The Cultural Conceptualisations of Psychological Distress and Help- Seeking among South Asian Immigrants in the UK and Canada

The South Asian diaspora is the largest diaspora in the world. In both the UK and Canada, South Asians make up a significant portion of the population. South Asians in these countries experience higher levels of Common Mental Disorders (CMDs) than other ethnic groups but tend to underutilise mental health services. My study aims to explore the cultural factors that influence how first- and second-generation South Asian immigrants in the UK and Canada experience, understand and seek help for psychological distress. I did a systematic review on the explanatory models of, and help-seeking for, CMDs among South Asians in high-income countries to examine the existing evidence base on my topic. I conducted semi-structured interviews (n=38) in London, UK and Toronto, Canada. Participants were first-and second-generation South Asian immigrants with self-reported experience of psychological distress within the past 5 years. I analysed the data using a reflexive thematic approach. I also hosted six public consultations (n=40) across the two study sites, where members of the South Asian community were invited to comment on the initial and final research findings. I found distinct generational differences in how first- and second-generation immigrants perceived the cause of their distress as well as their help-seeking behaviours and coping strategies across both study sites. My analysis suggests that participants attribute their distress to familial factors, but the factors themselves differ. First-generation participants cited post-migration stresses and the loss of their support system, while second-generation participants cited identity struggles, intergenerational trauma and pressure and expectations. Many participants preferred doing self-help activities and speaking to friends and/or family over professional help from General Practitioners and therapists, particularly for participants who are first-generation immigrants. Cultural factors such as collectivism, religion, and stigma were barriers to help-seeking across both generations. This research demonstrates that there is a lack of culturally appropriate mental health care for South Asians and other ethnically diverse populations. To address this problem, we must invest in community resources, run culturally sensitive anti-stigma and awareness campaigns, address the social determinants of mental health, and employ person-centered and structurally competent care. Finally, further research led by and in engagement with the South Asian community is required.