TY - JOUR

T1 - Why local concepts matter

T2 - Using cultural expressions of distress to explore the construct validity of research instruments to measure mental health problems among Congolese women in Nyarugusu refugee camp

AU - Greene, M. Claire

AU - Ventevogel, Peter

AU - Likindikoki, Samuel L.

AU - Bonz, Annie G.

AU - Turner, Rachael

AU - Rees, Susan

AU - Misinzo, Lusia

AU - Njau, Tasiana

AU - Mbwambo, Jessie K. K.

AU - Tol, Wietse A.

PY - 2023

Y1 - 2023

N2 - There is considerable variation in the presentation of mental health problems across cultural contexts. Most screening and assessment tools do not capture local idioms and culturally specific presentations of distress, thus introducing measurement error and overlooking meaningful variation in mental health. Before applying screening and assessment tools in a particular context, a qualitative exploration of locally salient idioms and expression of distress can help assess whether existing measures are appropriate in a specific context as well as what adaptations may improve their construct validity. We aimed to employ a mixed-methods approach to describe and measure cultural concepts of distress among female Congolese survivors of intimate partner violence in Nyarugusu refugee camp, Tanzania. This sequential study used data from 55 qualitative (free-listing and in-depth) interviews followed by 311 quantitative interviews that included assessments of symptoms of common mental disorder to explore whether the symptom constellations were consistent across these methodologies. Results from thematic analysis of qualitative data and exploratory factor analysis of quantitative data converged on three concepts of distress: huzuni (deep sadness), msongo wa mawazo (stress, too many thoughts), and hofu (fear). The psychometric properties of these constructs were comparable to those of the three original common mental disorders measured by the quantitative symptom assessment tools-anxiety, depression, and post-traumatic stress disorder-adding weight to the appropriateness of using these tools in this specific setting. This mixed-methods approach presents an innovative additional method for assessing the local "cultural fit" of globally used tools for measuring mental health in cross-cultural research.

AB - There is considerable variation in the presentation of mental health problems across cultural contexts. Most screening and assessment tools do not capture local idioms and culturally specific presentations of distress, thus introducing measurement error and overlooking meaningful variation in mental health. Before applying screening and assessment tools in a particular context, a qualitative exploration of locally salient idioms and expression of distress can help assess whether existing measures are appropriate in a specific context as well as what adaptations may improve their construct validity. We aimed to employ a mixed-methods approach to describe and measure cultural concepts of distress among female Congolese survivors of intimate partner violence in Nyarugusu refugee camp, Tanzania. This sequential study used data from 55 qualitative (free-listing and in-depth) interviews followed by 311 quantitative interviews that included assessments of symptoms of common mental disorder to explore whether the symptom constellations were consistent across these methodologies. Results from thematic analysis of qualitative data and exploratory factor analysis of quantitative data converged on three concepts of distress: huzuni (deep sadness), msongo wa mawazo (stress, too many thoughts), and hofu (fear). The psychometric properties of these constructs were comparable to those of the three original common mental disorders measured by the quantitative symptom assessment tools-anxiety, depression, and post-traumatic stress disorder-adding weight to the appropriateness of using these tools in this specific setting. This mixed-methods approach presents an innovative additional method for assessing the local "cultural fit" of globally used tools for measuring mental health in cross-cultural research.

KW - cultural concepts of distress

KW - idioms of distress

KW - mental health

KW - psychological distress

KW - refugees

KW - GENDER-BASED VIOLENCE

KW - INTIMATE PARTNER VIOLENCE

KW - SYMPTOM CHECKLIST

KW - DEPRESSION

KW - DISORDERS

KW - PREVALENCE

KW - TRAUMA

KW - QUESTIONNAIRE

KW - VALIDATION

KW - DIAGNOSIS

U2 - 10.1177/13634615221122626

DO - 10.1177/13634615221122626

M3 - Journal article

C2 - 36114647

VL - 60

JO - Transcultural Psychiatry

JF - Transcultural Psychiatry

SN - 1363-4615

IS - 3

ER -