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"Thinking too much": A systematic review of a common idiom of distress.
Abstract
Idioms of distress communicate suffering via reference to shared ethnopsychologies,
and better understanding of idioms of distress can contribute to effective clinical
and public health communication. This systematic review is a qualitative synthesis
of "thinking too much" idioms globally, to determine their applicability and variability
across cultures. We searched eight databases and retained publications if they included
empirical quantitative, qualitative, or mixed-methods research regarding a "thinking
too much" idiom and were in English. In total, 138 publications from 1979 to 2014
met inclusion criteria. We examined the descriptive epidemiology, phenomenology, etiology,
and course of "thinking too much" idioms and compared them to psychiatric constructs.
"Thinking too much" idioms typically reference ruminative, intrusive, and anxious
thoughts and result in a range of perceived complications, physical and mental illnesses,
or even death. These idioms appear to have variable overlap with common psychiatric
constructs, including depression, anxiety, and PTSD. However, "thinking too much"
idioms reflect aspects of experience, distress, and social positioning not captured
by psychiatric diagnoses and often show wide within-cultural variation, in addition
to between-cultural differences. Taken together, these findings suggest that "thinking
too much" should not be interpreted as a gloss for psychiatric disorder nor assumed
to be a unitary symptom or syndrome within a culture. We suggest five key ways in
which engagement with "thinking too much" idioms can improve global mental health
research and interventions: it (1) incorporates a key idiom of distress into measurement
and screening to improve validity of efforts at identifying those in need of services
and tracking treatment outcomes; (2) facilitates exploration of ethnopsychology in
order to bolster cultural appropriateness of interventions; (3) strengthens public
health communication to encourage engagement in treatment; (4) reduces stigma by enhancing
understanding, promoting treatment-seeking, and avoiding unintentionally contributing
to stigmatization; and (5) identifies a key locally salient treatment target.
Type
Journal articleSubject
AnxietyCultural concept of distress
Depression
Ethnopsychology
Global mental health
Idiom of distress
PTSD
Transcultural psychiatry
Anxiety
Culture
Depression
Ethnopsychology
Humans
Language
Mental Health
Stress, Psychological
Thinking
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https://hdl.handle.net/10161/10953Published Version (Please cite this version)
10.1016/j.socscimed.2015.10.044Publication Info
Kaiser, Bonnie N; Haroz, Emily E; Kohrt, Brandon A; Bolton, Paul A; Bass, Judith K;
& Hinton, Devon E (2015). "Thinking too much": A systematic review of a common idiom of distress. Soc Sci Med, 147. pp. 170-183. 10.1016/j.socscimed.2015.10.044. Retrieved from https://hdl.handle.net/10161/10953.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Brandon A. Kohrt
Adjunct Associate Professor in the Department of Psychiatry and Behavioral Sciences
Brandon Kohrt is a medical anthropologist and psychiatrist who completed his MD-PhD
at Emory University in 2009. He is currently Assistant Professor of Psychiatry, Global
Health, and Cultural Anthropology at Duke University. Dr. Kohrt has worked in Nepal
since 1996 researching and aiding victims of war including child soldiers. Since 2006
has worked with Transcultural Psychosocial Organization (TPO) Nepal. Dr. Kohrt has
been a consultant to The Carter Center Mental Health Program Liberia Init

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