RESUMO
Research on mental health in specific communities requires careful attention to cultural context and language. Studies on global mental health have increasingly analyzed idioms of distress, or culturally situated ways of conceptualizing, experiencing, and expressing distress. This study examines how idioms of distress are used and understood in Arcahaie, Haiti. The goal was to enrich current understanding of mental health conceptualization and communication by exploring the heterogeneity of common idioms of distress. Interviews with community members (N = 47) explored meanings and perceived causations of 13 idioms of distress. Major themes included pervasiveness of poverty, ruminative thinking, effects of Vodou and Christian belief systems, embodied distress, and the behavior of "crazy" people (moun fou). The findings suggest some specific pathways for potential community engagement projects, including training lay-leaders in cognitive behavioral therapy using existing socioreligious infrastructure and expanding access to social engagement activities. This research contributes to a small but growing body of literature on mental illness in Haiti and to methods for studying idioms of distress.
Assuntos
Comunicação , Transtornos Mentais , Estresse Psicológico , Ansiedade , Etnopsicologia , Haiti , Humanos , Transtornos Mentais/terapia , Saúde Mental/etnologia , Estresse Psicológico/etnologia , Estresse Psicológico/psicologiaRESUMO
The symptomatology for Post-Traumatic Stress Disorder (PTSD) narrowly focuses on particular diagnostic frames and a single triggering event. Such narrow definitions of trauma and recovery have been heavily critiqued by anthropologists and cultural psychiatrists for overlooking cultural complexity as well as the effects of multiple and overlapping events that may cause someone to become "traumatized" and thereby affect recovery. This article investigates how subjective reporting of traumatic experience in life history narratives relates to depressive and PTSD symptomatology, cultural idioms, and repeated traumatic experiences among low-income Mexican immigrant women in Chicago. We interviewed 121 Mexican immigrant women and collected life history narratives and psychiatric scales for depression and PTSD. Most women spoke of the detrimental effects of repeated traumatic experiences, reported depressive (49%) and PTSD (38%) symptoms, and described these experiences through cultural idioms. These data complicate the PTSD diagnosis as a discrete entity that occurs in relation to a single acute event. Most importantly, these findings reveal the importance of cumulative trauma and cultural idioms for the recognition of suffering and the limitation of diagnostic categories for identifying the needs of those who experience multiple social and psychological stressors.
Assuntos
Emigrantes e Imigrantes , Transtornos de Estresse Pós-Traumáticos , Ansiedade , Feminino , Humanos , Estresse PsicológicoRESUMO
The expressions resilience and posttraumatic growth represent metaphorical concepts that are typically found in Euro-American contexts. Metaphors of severe adversity or trauma and the expressions of overcoming it vary across cultures-a lacuna, which has not been given much attention in the literature so far. This study aimed to explore the metaphorical concepts that the Indigenous Pitaguary community in Brazil uses to talk about adaptive and positive responses to severe adversity and to relate them to their socio-cultural context. We carried out 14 semi-structured interviews during field research over a one-month period of fieldwork. The data were explored with systematic metaphor analysis. The core metaphors included images of battle, unity, spirituality, journeys, balance, time, sight, transformation, and development. These metaphors were related to context-specific cultural narratives that underlie the Pitaguary ontological perspective on collectivity, nature, and cosmology. The results suggest that metaphors and cultural narratives can reveal important aspects of a culture's collective mindset. To have a contextualized understanding of expressive nuances is an essential asset to adapt interventions to specific cultures and promote culture-specific healing and recovery processes.
Assuntos
Indígenas Sul-Americanos/psicologia , Metáfora , Crescimento Psicológico Pós-Traumático , Resiliência Psicológica , População Branca/psicologia , Adulto , Brasil/etnologia , Comparação Transcultural , Feminino , Humanos , Entrevistas como Assunto , Magia/psicologia , Masculino , Pessoa de Meia-Idade , Narração , População Rural , Suíça , Pensamento , Adulto JovemRESUMO
This article explores the pragmatic sensibilities that are implicit in idioms of distress among family caregivers for Alzheimer's disease in Teotitlán del Valle, a rural Zapotec-speaking community in Oaxaca, Mexico. Through analysis of caregivers' perceptions of progressive memory loss and related etiological understandings, this article emphasizes the pragmatism inherent to local health perspectives. In so doing, the article revisits Nichter's earliest formulation of idioms of distress as providing an alternative epistemological framework to appreciate how illness is varyingly understood. Such a framework is useful for understanding how idioms of distress are not aimed towards attaining accuracy about what illness is in an objective sense, but rather put into focus how such descriptions are both constitutive of-and themselves pragmatic responses to-broader social circumstances. This article concludes with a consideration of how idioms of distress empower individuals as agents of action.
