Idioms Of Distress Research Articles

A Glossary of Distress Expressions Among Kannada-Speaking Urban Hindu Women.

People's lived experiences of distress are complex, personal, and vary widely across cultures. So, too, do the terms and expressions people use to describe distress. This variation presents an engaging challenge for those doing intercultural work in transcultural psychiatry, global mental health, and psychological anthropology. This article details the findings of a study of common distress terminology among 63 Kannada-speaking Hindu women living in Mysuru, the second largest city in the state of Karnataka, South India. Very little existing scholarship focuses on cultural adaptation for speakers of Dravidian languages like Kannada; this study aims to fill this gap and support greater representation of this linguistic family in research on mental health, idioms of distress, and distress terminology. Between 2018 and 2019, we conducted a 3-phase study consisting of interviews, data reduction, and focus group discussions. The goal was to produce a non-exhaustive list of common Kannada distress terms that could be used in future research and practice to translate and culturally adapt mental health symptom scales or other global mental health tools.

Measuring culturally and contextually specific distress among Afghan, Iraqi, and Great Lakes African refugees.

Culturally and contextually valid measurement of psychological distress is critical, given the increasing numbers of forcibly displaced people and transnational migration. This study replicates an inductive process that elicited culturally specific expressions, understandings, and idioms of distress among Afghans to develop culturally specific measures of distress for Great Lakes Africans and Iraqis and expands this methodology to include a focus on the contexts of refugees resettled in the United States. To create the measures, we adapted Miller et al.'s (2006) model for the Afghan Symptom Checklist (ASCL) and conducted 18 semistructured qualitative interviews that attended to refugees' multiple settings; the impact of potentially traumatic events initially and postresettlement; and the experiences and impact of resettlement stressors. We tested the newly developed measures and existing ASCL with 280 recently resettled refugees (< 3 years) from Afghanistan, the Great Lakes region of Africa, and Iraq to assess factor structure, reliability, and construct validity. We successfully replicated and adapted a process for creating culturally specific measures of distress to create reliable and valid scales that consider culturally and contextually specific distress among several groups of forcibly displaced people. Our results highlight the salience of individuals' social contexts and how they are manifested as idioms of distress, bringing together two key areas of research: the social construction of mental health and social determinants of mental health. These findings have implications for improving measurement of psychological distress and for developing multilevel interventions that are culturally resonant and address factors beyond the individual level. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Shift-and-persist strategies as a potential protective factor against symptoms of psychological distress among young adults in Puerto Rico.

Residents of Puerto Rico are disproportionately exposed to social and environmental stressors (e.g., Hurricane María and the 2020 sequence of tremors) known to be associated with psychological distress. Shift-and-persist (SP), or the ability to adapt the self to stressors while preserving focus on the future, has been linked with lower psychological distress, but no study has evaluated this in Puerto Rico. This study examined the association between SP and psychological distress (including that from natural disasters) in a sample of young adults in Puerto Rico. Data from the Puerto Rico-OUTLOOK study (18-29 y) were used. Participants (n = 1497) completed assessments between September 2020 and September 2022. SP was measured with the Chen scale and categorized into quartiles (SPQ1-SPQ4). Psychological distress included symptoms of depression (CESD-10), anxiety (STAI-10), post-traumatic stress disorder (Civilian Abbreviated Scale PTSD checklist), and ataque de nervios (an idiom of distress used by Latinx groups). Outcomes were dichotomized according to clinical cutoffs when available, otherwise used sample-based cutoffs. Two additional items assessed the perceived mental health impact of Hurricane María and the 2020 sequence of tremors (categorized as no/little impact vs. some/a lot). Adjusted prevalence ratios (PR) and their 95% confidence intervals (CI) were estimated. The most commonly reported psychological distress outcome was PTSD (77%). In adjusted models, compared to SP Q1, persons in SP Q2-Q4 were less likely to have elevated symptoms of depression (PR Q2 = 0.79, 95% CI = 0.72-0.85; PR Q3 = 0.65, 95% CI = 0.58-0.73; and PR Q4 = 0.41, 95% CI = 0.35-0.48), PTSD (PR Q2 = 0.92, 95% CI = 0.87-0.98; PR Q3 = 0.86, 95% CI = 0.80-0.93; and PR Q4 = 0.76, 95% CI = 0.70-0.83), anxiety (PR Q2 = 0.39, 95% CI = 0.31-0.48; PR Q3 = 0.27, 95% CI = 0.20-0.37; and PR Q4 = 0.11, 95% CI = 0.07-0.17) and experiences of ataque de nervios (PR Q2 = 0.85, 95% CI = 0.76-0.94; PR Q3 = 0.79, 95% CI = 0.70-0.90; and PR Q4 = 0.68, 95% CI = 0.60-0.78). Compared to persons in SP Q1, persons in SP Q3-Q4 were less likely to report adverse mental health impacts from Hurricane María (PR Q3 = 0.66, 95% CI = 0.55-0.79; and PR Q4 = 0.53, 95% CI = 0.44-0.65) and the 2020 sequence of tremors (PR Q3 = 0.77, 95% CI = 0.61-0.98; and PR Q4 = 0.74, 95% CI = 0.59-0.94). SP was associated with lower psychological distress. Studies are needed to confirm our findings and evaluate potential mechanisms of action.

