Cultural consonance and psychological distress: examining the associations in multiple cultural domains

Photovoice for leveraging traditional, complementary, and integrative medicine amongst black adults to improve sleep health and overall health

Introduction

Average adults are recommended to have 7-8 h of sleep. However insufficient sleep (IS defined as <7 h/nightly) is associated with increased risk of chronic diseases such as cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Traditional, complementary, and integrative medicine (TCIM), a burgeoning area of research and practice, leverages both modern and traditional approaches to improve health. Despite TCIM's recognition as a tool to improve sleep and related outcomes, there is a gap in literature in addressing its impact among black individuals, who experience a disproportionate burden of IS and chronic disease. This qualitative study aimed to increase understanding of TCIM practices to overcome IS and overall health in black communities.

Methods

Using photovoice methodology, a qualitative tool which applies community-engaged principles to produce culturally informed results through interviews and digital media, consented participants were recruited from Miami, Florida and (1) instructed to capture images over one week that communicated their TCIM to improve sleep and overall health on their mobile device; (2) interviewed using individual, semi-structured procedures to add "voice" to the "photos" they captured for ~20 min; and (3) invited to participate in follow-up focus groups for refined discussion and data triangulation for ~1.5 h. Both individual and focus group interviews were conducted over Zoom with recordings transcribed for formal content analysis using Nvivo software.

Results

The sample included N = 25 diverse US black individuals (M = 37, SD = 13, range 21-57). Approximately a quarter of the sample were unemployed (N = 7) and majority were women (N = 21). Results highlighted five themes including: (1) natural wellness (sleep supplements, comfort beverages, aromatherapy, herbalism, outdoors); (2) self-care (self-maintenance, physical activity, spatial comfort); (3) leisure (pet support, play); (4) mental stimulation (mindfulness, reading); and (5) spiritual wellness (faith-based practices). Study results elucidate the heterogeneity of diverse US black individuals regarding sociocultural knowledge, beliefs, and behaviors.

Conclusion

Addressing IS in black communities requires a comprehensive strategy that integrates cultural sensitivity, family and community dynamics, education, mental health support, and informed policymaking. Future studies should consider how sleep health literacy, stress appraisal, and coping strategies may vary by race/ethnicity for tailored intervention.

Age at Arrival and Depression among Mexican Immigrant Women in Alabama: The Moderating Role of Culture

Mexican-born women in the U.S. are at high risk of depression. While acculturation is the primary analytical framework used to study immigrant mental health, this research suffers from (1) a lack of specificity regarding how cultural models of living and being take shape among migrants converging in new destinations in the U.S., and (2) methods to empirically capture the impact of cultural positioning on individual health outcomes. Instead of relying on proxy measures of age at arrival and time in the U.S. to indicate where an individual is located on the acculturation spectrum, this study uses cultural consensus analysis to derive the substance and structure of a cultural model for la buena vida (the good life) among Mexican immigrant women in Birmingham, Alabama, and then assesses the extent to which respondents are aligned with the model in their everyday lives. This measure of 'cultural consonance' is explored as a moderating variable between age at arrival in the U.S. and number of depressive symptoms. Results demonstrate that for those who arrived at an older age, those with lower consonance are at the highest risk for depression, while those who are more aligned with la buena vida are at lower risk.

Cultural Consonance in Food Consumption and Nutrient Intake in Southern Brazil

Culture influences food consumption and nutrient intake. In this paper we present a new approach in research, examining how knowledge and understanding of food is encoded in cultural models. The degree to which individuals match these shared models in their own consumption patterns is then measured, using the concept of cultural consonance. In research conducted in urban Brazil, the configuration of cultural models of food, and the association of cultural consonance in food with nutrient intake, are moderated by socioeconomic status. The theory and method employed here offers a new approach to the study of culture, food, and nutrient intake.

Context Matters for Food Security: Multi-Sited Evidence of Shared Cultural Models of Food Consumption

Anthropologists have long emphasized the social significance of foods and the contexts in which they are consumed. Expanding on this idea, we define the context of consumption as the non-eating behaviors that surround eating, such as the manner of food preparation, food sharing, and dietary patterns. In this study, we used cultural consensus analysis to assess whether there exist consistently shared, normative ideas about preferable context of food consumption in three diverse research sites: urban Ethiopia, rural Brazil, and rural Haiti. Our analysis demonstrates that in all three communities, there are distinct sets of behaviors that people identified as non-preferable because they reliably associate them with poverty and food insecurity, and behaviors that people identify as preferable because they reliably associate them with wealth and food security. Across the settings, there was little variation in agreement about behaviors across household composition, age, gender, and food security status. These findings suggest that people do indeed share culturally specific ideas about the context in which foods should be prepared and consumed, beyond the actual content of one's diet. Exploring these cultural models elucidates the social consequences of food insecurity, enabling researchers to better examine the relationship between food insecurity, social context, and well-being.

