How do people of South Asian origin with long-term physical conditions understand, experience and seek help for emotional distress? A systematic review.

The problem:

People with physical-mental comorbidity have a poorer quality of life, worse clinical outcomes and increased mortality than those with physical conditions alone.

People from some ethnic groups are less likely to recognise symptoms which may represent mental health problems. 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. This systematic review synthesises studies that explore perceptions of emotional distress in, and help-seeking by, SAs with LTCs. Emotional distress encompasses distress which can cause significant suffering but not be diagnosed as a mental health problem.

Our Approach:

Eight databases were searched for qualitative studies exploring emotional distress in SAs with diabetes or coronary heart disease, within primary and community care settings worldwide. 3,910 studies reduced to 2,581 after de-duplication. Two reviewers separately undertook title and abstract screening. 27 studies were included for full text screening and 20 in the review. Data extraction occurred independently; the CASP checklist was used to review the quality of the papers. Thematic synthesis was undertaken and GRADE-CERQual to assess the overall strength of evidence.

The Learning:

SAs with LTCs defined emotional distress in non-medical terminology such as tension and stress, even when diagnosed with conditions such as depression or anxiety. They described a strong link between emotional distress and physical illness. Acculturation was a prominent theme. There were some differences between men and women’s experiences. Participants did not find medical services useful, and instead sought help from other areas such as faith groups and family and friends.

Why it matters:

The review provides a greater understanding of SAs’ conceptualisation of emotional distress in the context of physical LTCs, leading to improvement in the recognition and management of emotional distress. This study has the potential to influence policy-makers and commissioners about service provision for this patient group.

Presenter:

Dr Hassan Awan, Keele University; h.awan@keele.ac.uk; Twitter DrHassanAwan

Co-authors/collaborators:
Dr Faraz Mughal, Keele University; Dr Tom Kingstone, Keele University; Professor Carolyn A. Chew-Graham, Keele University; Dr Nadia Corp, Keele University