5 Ways Culture Can Negatively Impact Mental Health

Our psychological journey is not only determined by our genetics. Our cultural and societal milieu can also influence the psychological bonds we form when we interact with others and ourselves. Cultural and societal norms can influence our thoughts and dictate how we interact with others and ourselves. Research has shown that while our socio-cultural environment may not heavily contribute to the development of conditions like schizophrenia and bipolar disorder, they do weigh heavily upon the causation of depression, anxiety, and PTSD. Hence, clinicians and psychologists often look at a patient’s social and cultural background for context regarding diagnosis and treatment. 

Below are some socio-cultural factors that can impact your mental health.

• Societal Structure

Some cultures normalize an attitude of self-reliance or stoicism. These sentiments are often found in cultures with an exaggerated concept of masculinity (i.e. machismo-culture ) and can cause negative impacts on men’s mental health. In 2012, the CDC found that Hispanics are most likely to meet the criteria for major depression. It is inferred that the machismo/ marianismo culture may be the cause. Machismo/marianismo culture emphasizes and promotes hyperbolized versions of masculinity and femininity. Psychologists observed the negative cognitive-emotional factors stemming from a society’s strict gender roles. Though there are not many studies examining the correlation between cultural construction of genders and negative cognition, there are some that link hyper-masculinity to anger and aggressiveness, which are also expressions of psychological distress, such as depression or anxiety. Additionally, a study published by the American Psychological Association that studied participants between ages 18- 24, self-identified as Hispanic or Latino from Central America, found that most of the participants had high levels of negative cognition and emotions regardless of gender. However, the problem extends beyond the scope of gender norms. Various social structures act on the intersections of identity and are also responsible for poor mental health among certain groups.  

Many minorities in America face disadvantages which can also negatively impact their mental health. Because racism and classism are intrinsically linked in America, it is no wonder that minorities are more vulnerable to mental health illnesses. Typically, minorities are targets of racial discrimination and subsequent wage discrimination, which can cause major depression and PTSD, especially for those in urban cities.

• Elements of migration as causation  

Each immigrant’s experience is unique, thus the development of a psychosomatic or psychological problems is not guaranteed. Though there is scant information on the prevalence of psychological disorders, such as anxiety, depression, or PTSD, in immigrants, there is a consensus that immigrants are prone to develop negative cognition. Some are more vulnerable than others. 

Refugees, asylum seekers, and temporary migrants are more likely to develop PTSD as they may have witnessed severe violence or trauma while leaving their country. In 1999, the Surgeon General published a report stating that up to 70% of refugees from Vietnam, Cambodia, and Laos met the diagnostic criteria for PTSD. 

But, pre-migratory experiences are not the only contributors to poor mental health. Psychological distress can arise from the problems they face in the host country. Upon arrival, many immigrants experience acculturative stress and disenchantment. They are confronted with a lack of access to resources and feelings of ‘”otherness” which can produce acculturative stress(Berry, 1997; Finch & Vega, 2003; Viruell-Fuentes, 2007). Acculturative stress is the psychological impact of adaption or assimilation to a new country. A paper published by psychologists at Queen’s University identified different stressors that contribute to the amount of acculturative stress among immigrants, refugees, sojourners/ temporary migrants, and natives. They found that the type of group, the nature of the host society, the demographics, social characteristics, and psychology of the individual contribute to the development or accumulation of acculturative stress. 

Migrant group and demographic play important roles in the development of mental health problems. For example, refugees and temporary immigrants may experience more mental health illnesses than those who have comfortably and permanently settled into their host country. (Berry et. al, 1987) as they are less in control over their circumstances (Rumbaut, 1985; Meinhardt et al., 1986).  

Additionally, culture and ingrained societal norms can affect an individual’s reaction to acculturative stress. Of the observations made by the psychologists at Queen’s University the most important one is that the amount of acculturative stress depends on the nature of the host or larger society. Is the society pluralist of multicultural ideology or does it encourage assimilation? Research shows that there are fewer mental health problems in societies that are pluralist and accepting of other cultures (Murphy, 1965). 

Disenchantment is also responsible for the development of mental health issues like major depression and anxiety. Due to a lack of resources and opportunities, many immigrants can become disenchanted and lose hope in the goals and dreams they may have had. This phenomenon is expanded in The Boat People and Achievement in America: A Study of Family Life, Hard Work, and Cultural Values. The authors observed that because of the lack of access to resources, such as proper healthcare and job opportunities, minorities often choose to work dead-end jobs to sustain their families and postpone their goals for the next generation. This causes a feeling of hopelessness and resignation which can lead to mental illnesses and other negative outcomes (Halpern, pg. 458).  