What game we are playing: the psychosocial context of problem gambling, problem gaming and poor well-being among Italian high school students

Gambling and gaming are not infrequent among adolescents and preventing low-risk youth from becoming at-risk appears to be a priority of public health strategies. Greater scrutiny of the risk and protective factors in the relationships and community of young people appears crucial in steering prevention initiatives adequately. This study aimed to explore the role of the qualities of relational networks (i.e. family functioning, perceived social and class support), family and peer approval and view of the social environment in predicting problem gambling, problem gaming and overall well-being among adolescents. High-school students aged 14-18 years (N: 595; female: 68,7%) completed a survey including the target variables. A multivariate multiple regression analysis was performed to examine the role of socio-demographic characteristics and psychosocial predictors on gaming, gambling, and well-being. Multivariate multiple regressions identify a common core underpinning problem gambling, gaming and poor well-being but also the distinct roles of psychosocial variables: being male, with low parental monitoring, and an anomic view of the social environment all predict problem gambling and gaming, which were also found to be associated. Low social support predicts problem gambling but not problem gaming; poor family functioning predicts problem gaming but not problem gambling. All the target psychosocial variables, except approval of gambling, predict poor well-being. On the whole the findings suggest the need to look more closely at the way adolescents, their system of activity and their culture participate in constructing the meaning of gambling and gaming activities and their impact on adolescents' well-being, so that future studies and strategies can more effectively examine the relational dynamics in which problem gambling and gaming develop.

Protective resources that promote wellbeing among New Zealand moms with young children facing socioeconomic disadvantage

Poor maternal mental health and well-being during early stages of parenting impact child developmental outcomes. The primary objective of this study was to explore protective resources that may confer resilience among mothers living in low resourced neighborhoods in New Zealand. A purposive, non-probabilistic sampling method was used to recruit an ethnically representative sample of mothers with children under the age of five living in high deprivation neighborhoods in Auckland, New Zealand (n = 74). Data was collected via focus groups and interviews. Analyses consisted of both a deductive, theory-driven approach, and an inductive, data-driven approach. The most frequently mentioned resources that supported positive mental health and well-being included: 1) social support, and specifically family and instrumental support; 2) neighborhood cohesion, including collective efficacy and neighborhood permanence; and 3) alignment with social and cultural norms, though tensions surrounding cultural identity were also identified as sources of stress by some mothers. These findings highlight how the socioecological context impacts subjective perceptions of environmental demands and modifiable factors that may be promoted to improve maternal mental health and well-being and subsequent child health and development outcomes.

Body fat patterning and blood pressure levels: a comparative study between the Rai and the Lepcha in Sikkim

We compared the perception of two ethnic groups in relation to health, obesity and blood pressure problems and its management, and to compare the body fat patterning and blood pressure levels between Rai and Lepcha ethnic groups. We chose Rai and Lepcha ethnic groups living in Ranka, a place which is 16 kilometres away from the city of Gangtok, Sikkim. The study involved 160 males (Rai = 80 and Lepcha = 80) of age 25–35 years. The participants were initially interviewed about their perception towards health, obesity and blood pressure problems and its management along with other socio-demographic and lifestyle variables. Later, body fat patterning and blood pressure levels of the participants were measured and compared between these two groups. Multiple linear regression analysis was performed to understand the association of body fat patterning and blood pressure levels with socio-demographic and lifestyle variables. Multivariate analysis of covariance (MANCOVA) was used to examine the relationship of ethnicity with both body fat patterning and blood pressure levels. We found a noticeable difference between Lepcha and Rai ethnic groups in perception towards health and obesity, blood pressure problems and its management. Similarly, a significant difference was observed in body fat patterning and blood pressure levels between Rai and Lepcha participants. MANCOVA revealed that the measures of body fat pattering and blood pressure levels differed significantly between these two ethnic groups, after controlling for lifestyle variables and age of the participants at time of interview. We concluded that there remains ethnic diversity, embedded in cultural behaviours and practices concerning health and obesity, hypertension and associated lifestyle patterns. Such practices, rooted in the belief system of an ethnic group is likely to inform the health condition of group members.

Unpacking the "black box" of global food insecurity and mental health

Food insecurity is a global concern. While it was once characterized mainly as a problem of undernutrition, it is now recognized that a person may be food insecure without experiencing hunger. Numerous studies have demonstrated that food insecurity is strongly related to poor mental health around the world, but the mechanisms that underpin that relationship remain poorly understood. One body of research from nutritional sciences posits that nutrient deficiency impacts brain function, producing symptoms of depression and anxiety. Another body of research from the social sciences posits that the social consequences of having to eat non-preferred foods or obtain food in socially unacceptable ways may compromise mental health through stress. This study was designed to clarify the mechanisms linking food insecurity and mental health using case studies in rural Brazil and urban Ethiopia. Working with samples consisting of about 200 adult household decision-makers (mostly female) recruited between 2015 and 2019 at each site, we tested for nutritional and social mediation of the food insecurity-mental health relationship using multivariable linear regression and mediation analysis. Our analyses found no evidence of mediation in either setting. Moreover, there was no association between nutritional status variables and food insecurity. These findings suggest that food insecurity likely impacts mental health directly through forms of basic needs deprivation, such as worrying about where one's next meal will come from, rather than by acting as a social signal or even by impacting nutritional status. These results underscore the power of basic-needs deprivation for impacting mental health.

