samples

BACKGROUND

The Beck Depression Inventory (BDI) and BDI-II (revised version) are some of the most widely used and comparable self-report scales for assessing the presence and severity of depressive symptoms in many countries. However, although the relative mean score of each symptom in different countries may vary, the cultural differences of BDI-II symptoms for each item have not been previously studied.

AIMS

To examine the overall picture of the magnitude of the symptoms in the Finnish population, and compare the relative mean score of each symptom between all published population-based samples from different countries fulfilling the search criteria.

METHOD

We conducted a search for population-based studies reporting BDI-II item, using Scopus, PsycINFO and PubMed, and five population-based samples were identified. Relative average scores for each item of the scale were calculated for the Finnish population and five populations from other countries. Meta-regression methods were used to test the differences in the relative score of each symptom between each country separately, and results were then visually compared with spider charts.

RESULTS

We found significant differences in several BDI-II item scores between countries: lower indecisiveness, higher changes in sleep pattern and higher irritability in Finland; higher loss of pleasure in Norway; higher loss of interest in the Dominic Republic; higher self-criticalness and feelings of punishment in Mexico; and higher sadness in Japan.

CONCLUSIONS

Based on the study fundings and including all currently published population-based samples with BDI-II scores, cultural differences in depressive symptoms should be considered when interpreting BDI-II item scores.

The Social Lives of Infectious Diseases: Why Culture Matters to COVID-19

Over the course of the year 2020, the global scientific community dedicated considerable effort to understanding COVID-19. In this review, we discuss some of the findings accumulated between the onset of the pandemic and the end of 2020, and argue that although COVID-19 is clearly a biological disease tied to a specific virus, the culture-mind relation at the heart of cultural psychology is nonetheless essential to understanding the pandemic. Striking differences have been observed in terms of relative mortality, transmission rates, behavioral responses, official policies, compliance with authorities, and even the extent to which beliefs about COVID-19 have been politicized across different societies and groups. Moreover, many minority groups have very different experiences of the pandemic relative to dominant groups, notably through existing health inequities as well as discrimination and marginalization, which we believe calls for a better integration of political and socioeconomic factors into cultural psychology and into the narrative of health and illness in psychological science more broadly. Finally, individual differences in, for example, intolerance of uncertainty, optimism, conspiratorial thinking, or collectivist orientation are influenced by cultural context, with implications for behaviors that are relevant to the spread and impact of COVID-19, such as mask-wearing and social distancing. The interplay between cultural context and the experience and expression of mental disorders continues to be documented by cultural-clinical psychology; the current work extends this thinking to infectious disease, with special attention to diseases spread by social contact and fought at least in part through social interventions. We will discuss cultural influences on the transmission, course, and outcome of COVID-19 at three levels: (1) cross-society differences; (2) within-society communities and intergroup relations; and (3) individual differences shaped by cultural context. We conclude by considering potential theoretical implications of this perspective on infectious disease for cultural psychology and related disciplines, as well as practical implications of this perspective on science communication and public health interventions.

Comparing the effects of emotional disclosure and peer helping writing on psychological distress among Chinese international students: The moderating role of rumination

OBJECTIVES

This study tested the effects of emotional disclosure writing and peer helping writing in reducing psychological distress among Chinese international students. This study also examined whether rumination and ambivalence over emotion expression moderated the effects of emotional disclosure and peer helping writing.

METHOD

One hundred forty-four Chinese international students were randomly assigned to one of three conditions: emotional disclosure, peer helping, or neutral control writing. Participants completed two 20-min writing sessions and questionnaires at baseline, 2-month follow-up, and 4-month follow-up.

RESULTS

We found no significant differences across the three writing conditions in levels of psychological distress over time. However, rumination emerged as a significant moderator in both emotional disclosure and peer helping intervention conditions. High ruminators generally experienced significant reductions in depressive symptoms, whereas low ruminators experienced increased depressive symptoms.

CONCLUSIONS

These findings demonstrate that the benefits of writing interventions may vary as a function of rumination.