A qualitative phenomenological exploration of prolonged grief in New Delhi, India.

Prolonged grief disorder (PGD) is a condition characterized by difficulty in coping effectively with the loss of loved ones. The proposed diagnostic criteria for PGD have been based predominantly on research from developed Western nations. The cultural variations associated with experience and expression of grief and associated mourning rituals have not been considered comprehensively. The current study aimed to understand the experience of prolonged grief in India through a qualitative enquiry with mental health professionals (focus group discussions) and affected individuals (key informant interviews). Several novel findings diverging from the current understanding of manifestation and narratives of PGD emerged from the study, including differences in the social contexts of bereavement and culture-specific magico-religious beliefs and idioms of distress. The findings point to limitations of existing diagnostic systems for PGD. The results of this study suggest that the assumption of content equivalence for psychiatric disorders across cultures may not be justified and that there is a need to develop culturally sensitive diagnostic criteria and assessment scales for PGD.

The experience of maternal mental distress in The Gambia: A qualitative study identifying idioms of distress, perceptions of contributing factors and the supporting role of existing cultural practices.

Maternal mental health problems are experienced frequently in the perinatal period and can be up to twice as common in women from low- and middle-income countries. The terms used to describe mental illness symptoms and the factors that contribute to developing these symptoms are affected by culture and context. Based on 14 focus group discussions held with pregnant women, health professionals and cultural leaders, this qualitative study aimed to understand women's experiences of mental distress during the perinatal period in The Gambia. To do this it aimed to 1) identify the most commonly used idioms of distress, 2) identify the factors believed to affect women's perinatal mental health and 3) explore the role of existing cultural practices, including musical practices, that were identified as locally significant in supporting maternal and mental health. Sondomoo tenkung baliyaa (Mandinka) and xel bu dalut (Wolof) were identified as the most commonly used idioms of distress which roughly translate to lack of a steady mind/heart. Using thematic analysis, six themes (Poverty of the healthcare system, Shifting cultural context, Economic factors, Social factors, Spiritual factors, and Cultural practices involving music) were identified to describe the factors that shape women's experience of mental health during the perinatal period. Lack of economic resources, the prevailing poverty of the health system, an unsupportive husband and spiritual attack by evil spirits or witches were common reasons given for a woman experiencing maternal mental distress. Various existing cultural practices involving music, such as fertility societies, naming ceremonies and community music-making, were recognised as valuable for supporting women's mental health during the perinatal period. This work emphasises that initiatives to support perinatal mental health should be grounded in an understanding of local community cultural practices, knowledge, and experiences.

The World Psychiatry Exchange Program in Iran: a unique academic and personal experience.