Prenatal Stress and Early Childhood Body Mass Index: A Path Analysis Approach

OBJECTIVES

Stress experienced by mothers during the prenatal period can have negative impacts on offspring development. Elevated BMI in childhood in response to early stress experience is a particularly critical outcome of interest since high BMI in childhood is associated with diabetes, heart disease and stroke in later life. The primary objective of this study was to analyze pathways between prenatal stress and early childhood BMI at 54-months of age and to begin to explore ethnic variations in these pathways.

METHODS

This study used the Growing Up in New Zealand (GUiNZ) dataset, which is a longitudinal, representative birth cohort study that began with recruiting pregnant women in 2009 and 2010 in Auckland, New Zealand. Path analysis modeling was used to explore risk and protective pathways between prenatal maternal stress and early childhood body mass index (BMI) at 54-months of age and differences by ethnicity (n = 5510).

RESULTS

Prenatal stress was positively associated with early childhood BMI at 54-months and maternal nutrition behaviors and length of exclusive breastfeeding mediated this direct relationship (χ² (1) = 0.83, p = 0.36; AIC = 50,496). Mediation and moderation paths varied by ethnicity.

CONCLUSIONS FOR PRACTICE

These findings contribute to the understanding of the intergenerational transmission of stress with respect to early childhood obesity. Reducing early stress exposure and/or addressing mediating and moderating factors linking stress experience with obesity development may prove to be more effective than attempting to alter health behaviors and trajectories in adulthood.

Political connections and psychosocial wellbeing among Women's Development Army leaders in rural amhara, Ethiopia: Towards a holistic understanding of community health workers' socioeconomic status

Little empirical research exists on the effects of health work on Community Health Workers' (CHWs') social relationships and status, yet these factors are important in understanding the broad social and behavioral drivers and impacts of CHW programs. This is particularly true for unpaid CHWs. Engaging with others as a CHW might help a worker to embody a valued role in society as a selfless, caring individual; or it might strengthen bonds with others and improve social networks and social capital. By combining qualitative, ethnographic, and survey data collected in rural Amhara, Ethiopia from 2013 to 2016, we evaluated the extent to which unpaid female workers in Ethiopia's Women's Development Army (WDA) were better able than their peers to achieve cultural consonance by building desired social connections or fulfilling locally salient models of virtuous womanhood. We conducted a cultural consensus survey (n = 74) and measured cultural consonance in a larger survey of adult women, including WDA leaders (n = 422). We also conducted participant observation and interviews with health officials, local health staff, and WDA leaders. In our study site, WDA leaders were more able than other women to fulfill the cultural ideal of having connections to various government officials. Yet these connections often did not lead to the benefits that WDA leaders hoped for. Also, in contrast to the findings of many other studies, achieving greater cultural consonance was not significantly associated with reduced psychological distress in this population. For women in this rural context, meanwhile, psychological distress is strongly associated with food and water insecurity, stressful life events, and social support. These findings point to the importance of social, economic and psychological support for rural women in Amhara, and specifically for unpaid CHWs.

Traces of culture: The feedback loop between behavior, brain, and disorder

Culture is part of an extensive series of feedback loops, which involve multiple organismic levels including social contexts, cognitive mediations, neural processes, and behavior. Recent studies in neuroscience show that culturally contingent social processes shape some neural pathways. Studying the influence of cultural context on neural processes may yield new insights into psychiatric disorders. New methodologies in the neurosciences offer innovative ways to assess the impact of culture on mental health and illness. However, implementing these methodologies raises important theoretical and ethical concerns, which must be resolved to address patient individuality and the complexity of cultural diversity. This article discusses cultural context as a major influence on (and consequence of) human neural plasticity and advocates a culture-brain-behavior (CBB) interaction model for conceptualizing the relationship between culture, brain, and psychiatric disorders. Recommendations are made for integrating neuroscientific techniques into transcultural psychiatric research by taking a systems approach to evaluating disorders.

Considering Cultural Consonance in Trustworthiness of Online Hotel Reviews among Generation Y for Sustainable Tourism: An Extended TAM Model

This study aims to predict Generation Y customers’ acceptance of user-generated content (UGC) websites by integrating an extended technology acceptance model (TAM), trustworthiness of online reviews, and cultural consensus and cultural consonance theory. To collect data, a free listing method was first used to recognize our ad hoc domain, i.e., the factors that determine the trustworthiness of online hotel reviews among Generation Y in South Korea, from an emic perspective. Based on the free listing results from 39 individuals, an online survey was conducted with 273 samples using a self-administered questionnaire. Cultural consensus analysis was conducted to determine whether there is a shared cultural model in trustworthiness factors among participants, and cultural consonance values were calculated. Then, a structural equation modeling technique was used to estimate how the proposed model explains the collected data. Results indicate that an agreed-upon cultural model of trustworthiness of online hotel reviews exists among sample members. Cultural consonance of trustworthiness was found to constitute a significant antecedent of perceived ease of use and attitude towards websites in the extended TAM model. This study can contribute to predict Generation Y customers’ acceptance of UGC websites and offer meaningful implications for sustainable tourism management, particularly when cultural variables are considered.

