"Thinking too much": A systematic review of a common idiom of distress.

Kaiser, Bonnie N

Haroz, Emily E

Kohrt, Brandon A

Bolton, Paul A

Bass, Judith K

Hinton, Devon E

England

2015-12-03T14:14:49Z

2015-12

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.

http://www.ncbi.nlm.nih.gov/pubmed/26584235

S0277-9536(15)30183-0

1873-5347

https://hdl.handle.net/10161/10953

eng

Elsevier BV

Soc Sci Med

10.1016/j.socscimed.2015.10.044

Anxiety

Cultural 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

"Thinking too much": A systematic review of a common idiom of distress.

Journal article

http://www.ncbi.nlm.nih.gov/pubmed/26584235

170

183

Clinical Science Departments

Cultural Anthropology

Duke

Global Health Institute

Institutes and Provost's Academic Units

Psychiatry & Behavioral Sciences

Psychiatry & Behavioral Sciences, Social and Community Psychiatry

School of Medicine

Trinity College of Arts & Sciences

University Institutes and Centers

Published

147