Emotional distress, anxiety, and depression in South Asians with long-term conditions: a qualitative systematic review

Abstract

People with physical-mental comorbidity have a poorer quality of life, worse clinical outcomes and increased mortality compared to people with physical conditions alone. South Asians (SAs) are the largest minority group in the UK and are more likely to have long-term conditions (LTCs) such as diabetes and heart disease. SAs are less likely to recognise symptoms which may represent mental health problems. To explore how people of SA origin with LTCs understand, experience and seek help for emotional distress, depression and anxiety. Systematic review of qualitative studies exploring emotional distress in SAs with diabetes or coronary heart disease, within primary and community care settings worldwide. Comprehensive searches of eight electronic databases from inception to 1st September 2021. Data extracted included study characteristics, and understanding, experience and help-seeking behaviour for emotional distress. Thematic synthesis was undertaken. The CASP checklist for qualitative studies was used to assess quality of papers, and GRADE-CERQual used to determine the overall strength of evidence. Twenty one studies from 3,165 unique citations were included. Three main themes were identified. Understanding of emotional distress: non-medical terminology used, such as ‘tension,’ and a complex relationship between emotional and physical illness. Experiences of emotional distress: multiple forms of inequality, distress at diagnosis of their LTC, cultural factors, and gender differences. Help-seeking behaviour: self-management, seeking help from family, friends, and faith, and inadequate clinical support. This review provides a greater understanding of SAs’ conceptualisation of emotional distress in the context of LTCs, to support improvement in its recognition and management.

Help-seeking during 1-year follow-up in Chinese patients diagnosed with type 2 diabetes mellitus comorbid major depressive disorder

“…Psychosocially, attribution, cognition and perception of disease, doctor-patient relationship, and coping strategies all affect one’s help-seeking behavior. Patients’ attribution and cognition of symptoms or diseases often affect their help-seeking behavior ( 21 , 22 ). Some of the patients in our study attributed depression either to difficulties in T2DM management, i.e.…”

“…A meta-analytic review suggested that as individuals in Asia or with Asian origins may be affected by collectivistic cultural orientation, they tend to deal with difficulties first within a core unit such as family ( 31 ), rather than reaching out for other resources. It was also suggested that treatment-seeking was associated with perceived failure of coping strategies ( 21 ). Some participants in our study expressed a preference for self-help, which could be interpreted as the need for autonomy and self-esteem.…”

Exploring the emotional impact of axial Spondyloarthritis: a systematic review and thematic synthesis of qualitative studies and a review of social media

“…Further insights into the mental health burden in people with axial SpA can be gleaned from qualitative research that captures affective experience [ 7 , 8 ]. Affective experience includes emotions and moods, which differ in duration and specificity but share dimensions of valence, motivation and arousal [ 8 ].…”

A qualitative study on lived experience of self‐harm in South Asians in the UK: From reasons to recovery

“…Also, to our knowledge, only one self‐harm study included British South Asian men adolescents (Klineberg et al, 2013). A recent systematic review has also illustrated a dearth of research on emotional distress and help‐seeking behaviour in South Asian men (Awan et al, 2022). In addition, despite the requirement for culturally sensitive treatments, there have been no studies on culturally adapted self‐harm interventions for South Asians in the UK.…”