Though there are many studies linking immigration and it’s to distress and potential development of mental health disorders, the research does not suggest immigration as a direct cause of psychological distress. However, though socio-cultural challenges such as poverty and violence are not unique to a specific class or group, they often affect certain races or ethnicities more. Hence, increasing the chance of exposure to these stressors. 

• From Mindset, Ideals, and Religion to Coping Mechanisms

Another cultural factor that can impact mental health is the predominating ideas that influence that culture. Each culture has different ways of interpreting mental health illnesses (Kleinman, 1988). The meaning attributed to mental health depends on the beliefs the culture has about whether the illness is real or imaginary, the connection between mind and body, and whether the mental illness deserves sympathy or stigma.   

 For example, a study conducted in 1999 found that Asian-American patients are more likely to report the somatic symptoms corresponding to psychological distress. Researchers inferred that it may be due to the culture’s root in Confucian ideologies. Though not empirically proven, they found that many patients preferred to list somatic symptoms of emotional or psychological distress– dizziness and lack of eating versus depression or anxiety. Researchers also believed that the prevalent dissonance or separation between the somatic symptoms and emotional symptoms may be due to seeing the mind and body as separate entities rather than linked. (Wang, pg 12). As such, this choice could either stem from religious beliefs or an internalized stigma about mental health. Regardless of the psychological distress, the patient will describe their mental illness in a way that is deemed socially acceptable. 

Cultural ideologies can also influence how individuals cope with psychological distress. Within both Confucian and Christian teachings, there is the concept of Tianming or divine providence. This concept plays a major influence on how people view major and uncontrollable setbacks. When there is a personal setback, an individual takes the burden upon themselves and self-reflects on what or where they failed. However, when confronted with illness or death, this is usually attributed to Tianming or divine providence. Though these teachings are sound and revered in many cultures that provide comfort to many, some use religion to negatively cope. Negative religious coping comes from an internal struggle with faith, and the individual sees their relationship with God as unstable. This then breeds hopelessness, dissatisfaction, and mental health illness like depression and anxiety.  

On the other hand, positive religious coping can reduce feelings of distress when facing personal setbacks. It is a collaborative and adaptive relationship between the individual and their religion or faith. A psychologist found that African-Americans are proactive when facing personal problems and are more likely to lean on spirituality to help them cope (Broman, 1996). 

• Familial Structure

Whether a person acknowledges or rejects their mental health can also depend on family dynamics. 

Early studies conducted in Great Britain observed the receptiveness and response to treatment in a schizophrenic patient. They found that patients who returned from hospitalizations to a hostile or less emotionally involved environments were more likely to relapse than those who returned to a warmer environment (Leff & Vaughn, 1985; Kavanaugh, 1992). It goes without saying that the reaction a family has towards a member with a mental health problem is dictated by societal and cultural norms. 

The findings in this study were applied to a study performed with Mexican American families. Researchers found that familial reactions and level of receptiveness affect a patient’s chances of relapsing– families that react with a lack of warmth and understanding can cause patients to relapse (Lopez et al., 1998). 

• Stigma and Mistrust

Another factor that can hinder proper mental health treatment is mistrust and stigma. In both Western and Eastern cultures, there is a stigma regarding mental health illnesses and treatment. Stigma relating to a patient’s socioeconomic class, race, educational background, or gender only serves to enforce feelings of shame and potentially preclude patients from getting proper treatment.

These feelings of disapproval are more pervasive and widely accepted in minority groups. Though there is little numerical research documenting why minorities fear treatment, it is inferred that it is a direct result of years of racial oppression and lack of adequate resources that fosters a deep mistrust towards health care institutions. Hence, minorities often forgo treatment opting to self-cope or turn to religion. 

• Lack of Resources: 

The last cultural factor than can negatively impact mental health is the number of resources. As stated above, minorities and marginalized groups are often the most affected. 

However, discrimination extends beyond societal norms. Systemic racial discrimination not only exists with the confines of governmental or educational institutions. It permeates medical institutions as well. 

According to the Commonwealth Fund Minority Health Survey, 43% of African Americans and 28% of Latinos expressed feeling racial discriminated against in a clinical setting. Only 5% of Caucasians felt this way. A study conducted at the University of South Florida found that white therapists were more biased in their evaluations of black depressed patients than non-black patients. 

An additional problem may be caused by language barriers. Personal or face-to-face communication is how therapy sessions are often conducted. If there is a language barrier between the patient and psychologist, the patient may be reticent to open up. therapies are usually the Patients are more responsive if 

Lastly, there is the matter of poor physical health. Studies have shown that communities of color are prone to developing health problems such as diabetes, high cholesterol, and obesity. As such, they also are at higher risk of developing mental health disorders. Without access to proper healthcare, many are left to tough it out on their own. 