The World Psychiatry Exchange Program in Iran is an academic experience we are delighted to share. As two participating early career psychiatrists, a local psychiatry faculty member manager, and the lead founder and international coordinator of the programme, we focus in this article on the unfolding of this new learning experience, the difficulties we encountered and the main lessons learned by the participants: commonalities and differences in training and practice in general adult psychiatry and child psychiatry in Tunisia and Iran, as well as in idioms of distress between the Arab and Persian cultures.

Idioms of distress: Feasibility trial findings on reducing somatic symptoms through a community-based, culturally integrated intervention in Somaliland

Background Somatic complaints play a central role in the posttraumatic psychological symptom presentation among people within many cultural contexts. One theory about the function of somatic symptoms suggests that diffuse bodily complaints serve as idioms of distress. However, few studies have examined the effect of culturally adapted trauma interventions on reducing somatic symptoms specifically implemented in a low-income country. Methods We examined the effects of Islamic Trauma Healing – a brief, group- and mosque-based, lay-led intervention – on somatic symptom reduction in a pre-post feasibility study conducted in Somaliland. Inclusion criteria were DSM-5 trauma exposure and DSM-5 re-experiencing or avoidance. Participants (N = 26; 12 men, 14 women) reported large intervention effects for somatic symptoms ( g = 2.74, SSS-8). Higher pre-intervention somatic symptoms showed moderate to large associations with higher overall PTSD symptoms ( r = .43, P = .03). At post-intervention, somatic symptoms were only significantly associated with higher PTSD avoidance symptoms ( r = .41, P = .04) and lower well-being ( r = -.49, P = .01). No gender effects on total somatic symptom scores were observed. Discussion Results of this feasibility trial bring into focus overlap between mental health symptom reporting and somatic concerns as conceptualized within the context of cultural idioms of distress. Moreover, these findings suggest that diffuse transdiagnostic somatic symptoms could offer opportunity to learn about the intersections among culture, posttraumatic stress, and idioms of distress as mechanisms in global mental health intervention development.

The Belly's Word: Domestic Violence in a Bengali Clinic.

Unspeakability is a dominant analytic lens in scholarship on gendered violence in India, but women can and do speak out. This article examines how Bengali women complain about domestic violence through peter katha, the belly's word. The capacious pet (belly) is the seat of tension, where abuse dwells in the body. At a clinic in Kolkata, India, women describe sensations of abdominal pain, pressure, and hunger to convey patterns and temporalities of violence. Yet complaints of belly pain go unacknowledged by local clinicians. Hygiene discourses frame poor women's bodies, not structural violence, as the problem. Peter katha is more than an idiom of distress: it is a genre of embodied complaint that illuminates violence as the accrual of harm and, in its dynamic and layered quality, moves beyond a binary of disclosure or concealment. Anthropologists may use peter katha to extend the conceptual vocabulary of gender and silence. [domestic violence, kinship, complaint, hygiene, belly, India].

Working with migrants and refugees - Ethical principles and dilemmas in psychiatry

AbstractMore than 100 million people are forcibly displaced including refugees, internally displaced persons and asylum seekers who have fled their homes to escape violence, conflict, and persecution. The vulnerable group of refugees and forcibly displaced people have a high burden of mental disorders, including post-traumatic stress disorder (PTSD), depression, idioms of distress, and prolonged-grief disorder, which are highly related to the load of traumatic circumstances surrounding refugees associated with human rights abuses, lack of human needs, and separation from others and many refugees are severely traumatized and suffer a variety of symptoms, and not all seek help. Their mental health problems are of emergency nature place a huge burden upon services which are difficult to deliver. This implies that mental health professionals and patients are more likely than ever to come from different cultural backgrounds. To have access to mental health care is often a challenge for them and most of them do not seek help. Unfortunately, these vulnerable groups are not treated equally according to ethical principles of mental health professionals. This presentation will focus on these dilemmas and discuss them.Disclosure of InterestNone Declared

Beyond recognition: beliefs, attitudes, and help-seeking for depression and schizophrenia in Ghana

