Culture & mental health

Some languages have no direct word for “depression” or “anxiety”. People may instead talk about a heavy heart, a troubled mind, “thinking too much”, feeling tired of life or feeling unsettled. These descriptions are real and meaningful ways of expressing distress.

Why it matters

• A provider may miss distress if they only listen for certain words
• Translating feelings can lose important meaning
• You may not recognise your own experience in clinical terms

A review of 138 studies found that “thinking too much” is a common way people describe distress in many parts of the world. It usually means worried, looping or unwanted thoughts. People linked it with tiredness, poor sleep, headaches, low appetite and pulling away from others.

The review found it overlaps with ideas like depression and anxiety but is not the same thing. It can also point to real-life problems, like money worries or troubled relationships, that need practical help as well as emotional support.

In parts of Latin America, some people speak of susto, a sense of distress after a frightening event. Researchers say it is best understood on its own terms, and that clinicians should ask people about their own words for distress.

People may explain emotional suffering as stress, a physical imbalance, a test of faith, a spiritual matter, a family problem, or the result of hard life events. Cultural beliefs about what causes illness and whether it is “real” affect whether and where people seek help.

Good to know

• Care works best when you and your provider understand each other’s views
• More than one explanation can be true at once
• Your beliefs about the cause deserve respect in care

Many people first turn to family, elders, clergy or traditional healers, or to a primary care doctor rather than a mental health specialist. These sources of support can be powerful. They can also work alongside professional mental health care.

Children of immigrants, people of mixed heritage, people who have moved countries and people who have changed or left a faith may live with more than one set of values. This can be a rich strength. It can also bring pressure to “fit” in two places at once.

It can feel like

• Being “too much” of one culture for one group and “not enough” for another
• Code-switching: changing how you speak or act in different places
• Pride and confusion at the same time

Moving to a new country takes great courage. Acculturation stress is the pressure of adapting to a new language, rules, jobs and ways of living. Research links it with worry, low mood and trauma symptoms in many immigrant and refugee groups, including young people.

Refugees may also carry experiences of war, loss and dangerous journeys. Research suggests the stress of resettling adds to this, and that the host country’s attitudes and policies affect how people cope. A U.S. review found immigrants use mental health care far less than the general population.

Being treated unfairly because of your race, ethnicity, faith, accent or background is painful. Racism and discrimination are linked to poorer mental and physical health. Over time, people may stay on guard, which takes energy and can affect sleep, mood and health.

Things that can help

• Lean on your values, strengths and cultural pride
• Protect your sleep and take breaks from upsetting news
• Talk about it with people who see you clearly
• Think through how you might respond next time, then try to set it aside
• Work with a counselor who has experience with racial stress

• Aches and pains with no clear cause
• Feeling tired all the time
• Headaches or a heavy head
• Stomach aches, poor appetite or nausea
• Tight chest or racing heart
• Trouble sleeping

Stress and low mood affect sleep, muscles, digestion and the heart. Body symptoms are real, and so is the emotional strain that can sit underneath them.

When distress shows up as body symptoms, people may visit doctor after doctor without anyone asking how they feel. Body complaints can make it harder to spot the emotional pain underneath, which can delay mental health care.

What can help

• Ask: “Could this be connected to stress or how I’ve been feeling?”
• Bring a family member or friend who knows how you’ve been
• Tell your provider about stress, worries or big life changes, even if you came in for a headache

For many people, care that includes the body feels more natural than talking alone. Breathing, gentle movement, prayer or meditation, rest and time in nature calm both body and mind.

Ideas

• A calming ritual from your own tradition
• A walk after a stressful conversation
• Regular sleep and meal times
• Slow breathing when your chest feels tight

“Saving face” means protecting your own or your family’s honor and standing in the community. It comes from a caring place: wanting to protect loved ones. But it can also mean people suffer quietly so no one “finds out”.

It might sound like

• “Don’t tell anyone outside the family.”
• “We handle our problems ourselves.”
• “What will people think?”

Many cultures value endurance, toughness and not complaining. These values help people survive hard times. But being strong does not mean doing everything alone. Getting support is a way to stay strong for the long run.

