Cultural and societal norms and expectations have a significant impact on mental health. Cultures can influence how an individual with a mental illness is perceived and supported, how likely they are to seek treatment, and the type of treatment they receive.
What is meant by culture?
Culture refers to the norms, beliefs, and behaviors of specific groups or communities. Cultural and societal norms and beliefs exist among many groups, including different races, ethnicities, religions, socioeconomic classes, professions, genders, and sexual orientations [1].
Culture might influence things such as clothing or dietary choices that people make within a specific community. It can also affect thoughts and expectations around the management of health issues. Culture can influence whether a person seeks help for mental health issues, whom they go to for help, and the potential outcome of their condition [2].
How does culture affect mental health outcomes?
Cultural and societal norms and expectations impact mental health outcomes in many ways.
Stigma
Although mental health is gradually becoming more widely discussed and understood, the stigmatization of people with mental illnesses is still prevalent worldwide. This can impact how people perceive individuals with mental health conditions and how they are represented within communities and in the media [1][3].
For example, it is common for people with mental illnesses to be portrayed as violent, dangerous, or criminal in film and television. This perpetuates the stigma and stereotyping of individuals with mental health conditions, increasing their shame and fear, reducing their likelihood of seeking treatment, and worsening outcomes [4].
Stigma affects not only individuals with mental illnesses but also their families. In many countries, families of people with mental illnesses face discrimination from their communities, which can impact the well-being and functioning of the family and further reduce the support available to the individual [3].
Understanding and communication of symptoms
Cultural differences can impact the way individuals understand and communicate about their health. People from families or communities in which mental health is not well understood might be unable to recognize the significance of specific symptoms or report them effectively when seeking treatment [2].
Some individuals may be more inclined to report physical than emotional symptoms due to cultural expectations or misunderstandings. The ability or desire to express emotion overtly varies significantly between cultures, genders, and religions, which can impact how professionals perceive mental illness and symptom severity [3].
For example, men are far less likely to discuss emotional symptoms of mental health conditions, often seeking treatment for physical symptoms or impaired functioning. This is partly due to cultural and societal expectations of men to present as masculine and non-emotional. This contributes to dramatically higher rates of suicide amongst men compared to women [5].
Similarly, research shows that Asian Americans are unlikely to seek treatment for emotional symptoms, instead choosing self-management or suppressing emotional distress. As such, they are far less likely to receive a mental health diagnosis than other ethnicities [3][6].
Additionally, cultural or societal differences may impact communication between clinicians and patients. Even when speaking the same language, people from different backgrounds could encounter misinterpretations of symptoms or the expectations of and adherence to treatments. These differences could also impact the forming of trusting therapeutic relationships [3][7].
Community support
How different cultures and communities support people with mental health conditions may vary significantly. For example, some religions or ethnic groups might not trust or believe in Western medicine, choosing to seek support from priests, religious leaders, traditional healers, or family members instead of mental health professionals [2][3].
While utilizing a support system can benefit those experiencing mental illness, this may also prevent access to necessary treatments, potentially worsening outcomes.
Furthermore, the idea of mental health was previously, and in some cultures continues to be, viewed as a supernatural idea or spiritual possession. In these instances, individuals are unlikely to receive necessary treatment and may be ostracized by their community due to fear and misunderstanding [1].
Causes
Mental health conditions are often caused by a complex combination of genetic, environmental, cultural, and psychosocial factors. Some conditions, such as schizophrenia and bipolar disorder, are found to be equally prevalent within different countries, cultures, and societies. This suggests that cultural factors likely play a small part in the development of these conditions [3].
However, other conditions, such as depression and post-traumatic stress disorder (PTSD), are found to be of varying prevalence. This suggests that cultural and societal factors have a more considerable influence on the development of these conditions [8][9].
For example, exposure to poverty, crime, violence, illness, and other stressors can significantly increase the risk of depression. Similarly, exposure to wars, terrorist activity, abuse, and life-threatening situations substantially increases the risk of PTSD [3][10].
While these factors may occur in any country or society, certain countries, professions, and socioeconomic groups are more likely to be exposed to these circumstances, thus increasing the risk of mental illness within these groups [3].
Similarly, groups exposed to discrimination are far more likely to experience mental illness. For example, the prevalence of mental health conditions such as depression and anxiety is far greater amongst the LGBTQ population than among heterosexual and cisgender individuals [11].
Clinician bias and stereotyping
Cultural differences can influence how people are assessed and diagnosed with mental illnesses. For example, studies show that Black Americans are significantly more likely to be diagnosed with schizophrenia and much less likely to receive a diagnosis of depression and anxiety than other races and ethnicities [3][12].
Similarly, the quality and appropriateness of treatment varies between cultural groups. Studies have shown that people in the US who are Black, male, or of lower education levels receive a reduced quality of depression and anxiety treatments compared to others [13].
These examples may, in part, be due to clinicians holding racist stereotypes or biases and have also been found to be related to clinician biases associated with professional culture and socioeconomic status [3][14].
Treatments
Culture can also influence how an individual feels about specific mental health treatments. For example, some people might be unwilling to utilize medications due to fears about side effects or the potential for addiction. This could be influenced by family, societal, or religious views of medications [15].