ABSTRACT Research on the beliefs and attitudes regarding specific mental disorders in Ghana is limited. A vignette study was conducted to examine the relationship between causal attributions, help-seeking, and stigma towards depression and schizophrenia using lay Ghanaians (N = 410). This adapted questionnaire presented two unlabelled vignettes about a hypothetical person with the above disorders for participants to provide their impressions. Next, participants answered questions on beliefs and attitudes regarding this person. The results showed that causal beliefs about mental disorders related to different treatment options, and stigma. Contrary to previous literature, religious belief did not negatively associate with professional help-seeking for the mental disorders. In conclusion, results suggest that integration of “idioms of distress' into mental health assessment and interventions may benefit Ghanaians. Our findings have implications for mental health literacy and anti-stigma campaigns in Ghana and other developing countries in the region.

Depression among married women in Assam: A qualitative study

Background: Women are at greater risk for depressive disorders than men. They are also known to be genetically and biologically vulnerable. Indian women mostly express their mental stress as somatic complaints and many other psychosocial factors influence as well as maintain the depressive symptoms. The psychosocial needs of women are often projected through the presentation of their depressive symptoms. Aim: The present study aimed to explore the psychosocial problems of married women diagnosed with depressive disorder. Methods: The study used a qualitative approach with exploratory research design. This study was carried out in the outpatient department of Lokopriya Gopinath Bordoloi Regional Institute of Mental Health in Tezpur (Assam). Purposive sampling was used and eight women were selected for the study. In-depth interviews were conducted to explore the psychosocial stressors, experiences, and illness narratives (idioms of distress) of these women. Among eight women who consented to participate in the study, six completed the study. Results: The salient findings of this study are that the women diagnosed with mild to moderate depressive disorders conveyed their mental health issues through various physical and emotional problems. Women expressed their problems primarily through somatic complaints, typically a variety of aches in different body parts, lethargy, excessive thinking, and decreased enthusiasm. Psychosocial factors centered around various social contexts and interpersonal issues, economic difficulties, marital difficulties and housing problems. Conclusion: The women’s narratives focuses predominantly on the socioeconomic and interpersonal difficulties as the underlying cause of their distressing symptoms is projective of psychosocial aberrations. Experiences expressed by women are located in their social world.

From idioms of distress, concern, and care to moral distress leading to moral injury in the time of Covid.

In this invited commentary on the thematic issue of Transcultural Psychiatry on idioms of distress, concern, and care, I provide a brief overview of how my research agenda evolved over the years while conducting community and clinic-based research in South and Southeast Asia as well as North America. I then suggest areas where future research on idioms of distress, concern, care, and resilience will be needed among different demographics given social change and shifts in how we communicate face to face and in virtual reality, the impact of medicalization, pharmaceuticalization and bracket creep, changes in indigenous healing systems, and hybridization. I further call attention to the importance of conducting idioms guided research in occupational settings. Toward this end I highlight the moral distress health care workers in the U.S. have experienced during the Covid-19 pandemic and point out the importance of differentiating individual burnout from moral injury related to structural distress. I conclude by discussing the general utility of an idioms of distress perspective in the practice of cultural psychiatry and suggest that this perspective needs to be included in the training of all practitioners regardless of the system of medicine they practice. Doing so may enable the formation of mental health communities of practice in contexts where there are pluralistic health care arenas.

Causal beliefs regarding schizophrenia and help-seeking behaviors among patients with schizophrenia and family caregivers attending psychiatric clinics in Cambodia.

Schizophrenia often follows a chronic or recurrent course, placing an immense burden on patients and their families. Mental health services in Cambodia are still highly limited, thus there is a major treatment gap. It is common that people consult traditional healers (Kru Khmer) and monks. In this culture, people who receive psychiatric medical treatment are expected to exhibit higher mental health literacy, but little is known about this factor. In this study, we interviewed 59 patients with schizophrenia and 59 family caregivers attending psychiatric clinics in Cambodia. Through qualitative analysis using a thematic analysis approach, we extracted eight themes of causal beliefs regarding schizophrenia: (1) spiritual beliefs, (2) cultural symptoms, (3) physical problems, (4) heredity, (5) substance abuse, (6) traumatic events, (7) stress in human relationships or in one's social environment, and (8) socioeconomic position. We found that "thinking too much" (kit chroeun) and "worrying too much" (prouy / barom chroeun), cultural idioms of distress, were recognized as causal factors of schizophrenia by both parents and family caregivers. Some participants were aware of the possible causal factors in light of the latest psychiatry findings, such as genetic factors and childhood trauma. Our data show that causal beliefs are not a decisive factor in shortening the duration of untreated psychosis (DUP). In Cambodia, where the treatment for schizophrenia is pluralistic, we suggest that it is crucial to embed the meaning of psychiatric treatment into local meaning worlds for better help-seeking behaviors.

