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Cited by 35Mental Health Treatment and AccessMental Health and PsychiatryCultural Competency in Health Care

My heart die in me”: idioms of distress and the development of a screening tool for mental suffering in southeast liberia

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Fabian, Katrin, Fannoh, Josiah, Washington, George G., Geninyan, Wilfred B., Nyachienga, Bethuel, Cyrus, Garmai, Hallowanger, Joyce N., Beste, Jason +2 more·2018·Culture Medicine and Psychiatry
DOI 10.1007/s11013-018-9581-zPMC PMC6105511
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Abstract

The integration of culturally salient idioms of distress into mental healthcare delivery is essential for effective screening, diagnosis, and treatment. This study systematically explored idioms, explanatory models, and conceptualizations in Maryland County, Liberia to develop a culturally-resonant screening tool for mental distress. We employed a sequential mixed-methods process of: (1) free-lists and semi-structured interviews (n = 20); patient chart reviews (n = 315); (2) pile-sort exercises, (n = 31); and (3) confirmatory focus group discussions (FGDs); (n = 3) from June to December 2017. Free-lists identified 64 idioms of distress, 36 of which were eliminated because they were poorly understood, stigmatizing, irrelevant, or redundant. The remaining 28 terms were used in pile-sort exercises to visualize the interrelatedness of idioms. Confirmatory FDGs occurred before and after the pile-sort exercise to explain findings. Four categories of idioms resulted, the most substantial of which included terms related to the heart and to the brain/mind. The final screening tool took into account 11 idioms and 6 physical symptoms extracted from patient chart reviews. This study provides the framework for culturally resonant mental healthcare by cataloguing language around mental distress and designing an emic screening tool for validation in a clinical setting.

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  • Existing screening tools for perinatal psychological distress are often developed in Western contexts and may not resonate with the experiences of women in Sierra Leone.

    “The existing screening tools for perinatal psychological distress are often developed in Western contexts and may not resonate with the experiences of women in Sierra Leone (Fabian et al., 2018).”

    From Developing and validating the Sierra Leone perinatal psychological distress scale through an emic-etic approach (2025) · cites this paper as Fabian et al., 2018

    The Introduction (page not available in our copy) says that translating DSM- or ICD-based screening tools can fail to capture expressions of mental suffering in non-Western cultures, supporting the general concern about cultural fit. The paper develops a screener for mental suffering in southeast Liberia; it does not address perinatal distress or the experiences of women in Sierra Leone. (LLM, conf=0.88)

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  • The imposition of Western conceptualizations of mental illness on non-Western cultures has been critiqued for perpetuating paternalistic practices and excluding local cosmologies.

    “Furthermore, the imposition of Western conceptualizations of mental illness on non-Western cultures has been critiqued for perpetuating paternalistic practices and excluding local cosmologies, highlighting the need for emic research approaches that recognize non-Western idioms of distress (Fabian et al., 2018; Kaiser & Weaver, 2019).”

    From Developing and validating the Sierra Leone perinatal psychological distress scale through an emic-etic approach (2025) · cites this paper as Fabian et al., 2018

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Authors
Fabian, K., Fannoh, J., Washington, G. G., Geninyan, W. B., Nyachienga, B., Cyrus, G., Hallowanger, J. N., Beste, J., Rao, D., & Wagenaar, B. H.
Affiliations
  • University of Washington (US)
  • William V. S. Tubman University (LR)
  • Brigham and Women's Hospital (US)
Corresponding author
Fabian, Katrin
ORCID
Venue
Culture Medicine and Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2018-05-04
Volume
42
Issue
3
Pages
684-703
ISSN
  • 0165-005X (ISSN-L)
  • 1573-076X
DOI
10.1007/s11013-018-9581-z
PMC
PMC6105511
OpenAlex
W2801767641
Cited by
35
References
45
Citations by year
2026: 15 · 2025: 3 · 2024: 2 · 2023: 3 · 2022: 4 · 2021: 2 · 2020: 3 · 2019: 3
FWCI
2.71
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Culture Medicine and Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • ResearchWorks at the University of Washington (University of Washington) (submittedVersion)
Funders
National Institute of Mental Health (K01MH110599)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
Keywords
idioms of distress, mental health stigma
MeSH terms
Adult, Humans, Liberia, Mental Health Services, Terminology as Topic, Stress, Psychological, Qualitative Research, Culturally Competent Care

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