Dua Ti Dawa Ti: understanding psychological distress in the ten districts of the Kashmir Valley and community mental health service needs

Abstract

BackgroundAn extensive body of research exists looking at the level of psychological distress in populations affected by political conflict. Recommended response to psychological distress in humanitarian crises is still based on frameworks for interventions developed in western/European contexts including psychological first aid, counselling and group therapy. While there is growing, but limited, evidence that culturally modified interventions can lead to reduction in symptoms of psychological distress in conflict affected populations, there is a need to understand mental health help-seeking behaviour and mental health service needs from the perspective of affected communities.MethodsThis study employed a qualitative exploratory research design based on principles of grounded theory. A combination of convenience and snowball sampling was used to recruit 186 adults from the general population to 20 focus group discussions; 95 men, median age 40 years, interquartile range (IQR): 27–48 years and 91 women, median age 40 years IQR: 32–50 years. Trained Kashmiri facilitators used a semi-structured interview guide to ascertain community perceptions on mental illness, help-seeking and service needs from the perspective of communities in the Kashmir Valley. Content analysis of transcripts resulted in the identification of seven overarching themes.ResultsCommon locally recognized symptoms of psychological distress were synonymous with symptoms listed in the Hopkins Symptoms Checklist (HSCL-25) and the Harvard Trauma Questionnaire (HTQ). Protracted political insecurity was highlighted as a major perceived cause of psychological distress in communities. Mental health help-seeking included traditional/spiritual healers in combination with practitioners of western medicine, with access highlighted as the main barrier. Divergent views were expressed on the effectiveness of treatment received. Participants’ expressed the need for investment in mental health literacy to improve the community’s capacity to recognize and support those suffering from psychological distress.ConclusionsOur findings demonstrate the universality of symptoms of psychological distress whilst simultaneously highlighting the importance of recognizing the cultural, spiritual and contextual framework within which psychological distress is understood and manifest. Co-constructed models of community based mental health services are needed.

Help-seeking for mental health concerns: review of Indian research and emergent insights

“…Persons with schizophrenia who believed in supernatural explanations of the illness had poor insight, whereas those with an awareness of the consequences of illness showed higher levels of insight and early help-seeking. A pattern suggesting self-serving bias and the role of stigma was also observed in this sample, wherein the hypothetical person in the vignette was readily recognized as suffering from a mental illness, but such identification was rarely used by patients for themselves [55]. The reviewed studies indicate that when faith healing did not provide any improvement or provided only short-term improvement, patients and their caregivers progressed to medical management as a last resort [37,39,48].…”

“…They helped others by guiding them into treatments by mental health professionals, expressed interest in increasing awareness and reducing stigma related to mental illness [38]. However, the continuation of faith healing alongside medical treatment has also been noted in a few studies highlighting the significance of culturally approved ways of dealing with mental illness [31,56]. Despite availability of mental health services and awareness about the same, urban context and higher education levels, sources of help other than mental health services may be initially chosen due to multiple factors such as apprehensions and misconceptions about treatment as well as stigma [39,47].…”

Health-related quality of life in refugee youth and the mediating role of mental distress and post-migration stressors

“…Mental distress would then make people behave and react in ways that create more stressful situations, for example, by avoiding social interaction or making impulsive financial choices. The general burden of mental distress could also act as a worry or stressor in itself and is in fact included in some post-migration stressor scales [ 52 ]. The interaction between distress and stressors suggests a bidirectional relationship where both processes occur, also shown in other studies [ 53 , 54 ], creating a more complex and transactional model [ 51 ].…”

Asian Indians in the United States and Posttraumatic Stress Disorder Interventions: A Narrative Literature Review

“…Asian Indians in the U.S. are disproportionately impacted by several socio-cultural and economic determinants of poor mental health. They include stigma and silence surrounding mental health issues, shame associated with seeking mental health services, language barriers (e.g., lack of bilingual practitioners or interpreters), economic challenges (e.g., inadequate health insurance), social inequality challenges (e.g., limited access to transportation or to childcare serving as barriers to attending therapy appointments), immigration-related stressors, few culturally-responsive mental health services (e.g., no racial-ethnic match between clinicians and clients), and lack of knowledge of available mental health services (Abe-Kim & Takeuchi, 1996; Chandra et al, 2016; De Gagne et al, 2015; Housen et al, 2019; Loya et al, 2010; Sue et al, 1991; Sue et al, 2012; Tewary, 2005; Tummala-Narra, 2013; Tummala-Narra & Deshpande, 2018; US Department of Health and Human Services Office of the Surgeon General, 2001). Further, Asian Indians often perceive mental health symptoms as self-inflicted behaviors to seek attention or incentives (Tewary, 2005), tend to prioritize physical well-being over mental health (Tewary, 2005), and can have negative beliefs regarding mental health treatment (e.g., “counseling is not a South Asian thing,” Inman, Yeh, et al, 2007).…”