Knowledge of psychology in Cambodia: Exploring the relationships to demographics, psychopathology, and idioms of distress.

Rates of mental health disorders in Cambodia are markedly higher than in other low- or middle-income countries. Despite these high rates, mental healthcare resources remain scarce and mental health stigma is pervasive, particularly for vulnerable populations of young women and individuals of low socioeconomic status. To address this gap, teaching Western mental health treatments and using a mental healthcare framework are recommended within the Cambodian context. However, Western frameworks do not address cultural syndromes or idioms of distress and operate from an individualistic perspective that does not address cultural values and beliefs. The present study employs a mental health literacy framework in an exploratory analysis of rates of psychological knowledge in a nationally representative sample of Cambodian adults (N = 2,690). To address recommendations for increasing mental healthcare, we designed a survey to investigate Cambodians' knowledge about mental health constructs. Results indicated that only 18.9% of Cambodians knew about psychology, and chi-square analyses revealed that women, individuals in rural areas, and individuals with significant distress due to cultural symptoms and syndromes reported knowing about psychology significantly less than their male and non-distressed counterparts. Additionally, those who reported higher income and higher levels of education indicated significantly higher rates of psychological knowledge, as did those with clinically significant rates of PTSD, at a rate of knowledge approaching significance. Implications for this study include the need to tailor interventions and resources to vulnerable populations, to assess the fit of current recommendations for the Cambodian context, and to further emphasize the need for culturally responsive interventions that address all presentations of Cambodian distress and align with understandings of mental health within the nation.

COVID-19 and decreased asylum access: mother work, precarity and preocupación among Central American asylum-seekers in Los Angeles

ABSTRACT In 2020, the public health response to the COVID-19 pandemic and the U.S. government’s increased legal restrictions on asylum-seekers acted together to increase social, economic and legal precarity in the lives of Central American asylum-seeking mothers in Los Angeles. In this context, these asylum-seeking mothers discussed their intersectional precarities through the idiom of distress “preocupación”, which signalled the concerns, worries, and fears they had in relation to the daily mother work of raising their children. Using ethnographic data collected during the COVID-19 pandemic, I examine how the intersectional precarities Central American asylum-seeking mothers faced necessitated protecting their children from their own preocupación. Through this, I argue that by using the analytic of preocupación it is possible to see exactly how racial and legal barriers to care increase precarity in the lives of asylum-seeking mothers in the U.S., and the detrimental impact that intersectional precarities have on asylum-seekers’ mother work today.