Cross-cultural validation of the Mood Questionnaire in three Spanish-speaking countries Argentina, Ecuador, and Spain

This study validates the Mood Questionnaire for adults in three Spanish-speaking countries: Argentina, Ecuador, and Spain. It then analyzes the influence of gender and cultural differences on mood, and whether there is a relationship between mood, emotional intelligence, and the Avoidance of Responsibility. A convenience sample of 1048 adults, with a middle-class socioeconomic background, was selected from three Spanish-speaking countries (Spain, Argentina, and Ecuador). The psychometric properties of the Mood Questionnaire are adequate, which is particularly interesting given the need for transcultural tools to evaluate moods. Moreover, the mood was associated with avoidance of responsibility and emotional intelligence. In addition, differences in mood were observed according to country and gender. These findings are interesting because the Spanish version of the Mood Questionnaire has been validated for children but not for adults, and it compares three Spanish-speaking countries. The use of this diagnostic tool with Spanish adults can be justified according to these results.

Not All Forms of Independence Are Created Equal: Only Being Independent the "Right Way" Is Associated With Self-Esteem and Life Satisfaction

Past research has found a strong and positive association between the independent self-construal and life satisfaction, mediated through self-esteem, in both individualistic and collectivistic cultures. In Study 1, we collected data from four countries (the United States, Japan, Romania, and Hungary; N = 736) and replicated these findings in cultures which have received little attention in past research. In Study 2, we treated independence as a multifaceted construct and further examined its relationship with self-esteem and life satisfaction using samples from the United States and Romania (N = 370). Different ways of being independent are associated with self-esteem and life satisfaction in the two cultures, suggesting that it is not independence as a global concept that predicts self-esteem and life satisfaction, but rather, feeling independent in culturally appropriate ways is a signal that one’s way of being fits in and is valued in one’s context.

Gender Differences in Psychological Symptoms and Psychotherapeutic Processes in Japanese Children

Gender differences have been documented in the prevalence of psychological symptoms. Tic disorders and autism spectrum disorder (ASD) are more common in male clinical samples, while selective mutism and trichotillomania are more common in female clinical samples. In a review of 84 published case studies of Japanese children, this study explored gender differences in the prevalence of four categories of symptoms and expressions made in therapy for tics, selective mutism, autism spectrum disorder (ASD), and trichotillomania. Case studies were evaluated using both qualitative coding and statistical analysis. The findings were mostly consistent with epidemiological surveys and empirical research on adults. The gender differences in symptom prevalence and their expression could be summarized as differences in more direct aggression for boys versus indirect aggression for girls. The objective and progress in the therapy were to control impulsive energy for boys and to express energy for girls.

Cultural Context in DSM Diagnosis: An American Indian Case Illustration of Contradictory Trends

Recent revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) increasingly acknowledge the importance of cultural context for the diagnosis of mental illness. However, these same revisions include evolving diagnostic criteria that simultaneously decontextualize particular disorders such as Major Depressive Disorder (MDD) and Posttraumatic Stress Disorder (PTSD). As a result, the DSM reflects a contradictory role for context in psychiatric diagnosis. The case analysis presented here frames the consequences of this contradictory trend for an American Indian woman with a history of DSM-IV MDD and PTSD, whose diagnostic portrait is substantively altered in light of more recent DSM-5 criteria. Specifically, consideration of this respondent's bereavement-related illness experience suggests that a sociocentric cultural frame of reference, which places high value on interdependent personal relationships, is not well-captured by DSM-5's revised MDD or PTSD criteria, or the newly proposed categories of traumatic bereavement or Persistent Complex Bereavement Disorder. The respondent's illness experience argues for greater recognition of this contradictory diagnostic trend, suggesting a need for future resolution of this tension toward more valid diagnosis for culturally diverse populations.