Cultural Scripts of Traumatic Stress: Outline, Illustrations, and Research Opportunities

As clinical-psychological scientists and practitioners increasingly work with diverse populations of traumatized people, it becomes increasingly important to attend to cultural models that influence the ways in which people understand and describe their responses to trauma. This paper focuses on potential uses of the concept of cultural script in this domain. Originally described by cognitive psychologists in the 1980s, scripts refer to specific behavioral and experiential sequences of elements such as thoughts, memories, attention patterns, bodily sensations, sleep abnormalities, emotions and affective expressions, motivation, coping attempts, and ritualized behaviors that are relevant to posttraumatic adjustment. We differentiate between experiences of traumatic stress that are scripted (e.g., cultural explanations are available) versus unscripted. Further characteristics such as script tracks, the effect of script interruptions, and contextual fit of scripts with other cultural models are also described. We consider examples of traumatic stress associated with war and organized, sexualized violence from "Western" and "non-Western" world regions. The concluding part of this review describes a number of possibilities for methodological approaches to assessment of cultural scripts. Capturing central elements of the script(s) of trauma would aid psychological researchers and clinicians in understanding the experiences of trauma in cultural context, which could ultimately lead to better clinical service opportunities worldwide.

Social Values and Determinants of Cultural Fit in Quebec: The Roles of Ancestry, Linguistic Group, and Mental Health Status

Many quantitative cross-cultural research studies assume that cultural groups consist of anyone born and raised in the same country. Applying these criteria to the formation of study samples may produce cohorts that share a country but are heterogeneous in relevant domains of culture. For example, in Canada, Franco- and Anglo-Canadians are generally assumed to represent different linguistic groups but the same cultural group. However, speaking a different first language also can mean exposure to different media, information, and conventions, which are known to shape certain cultural domains, such as social values. Other factors may also produce cultural heterogeneity. For example, ancestral origins and recency of familial migration may influence endorsed social values after exposure to diverse cultures or norms. Mental health status or psychiatric conditions may also influence subscription of social values due to different lifestyle demands. Understanding the nuanced contributions of diverse backgrounds to cultural membership and fit (i.e., the degree to which an individual behaves like other cultural members) is useful when performing quantitative cross-cultural studies to minimize alternative explanations for statistical outcomes. This study used Cultural Consensus Analysis (CCA) to assess the cultural fit of social values for 222 Canadians, who had participated in cross-cultural neuropsychological experiments. CCA is an anthropological statistical method for evaluating cultural agreement of a sample. Participants were systematically evaluated by linguistic groups (French and English), migratory generation (1st-3rd+), and mental health status (healthy and patient). Group and individual variances were statistically interrogated. Results demonstrated that Franco- and Anglo-Canadians represent different cultural groups cohabitating in Quebec. Social values dividing Franco- and Anglo-Canadians were also identified. Second and third generation Canadians held more heterogeneous social values than Canadians, whose families had migrated earlier. Second generation Canadians with psychiatric disorders showed notably reduced cultural fit with other Canadians, which supports other literature reporting difficulties experienced by second generation migrants. However, third and later generations of Canadians with psychiatric disorders held a greater range of social values compared to healthy Canadians but still were good fits for Canadian culture. This study concluded that linguistic group and migratory generation partially determines cultural group for the social values domain while mental health status does not, contrary to theories proposed by previous literature.

"If One Does Not Fulfil His Duties, He Must Not Be a Man": Masculinity, Mental Health and Resilience Amongst Sri Lankan Tamil Refugee Men in Canada

Refugee men face unique mental health stressors in the pre- and post-migratory periods. However, there has been little in-depth research on the mental health of refugee men in Canada. Given this situation, the overall aim of this study is to explore the psycho-social experience of Sri Lankan Tamil refugee men in Canada. Particular objectives include better understanding any inter-relationship between war-trauma, migration, concepts of masculinity and mental health. The study employed a two-phase participatory action research design based on the grounded theory approach. Phase 1 involved an 8-month ethnography conducted in Sri Lanka. Phase 2 consisted of qualitative interviews with 33 Sri Lankan Tamil refugee men living in Canada. Consistent with grounded theory, analysis was conducted inductively and iteratively. Four specific themes emerged from the data (i) gendered helplessness of war: participants commonly reported ongoing negative rumination regarding experiences where they were unable to adequately protect loved ones from physical suffering or death; (ii) reduced capacity: participants frequently felt unable to fulfill culturally sanctioned duties, such as supporting their family, due to ongoing pre- and post-migratory stress; (iii) redundancy: many participants felt that they were useless in Canada, as they could not fulfill typical masculine social roles (e.g. provider) due to factors such as unemployment and underemployment; (iv) intimate criticism: some participants reported that their spouses would often attempt to 'shame' them into greater achievement by constantly reminding them of their 'failures'. Many found this distressing. These various failures culminated in a state that we label "depleted masculinity", which participants linked to emotional and behavioural problems. Participants reported that they actively tried to rebuild their masculine identity, for example by adopting leadership roles in community organizations, which fostered resiliency. Results suggest a need to review and rebuild masculine identity to support the mental health of refugee men.