Working with interpreters in mental health

281 million people were recorded as having migrated across national borders by the United Nations in 2021, this equates to approximately 3.6 percent of the world’s population. Forced migrants/refugees account for 12 per cent of all international migrants. A percentage of these people will not speak the language of their new country fluently. If they are to access and utilize mental health services, they will require access to an interpreter. This paper provides guidance on working with interpreters in health settings when the work is either face to face or on-line. These guidelines are based on those written by the authors for the British Psychological Society. Working effectively with interpreters should be a skill in the repertoire of every clinician. This is to ensure that equal opportunities are upheld and that certain groups (including forced migrants) are not denied access to mental health services. Interpreters may also assist with teaching clinicians about diverse cultural views surrounding mental health and well-being. They may also advise on idioms of distress, cultural meanings and expression of emotional problems across cultures, explanatory health models and contextual factors which may help extend the repertoire of clinicians. The guidelines cover key recommendations for practice, booking and finding an interpreter, preparation before the consultation/meeting, practical considerations, preparation with the interpreter, during the meeting/consultation, issues to address after the meeting, written translations, psychometric testing, working by telephone or online and other issues to consider when working with an interpreter. These are reproduced below (with the permission of the BPS) in a shortened and updated form. Key recommendations for practice Undertake a language needs analysis of the population covered by your service or Trust and consider how you will best meet needs. If you have not undertaken training in working with interpreters, undertake a training course. If you are working with an interpreter unexpectedly and training is not feasible, read these or other relevant guidelines and allocate time to consider the issues or discuss them with a more experienced colleague. Check that the interpreter is qualified and appropriate for the consultation/meeting and speaks the service user’s first language. Allocate 10–15 minutes in advance of the session to brief the interpreter about the purpose of the meeting and to enable them to inform you about any cultural issues which may have bearing on the session. Be mindful of issues of confidentiality and trust when working with someone from a small language community as the service user may be anxious about being identifiable and mistrustful of an interpreter’s professionalism. This has particular relevance when working with forced migrants. State clearly that you alone hold clinical responsibility for the meeting. Commit to a collaborative working relationship based on trust and mutual respect. Match if appropriate for gender, age or religion, avoid using relatives and never use a child. Create an atmosphere where each member of the triad feels able to ask for clarification if anything is unclear and be respectful to your interpreter, they are an important member of the team who makes your work possible. Be aware of the well-being of your interpreter and mindful of the risk of vicarious traumatization. Consider what support they will be offered, and if they are subcontracted from an external agency, be aware that there is often little support provided by their employer. At the end of the session always allocate 10–15 minutes to debrief the interpreter about the session and offer support and supervision as appropriate. Extreme caution should be exercised when considering the use of translated assessment measures as languages and concepts are not interchangeable and results may therefore not be valid or meaningful. All written translations used should have been back translated to ensure they are fit for purpose. Commissioners of health services need to ensure that there are clear pathways to support for all members of their local community including those who do not speak the majority language.

(PO-168) Culture Bound Syndrome or Idiom of Distress? A Case of Brief Jinn Possession with Atypical Features in Afghani Patient

(PO-168) Culture Bound Syndrome or Idiom of Distress? A Case of Brief Jinn Possession with Atypical Features in Afghani Patient

PTSD is not the emblematic disorder of the COVID-19 pandemic; adjustment disorder is

BackgroundPosttraumatic stress disorder (PTSD) has been hailed by some as the emblematic mental disorder of the COVID-19 pandemic, assuming that PTSD’s life-threat criterion was met de facto. More plausible outcomes like adjustment disorder (AD) have been overlooked.MethodsAn online cross-sectional survey was launched in the initial stage of the pandemic using a convenience sample of 5 913 adults to compare the prevalence of COVID-related probable PTSD versus probable AD. The abridged Impact of Event Scale – Revised (IES-6) assessed the severity of trauma- and stressor-related symptoms over the previous week. Demographic and pandemic-related data (e.g., receiving a formal diagnosis of COVID-19, job loss, loss of loved one, confinement, material hardship) were collected. A Classification and Regression Tree analysis was conducted to uncover the pandemic experiences leading to clinical ‘caseness’. Caseness was defined by a score > 9 on the IES-6 symptom measure and further characterized as PTSD or AD depending on whether the Peritraumatic Distress Inventory’s life-threat item was endorsed or not.ResultsThe participants were predominantly Caucasian (72.8%), women (79.2%), with a university degree (85%), and a mean age of 42.22 (SD = 15.24) years; 3 647 participants (61.7%; 95%CI [60.4, 63.0]) met the threshold for caseness. However, when perceived life-threat was accounted for, only 6.7% (95%CI [6.1, 7.4]) were classified as PTSD cases, and 55% (95%CI [53.7, 56.2]) as AD cases. Among the AD cases, three distinct profiles emerged marked by the following: (i) a worst personal pandemic experience eliciting intense fear, helplessness or horror (in the absence, however, of any life-threat), (ii) a pandemic experience eliciting sadness/grief, and (iii) worrying intensely about the safety of significant others.ConclusionsStudies considering the life-threat criterion as met de facto during the pandemic are confusing PTSD for AD on most counts. This misconception is obscuring the various AD-related idioms of distress that have emerged during the pandemic and the actual treatment needs.