A different way to see it

• A strong person gets a broken arm treated
• Caring for your mind helps you care for your family
• Speaking up can make it easier for others to do the same

Some communities have a history of being treated unfairly or harmed by health and government systems. Mistrust rooted in this history, along with stigma and language barriers, can keep people away from care. Bias from providers can also lead to misunderstanding or misdiagnosis.

What can help

• Ask questions about how your information is used and kept private
• Bring a trusted person with you
• Know you can change providers if you don’t feel respected
• Look for providers who share or understand your background

• Compare mental health to physical health: both need care
• Invite a respected elder or faith leader into the conversation
• Share stories of people who got help and are doing well
• Start with one trusted person, not the whole family
• Use everyday words: “stress”, “heavy heart”, “feeling worn out”

Researchers note that local phrases for distress, like “thinking too much”, are often felt to be less stigmatising than clinical labels. Starting with familiar words can open the door.

In many cultures, people see themselves first as part of a family or community. Decisions about school, work, marriage and health may be made together. This can give a strong sense of belonging, support and purpose.

Strengths

• A built-in support network
• Shared responsibility in hard times
• Strong sense of identity and roots

Possible pressures

• Feeling your own needs don’t count
• Guilt about wanting something different
• Worry about letting everyone down

In other cultures, people are encouraged to make their own choices and become independent from family early. This can bring freedom and self-expression.

Strengths

• Encouragement to speak up for your needs
• Freedom to choose your own path

Possible pressures

• Feeling you must handle everything alone
• Loneliness and less built-in support

Respecting parents and elders is a precious value in many cultures and faiths. It can feel impossible to disagree with them or to say you are struggling. Respect and honesty can live together, though it may take careful words.

Ideas

• Ask a trusted relative or elder to support you
• Choose a calm, private moment
• Share your feelings as a request for their help, not a complaint
• Start by thanking them for their care and sacrifices

Many families, especially those who sacrificed a great deal, hope their children will do well in school, work or marriage. These hopes come from love. But constant pressure can lead to stress, fear of failure and feeling that your worth depends on results.

What can help

• Celebrate effort, not only results
• Find a mentor or counselor to talk things through
• Separate your worth from your grades or job title
• Share your own goals and worries with your family

In families who have moved countries, children often learn a new language and culture faster than their parents. This can lead to misunderstandings about dating, clothes, independence, faith or career. Parents may worry about losing their culture. Children may feel caught in the middle.

What can help

• Find community events that welcome all generations
• Remember you are on the same side, even when you disagree
• Share stories from the home country and from school or work
• Talk about which traditions matter most to each of you

• “Can we do sessions in my language, or with an interpreter?”
• “Have you worked with people from my culture or faith?”
• “How do you handle beliefs that might be different from yours?”
• “How do you include family in care, if I want that?”
• “What happens to my information? Who can see it?”

U.S. national standards for culturally and linguistically appropriate services say health organizations should offer language help at no cost to people with limited English, tell people this help is available, and use trained interpreters rather than untrained people or children.

Tips

• Ask for a trained interpreter when you book
• Ask for written materials in your language
• Say if you’d prefer an interpreter of a particular gender
• Speak to the provider, not the interpreter, and take your time

In many families, children translate at doctor visits, banks or schools. This shows love and skill. But it can expose children to worrying adult news and put them in a difficult spot. Guidance for health services says untrained people and minors should not be used as interpreters.

Better options

• Ask for a free, trained interpreter at health appointments
• Keep children out of sensitive conversations when possible
• Use telephone or video interpreting services

Look for a provider who

• Asks about your culture, faith and family, instead of assuming
• Doesn’t judge or stereotype
• Respects your beliefs about what causes distress
• Uses your words for how you feel
• Works with you to choose goals

Many people use traditional healers, cultural ceremonies or spiritual practices along with professional care. Tell your provider about everything you use, so they can understand the whole picture and support you safely.

• Community health centers, often with sliding-scale fees
• Community organizations serving specific cultural groups
• Faith-based counseling services
• Free peer support groups
• Refugee and immigrant support organizations
• University training clinics

• Avoid busy, rushed or stressful times
• Start with the family member who is most likely to listen
• Take a walk together. Side-by-side talks can feel easier
• Talk one-on-one first, rather than to everyone at once

If words like “depression” or “therapy” might upset your family, start with familiar words. Describe what you feel and how it affects daily life.