Further barriers to treatment could include the matching of specific gender, ethnicity, or religion between the clinician and patient. Some individuals may feel uncomfortable seeking treatment from a professional with these differences, thus impairing treatment seeking or continuation [3].
Studies have shown that, in the US, white people are significantly more likely than any other race or ethnicity to seek mental health treatment. Barriers to treatment are often reported as related to fears of specific treatments, mistrust of clinicians, and fear of racism and discrimination [14][16].
Conclusion
Many cultural and societal norms and beliefs impact the diagnosis and treatment of people with mental health conditions. Stigma, discrimination, racism, and stereotyping all negatively impact mental health and treatment outcomes [2][3].
As such, professionals must be aware of cultural and societal impacts and aim to provide equal, appropriate, and compassionate treatment to all who utilize mental health services.
- Subudhi, C. (2014). Culture and Mental Illness. Social Work Practice in Mental Health: Cross-Cultural Perspectives, 141, 132-140. Retrieved from https://www.researchgate.net/profile/Chittaranjan-Subudhi-2/publication/270762975_Culture_and_Mental_Illness/links/54b4adac0cf28ebe92e4818f/Culture-and-Mental-Illness.pdf
- Njoku, A. (2020). The Relationship Between Culture and Mental Illness. Our Time. Retrieved from https://ourtime.org.uk/stories/the-relationship-between-culture-and-mental-illness/
- Office of the Surgeon General (US); Center for Mental Health Services (US); National Institute of Mental Health (US). (2001). Chapter 2 Culture Counts: The Influence of Culture and Society on Mental Health. InMental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General.Rockville, MD: Substance Abuse and Mental Health Services Administration (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK44249/
- Corrigan, P.W., & Watson, A.C. (2002). Understanding the Impact of Stigma on People with Mental Illness. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 1(1), 16–20. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/
- Gough, B., & Novikova, I. (2020). Mental Health, Men and Culture: How Do Sociocultural Constructions of Masculinities Relate to Men’s Mental Health Help-Seeking Behaviour in the WHO European Region?Copenhagen: WHO Regional Office for Europe. (Health Evidence Network Synthesis Report, No. 70.) Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK559704/
- Lin, K.M., & Cheung, F. (1999). Mental Health Issues for Asian Americans. Psychiatric Services (Washington, D.C.), 50(6), 774–780. Retrieved from https://doi.org/10.1176/ps.50.6.774
- Cooper-Patrick, L., Gallo, J.J., Gonzales, J.J., Vu, H.T., Powe, N.R., Nelson, C., & Ford, D.E. (1999). Race, Gender, and Partnership in the Patient-Physician Relationship. JAMA, 282(6), 583–589. Retrieved from https://doi.org/10.1001/jama.282.6.583
- U.S. Department of Health and Human Services. (1999)Mental Health: A Report of the Surgeon General. Rockville, MD: DHHS.
- Bromet, E., Andrade, L.H., Hwang, I., Sampson, N.A., Alonso, J., de Girolamo, G., de Graaf, R., Demyttenaere, K., Hu, C., Iwata, N., Karam, A.N., Kaur, J., Kostyuchenko, S., Lepine, J-P., Levinson, D., Matschinger, H., Mora, M.E.M., Browne, M.O., Posada-Villa, J., …& Kessler, R.C. (2011). Cross-National Epidemiology of DSM-IV Major Depressive Episode. BMC Med, 9, 90. Retrieved from https://doi.org/10.1186/1741-7015-9-90
- American Psychiatric Association. (2013). The Diagnostic and Statistical Manual of Mental Disorders (5thed). Arlington, VA: APA.
- Mental Health America. (2023). LGBTQ+ Communities and Mental Health. MHA. Retrieved from https://mhanational.org/issues/lgbtq-communities-and-mental-health
- Borowsky, S.J., Rubenstein, L.V., Meredith, L.S., Camp, P., Jackson-Triche, M., & Wells, K.B. (2000). Who is at Risk of Nondetection of Mental Health Problems in Primary Care? Journal of General Internal Medicine, 15(6), 381–388. Retrieved from https://doi.org/10.1046/j.1525-1497.2000.12088.x
- Young, A.S., Klap, R., Sherbourne, C.D., & Wells, K.B. (2001). The Quality of Care for Depressive and Anxiety Disorders in the United States. Archives of General Psychiatry, 58(1), 55–61. Retrieved from https://doi.org/10.1001/archpsyc.58.1.55
- Williams, D.R., & Williams-Morris, R. (2000). Racism and Mental Health: The African American Experience. Ethnicity & Health, 5(3-4), 243–268. Retrieved from https://doi.org/10.1080/713667453
- Dwight-Johnson, M., Sherbourne, C.D., Liao, D., & Wells, K.B. (2000). Treatment Preferences Among Depressed Primary Care Patients. Journal of General Internal Medicine, 15(8), 527–534. Retrieved from https://doi.org/10.1046/j.1525-1497.2000.08035.x
- LaVeist, T.A., Diala, C., & Jarrett, N.C. (2000). Minority Health in America (pp. 194–208). Baltimore, MD: Johns Hopkins University Press
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Morgan Blair is a licensed therapist, writer and medical reviewer, holding a master’s degree in clinical mental health counseling from Northwestern University.
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