Traces of culture: The feedback loop between behavior, brain, and disorder

Culture is part of an extensive series of feedback loops, which involve multiple organismic levels including social contexts, cognitive mediations, neural processes, and behavior. Recent studies in neuroscience show that culturally contingent social processes shape some neural pathways. Studying the influence of cultural context on neural processes may yield new insights into psychiatric disorders. New methodologies in the neurosciences offer innovative ways to assess the impact of culture on mental health and illness. However, implementing these methodologies raises important theoretical and ethical concerns, which must be resolved to address patient individuality and the complexity of cultural diversity. This article discusses cultural context as a major influence on (and consequence of) human neural plasticity and advocates a culture-brain-behavior (CBB) interaction model for conceptualizing the relationship between culture, brain, and psychiatric disorders. Recommendations are made for integrating neuroscientific techniques into transcultural psychiatric research by taking a systems approach to evaluating disorders.

A Point in the Heart: Concepts of Emotional Distress Among Albanian-Speaking Immigrants in Switzerland

Cultural variability regarding concepts of distress for common mental disorders (CMD) has been reported extensively in cultural clinical psychology across the globe. However, little is known about illness narratives in social communities from Southeast Europe. The purpose of this paper is to identify cultural concepts of distress (CCDs) among Albanian-speaking immigrants in Switzerland and to integrate the findings into literature from other parts of the world. Twenty semi-structured qualitative interviews were conducted using the Barts Explanatory Model Inventory (BEMI). A set of concepts was described through content analysis and semantic network analysis. The results show complex expressions of distress, which are mainly associated with post-migration living difficulties. Social problems and life-changing events mark the onset of the most common symptoms. Self-management and social support were described as the most important coping behaviors. Participants expressed trust in physical health care but little belief in psychotherapy. There is indication that mental illnesses are stigmatized in this population. It is therefore important to use non-stigmatizing terms in health communication. Moreover, individuals from this community consider suffering to be part of life, and they assume that this suffering must be endured with patience. It is vital to address these beliefs in psychological interventions.

Culturally shared metaphors expand contemporary concepts of resilience and post-traumatic growth: contrasting an indigenous Brazilian community and a Swiss rural community

The metaphorical concepts resilience and post-traumatic growth (PTG) reflect the contemporary Western understanding of overcoming highly challenging life events. However, it is known that across different cultures, a broad range of metaphorical idioms for describing adaptive responses to severe adversity exists. This study aimed to explore and contrast two distinct cultural groups' culturally shared metaphors for overcoming severe adversities. Fieldwork was conducted in two rural communities: an indigenous Brazilian community that has experienced severe collective adversity and a mountain village in Switzerland that has survived a natural disaster. We carried out separate qualitative metaphor analyses of semistructured interview data from each community. There were some similarities in the metaphorical narratives of the two cultural groups, for example, in metaphors of balance, changed perspective, collective cohesion and life as a journey The main variations were found in metaphors of magical thinking, equilibrium and organic transformation used by the Brazilian group and metaphors of work, order and material transformation used by the Swiss group. Results from this study suggest that the Western-devised concepts of resilience and PTG can be further expanded, which is highlighted by the variety of culturally shared metaphors. Metaphorical idioms for overcoming severe adversity may be determined by the type of trauma as well as by the sociocultural and historical context. Our findings indicate potential approaches to the cultural adaptation of psychological interventions.

Network models can help focus research on the role of culture and context in psychopathology, but don't discount latent variable models

Borsboom et al. correctly note that the use of latent variable models in cross-cultural research has resulted in a futile search for universal, biological causes of psychopathology; however, this is not an inevitable outcome of such models. While network analytic approaches require further development, network models have the potential to better elucidate the role of cultural and contextual variables related to psychopathology.

