Understanding Idioms of Distress Using Ethnography and Community Based Participatory Research

Building on previous CBPR-informed studies, this presentation describes an ethnographic study examining mental health stigma and cultural idioms of distress in culturally-diverse communities. Via engagement with community-based organizations in Lao, Native American, Latino and African American communities, this project addresses barriers to mental health care in underserved communities using a CBPR approach. We include community members in developing study design, data collection, and analysis. Using anthropological “deep fieldwork” methods of participant observation, in-depth interviews, and focus groups, this study works collaboratively with each fieldsite to explore local understandings of distress and wellness. Interviews use the Cultural Formulation Interview, a new instrument used to explore cultural idioms of mental distress. This open-ended guide does not assume distress falls easily into biomedical categories, but allows respondents to conceptualize their distress in religious, cultural, or social terms. Parallel interviews with close friends/family inform how they are perceived by others within their social network. We also conduct ongoing participant observation to learn through direct social interaction the norms, customs, and values of each group. Finally, we conduct a focus group with leaders and providers within each community group to better understand concepts of distress and wellbeing. Rather than publishing study results in scholarly journals which may have limited relevance for community members, the collaborative research team at each site identifies the kinds of findings and dissemination methods that will be most useful. Lessons learned and examples from each cultural community will be described, such as psychoeducation pamphlets for physicians about Lao mental health beliefs.