Tamming Teisi, Otake Yuko
Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
BMJ Glob Health. 2020 Jul;5(7). doi: 10.1136/bmjgh-2020-002304.
How and why people in a particular setting turn to a specific coping strategy for their distress is pivotal for strengthening mental healthcare and this needs to be understood from a local point of view. Prior research in northern Rwanda documented common local concepts of distress for the population that cannot receive assistance despite severe adversities; however, the locally-perceived causes, manifestation and coping strategies and their associations are still unclear.
The qualitative study in the Musanze district, northern Rwanda, was informed by Interpretative Phenomenological Analysis. In-depth interviews were conducted with people with lived experience and those in close contact with people with lived experience of distress. Ethnographic observation was conducted and the analyses were complimented by an earlier ethnography in the same village.
Study participants (n=15) included community members with lived experience of mental distress and/or those with close friends or family with lived experience. The perceived manifestations of the mental distresses were diverse and the causal attributions shifted from more social, concrete and explainable (eg, loss) towards magical, more abstract and unexplainable (eg, poisoning). Finally, participants sought coping strategies in accordance with their causal attribution in ways that made sense to them.
The coping strategies were chosen according to the perceived aetiology of the symptoms and they were perceived to be effective for their distress. Local coping strategies that match people's help-seeking patterns should therefore be supported in policy and programmes. In Rwanda this requires a mutual training of medical professionals and traditional healers and establishing co-treatment within two parallel systems. This also requires the support for programmes and initiatives that strengthen positive interactions and change in circumstances.
在特定环境中，人们如何以及为何针对自身痛苦采用特定的应对策略，这对于加强精神卫生保健至关重要，且需要从当地视角加以理解。卢旺达北部此前的研究记录了尽管面临严重逆境但仍无法获得援助的人群中常见的当地痛苦概念；然而，当地所感知的病因、表现形式、应对策略及其关联仍不明确。
卢旺达北部穆桑泽区的这项定性研究采用了解释现象学分析方法。对有实际经历的人和与有痛苦实际经历的人密切接触的人进行了深入访谈。进行了人种志观察，并以同一村庄早期的人种志研究作为补充分析。
研究参与者（n = 15）包括有精神痛苦实际经历的社区成员和/或有亲密朋友或家人有实际经历的人。所感知的精神痛苦表现形式多样，因果归因从更具社会性、具体且可解释的（如损失）转向神奇、更抽象且无法解释的（如中毒）。最后，参与者根据其因果归因以对他们有意义的方式寻求应对策略。
应对策略是根据所感知的症状病因来选择的，并且他们认为这些策略对其痛苦有效。因此，政策和项目应支持与人们求助模式相匹配的当地应对策略。在卢旺达，这需要对医学专业人员和传统治疗师进行相互培训，并在两个平行系统内建立联合治疗。这还需要支持加强积极互动和改善环境的项目及倡议。
