"Thinking too much": A systematic review of a common idiom of distress.
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2015-12
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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.
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Kaiser, Bonnie N, Emily E Haroz, Brandon A Kohrt, Paul A Bolton, Judith K Bass and Devon E Hinton (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.
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Brandon A. Kohrt
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 Initiative since 2010. Dr. Kohrt is the component lead for the Grand Challenges Canada funded Mental Health Beyond Facilities (mhBeF) program in Nepal, Liberia, and Uganda. Dr. Kohrt has published scientific articles and book chapters about mental health among conflict- and disaster-affected populations in Nepal, Liberia, and Haiti. Dr. Kohrt has collaborated on numerous documentary films about human rights and global health including Returned: Child Soldiers of Nepal’s Maoist Army.
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