You could say

• “I’ve been feeling very tired and heavy inside for weeks.”
• “I want to feel like myself again, and I need some help.”
• “My mind won’t stop worrying, and I can’t sleep.”

For example

• “A doctor would help with a broken leg. This is the same.”
• “Getting help will help me do well in school.”
• “I want to be healthy so I can take care of you.”
• “Our faith teaches us to care for the body and mind God gave us.”

Family members may react with worry, denial, anger or silence at first. They may need time to think. Many come around later, especially once they see you are serious and getting better.

What can help

• Ask a trusted relative, elder or faith leader to help
• Get support from friends or a counselor in the meantime
• Give them time and try again later
• Share simple information, like this guide

• Avoid blame or questions like “What did you do wrong?”
• Keep what they shared private, unless their safety is at risk
• Offer to help find support, and go with them if they want
• Say: “Thank you for telling me. I’m here for you.”
• Stay calm and listen without rushing to fix things

People may describe distress as stress, tiredness, a heavy heart, “nerves”, headaches, a spiritual struggle or a test, rather than “depression” or “anxiety”. Use the words they use. Ask what it feels like and what they think might help.

Helpful questions

• “How have you been feeling, in your body and in your heart?”
• “What do people in our family usually do when things feel like this?”
• “What would help you feel even a little better this week?”

• “Don’t tell anyone, what will people think?”
• “It’s all in your head.”
• “Just pray more.” (Prayer can be a comfort, but this can make someone feel their struggle is a spiritual failure)
• “People like us don’t get depressed.”
• “You’re too strong for this.”

Shame and fear of “losing face” are some of the biggest reasons people delay getting help. Keeping things private can be respectful, but secrecy that stops someone from getting care can cause harm.

Many people find comfort in prayer, scripture, rituals and their faith community while also seeing a counselor. You can help by respecting their beliefs and gently encouraging professional support when needed.

Ways to help

• Help them ask a provider: “Will my beliefs be respected here?”
• Help them find a counselor who respects their faith or shares their background
• Offer to pray, read or attend services together, if they would like that
• Suggest speaking with a trusted faith leader who is supportive of mental health care

• Bring food, help with chores, or care for children so they can rest
• Drive them to an appointment, or sit with them during a telehealth call
• Help find a provider who speaks their language, or ask for a free interpreter
• Help them explain things to older relatives, if they want that

Under U.S. national standards for culturally and linguistically appropriate services, health care organizations are encouraged to offer language help at no cost.

In many cultures, one person, often a daughter, mother or eldest child, carries much of the caring. It can be tiring and lonely, especially if mental health isn’t talked about openly at home.

• Consider counseling or a support group for family members
• Find one person you can talk honestly with
• Keep up your own faith, hobbies and rest
• Share the load with siblings, relatives or friends

Around the world, about 1 in 7 people were living with a mental disorder in 2023. How people describe and cope with distress varies, but emotional suffering is part of being human everywhere.

Struggling emotionally is not a sign of weak faith. Faith can be a source of strength and comfort, and many people of faith also benefit from professional support.

Culturally responsive care works with your values, not against them. You choose your goals, and many providers welcome family involvement if you want it.

Headaches, tiredness and stomach trouble are common ways people experience distress, in every culture. The body and mind are deeply connected.

Phrases like “thinking too much” or “a heavy heart” are real ways of describing suffering. Researchers recommend that care uses these local words, rather than replacing them with clinical labels.

988 offers calls, texts and chat in Spanish, and phone interpreters in more than 240 languages. Many health services offer free interpreters too.

Cultural centers and associations host festivals, language classes, meals and support for newcomers. They can be a bridge to services and a way to keep traditions alive.

Ways to get involved

• Attend a cultural festival or meal
• Join a dance, music or language group
• Volunteer to help newcomers settle in

Many faith communities run support groups, visiting programs, food banks and youth groups. Over half of people in religious communities in one U.S. poll said their community talks about mental health openly and without stigma.

Not everyone feels accepted in their cultural or faith community, for example because of their identity, choices or past hurts. You deserve belonging too. Interfaith groups, inclusive faith communities, peer groups and chosen family can all offer support.

• Check in on newcomers and people living alone
• Help translate information for elders
• Invite a speaker to a community or faith event
• Share this guide with someone who might need it
• Talk openly about your own experience, if you feel safe