Abstract
In low- and middle-income countries (LMIC) it is vital to understand acceptable, comprehensive, and culturally appropriate ways of communicating about mental distress. Diagnostic terminology is rarely used, may be stigmatizing, and is subject to misinterpretation. Local terms, such as idioms of distress, can improve mental health literacy and service delivery. Our objective was to examine lived experience and coping connected to distress and depression in an under-researched population: young men from LMIC urban slums. We conducted 60 qualitative interviews with men (ages 18–29) in Bhashantek slum, Bangladesh. Themes were generated using thematic analysis and grounded theory techniques. The heart-mind (mon), mentality (manoshikota), mood (mejaj), head (matha or “brain”), and body (shorir) comprised the self-concept, and were related to sadness, hopelessness, anger, worry, and mental illness. The English word “tension” was the central idiom of distress. “Tension” existed on a continuum, from mild distress or motivational anxiety, to moderate distress including rumination and somatic complaints, to severe psychopathology including anhedonia and suicidality. Respondents connected “tension” to burnout experiences and mental illness which was summarized in an ethnopsychological model. These findings can inform culturally sensitive measurement tools and interventions that are acceptable to the community, potentially increasing engagement and enhancing therapeutic outcomes.
Highlights
Depression is a major public health problem across the world affecting an estimated 300 million people globally (Patel et al 2016)
More than 80 percent of the people with mental illness reside in low- and middle-income countries (LMIC) (Rathod et al 2017), the diagnostic categories of depression and its screening and measurement tools, have been developed in highresource, Western cultural contexts
Research mostly conducted in North America and Europe inform the diagnostic criteria for depression in the Diagnostic and Statistical Manual (DSM) and the International Classification of Disease (ICD), the two prominent psychiatric systems of nosology (American Psychiatric Association 2013; World Health Organization 1992)
Summary
Depression is a major public health problem across the world affecting an estimated 300 million people globally (Patel et al 2016). Most psychological treatments are developed in relation to Western concepts and descriptions of depression, and evidence for effectiveness is determined by changes in Western biomedical symptoms of depression (Cuijpers et al 2008). This raises questions about whether the most important aspects of suffering are being identified and whether interventions are impacting those aspects of life and experience most valued in local settings (Chevance et al 2020)
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