Explanatory models of common mental disorders among South Asians in high-income countries: A systematic review

Mental health service use by individuals of South Asian origin living outside of South Asia is influenced by cultural factors such as endorsing psycho-social-spiritual over biological explanations, somatisation, and stigma. The aim of this review is to synthesise the evidence about (a) explanatory models of common mental disorders (CMDs) among people of South Asian origin residing in high-income countries, and (b) their help-seeking for CMDs, including formal and informal care. The systematic review protocol was registered a priori on Prospero (registration number CRD42021287583). We ran extensive searches on explanatory models and help-seeking of people of South Asian origin across five databases (MEDLINE, Embase, Cumulated Index to Nursing and Allied Health (CINAHL), PsycINFO, and Global Health). We extracted the data and conducted a narrative synthesis. We included 33 reports and 29 studies (9,030 participants). The participants in the included studies viewed CMDs through a psychosocial rather than a biological lens (e.g., resulting from family issues vs. neurotransmitters). Causal attributions included life stressors and attitudinal and religious/spiritual factors. Commonly used help-seeking strategies included private coping (i.e., crying or praying), speaking to friends and family, and visiting their General Practitioner. We can conclude that cultural factors play an important role in how South Asian individuals experience and understand CMDs. To cope, they use pluralistic help-seeking strategies. Implications for clinical practice and policy include increasing research on the explanatory models of CMDs, involving family in services, and developing community-based interventions for individuals who do not engage with formal care.