“Tension” and distress in South Asia: A systematic literature review

This systematic literature review summarizes academic knowledge on “tension” among South Asian and diaspora populations. “Tension” (sometimes transliterated as tenshun) is a term used across South Asia to talk about stress and distress, but the existing literature is dispersed and has never been analyzed synthetically. Following PRISMA guidelines, we searched 8 academic databases and solicited additional contributions from professional listservs. This process led to a final group of 122 records addressing “tension” in South Asian groups. The majority of studies took place in India and focused on mixed-gender adult samples. Many records reported differences in “tension” experience and vulnerability based on gender, while a few addressed differences based on age or socioeconomic group. Across records, “tension” described a wide range of physical and affective symptoms, and reflected distress experiences ranging from everyday hassles up to severe distress or even suicidality. “Tension” was often conceptualized via a hydraulic ethnopsychological model in which pent-up emotion expressed itself through physical or affective symptoms. Tension was often understood as an intermediary state between external stressors and internal states of pathology. People endorsed a variety of internal and external coping strategies, but several emphasized that only meaningful changes in adverse circumstances could solve “tension.” There was no consensus on whether “tension” is best characterized as an idiom of distress or a cultural syndrome, but based on the breadth of results reflected in this literature, we suggest that it is best understood under the umbrella term cultural concept of generalized psychosocial distress. To address gaps in the literature on “tension,” future research could work among populations outside India, could conduct direct comparative studies of how experiences vary by caste, gender, age, and socioeconomic status, and could explore the potential clinical value of “tension” for broaching discussions between patients and providers about distress.

A pilot study adapting and validating the Harvard Trauma Questionnaire (HTQ) and PTSD checklist-5 (PCL-5) with Indian women from slums reporting gender-based violence

BackgroundDespite high rates of gender-based violence (GBV) in India, culturally sensitive measures that examine universal and culturally relevant trauma reactions are lacking. Although the Harvard Trauma Questionnaire (HTQ) has been used in India, no study has adapted the measure in full for use with this population. Similarly, the PTSD checklist-5 (PCL-5) has not yet been validated in India. This study describes the adaptation, validation, and results from the adapted HTQ, and embedded PCL-5, for Indian women from slums reporting GBV.MethodThis study used the adaptation framework proposed by the HTQ measure developers. The adapted HTQ contained a (1) trauma screen relevant for stressors faced by Indian women from slums, (2) description of the index trauma, (3) description of any ongoing stressors, (4) universal trauma reactions (i.e., PTSD measured by the PCL-5), and culturally relevant trauma reactions (i.e., idioms of distress measured by a scale developed for the study). This measure was piloted on 111 women from Indian slums in face-to-face interviews. Trauma characteristics, types of ongoing stressors, and psychometric properties of the PCL-5 and idioms of distress scale were explored. These scales were validated against measures of depression (PHQ-9), anxiety (GAD-7), and somatic complaints (PHQ-15).ResultsThe majority of participants (77%) reported physical beatings, 18% reported unwanted sexual touch, and 28.8% reported infidelity as the primary emotional abuse. Further, 96.7% of GBV was perpetrated by partner or family member and over half reported ongoing stressors (e.g., poverty-related strain). The PCL-5 embedded in the HTQ yielded good internal consistency (Cronbach’s alpha = .88) as did the idioms of distress scale with deletion of one item (Cronbach’s alpha = .80). Both scales were externally valid, yielding large correlations with depression, anxiety, and somatic complaints (rs between .54 and .80, ps < .05).DiscussionThis is the first study to develop a comprehensive measure of trauma exposure with universal and culturally relevant trauma reactions in India. This study also enhances HTQ usage in India by delineating all the steps in the adaptation process. Results can inform the development of trauma-focused interventions for Indian women from slums.