Heritage Acculturation Is Associated With Contextual Factors at Four Different Levels of Proximity

What factors explain the extent to which members of cultural minorities maintain their heritage cultural engagement? Although this process, called heritage acculturation, has significant implications for adjustment, we know little about its antecedents. The present work sought to address two shortcomings of acculturation research: (a) the need to characterize antecedents of acculturation orientations and (b) the need to consider acculturation as a contextual phenomenon. Some studies have documented associations between acculturation and specific contextual variables (e.g., family socialization), but an important feature of this research was to examine the unique contribution of factors at multiple levels of proximity simultaneously. Specifically, this study considered intraindividual, home, social network, and neighborhood-level contextual correlates of heritage acculturation. The overarching hypothesis tested among multicultural university students in Canada ( n = 271) was that people whose life contexts are more strongly imbued with heritage cultural influences would report greater heritage acculturation. Results fully supported this hypothesis. Greater heritage language competence, “parental” living arrangements, a more extensive heritage social network, and living in an ethnically denser neighborhood were all related to greater heritage cultural maintenance. Further, only heritage network extensiveness was negatively related to mainstream cultural engagement—attesting to the cultural specificity of these associations. These results suggest that none of the four contextual levels considered here was sufficient on its own to understand participants’ heritage acculturation and that we need a holistic view of the person in her or his multiple contexts when studying acculturation.

Comparison of the Factor Structure of the Patient Health Questionnaire for Somatic Symptoms (PHQ-15) in Germany, the Netherlands, and China. A Transcultural Structural Equation Modeling (SEM) Study

Background: Persistent somatic symptoms are associated with psychological distress, impaired function, and medical help-seeking behavior. The Patient Health Questionnaire (PHQ)-15 is used as a screening instrument for somatization and as a monitoring instrument for somatic symptom severity. A bifactorial model has been described, with one general factor and four orthogonal specific symptom factors. The objective of the present study was to assess and to clarify the factor structure of the PHQ-15 within and between different countries in Western Europe and China. Method: Cross-sectional secondary data analysis performed in three patient data samples from two Western European countries (Germany N = 2,517, the Netherlands N = 456) and from China (N = 1,329). Confirmatory factor analyses (CFA), and structural equation modeling (SEM) analysis were performed. Results: The general factor is found in every sample. However, although the outcomes of the PHQ-15 estimate severity of somatic symptoms in different facets, these subscales may have different meanings in the European and Chinese setting. Replication of the factorial structure was possible in the German and Dutch datasets but not in the dataset from China. For the Chinese dataset, a bifactorial model with a different structure for the cardiopulmonary factor is suggested. The PHQ-15 could discern somatization from anxiety and depression within the three samples. Conclusion: The PHQ-15 is a valid questionnaire that can discern somatization from anxiety and depression within different cultures like Europe or China. It can be fitted to a bifactorial model for categorical data, however, the model can only be recommended for use of the general factor. Application of the orthogonal subscales in non-European samples is not corroborated by the results. The differences cannot be ascribed to differences in health care settings or by differences in concomitant depression or anxiety but instead, a cultural factor involving concepts of disease may play a role in this as they may play a role in the translation of the questionnaire. Further research is needed to explore this, and replication studies are needed regarding the factorial structure of the PHQ-15 in China.

Convergence in feeling, divergence in physiology: How culture influences the consequences of disgust suppression and amplification among European Americans and Asian Americans

Much empirical work documents the downsides of suppressing emotions. Emerging research points to the need for a more sophisticated and culturally informed approach to understanding the consequences of emotion regulation. To that end, we employed behavioral, self-report, and psychophysiological measures to examine the consequences of two types of emotion regulation (suppression and amplification) in a sample of 28 Asian Americans and 31 European Americans. Participants were shown a neutral film and then a series of disgust-eliciting films during which they were asked to regulate their response by suppressing or amplifying their emotional behavior (counterbalanced). Despite self-reporting equal levels of disgust, European Americans showed greater skin conductance reactivity than Asian Americans in both regulation conditions, but not in response to a neutral film. These findings extend work on divergence in the consequences of emotion regulation across different cultural groups, which could help identify optimal emotion regulation strategies for health and well-being.

Low prevalence of the use of the Chinese term for 'psychiatry' in the names of community psychiatry clinics: A nationwide study in Taiwan

BACKGROUND

Relabeling has been proposed as a strategy to reduce the stigma associated with mental illnesses. Previous studies have shown that changing the names of psychiatry clinics has led to reduced feelings of being stigmatized among patients. In Taiwan, terms other than 'psychiatry' (in Chinese, jīng shén kē) are more commonly used in the names of psychiatry clinics. The term 'psychosomatic clinics' is widely used instead.

