Why local concepts matter: Using cultural expressions of distress to explore the construct validity of research instruments to measure mental health problems

There is considerable variation in the presentation of mental health problems across cultural contexts. Most screening and assessment tools do not capture local or culturally specific presentations of distress, thus introducing measurement error and overlooking meaningful variation in mental health. Before applying screening and assessment tools in a particular context, a qualitative exploration of locally salient idioms and expression of distress can help assess whether existing measures are appropriate in a specific context as well as what adaptations may improve their construct validity.

This study employed a mixed-methods approach with the aim of describing and measuring cultural concepts of distress among female Congolese survivors of intimate partner violence in Nyarugusu refugee camp, Tanzania. Results from the data converged on three concepts of distress: huzuni (deep sadness), msongo wa mawazo (stress, too many thoughts), and hofu (fear). The psychometric properties of these constructs were comparable to those of the three original common mental disorders measured by the quantitative symptom assessment tools—anxiety, depression, and post-traumatic stress disorder—adding weight to the appropriateness of using these tools in this specific setting.

This mixed-methods approach presents an innovative additional method for assessing the local “cultural fit” of globally used tools for measuring mental health in cross-cultural research.