SSM: Qualitative Research in Health (Dec 2022)
When distress becomes disease: The social context and uses of disease attributions in common mental disorder
Abstract
Background: Common mental disorder is closely linked to life situations. Some individuals with depression and anxiety view their condition as disease/disorder, while others report purely situational attributions. This exploratory, cross cultural study examined the context, impact and social uses of disease attributions (DAs) in mothers experiencing perinatal distress. Methods: Twenty-one European American (EA) and 17 South Asian (SA) mothers were recruited for the study. Mothers reporting a recent episode of distress participated in telephone interviews regarding their symptoms, experiences, and conceptual models of distress. Quantitative symptom were collected and subjected to descriptive analysis using SPSS. Qualitative interview data were analyzed using standard methods. Results: About half the sample made biological/disease attributions. The types of “diseases” referenced by participants differed dramatically across the two groups. SAs referenced a set of conditions understood to reflect a biological process of bodily weakening. EAs referenced psychiatric diagnoses such as ‘anxiety disorder,’ or ‘depression,’ popularly attributed to faulty brain chemistry. Compared to participants making situational attributions only, “disease attributors' reported more accommodating social networks and more treatment seeking behaviors. DAs functioned to signal distress and justify withdrawal from social roles. DAs were associated with specific symptom patterns. In both groups, DAs were closely associated with mystery and ambiguity, in keeping with the contested/problematic nature of such attributions. Conclusions: More research is needed on the social context, uses, and impacts of DAs for CMD. This study sheds some light on these factors and offers questions for further exploration.