AIMS

This study investigated the characteristics of psychiatry clinic names in order to better understand the role of clinic names in primary care settings.

METHODS

Relevant data were extracted from an open database maintained by the government of Taiwan. These data included the names of community psychiatry clinics and hospital-based psychiatry clinics, population size and the degree of urbanization in the area served by each clinic.

RESULTS

At the time of this study, there were 254 community psychiatry clinics and 190 hospital-based psychiatry clinics in Taiwan. Only 18.9% of the community clinic names included the term 'psychiatry'. Additionally, 14.6% of community clinic names and 28.4% of hospital-based clinic names included the term 'psychosomatics'. The regions in which clinics without 'psychiatry' in their names were located had significantly larger populations and higher levels of urbanization than the regions in which clinics with 'psychiatry' in their names were located.

CONCLUSION

A low prevalence of the term 'psychiatry' in community psychiatry clinic names was found in Taiwan. The stigma associated with psychiatry and other socio-cultural factors are hypothesized to explain this phenomenon.

The Chinese Experience of Rapid Modernization: Sociocultural Changes, Psychological Consequences?

Mainland China has undergone profound changes dating back to the nineteenth century, including a contemporary period of rapid modernization that began in the 1980s. The result has been dramatic social, cultural, and economic shifts impacting the daily lives of Chinese people. In this paper, we explore the psychological implications of sociocultural transformation in China, emphasizing two central themes. First, rising individualism: findings from social and developmental psychology suggest that China’s rapid development has been accompanied by ever-increasing adherence to individualistic values. Second, rising rates of depression: findings from psychiatric epidemiology point to increasing prevalence of depression over this same time period, particularly in rural settings. We argue that links between sociocultural and psychological shifts in China can be usefully studied through a cultural psychology lens, emphasizing the mutual constitution of culture, mind, and brain. In particular, we note that the link between social change, individualism, and rising mental illness deserves careful attention. Our review suggests that shifting values and socialization practices shape emotion norms of concealment and display, with implications for depressive symptom presentation. The challenge comes with interpretation. Increasing prevalence rates of depression may indeed be a general response to the rapidity of sociocultural change, or a specific consequence of rising individualism—but may also result from increasingly ‘Western’ patterns of symptom presentation, or improvements in diagnostic practice. We conclude by considering the challenges posed to standard universal models of psychological phenomena.

The Effectiveness of Somatization in Communicating Distress in Korean and American Cultural Contexts

Previous research has documented that Asians tend to somatize negative experiences to a greater degree than Westerners. It is posited that somatization may be a more functional communication strategy in Korean than American context. We examined the effects of somatization in communications of distress among participants from the US and Korea. We predicted that the communicative benefits of somatic words used in distress narratives would depend on the cultural contexts. In Study 1, we found that Korean participants used more somatic words to communicate distress than US participants. Among Korean participants, but not US participants, use of somatic words predicted perceived effectiveness of the communication and expectations of positive reactions (e.g., empathy) from others. In Study 2, we found that when presented with distress narratives of others, Koreans (but not Americans) showed more sympathy in response to narratives using somatic words than narratives using emotional words. These findings suggest that cultural differences in use of somatization may reflect differential effectiveness of somatization in communicating distress across cultural contexts.