Internalized Cultural Models, Congruity With Cultural Standards, and Mental Health

Using the cultural consonance theory and the assumptions embedded in the culture consensus model, the present article addresses the associations between consensually understood and collectively shared cultural models and individual mental health. The study specifically explored the role of internalization. A structured survey was developed to extract the local variant of the American cultural model of a “good, worthy life.” The data collected in New England in fall 2012 ( N = 306) contained measures of the individual familiarity with the cultural model, the degree of internalization of its elements, the extent to which each informant’s lifestyle matched the model in their daily life, and measures of positive and negative mental health. The results confirm that the degree of cultural competence and internalization of cultural ideas affect inter-informant variation in both negative and positive mental health, but the relationship is a complex one.

What You Know, What You Do, and How You Feel: Cultural Competence, Cultural Consonance, and Psychological Distress

Describing the link between culture (as a phenomenon pertaining to social aggregates) and the beliefs and behaviors of individuals has eluded satisfactory resolution; however, contemporary cognitive culture theory offers hope. In this theory, culture is conceptualized as cognitive models describing specific domains of life that are shared by members of a social group. It is sharing that gives culture its aggregate properties. There are two aspects to these cultural models at the level of the individual. Persons have their own representations of the world that correspond incompletely to the shared model-this is their 'cultural competence.' Persons are also variable in the degree to which they can put cultural models into practice in their own lives-this is their 'cultural consonance.' Low cultural consonance is a stressful experience and has been linked to higher psychological distress. The relationship of cultural competence per se and psychological distress is less clear. In the research reported here, cultural competence and cultural consonance are measured on the same sample and their associations with psychological distress are examined using multiple regression analysis. Results indicate that, with respect to psychological distress, while it is good to know the cultural model, it is better to put it into practice.

Perinatal depression in Nigeria: perspectives of women, family caregivers and health care providers

Background

Perinatal maternal depression is common and undertreated in many sub-Saharan African countries, including Nigeria. While culture shapes the social determinants and expression of depressive symptoms, there is a dearth of research investigating these processes in African contexts.

Methods

To address this gap, we conducted in-depth interviews with 14 women with perinatal depression, 14 of their family caregivers and 11 health providers, using the McGill Illness Narrative Interview as part of a larger trial of a stepped-care intervention. Interpretation of themes was guided by cultural constructivist and critical anthropological perspectives that situate perinatal depression in its complexity as a disorder that is embedded in webs of social relations and embodied practices.

Results

Study respondents used idioms of distress that identified perinatal conditions that consist of somatic, affective, cognitive and behavior symptoms found in depressive disorders. Respondents viewed mental health problems in the perinatal period as tied to sociomoral concerns over gender roles and women’s position within the household. Conflict between women’s effort to be assertive to address interpersonal problems, while needing to be seen as non-aggressive contributed to their distress. Causal explanations for depression included husband’s lack of care, family problems, “spiritual attack”, having a female child when a male child was desired, and not resting sufficiently after childbirth. Guilt about breaching social norms for women’s conduct contributed to self blame, and feelings of shame.

Conclusions

Clinical assessment and interventions as well as public health prevention strategies for perinatal depression in global mental health need to consider local social contexts and meanings of depression, which can be explored with narrative-based methods.

Electronic supplementary material

The online version of this article (doi:10.1186/s13033-017-0134-6) contains supplementary material, which is available to authorized users.

Cultural consonance, deprivation, and psychological responses for niche construction

Cultural consonance is a measure of culturally encoded goals relevant to psychological, behavioral, and health responses to deprivation. Similar to extrinsic mortality, low cultural consonance and an associated inability to predict adaptive outcomes may activate impulsivity, delay discounting, and reward seeking. Low cultural consonance could promote “fast life history” in low-quality environments and motivate cultural niche construction for local adaptation.

Culturally determined risk factors for postnatal depression in Sub-Saharan Africa: a mixed method systematic review

BACKGROUND

Research suggests that African women experience postnatal depression (PND) at a similar rate to that reported in developed countries. If PND is to be better understood in African populations, its risk factors need to be reliably identified. Studies in the developing world have found that risk factors are often culturally determined. This review aimed at improving our understanding of the culturally determined risk factors of PND within Sub-Saharan Africa by integrating evidence from quantitative and qualitative studies.

METHODS

A mixed-method systematic review was employed. Nine quantitative and three qualitative studies were quality assessed, synthesised, and integrated.

RESULTS

Quantitative studies indicated that stressful life events, cultural values and the African extended family system have an influential role in women's experience of PND. Qualitative studies described the impact of negative cultural perceptions of others and adhering to cultural traditions and values as contributing to the development and maintenance of PND.

