Still Standing Inside: A Local Idiom Related to Trauma among Namibian Speakers of Khoekhoegowab.

Euro-centric psychiatric conceptualizations often ignore the interplay of local with universal factors in psychological suffering. Emic, locally focused perspectives can enrich etic knowledge to provide culturally sensitive care and to better elucidate the role of culture in mental illness. This study explored the idiom Tsûsa ǃNaeǃkhais xa hâǃnâ/mâǃnâ/ǂgâǃnâhe hâ (a terrible event has entered a person and remains standing inside), which was understood to relate to experiences of trauma and post-traumatic stress, among speakers of Khoekhoegowab, a southern-African click language. Semi-structured interviews were conducted with 16 participants from six urban and rural communities in Namibia. Questions probed perceptions of the idiom in terms of etiology, course, and risk and resilience factors from a socio-ecological framework. Five key themes were identified using thematic analysis: origin in a shocking event; intrusive recurrence of memories, "it keeps on coming back"; the close interplay between mental and physical suffering; the importance of active engagement in healing through prayer and acceptance; and the role of the community in both alleviating and amplifying distress. Our findings highlight local norms and strategies for adaptive coping, and the benefits of exploring local idioms to elucidate the braiding together of universal and cultural elements in psychological distress.

Perceived discrimination and depressive symptoms among immigrant-origin adolescents.

Although discrimination has been found to contribute to psychological distress among immigrant populations, there are few studies that have examined the relationship between racial and ethnic discrimination in the school setting among foreign-born immigrant and U.S.-born immigrant-origin adolescents. This study examined the relationship between perceived discrimination by adults and peers in the school setting and depressive symptoms in a sample (N = 95) of racial minority immigrant-origin adolescents (13 to 19 years of age) attending an urban high school. We examined the relation between perceived discrimination and depressive symptomology across gender and nativity status (foreign born vs. U.S. born), and the potential moderating role of ethnic identity and social support. Consistent with previous research, girls reported higher levels of depressive symptomology than boys, although the relationship between perceived discrimination and depressive symptoms was significant for both boys and girls. Perceived discrimination by adults and by peers at school was positively related to depressive symptoms for U.S.-born adolescents. For U.S.-born adolescents, ethnic identity mitigated the negative effects of perceived adult discrimination on depressive symptoms. However, ethnic identity did not moderate the relationship between perceived peer discrimination and depressive symptoms. Social support did not moderate the relationship between adult and peer discrimination and depressive symptoms for either foreign-born or U.S.-born adolescents. The findings support previous research concerning the immigrant paradox and highlight the importance of context in the relationship between perceived discrimination and mental health. Implications for future research and intervention are discussed.

Putting families in the center: family perspectives on decision making and ADHD and implications for ADHD care.

OBJECTIVE: To examine components of family-centered care in families' stories about treatment decision making for their child with ADHD. METHOD: Twenty-eight families participated in qualitative interviews that addressed families' perspectives on (a) the treatment decision-making process, (b) the cause and impact of their child's symptoms, and (c) treatment goals and preferences. RESULTS: The majority of families preferred to be primary or shared decision makers regarding treatment decisions. Families' perspectives on the cause of the child's symptoms varied and often were not consistent with a biomedical framework. Families described multiple areas of impairment on child, family relationships, and family functioning. Perspectives toward evidence-based treatments were mixed, with families also expressing interest in and pursuing interventions not delineated in current treatment guidelines. CONCLUSION: These findings reinforce the importance of eliciting families' perspectives and involving these important stakeholders in shared decision making as critical components of family-centered care for children with ADHD.