Cultural Identity Among Afghan and Iraqi Traumatized Refugees: Towards a Conceptual Framework for Mental Health Care Professionals

Simon P N Groen,Cornelis J Laban,Annemiek Richters,Walter L J M Devillé

doi:10.1007/s11013-016-9514-7

Simon P N Groen, Cornelis J Laban + Show 2 more

Open Access

https://doi.org/10.1007/s11013-016-9514-7

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Abstract

Cultural identity in relation with mental health is of growing interest in the field of transcultural psychiatry. However, there is a need to clarify the concept of cultural identity in order to make it useful in clinical practice. The purpose of this study is to unravel the complexity and many layers of cultural identity, and to assess how stress and acculturation relate to (changes in) cultural identity. As part of a larger study about cultural identity, trauma, and mental health, 85 patients from Afghanistan and Iraq in treatment for trauma-related disorders were interviewed with a Brief Cultural Interview. The interviews were analysed through qualitative data analysis using the procedures of grounded theory. The analysis resulted in three domains of cultural identity: personal identity, ethnic identity and social identity. Within each domain relationships with stress and acculturation were identified. The results offer insight into the intensity of changes in cultural identity, caused by pre-and post-migration stressors and the process of acculturation. Based on the research findings recommendations are formulated to enhance the cultural competency of mental health workers.

Highlights

Cultural identity in relation to mental health is of growing interest in the field of transcultural psychiatry
The Brief Cultural Interview (BCI) is used in a narrative fashion, in which the 27 questions serve as a guideline leaving space for dialogue, in line with methodological recommendations for use of the Outline for Cultural Formulation (OCF) that include a graceful flow of questions and answers, an open inquiry, and an attitude of empathic concern (Mezzich et al 2009b)
Redefining and clustering the codes led to 56 codes. These codes were aggregated in 18 subgroups (e.g., Dutch, mother tongue, other languages, languages among children and literacy were categorized as ‘language’). These subgroups were further classified into three main domains of cultural identity each containing six items: 1) personal identity; 2) ethnic identity; and 3) social identity

Summary

Introduction

Cultural identity in relation to mental health is of growing interest in the field of transcultural psychiatry. The most obvious way in today’s cultural psychiatry to address that need is the use of the Outline for Cultural Formulation (OCF) in the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV, American Psychiatric Association 1994), which holds cultural identity as its first component. In the OCF, cultural identity is divided into three subheadings: individual’s ethnic or cultural reference group(s); degree of involvement with both the culture of origin and the host culture (for immigrants and ethnic minorities); and language abilities, use, and preference (including multilingualism, Lewis-Fernandez 1996:137)

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