LIMITATIONS

The small number of studies is a limitation within the available body of research. Search strategies only included English language articles.

CONCLUSIONS

Although some risk factors for postnatal depression were similar to those identified in studies in developed countries, important differences exist; most notably the influence of traditional African value systems, customs and antenatal exposure to extreme societal stress. The findings of this review are especially important for the development of a predictive model for PND within Sub-Saharan Africa and when working with migrant Sub-Saharan African mothers.

How religious status shapes psychological well-being: cultural consonance as a measure of subcultural status among Brazilian Pentecostals

Research on subjective social status has long recognized that individuals occupy multiple social hierarchies, with socioeconomic status (SES) being but one. The issue, as such, has been to identify culturally meaningful measures of social status. Through cognitive anthropological theory and methods, I show that it is possible to identify multiple cultural models of "status," and objectively measure an individual's level of adherence, or consonance, with each-effectively placing them within the multidimensional space of social hierarchies. Through a mixed qualitative and quantitative study of 118 Brazilian Pentecostals carried out from 2011 to 2012, I show that dominant and limitedly-distributed cultural models of status operate simultaneously and concurrently in the lives of those who hold them. Importantly, each marker of cultural status moderates the other's association with psychological well-being. I argue that the importance of a given social hierarchy is framed by cultural values. For Brazilian Pentecostals, their limitedly distributed model of religious status alters the influence of more dominant societal indicators on psychological well-being. The interaction between religious and secular lifestyle statuses on psychological health is stronger than the association of SES, effectively explaining 51% of the variance. This finding suggests that among some populations, limitedly distributed cultural models of status may be a dominant force in shaping measures of well-being.

CULTURAL PHENOMENA AND THE SYNDEMIC FACTOR: SUBSTANCE ABUSE, VIOLENCE, HIV, AND DEPRESSION AMONG HISPANIC WOMEN

Researchers exploring the health of Hispanics in South Florida utilizing a combination of qualitative and quantitative research methods have identified that substance abuse, violence, risky sexual behavior, and depression are not only conceptualized as tightly interrelated health and social problems, but also hold together in a measurement model to represent an underlying phenomenon (i.e., the Syndemic Factor). The purpose of this study is to test hypothesized relationships between cultural phenomena and the Syndemic Factor among community-dwelling Hispanic women. Standardized questionnaires assessing Acculturation, Hispanic Stress, Familism, and the Syndemic Factor were administered to a cross-sectional sample of 548 Hispanic women from South Florida. Structural equation modeling was used to analyze relationships. The model explained 61 percent of the variance in the Syndemic Factor. There was a large positive relationship between the Syndemic Factor and Hispanic Stress, and a small inverse relationship between the Syndemic Factor and Familism. Women with high Hispanic Acculturation and low U.S. Acculturation scored lower on the Syndemic Factor than Integrated/Bicultural women. Familism buffered the relationship between Hispanic Stress and the Syndemic Factor. Structural, community, family, and individual prevention strategies that address underlying conditions associated with the Syndemic Factor must be developed and formally evaluated.

How culture shapes the body: cultural consonance and body mass in urban Brazil

OBJECTIVES

The aim of this article is to develop a model of how culture shapes the body, based on two studies conducted in urban Brazil.

METHODS

Research was conducted in 1991 and 2001 in four socioeconomically distinct neighborhoods. First, cultural domain analyses were conducted with samples of key informants. The cultural domains investigated included lifestyle, social support, family life, national identity, and food. Cultural consensus analysis was used to confirm shared knowledge in each domain and to derive measures of cultural consonance. Cultural consonance assesses how closely an individual matches the cultural consensus model for each domain. Second, body composition, cultural consonance, and related variables were assessed in community surveys. Multiple regression analysis was used to examine the association of cultural consonance and body composition, controlling for standard covariates and competing explanatory variables.

RESULTS

In 1991, in a survey of 260 individuals, cultural consonance had a curvilinear association with the body mass index that differed for men and women, controlling for sociodemographic and dietary variables. In 2001, in a survey of 267 individuals, cultural consonance had a linear association with abdominal circumference that differed for men and women, controlling for sociodemographic and dietary variables. In general, as cultural consonance increases, body mass index and abdominal circumference decline, more strongly for women than men.

CONCLUSIONS

As individuals, in their own beliefs and behaviors, more closely approximate shared cultural models in socially salient domains, body composition also more closely approximates the cultural prototype of the body.

Do positive or negative experiences of social support relate to current and future health? Results from the Doetinchem Cohort Study

Background

Cross-sectional studies have reported associations between social support and health, but prospective evidence is less conclusive. This study aims to investigate the associations of positive and negative experiences of social support with current and future lifestyle factors, biological risk factors, self-perceived health and mental health over a 10-year period.

Methods

Data were from 4,724 Dutch men and women aged 26-65 years who participated in the second (1993-1997) and in the third (1998-2002) or fourth (2003-2007) study round of the Doetinchem Cohort Study. Social support was measured at round two using the Social Experiences Checklist. Health was assessed by several indicators such as smoking, alcohol consumption, physical activity, fruit and vegetable intake, overweight, hypertension, hypercholesterolemia, self-perceived health and mental health. Tertiles of positive and negative experiences of social support were analysed in association with repeated measurements of prevalence and incidence of several health indicators using generalised estimating equations (GEE).