Assuntos
Doença de Alzheimer/etnologia , Cuidadores , Família/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Indígenas Norte-Americanos/etnologia , Idioma , Estresse Psicológico/etnologia , Adulto , Idoso , Doença de Alzheimer/enfermagem , Feminino , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Pesquisa QualitativaRESUMO
With the aim of advancing the cross-cultural investigation of the folk illness nervios, I conducted a dual-sited comparative study of symptom descriptions among two diverse research settings in Honduras. Baer et al. (Cult Med Psychiatry 27(3):315-337, 2003) used cultural consensus modeling (CCM) to confirm a core description of nervios among four Latino groups in the US, Mexico, and Guatemala, but observed that overall agreement and average competence in a shared illness model decreased along a gradient from presumably more-to-less economically developed sites. This has left unresolved whether such variation extends to other Latin American regions. This paper is an exploratory analysis of inter- and intracultural variation in nervios symptom descriptions by 50 Hondurans from the market town of Copán Ruinas (n = 25) and city of San Pedro Sula (n = 25). I performed CCM using a combination of free-listing, pile-sorting, and rating activities to establish if respondents across sites share a single model of nervios. I found consensus for the San Pedro Sula subsample, but not for Copán Ruinas or for the overall sample. Results suggest nervios is constitutive of differing forms of distress ranging from chronic illness to acute suffering, as well as anger- and panic-based manifestations that overlap with biomedical ideas about depression, anxiety, and panic disorder. This variation derives in part from demographic factors such as age, gender, and residence, but may also result from ethnic and regional diversity among subsamples. However, consensus only being present among San Pedro Sula respondents suggests their greater awareness of cultural distinctions between biomedical and folk medical knowledge, which is likely due to their exposure to manifold health frameworks in those settings.
Assuntos
Transtornos Mentais/etnologia , Modelos Psicológicos , Terminologia como Assunto , Adulto , Ansiedade/etnologia , Consenso , Depressão/etnologia , Etnopsicologia , Feminino , Honduras/etnologia , Humanos , Masculino , Estresse Psicológico/etnologiaRESUMO
BACKGROUND: The nature and severity of 3 categories of maternal stressors (nutritional, infectious, and psychosocial) that may impact maternal health and early infant growth are not often considered together. OBJECTIVES: To describe quantitative methodologies; assess construct validity of questionnaires; report variability in sociodemographic, obstetric, nutritional, infectious, and psychosocial characteristics; and compare characteristics between pregnancy and lactation and between study cohorts of Mam-Mayan mother-infant dyads. METHODS: Grounded in participatory action research and a socioecological framework, this observational study enrolled a longitudinal cohort of 155 women, followed during pregnancy (6-9 months), early (0-6 weeks), and later (4-6 months) postpartum, and 2 cross-sectional cohorts (60 early and 56 later postpartum). Household and social factors; obstetric history; nutritional, infectious, and psychosocial stressors; and infant characteristics were explored. RESULTS: Diet diversity (3.4 ± 1.3) and adult food security (38%) were low. Urinary and gastrointestinal infections were rare (<5%), whereas experience of local idioms of distress was frequent (20%-50%). Participants reported low maternal autonomy (81%), high paternal support (70%), small social support networks (2.7 ± 1.3 individuals), and high trust in family (88%) and community-based institutions (61%-65%) but low trust in government services (6%). Domestic violence was commonly reported (22%). Infant stunting was common (36% early postpartum and 43% later postpartum) despite frequent antenatal care visits (7.5 ± 3.8). Participant engagement with the research team did not influence study outcomes based on comparisons between longitudinal and cross-sectional cohorts. CONCLUSIONS: The variability in sociodemographic, nutritional, and psychosocial variables, will allow exploration of factors that promote resilience or increase vulnerability of the mother-infant dyad.
Assuntos
Lactação , Fenômenos Fisiológicos da Nutrição Materna , Complicações na Gravidez/epidemiologia , População Rural , Adulto , Estudos Transversais , Dieta , Violência Doméstica/estatística & dados numéricos , Feminino , Abastecimento de Alimentos , Transtornos do Crescimento/epidemiologia , Guatemala/epidemiologia , Humanos , Lactente , Mortalidade Infantil , Transtornos da Nutrição do Lactente/epidemiologia , Recém-Nascido , Lactação/fisiologia , Lactação/psicologia , Estudos Longitudinais , Período Pós-Parto , Gravidez , Complicações na Gravidez/fisiopatologia , Complicações na Gravidez/psicologia , Complicações Infecciosas na Gravidez/epidemiologia , Estresse Psicológico/complicações , Estresse Psicológico/epidemiologia , Inquéritos e QuestionáriosRESUMO
The lack of culturally appropriate mental health assessment instruments is a major barrier to screening and evaluating efficacy of interventions. Simple translation of questionnaires produces misleading and inaccurate conclusions. Multiple alternate approaches have been proposed, and this study compared two approaches tested in rural Haiti. First, an established transcultural translation process was used to develop Haitian Kreyòl versions of the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). This entailed focus group discussions evaluating comprehensibility, acceptability, relevance, and completeness. Second, qualitative data collection was employed to develop new instruments: the Kreyòl Distress Idioms (KDI) and Kreyòl Function Assessment (KFA) scales. For the BDI and BAI, some items were found to be nonequivalent due to lack of specificity, interpersonal interpretation, or conceptual nonequivalence. For all screening tools, items were adjusted if they were difficult to endorse or severely stigmatizing, represented somatic experiences of physical illness, or were difficult to understand. After the qualitative development phases, the BDI and BAI were piloted with 31 and 27 adults, respectively, and achieved good reliability. Without these efforts to develop appropriate tools, attempts at screening would have captured a combination of atypical suffering, everyday phenomena, and potential psychotic symptoms. Ultimately, a combination of transculturally adapted and locally developed instruments appropriately identified those in need of care through accounting for locally salient symptoms of distress and their negative sequelae.