From culture to symptom: Testing a structural model of "Chinese somatization"

"Chinese somatization" has been frequently discussed over the past three decades of cultural psychiatry, and has more recently been demonstrated in cross-national comparisons. Empirical studies of potential explanations are lacking, however. Ryder and Chentsova-Dutton (2012) proposed that Chinese somatization can be understood as a cultural script for depression, noting that the literature is divided on whether this script primarily involves felt bodily experience or a stigma-avoiding communication strategy. Two samples from Hunan province, China-one of undergraduate students (n = 213) and one of depressed psychiatric outpatients (n = 281)-completed the same set of self-report questionnaires, including a somatization questionnaire developed in Chinese. Confirmatory factor analysis demonstrated that Chinese somatization could be understood as two correlated factors: one focusing on the experience and expression of distress, the other on its conceptualization and communication. Structural equation modeling demonstrated that traditional Chinese cultural values are associated with both of these factors, but only bodily experience is associated with somatic depressive symptoms. This study takes a first step towards directly evaluating explanations for Chinese somatization, pointing the way to future multimethod investigations of this cultural script.

Respiratory Sinus Arrhythmia Is Prospectively Associated With Early Trajectories of Acculturation Among New International Students

Respiratory sinus arrhythmia (RSA) is a marker of parasympathetic activity hypothesized to index a neurophysiological system supporting social engagement behaviors. Following migration, people must navigate and adapt to a new sociocultural environment. Whether RSA affects this psychological acculturation process is unknown. This longitudinal study investigated whether resting RSA on arrival in the receiving country was related to changes in cultural orientations toward both mainstream and heritage cultural groups during the first 5 months following migration. Sixty new international students provided information on their cultural orientations toward the mainstream and heritage cultural groups shortly after arrival in the new country and 2 and 5 months after the first assessment. Results indicated that both heritage and mainstream orientations increased linearly over time. Furthermore, greater resting RSA at baseline was prospectively associated with larger increases in positive orientation toward the mainstream culture but not the heritage culture, over and above individual differences in extraversion, depression, and anxiety. These data provide longitudinal evidence that higher RSA promotes an approach-oriented stance toward a novel cultural environment.

"I felt sad and did not enjoy life": Cultural context and the associations between anhedonia, depressed mood, and momentary emotions

The meanings of "anhedonia" and "depressed mood," the cardinal emotional symptoms of major depression, may be shaped by cultural norms regarding pleasure and sadness. Thirty-two European Americans, 26 Hispanic Americans, 33 Asian Americans, and 20 Russian Americans provided reports of (a) depressive symptoms, (b) momentary emotions and pleasure, and (c) global subjective well-being. Momentary reports were collected over 10 days using handheld personal digital assistants. Reports of anhedonia were associated with heightened levels of momentary low arousal negative emotions (e.g., sadness), whereas reports of depressed mood were associated with dampened levels of momentary positive emotions (e.g., happiness). Symptoms of anhedonia and depressed mood interacted in their associations with momentary pleasure. In addition, the associations of anhedonia and depressed mood with positive emotions and life satisfaction differed across cultural groups. Specifically, these symptoms were associated with dampened positive emotions in the Asian American group only. Additionally, anhedonia was associated with dampened global life satisfaction in the European American group only. These results suggest that reports of anhedonia and depressed mood cannot be interpreted at face value as specific and culture-free indicators of emotional deficits. Instead, they appear to signal changes in the balance of positive and negative emotions, with the exact nature of these signals shaped at least in part by cultural context. This conclusion has important consequences for the clinical interpretation of depressive symptoms in multicultural societies.

Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language

BACKGROUND

Miscommunication in the healthcare sector can be life-threatening. The rising number of migrant patients and foreign-trained staff means that communication errors between a healthcare practitioner and patient when one or both are speaking a second language are increasingly likely. However, there is limited research that addresses this issue systematically. This protocol outlines a hospital-based study examining interactions between healthcare practitioners and their patients who either share or do not share a first language. Of particular interest are the nature and efficacy of communication in language-discordant conversations, and the degree to which risk is communicated. Our aim is to understand language barriers and miscommunication that may occur in healthcare settings between patients and healthcare practitioners, especially where at least one of the speakers is using a second (weaker) language.

METHODS/DESIGN

Eighty individual interactions between patients and practitioners who speak either English or Chinese (Mandarin or Cantonese) as their first language will be video recorded in a range of in- and out-patient departments at three hospitals in the Metro South area of Brisbane, Australia. All participants will complete a language background questionnaire. Patients will also complete a short survey rating the effectiveness of the interaction. Recordings will be transcribed and submitted to both quantitative and qualitative analyses to determine elements of the language used that might be particularly problematic and the extent to which language concordance and discordance impacts on the quality of the patient-practitioner consultation.