Results

Positive and negative experiences of social support were associated with prevalence and incidence of poor mental health. For the lowest tertile of positive support, odds ratios were 2.74 (95% CI 2.32-3.23) for prevalent poor mental health and 1.86 (95% CI 1.39-2.49) for incident poor mental health. For the highest tertile of negatively experienced support, odds ratios for prevalent and incident poor mental health were 3.28 (95% CI 2.78-3.87) and 1.60 (95% CI 1.21-2.12), respectively. Low levels of positive experiences of social support were also associated with low current intake of fruits and vegetables, but not with future intake. Negative experiences of social support were additionally associated with current smoking, physical inactivity, overweight and poor self-perceived health. Furthermore, high levels of negative experiences of social support were associated with future excessive alcohol consumption (OR 1.42; 95% CI 1.10-1.84), physical inactivity (95% CI 1.28; 1.03-1.58) and poor self-perceived health (OR 1.36; 95% CI 1.01-1.82).

Conclusions

This study showed that social support might have a beneficial effect on lifestyle and health, with negative experiences of social support affecting lifestyle and health differently from positive experiences of social support.

Volunteerism or Labor Exploitation? Harnessing the Volunteer Spirit to Sustain AIDS Treatment Programs in Urban Ethiopia

Based on ethnographic research in Addis Ababa, Ethiopia, this paper describes NGO efforts to encourage AIDS care volunteers to eschew material returns for their labor and instead reflect on the goodness of sacrificing to promote the survival of people living with HIV/AIDS. Consensus analysis of motivational survey data collected from a sample of AIDS care volunteers (n=110) suggests that they strongly share a sacrificial and prosocial motivational model. These results may be explained by several factors, including the efforts of the organizations to shape volunteers' motivations, the self-selection of volunteers, positive reinforcement in seeing one's patients become healthy, and social desirability bias. In-depth interviews examining the motivations and behaviors of volunteers reveal a more complicated picture: even ostensibly devoted and altruistic volunteers strongly question their service commitments. The complexity and ambivalence of volunteers' motivations reflect the profound uncertainty that they face in achieving improved socioeconomic status for themselves and their families amid widespread unemployment and sharply rising food prices. Their desires for economic opportunities explain why local NGOs exert so much effort to shape and sustain-and yet fail to completely control-their motivations. This recasts economically-insecure volunteers' consent to donate their labor as a process of negotiation with their organizers. Future research should explore how models of health care volunteerism and volunteer motivations are shaped by individual and collective experiences in political-economic context.

Does perceived stress mediate the effect of cultural consonance on depression?

The importance of appraisal in the stress process is unquestioned. Experience in the social environment that impacts outcomes such as depression are thought to have these effects because they are appraised as a threat to the individual and overwhelm the individual's capacity to cope. In terms of the nature of social experience that is associated with depression, several recent studies have examined the impact of cultural consonance. Cultural consonance is the degree to which individuals, in their own beliefs and behaviors, approximate the prototypes for belief and behavior encoded in shared cultural models. Low cultural consonance is associated with more depressive symptoms both cross-sectionally and longitudinally. In this paper we ask the question: does perceived stress mediate the effects of cultural consonance on depression? Data are drawn from a longitudinal study of depressive symptoms in the urban community of Ribeirão Preto, Brazil. A sample of 210 individuals was followed for 2 years. Cultural consonance was assessed in four cultural domains, using a mixed-methods research design that integrated techniques of cultural domain analysis with social survey research. Perceived stress was measured with Cohen's Perceived Stress Scale. When cultural consonance was examined separately for each domain, perceived stress partially mediated the impact of cultural consonance in family life and cultural consonance in lifestyle on depressive symptoms. When generalized cultural consonance (combining consonance in all four domains) was examined, there was no evidence of mediation. These results raise questions about how culturally salient experience rises to the level of conscious reflection.

More Similar than Different? Exploring Cultural Models of Depression among Latino Immigrants in Florida

The Surgeon General's report, "Culture, Race, and Ethnicity: A Supplement to Mental Health," points to the need for subgroup specific mental health research that explores the cultural variation and heterogeneity of the Latino population. Guided by cognitive anthropological theories of culture, we utilized ethnographic interviewing techniques to explore cultural models of depression among foreign-born Mexican (n = 30), Cuban (n = 30), Columbian (n = 30), and island-born Puerto Ricans (n = 30), who represent the largest Latino groups in Florida. Results indicate that Colombian, Cuban, Mexican, and Puerto Rican immigrants showed strong intragroup consensus in their models of depression causality, symptoms, and treatment. We found more agreement than disagreement among all four groups regarding core descriptions of depression, which was largely unexpected but can potentially be explained by their common immigrant experiences. Findings expand our understanding about Latino subgroup similarities and differences in their conceptualization of depression and can be used to inform the adaptation of culturally relevant interventions in order to better serve Latino immigrant communities.

