Trauma-related cultural concepts of distress: A systematic review of qualitative literature from the middle east and North Africa, and Sub-Saharan Africa

Culture shapes how individuals experience, understand, and express trauma-related distress. The study of cultural concepts of distress (CCDs) provides valuable insights into culturally specific symptoms, syndromes, and explanatory models that emerge in different contexts. Incorporating CCDs into research and clinical practice not only allows for a better understanding of individuals' experiences but is also a key element in better understanding how psychological processes are perceived within various cultural contexts. This systematic review aimed to compile qualitative research on trauma-related CCDs in the Middle East and North Africa (MENA) as well as Sub-Saharan Africa (SSA) to facilitate their use by researchers and practitioners working with these populations from these regions. Searches were conducted in sixteen databases using search terms for countries, methods, symptoms, and trauma exposure. Forty-one studies were included, identifying a total of eighty CCDs and fifty-two idioms of distress. Findings revealed multiple etiologies, going beyond trauma to include structural, psychosocial and spiritual factors. The severity of distress ranged from normal and transient to severe and profoundly stigmatizing, depending on the symptomatic manifestations, their consequences, and the nature of the traumatic experiences. Finally, the findings suggest that effective interventions must extend beyond individual-focused approaches to address broader social, structural and community-level factors.