DISCUSSION

Understanding the role that language plays in creating barriers to healthcare is critical for healthcare systems that are experiencing an increasing range of culturally and linguistically diverse populations both amongst patients and practitioners. The data resulting from this study will inform policy and practical solutions for communication training, provide an agenda for future research, and extend theory in health communication.

Transatlantic variation in the attributed etiology of psychosis

BACKGROUND

Differences in transatlantic perception of psychosis have been reported in the historical psychiatric literature.

AIMS

This study aims to determine if articles in the American Journal of Psychiatry (AJP) are more likely to attribute biological factors to the etiology of psychosis than those of the British Journal of Psychiatry (BJP).

METHODS

A systematic MEDLINE search for articles in the AJP and BJP from 2005 to 2007 identified 360 abstracts with psychosis and etiology-related words. Chi-square analyses were used to test differences in the proportion of attributed biological or psychosocial etiology of psychosis in each journal.

RESULTS

A greater proportion of abstracts (83/87) in the AJP attributed biological etiology of psychosis (χ(2) = 12.33, df = 1, p < 0.001), while a greater proportion in the BJP (16/44 abstracts) attributed psychosocial etiology (χ(2) = 19.76, df = 1, p < 0.001).

CONCLUSIONS

The AJP tends to publish biomedical explanations of psychosis, while the BJP shows a relative preference for psychosocial theories.

Feeling right is feeling good: psychological well-being and emotional fit with culture in autonomy- versus relatedness-promoting situations

The current research tested the idea that it is the cultural fit of emotions, rather than certain emotions per se, that predicts psychological well-being. We reasoned that emotional fit in the domains of life that afford the realization of central cultural mandates would be particularly important to psychological well-being. We tested this hypothesis with samples from three cultural contexts that are known to differ with respect to their main cultural mandates: a European American (N = 30), a Korean (N = 80), and a Belgian sample (N = 266). Cultural fit was measured by comparing an individual's patterns of emotions to the average cultural pattern for the same type of situation on the Emotional Patterns Questionnaire (De Leersnyder et al., 2011). Consistent with our hypothesis, we found evidence for "universality without uniformity": in each sample, psychological well-being was associated with emotional fit in the domain that was key to the cultural mandate. However, cultures varied with regard to the particular domain involved. Psychological well-being was predicted by emotional fit (a) in autonomy-promoting situations at work in the U.S., (b) in relatedness-promoting situations at home in Korea, and (c) in both autonomy-promoting and relatedness-promoting situations in Belgium. These findings show that the experience of culturally appropriate patterns of emotions contributes to psychological well-being. One interpretation is that experiencing appropriate emotions is itself a realization of the cultural mandates.

Extending a structural model of somatization to South Koreans: Cultural values, somatization tendency, and the presentation of depressive symptoms

BACKGROUND

Somatization refers to the tendency to emphasize somatic symptoms when experiencing a psychiatric disturbance. This tendency has been widely reported in patients from East Asian cultural contexts suffering from depression. Recent research in two Chinese samples have demonstrated that the local cultural script for depression, involving two aspects-the experience and expression of distress (EED) and conceptualization and communication of distress (CCD)-can be evoked to help explain somatization. Given the beliefs and practices broadly shared across Chinese and South Korean cultural contexts, the current study seeks to replicate this explanatory model in South Koreans.

METHODS

Our sample included 209 psychiatric outpatients from Seoul and Wonju, South Korea. Self-report questionnaires were used to assess somatization tendency, adherence to traditional values, and psychological and somatic symptoms of depression.

RESULTS

Results from SEM showed that the EED and CCD factors of somatization tendency were differently associated with cultural values and somatic symptoms, replicating our previous findings in Chinese outpatients.