Sociocultural practices in Ethiopia: association with onset and persistence of postnatal common mental disorders

BACKGROUND

Traditional perinatal practices may protect against postnatal common mental disorders (CMD) in non-Western societies.

AIMS

To evaluate the association between perinatal practices and postnatal CMD in rural Ethiopia.

METHOD

A population-based sample of 1065 women was followed up from pregnancy until 2 months postpartum. Qualitative investigation informed the development of scales measuring attitudes towards and adherence to perinatal practices. Postnatal CMD was measured using the Self-Reporting Questionnaire.

RESULTS

Endorsement of sociocultural perinatal practices was associated with lower odds of antenatal CMD persisting into the postnatal period (adjusted odds ratio (OR) = 0.66, 95% CI 0.45-0.95). Women who endorsed protective and celebratory perinatal practices but were unable to complete them had increased odds of incident (adjusted OR = 7.26, 95% CI 1.38-38.04) and persistent postnatal CMD (adjusted OR = 2.16, 95% CI 1.11-4.23) respectively.

CONCLUSIONS

There is evidence for an independent role of sociocultural practices in maintaining perinatal mental health in this Ethiopian community.

Cultural consonance and psychological well-being. Estimates using longitudinal data from an Amazonian society

Researchers have hypothesized that the degree to which an individual's actual behavior approximates the culturally valued lifestyle encoded in the dominant cultural model has consequences for physical and mental health. We contribute to this line of research by analyzing data from a longitudinal study composed of five annual surveys (2002-2006 inclusive) of 791 adults in one society of foragers-farmers in the Bolivian Amazon, the Tsimane'. We estimate the association between a standard measure of individual achievement of the cultural model and (a) four indicators of psychological well-being (sadness, anger, fear and happiness) and (b) consumption of four potentially addictive substances (alcohol, cigarette, coca leaves and home-brewed beer) as indicators of stress behavior. After controlling for individual fixed effects, we found a negative association between individual achievement of the cultural model and psychological distress and a positive association between individual achievement of the cultural model and psychological well-being. Only the consumption of commercial alcohol bears the expected negative association with cultural consonance in material lifestyle, probably because the other substances analyzed have cultural values attached. Our work contributes to research on psychological health disparities by showing that a locally defined and culturally specific measure of lifestyle success is associated with psychological health.

Postnatal mental distress in relation to the sociocultural practices of childbirth: an exploratory qualitative study from Ethiopia

Sociocultural patterning of the postnatal period in non-Western settings has been hypothesised to protect against postnatal depression. In 2004, in a predominantly rural area of Ethiopia, we conducted 25 in-depth interviews and five focus group discussions with purposively selected participants including perinatal women, fathers, grandmothers, traditional and religious leaders, birth attendants and community leaders. Our main objectives were (1) to examine societal recognition of problematic distress states in the postnatal period and relate this to Western conceptualisations of postnatal depression and (2) to relate the occurrence of distress states to sociocultural patterning of the postnatal period. Inductive analysis was employed to identify salient themes. Participants spontaneously described culturally problematic distress states occurring in the postnatal period, although did not consider them to be illness. Vulnerability and danger of the postnatal period was emphasised, with risk of supernatural attack and physical harm leading to distress states. Participants also spoke of how gender disadvantage and economic strain intersect with cultural patterning of the postnatal period, threatening mental health due to the resulting disappointed expectations and exclusion, as well as exacerbation of pre-existing problems. Cultural dissonance, where a person's beliefs or actions are out of kilter with strong prevailing cultural norms, may be an important risk factor for postnatal distress in rural Ethiopia, where the postnatal period is extensively culturally elaborated.

A prospective study of cultural consonance and depressive symptoms in urban Brazil

Cultural consonance refers to the degree to which individuals, in their own beliefs and behaviors, approximate the prototypes for belief and behavior encoded in shared cultural models. In previous cross-sectional studies, lower cultural consonance in several cultural domains was associated with worse health outcomes, including greater psychological distress. The current paper extends these findings in three ways. First, the effect of cultural consonance on depressive symptoms is tested in a prospective study. Second, it is hypothesized that the effect of cultural consonance in a specific cultural domain will depend on the degree of cultural consensus within that domain: the higher the cultural consensus, the greater the effect of change in cultural consonance in that domain on depressive symptoms. Third, it is hypothesized that cultural consonance will have an inverse effect on depressive symptoms independent of the occurrence of stressful life events (a well-known risk factor for depression). We tested these hypotheses in a study conducted in urban Brazil, and found that change in cultural consonance (assessed as a general construct) was associated with depressive symptoms at a 2-year follow-up. Furthermore, cultural consonance in the domains in which there was highest cultural consensus--the domains of family life and lifestyle--was more strongly associated with depressive symptoms at follow-up than cultural consonance in domains with lower cultural consensus. Finally, all of these effects were independent of stressful life events. These results lend further support to the importance of cultural consonance in relation to human health.