Social Issues

Cultural Understanding of Mental Health

A mix-method approach to the cultural understanding of distress and the non-use of mental

            health services by Danielle Groleau, Pierre Pluye, and Lucie Nadeau


It is a common concern that mental health issues affect people of all races, and differences in cultural norms have a tendency to influence whether or not people with mental problems use mental health services. According to Groleau, Pluye, & Nadeau (2007), mental health behaviors are associated with individual subjective experiences of those who are experiencing mental health problems. In addition, mental health patients often give different meanings when describing their symptoms in different ways, and this determines diagnoses and treatment courses taken. This is something that also has a bearing on prognosis and outlook and self-care efficacy, including how patients adhere to their clinical and medicinal protocols. This offers some insight into why mental health services may be underutilized, or under utilized, and this is a serious matter that needs adjusting, as suggested by the research highligted in this article.

It is important for medical science to understand how people from various cultures perceive their mental health problems, because it is a sign of whether or not they will utilize mental health services. It is also important to understand the public’s perception of mental illness and the many people it affects. Society’s influence and reactions toward people who are mentally ill may make a difference in non-utilization, due to collective attitudes. This is something that may discourage a mentally ill person from seeking out profressional mental health services, especially people from cultures that perceive mental illness as taboo, due to their cultural beliefs. Help-seeking behaviors toward mental health services can be influenced by society and may block the management of mental health in those who need it (Groleau, Pluye, & Nadeau, 2007).


Purpose of the Study

This research study focuses on the effectiveness of mixed-method designs for studying behaviors related to mental health issues in a community with mixed cultures. Mixed-methods include both qualitative and quantitative research. Qualitative research examines internal concepts such as those related to understanding cultural phenomena, and quantitative research examines external concepts such as measureable data like that collected from surveys.

Theoretical Framework

The theoretical framework of this research includes making an assessment of the relationship between qualitative and quantitative studies as they pertain to mental health. The article states that quantitative studies are somewhat limited for this purpose because of the subjectivity of human behavior, where variables come into play when it comes to theory and what is real. Also, individual cases are so different that not all generalizations fit and the element of discovery is often missing in quantitative analyses.

Qualitative research is quite different. This method focuses on discovery and exploration of complex phenomena such as culturalism. It examines the nature of reality in a social context, the thouroughness of the researcher, and the significance of inquiry.

Research Questions

The research questions hinge on qualitative research being integrated into social quantitative research, as well as behavioral quantitative research. This is known as mixed-method research, commonly used successfully in developmental mental health research. The hypothesis examiens the effectiveness of Sequential Transformative Design, which includes two phases of collecting and analyzing data – quantitative (QT) and qualitiative (QL). The use of both of these phases in mental health study may give insights into understanding the mental health process better or how to advocate for mental health patients.

The research variables for this study include the QT phase of the study as initially describing mental health problems and the behaviors associated with them within a particular population. Another variable is the whole of epidemiological characteristics used for sampling the QL phase of the study. In addition, the relationship between QT and QL and the results considered for guidance, pertaining to the conceptualization of innovative approaches to the implementation of customized mental health services.


The research design included examining the implementation of QT and QL project phases, related to Sequential Transformative Design. The intention was illustrating how this type of design allows for both internal and external confirmation of research result validity. This is for the purpose of identifying and understanding specific community health issues and assisting in developing customized mental health services for the community. The community researched was in Montreal, Canada.

Research Sampling, Data Collection and Data Recording Procedures

Data was collected from a sample out of the culturrally diverse community of 2,400 residents via quantitiative telephone surveys. Questions asked focused on mental health services utilization and reasons for not using the services of mental health organizations. Quantitative information was also collected through literature review searches. In addition, the data collected measured the participants’ perceived distress levels.

After the quantatitive phase was completed, then the qualitative stage was started. This stage focused on determining the influence of social and cultural contexts related to mental health behaviors, particularly among distressed participants. The participants for this phase were members of one of three immigrant groups – West Indian, Vietnamese or Filipino. In addition, two non-immigrant groups were a part of the study, and they were from Canada and were either French-speaking or English-speaking natives.

