dc.description.abstract
The significance of culture in clinical psychology has grown notably in recent years due to an increased awareness of its impact on mental health. In the field of psychotraumatology, research has evolved significantly, leading to a better understanding of etiology, risk factors, and effective treatments. However, research remains dominated by concepts from WEIRD countries (Western, Educated, Industrialized, Rich, Democratic). While there is some support for the cross-cultural validity of the construct of posttraumatic stress disorder (PTSD), cultural variation in experiencing and expressing symptoms has been observed.
As a result, there is a growing need for more inclusive approaches to trauma research that consider aspects of culture in clinical research. However, investigating these complex relationships presents significant challenges. Despite numerous attempts, reaching a consensus on the definition of culture has proven challenging. While researchers widely acknowledge the complexity of culture in theory, cross-cultural comparisons in practice still rely primarily on simplistic classifications such as race or ethnicity. This reductionist approach not only overlooks substantial variations within ethnic groups but also perpetuates stereotypes, failing to capture the complex dynamics that influence mental health.
This thesis presents findings from three studies that investigate the intersections of cultural and sociodemographic variables in PTSD research. To this aim, two concepts will serve as examples to illustrate how methodological and conceptual considerations about culture can benefit trauma research: 1) causal beliefs about PTSD and 2) acculturation orientation.
Studies 1 and 2 used data from a vignette study conducted via an online survey with 737 participants from Germany, Greece, Ecuador, Mexico, and Russia. The survey included both a structured questionnaire on causal beliefs about PTSD and an open-ended question on possible causes for the problems described in the vignette. Additionally, several sociodemographic and cultural variables were included in the survey.
Study 1 investigated latent classes of causal beliefs about PTSD in participants from Germany, Greece, Russia, Ecuador, and Mexico and cultural and sociodemographic correlates of latent class membership. Three latent classes with differential profiles of causal beliefs about PTSD were identified. Country of residence, gender, and characteristics related to the illness were identified as correlates of class membership.
Study 2 focused on the intersections of gender and culture in causal beliefs about PTSD by combining qualitative and quantitative methods. The results showed that participants held a wide variety of causal beliefs, with most focusing on psychological causes, traumatic experiences, and social causes, often expressing beliefs from more than one domain simultaneously. Differences in causal beliefs were found by country and gender, with female participants being more likely to mention external factors such as the traumatic event or social and societal factors. Exploratory analyses indicated interactions between country and gender.
Study 3 used data from a survey with 101 Arabic-speaking refugee youth aged 14-18 conducted in schools in Berlin. The study included questionnaires about several acculturation variables and mental health. The study investigated associations between cultural orientation and mental health in Arabic-speaking refugee youth. Cultural orientation was generally high towards both the German and the heritage culture, but neither associated with PTSD symptoms nor with depressive symptoms. However, the number of friends in Germany was negatively associated with the amount of both depressive symptoms and PTSD symptoms, and better German language skills were associated with lower scores of depressive symptoms. Exploratory analyses performed separately for girls and boys indicated that risk and protective factors for mental health symptoms may differ between girls and boys, for example, with language skills and number of friends being related to mental health only for girls but not for boys.
In summary, the results emphasize the need for a nuanced understanding of cultural influences in trauma research. They suggest methodological approaches that consider multiple facets of culture and intersectionality and stress the importance of gender-sensitive approaches in cultural clinical research.
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