LIMITATIONS

The reliance on a brief self-report measure of somatization tendency, not originally designed to assess separate EED and CCD factors, highlights the need for measurement tools for the assessment of cultural scripts in cross-cultural depression research.

CONCLUSIONS

The replication of the Chinese structural model of somatization in South Korea lends empirical support to the view that somatization can be understood as the consequence of specific cultural scripts. These scripts involve the experience and expression of distress as well as culturally meaningful ways in which this distress is conceptualized and communicated to others.

Reconciling evidence-based practice and cultural competence in mental health services: introduction to a special issue

The calls for evidence-based practice (EBP) and cultural competence (CC) represent two increasingly influential mandates within the mental health professions. Advocates of EBP seek to standardize clinical practice by ensuring that only treatment techniques that have demonstrated therapeutic outcomes under scientifically controlled conditions would be adopted and promoted in mental health services. Advocates of CC seek to diversify clinical practice by ensuring that treatment approaches are designed and refined for a multicultural clientele that reflects a wide variety of psychological orientations and life experiences. As these two powerful mandates collide, the fundamental challenge becomes how to accommodate substantive cultural divergences in psychosocial experience using narrowly prescriptive clinical practices and approaches, without trivializing either professional knowledge or cultural difference. In this Introduction to a special issue of Transcultural Psychiatry, the virtue of an interdisciplinary conversation between and among anthropologists, psychologists, psychiatrists, and social work researchers in addressing these tensions is extolled.

Unpacking Cultural Variations in Social Anxiety and the Offensive-Type of Taijin Kyofusho Through the Indirect Effects of Intolerance of Uncertainty and Self-Construals

This article presents two studies that aim to unpack cultural variations in general social anxiety (SA) and the offensive-type of Taijin Kyofusho (OTKS)—a type of SA characterized by the extreme fear of offending others. Cultural variations in the expression and manifestation of SA are well established; however, the mechanisms underpinning this relation are unclear. The present studies use the Parallel Multiple Mediation Model to study how SA and OTKS are jointly shaped by self-construal and intolerance of uncertainty (IU). Study 1 compared Euro-Canadians and Chinese migrants in Canada. Results showed a mean group difference in OTKS, but not SA, with the difference mediated by IU. Study 2 tested this pattern of multiple mediations in Japanese, Chinese, and Euro-Canadian cultural contexts. Results showed significant differences among these three cultural groups on both SA and OTKS via multiple mediators (e.g., independent vs. interdependent self-construals and IU). Findings in both studies revealed that OTKS seems to be a psychopathology that is not specific to Japanese participants. The underlying mechanisms and processes of OTKS are also significantly different from SA. Significant cultural variations in SA and OTKS between Chinese versus Japanese cultural contexts were observed in Study 2. These studies demonstrate the conceptual and empirical advantages of using more complex models to unpack the psychological mechanisms shaping cultural variations in SA and OTKS.

Somatic Referencing and Psychologisation in Emotion Narratives: A USA–Ghana Comparison

Ameka (2002), Dzokoto and Okazaki (2006) and Guerts (2002) have observed a preponderance of somatic references in the communication of emotion in several spoken Ghanaian languages. This suggests that embodiment features prominently in Ghanaian cultural scripts of emotions. Unfortunately, the structure of English—Ghana’s official language due to its British colonial history—does not provide opportunities for somatic referencing in its emotion lexicon. How, then, do English-speaking Ghanaians express emotions, given the discrepancy between the cultural scripts and the structural limitations of the English emotion lexicon? To answer this question, 186 Ghanaian and181 American college students recalled what they considered one of their top ten most significant positive or negative emotional events, and indicated recalled physiological changes on a blank diagram of the human body. A subgroup of the larger sample provided written narratives about their most significant emotional event. Using thematic investigations and Linguistic Inquiry Word Count software, data analysis explored the nature of discourse about emotions in English, with particular focus on affective and embodied referents in the emotion narratives. Ghanaians reported fewer emotion words, but not more somatic words. The implications of the findings for somatisation are discussed.