Participants of the study reported being in distress or having medically unexplained symptoms and were not users of mental health services.

Data Analysis

Data analysis was completed with the McGill Illness Narrative Interview Schedule (MINI). The MINI is a qualitative, semi-structured interview schedule that is based on theory. This form of analysis defines sociocultural concepts, mental health behaviors and emotional or somatic symptoms. The MINI also enhances quantiative data.


Results of the study showed immigrants were non-users of mental health services, and there was no definitive explanation of this occurrence. This is inspite of the fact that the first phase of the project showed good external validity.

The results also showed that participants basically use three forms of reasoning when explaining their illnesses or the symptoms associated with them, as follows: “(i) representations based on explanatory models arising from causal thinking such as attributions; (ii) knowledge based on patients’ own prototypical experiences of self or others, which allows patients to reflect on their illness through analogical reasoning; or (iii) representations organized in chain-complexes in which past experiences are linked metonymically to present symptoms through a sequence of events leading to present circumstances without referring to a causal relationship” (Groleau, Pluye, & Nadeau, 2007, p. 734). This is where the mixed-design helped determine why distressed participants from diverse cultural communities under-utilized mental health services, as reported from the interview results. However, interviews from the MINI were only analyzed using the results of the Vietnamese and West Indian groups. Consequently, the qualitative studies were used to explain the cultural influence of why the Vietnamese participants did not use mental health services, and the explanations they gave for their emotional or somatic symptoms. These were the results of the part of the study that included 18 Vietnamese immigrants living in a neighborhood in Montreal, who reported distress symptoms.

Quantitative and Qualitative Results

The QT part of the research (Phase I) identified that those immigrants who reported being distressed did not use mental health services. The 2,400 participants in this phase of the study showed accurate external validity for assuming the generalization of the phenomena in the regional community among similar cultures in the Canadian communities. The QT results of this stage were not significant for explaining immigrant-specific mental health behaviors, which may be based on what motivates them to make decisions toward their health choices.

The QL part of the research (Phase II) showed usefulness in the area of exploring the meanings given by the participants regarding their illnesses and health behaviors associated with them, based on cultural or historical contexts. The QL tools contribute to understanding determinants of health-related behavior and allow for more focused developments of interventions, based on individual and contextual relationships.

Both the quantitative and qualitaive methods contribute to the research and prove that mixed-method approaches to study is significant for developing and implementing more focused research and also for better tailoring of mental health utilization interventions. This allows for better understanding of cultural barriers to mental health utilization and evaulation of cultural perspectives as it pertains to change in this area.


Conclusion and Recommendations

It is concluded that a mixed-method study approach to initiating utilization of mental health services among specific cultural groups is viable. In particular, the Sequential Transformative Design model may be significantly affective in initiating social change, which can have a positive effect on utilization. This design model focuses on understanding why people make certain choices regarding their health care, as it pertains to what happens in their lives. This is the effectiveness in the mixed-method approach because it is also influential in predicting human behavior as it pertains to making health choices.

The role of mental health practices is significant for improving mental health services utilization. This study’s approach to mixed-methods supports positive affects across cultures and how perspectives are viewed concerning mental health issues and behaviors. It is important that various cultural tendencies and sensitivities are taken into account when developing interventions to eliminate non-utilization of mental health services among specific groups and communities.

The promotion of mental health services in a multicultural context is needed, and is recommended focus for clinicians and health service providers, particularly with the proven usefulness of mixed-method strategies for improving utilization of mental health services. In addition, it is noted that culture plays a significant role in health-specific behaviors, especially when it comes to mental illness. Culture also shapes how people perceive mental health professionals and seeking help from them. Therefore, it is important to promote positive changes in approaches to mental health services utilization, particularly when it involves multiculturalism and changing attitudes toward the utilization of mental health services around the world.