Elsevier

Clinical Psychology Review

Volume 28, Issue 2, February 2008, Pages 211-227
Clinical Psychology Review

A conceptual paradigm for understanding culture's impact on mental health: The cultural influences on mental health (CIMH) model

https://doi.org/10.1016/j.cpr.2007.05.001Get rights and content

Abstract

Understanding culture's impact on mental health and its treatment is extremely important, especially in light of recent reports highlighting the realities of health disparities and unequal treatment. This article provides a conceptual paradigm for understanding how culture influences six mental health domains, including (a) the prevalence of mental illness, (b) etiology of disease, (c) phenomenology of distress, (d) diagnostic and assessment issues, (e) coping styles and help-seeking pathways, and (f) treatment and intervention issues. Systematic interrelationships between each of these domains are highlighted and relevant literature is reviewed. Although no one model can adequately capture the complex facets of culture's influence on mental health, the Cultural Influences on Mental Health (CIMH) model serves as an important framework for understanding the complexities of these interrelationships. Implications for clinical research and practice are discussed.

Section snippets

Cultural issues in the development of illness

At a basic level, we understand that the cultural background and characteristics of the individual plays an important role in the etiology of disease and the resulting psychological distress and mental illness as illustrated by Pathways A and B in Fig. 1. For instance, we know that the day to day experiences of people from different backgrounds may be very different. We also know that ethnic minorities are likely to be exposed to a disproportionate burden of unique stressful experiences. A

References (140)

  • P.M. Barnes et al.

    Complementary and alternative medicine use among adults: United States, 2002

    Advance Data from Vital and Health Statistics

    (2004)
  • Barnouw, V. Culture and personality. Chicago: Dorsey...
  • R.M. Becerra et al.

    Folk medicine use: diverse populations in a metropolitan area

    Social Work in Health Care

    (1995)
  • R.H. Beinecke

    Comparing implementing the transformation to quality mental health systems in England and the United States with recommendations for areas of international shared learning and collaboration

    International Journal of Mental Health

    (2005)
  • J.W. Berry

    Acculturation and health: theory and research

  • J.W. Berry et al.

    Acculturation and adaptation

  • H. Betancourt et al.

    The study of culture, ethnicity, and race in American psychology

    American Psychologist

    (1993)
  • D.G. Blazer et al.

    The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey

    American Journal of Psychiatry

    (1994)
  • S.J. Borowsky et al.

    Who is at risk of nondetection of mental health problems in primary care?

    Journal of General Internal Medicine

    (2000)
  • C. Breaux et al.

    Use of mental health services by ethnically diverse groups within the United States

    The Clinical Psychologist

    (1999)
  • D.R. Brown et al.

    Major depression in a community sample of African Americans

    American Journal of Psychiatry

    (1995)
  • Brown, E.R., Ojeda, V.D., Wyn, R., & Levan, R. (2000). Racial and ethnic disparities in access to health insurance and...
  • J.M. Carlsson et al.

    A follow-up study of mental health and health-related quality of life in tortured refugees in multidisciplinary treatment

    Journal of Nervous and Mental Disease

    (2005)
  • R.K. Chao

    Beyond parental control and authoritarian parenting style: understanding Chinese parenting through the cultural notion of training

    Child Development

    (1994)
  • C.N. Chen et al.

    The Shatin community mental health survey in Hong Kong I: major findings

    Archives of General Psychiatry

    (1993)
  • N.N. Chernoff

    NIMH Study: Blacks mentally healthier

    American Psychological Society

    (2002)
  • F. Cheung

    Somatization among Chinese: a critique

    Bulletin of the Hong Kong Psychological Society

    (1982)
  • F.K. Cheung et al.

    Community mental health and ethnic minority populations

    Community Mental Health Journal

    (1990)
  • J. Chin et al.

    Beyond self-interest: Asian Pacific Americans toward a community of justice

    UCLA Asian Pacific American Law Journal

    (1996)
  • D. Chin et al.

    Access to health care among Chinese, Korean, and Vietnamese Americans

  • C. Chun et al.

    Health care issues among Asian Americans: implications of somatization

  • R. Clark et al.

    Racism as a stressor for African Americans

    American Psychologist

    (1999)
  • K. Conway

    Coping with the stress of medical problems among Black and White elderly

    International Journal of Aging and Human Development

    (1985)
  • G. Costantino et al.

    Cuento therapy: a culturally sensitive modality for Puerto Rican children

    Journal of Consulting & Clinical Psychology

    (1986)
  • G. Corey et al.

    Issues and ethics in the helping professions

    (1993)
  • P. Corrigan

    How stigma interferes with mental health care

    American Psychologist

    (2004)
  • J.A. Davis et al.

    General social surveys, 1972-1990

    (1990)
  • Department of Health

    Delivering race equality: A framework for action

    (2003)
  • V.A. Dzokoto et al.

    Understanding genital-shrinking epidemics in West Africa: Koro, Juju, or mass psychogenic illness?

    Culture, Medicine, and Psychiatry

    (2005)
  • J.A. Egeland et al.

    Amish Study, III: The impact of cultural factors on diagnosis of bipolar illness

    American Journal of Psychiatry

    (1983)
  • D. Eisenberg et al.

    Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey

    Journal of the American Medical Association

    (1998)
  • J.I. Escobar et al.

    Somatization in the community

    Archives of General Psychiatry

    (1987)
  • J.I. Escobar et al.

    Immigration and mental health: Mexican Americans in the United States

    Harvard Review of Psychiatry

    (2000)
  • S. Fernando

    Multicultural mental health services: projects for minority ethnic communities in England

    Transcultural Psychiatry

    (2005)
  • A.R. Fischer et al.

    Reconceptualizing multicultural counseling: universal healing conditions in a culturally specific context

    Counseling Psychologist

    (1998)
  • J.H. Flaskerud et al.

    Effects of an Asian client-therapist language, ethnicity and gender match on utilization and outcome of therapy

    Community Mental Health Journal

    (1991)
  • R.R. Frerichs et al.

    Prevalence of depression in Los Angeles County

    American Journal of Epidemiology

    (1981)
  • L.K. George et al.

    Spirituality and health: what we know, what we need to know

    Journal of Social and Clinical Psychology

    (2000)
  • N. Goater et al.

    Ethnicity and outcome of psychosis

    British Journal of Psychiatry

    (1999)
  • E. Gong-guy et al.

    Clinical issues in mental health service delivery to refugees

    American Psychologist

    (1991)
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