Peking University Beijing, Beijing, China (People's Republic)
Abstract Body Evidence suggests that cultural factors provide a basic framework for how individuals understand psychological distress. Cultural beliefs influence symptom interpretation, causal attributions, and help-seeking behavior, all of which are clinically relevant to cognitive behavioral therapy (CBT). However, existing CBT models are grounded in Western conceptualizations of dysfunctional cognition. Evidence remains limited on how culture shapes distress experiences and beliefs in Chinese populations. In this qualitative study, we conducted semi-structured interviews informed by the DSM-5 Cultural Formulation Interview (CFI) and CBT theory. Participants included three groups: (1) healthy young adults from across China, representing 13 ethnic groups (N = 18); (2) psychiatrists and nurses from a tertiary psychiatric hospital in Dali, Yunnan, serving a multiethnic region (N = 20); and (3) psychiatric inpatients from the same hospital, drawn from multiple ethnic groups (N = 12). Interviews covered distress definitions, cultural attributions and symptom meaning, family and community context, help-seeking pathways, and cultural fit in clinical communication. Preliminary analyses suggest that cultural illness beliefs constitute a core component of individuals’ illness cognition and organize distress experiences in systematic ways. This organization progresses from meaning-making to emotional responding and behavioral coping, shaping the overall distress experience. Participants commonly understood psychological symptoms through shared cultural explanatory models. They linked distress to moral evaluation, role obligations, family relationships, and social norms, rather than viewing it as an individual internal problem. Across interviews, participants placed the family at the center of distress accounts and described distress as a shared family experience. Distress was often expressed in family-related terms, such as “burdening the family,” “disrupting family harmony,” or “affecting others.” Participants linked symptoms to family roles, obligations, and relationships. Across groups, participants described family members as the primary caregivers in China. Family members provided daily care and emotional support, managed practical needs, and shaped help-seeking and treatment decisions. This pattern supports the relevance of family-based interventions and provides empirical evidence on how culture shapes cognitive processes in China.