There will always be the question of nature versus nurture. I found that it often involves both. They are forces that constantly act upon our lives, but it is important to remember that, in the end, you are responsible for the outcome.  

Let us know in the comments below what you thought of this article!

Take care!

Additional Resources:

Ano GG, Vasconcelles EB. Religious coping and psychological adjustment to stress: a meta-analysis. J Clin Psychol. 2005;61(4):461-480. doi:10.1002/jclp.20049

Broman, C. L. (1996). Coping with personal problems. In H. W. Neighbors & J. S. Jackson (Eds.), Mental health in Black America (p. 117–129). Sage Publications, Inc. 

Da Silva, Nicole et al. “Acculturative Stress, Psychological Distress, and Religious Coping Among Latina Young Adult Immigrants.” The Counseling psychologist vol. 45,2 (2017): 213-236. doi:10.1177/0011000017692111

Davis, Regina G et al. “Treatment barriers for low-income, urban African Americans with undiagnosed posttraumatic stress disorder.” Journal of traumatic stress vol. 21,2 (2008): 218-22. doi:10.1002/jts.20313

Halpern, Joel, “Refugees as Immigrants: Cambodians, Laotians and Vietnamese in America.; The Boat People and Achievement in America: A Study of Family Life, Hard Work, and Cultural Values” (1991). The Journal of Asian Studies. 51.https://scholarworks.umass.edu/anthro_faculty_pubs/51

Howard, Claire. The State of Minority Mental Health. 12 Apr. 2018, www.mentalhealthfirstaid.org/external/2018/04/state-minority-mental-health/. 

Jia CX, Zhang J. Confucian Values, Negative Life Events, and Rural Young Suicide with Major Depression in China. Omega (Westport). 2017;76(1):3-14. doi:10.1177/0030222815575014

Kim PY, Kendall DL, Webb M. Religious coping moderates the relation between racism and psychological well-being among Christian Asian American college students. J Couns Psychol. 2015;62(1):87-94. doi:10.1037/cou0000055

Lin KM, Cheung F. Mental health issues for Asian Americans. Psychiatr Serv. 1999;50(6):774-780. doi:10.1176/ps.50.6.774

Murphy, H.B.M. 1965 “Migration and the Major Mental Disorders”. In Mobility and Mental Health. Springfield, MA: Thomas.

Nuñez, Alicia et al. “Machismo, Marianismo, and Negative Cognitive-Emotional Factors: Findings From the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study.” Journal of Latina/o psychology vol. 4,4 (2016): 202-217. doi:10.1037/lat0000050

Office of the Surgeon General (US); Center for Mental Health Services (US); National Institute of Mental Health (US). Mental 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); 2001 Aug. Chapter 2 Culture Counts: The Influence of Culture and Society on Mental Health. Available from: https://www.ncbi.nlm.nih.gov/books/NBK44249/

Parto, Jacklyn A et al. “Symptoms of posttraumatic stress disorder among urban residents.” The Journal of nervous and mental disease vol. 199,7 (2011): 436-9. doi:10.1097/NMD.0b013e3182214154

Pratt LA, Brody DJ. Depression in the United States household population, 2005–2006. National Center for Health Statistics [NCHS] Data Brief. 2008;7:1–8.

Sussman LK, Robins LN, Earls F. Treatment-seeking for depression by black and white Americans. Soc Sci Med. 1987;24(3):187-196. doi:10.1016/0277-9536(87)90046-3

The Boat People and Achievement in America: A Study of Family Life, Hard Work, and Cultural Values. by Nathan Caplan, John K. Whitmore, and Marcellah Chou. Ann Arbor: The University of Michigan Press, 1989. 

U.S. Department of Health and Human Services. (1999) Mental health: A report of the Surgeon General. , Rockville, MD

Vega WA, Kolody B, Aguilar-Gaxiola S, Alderete E, Catalano R, Caraveo-Anduaga J. Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Arch Gen Psychiatry. 1998;55(9):771-778. doi:10.1001/archpsyc.55.9.771

Wang, Jun. “The Attribution Theory of Confucianism and Its Function To Mental Health.” IOSR Journal of Humanities and Social Science, vol. 21, no. 07, 2016, pp. 10–16., doi:10.9790/0837-2107061016. 

Weissman MM, Bland RC, Canino GJ, et al. The cross national epidemiology of obsessive compulsive disorder. The Cross National Collaborative Group. J Clin Psychiatry. 1994;55 Suppl:5-10.

Yehuda R. Biology of posttraumatic stress disorder. J Clin Psychiatry. 2000;61 Suppl 7:14-21.