Effect of Culture on Physical and Psychological Aspects of Health: It’s Endemic

No physical or psychological illness can be effectively treated without an appreciation for the cultural background of those afflicted. Culturally mediated beliefs regarding Western versus traditional medicines, for example, may affect patient choice of treatment. Such beliefs along with culturally mediated dietary habits may directly affect aspect of care including drug choice or selection of health care practitioner. While the effects of culture and acculturation on mental health is perhaps more carefully researched than ever before, we are increasingly aware that no intervention, be it physical or psychological, can be completely effective without consideration of culture. This issue of the Journal of Health Service Psychology outlines some of the conceptual and clinical challenges that may arise when serving patients, including those from underrepresented or underserved backgrounds. With the inclusion of Dean Steve Smith’s annual review of the US Supreme Court docket, the current issue also highlights the influence of state and federal legislation on the planning and delivery of health care.

Ashton and Murray (2022) note that treatment standards in the surgical and non-surgical management of breast cancer are constantly evolving and that as knowledge accumulates the specificity of psychological interventions also increases. As those authors point out, hereditary mutations may occur more frequently in certain ancestral groups (e.g., those of Ashkenazi Jewish ancestry); mental health providers should be sensitive to the effects of cultural factors such as religious law on health care decisions. Sadly, adverse breast cancer survival outcomes are apparent in some underrepresented groups, notably Black women, which may be due to disparities in the delivery of health care. The authors demonstrate the importance of cultural awareness and individualized care in providing psychological services to support and advocate for women with breast cancer.

DeLapp and Gallo (2022) provide us with a case exemplifying the importance of assessing race-related stress in adolescents and young adults of color and again reminds us that shared events may be differentially impactful on those from underrepresented backgrounds. Race-related stress may be a particularly salient factor in adolescents and young adults because such individuals may have to simultaneously cope with processes of identity development and role clarification. While cautioning that flexibility in implementation is key (as with many standardized treatment approaches), they outline concrete steps for incorporating race-related stress principles into an evidence-based treatment regimen.

Shamji et al. (2022) remind us that the assessment of cultural and linguistic differences is a key treatment component in patients living with sequelae of COVID-19. Assessment of impaired executive functioning in long-COVID sufferers can be complicated by language barriers for some Indian American individuals, as does the lack of testing norms in specific sub-populations. As Shamji et al. observe, faulty cultural assumptions can negatively affect test selection and interpretation as well as overall health care decision-making.

When psychological service provision intersects with the criminal justice system, as occurs when mandatory reporting laws are triggered, cultural sensitivity is especially important, as documented in a case of child maltreatment presented by Mascari (2022). It is relatively obvious that linguistic difficulties may complicate the process of evaluation of abuse. It is less obvious but no less important to understand the effects of culture on the disclosure of abuse and even its interpretation. Mascari’s case synopsis examines both these issues in the context of an abuse evaluation in a family from an underrepresented background in mental health care.

Smith (2022) provides us with his annual legal analysis of US Supreme Court decisions that have ramifications for psychologists and other mental health practitioners. Not surprisingly, the court’s unusual decision in Dobbs v. Jackson Women’s Health has the greatest potential implication for psychologists working with women in the area of reproductive health. An unanswered question is how similar legal and legislative issues might affect psychologists working with patients in the area of gender identity. As Smith noted, in the days before Roe v. Wade was decided, psychologists were called upon to determine whether an abortion was required to preserve the mental health of a mother. Is the profession prepared to return to this area of practice if legislatures make it necessary?

It was a momentous US Supreme Court term in many respects. Although the court’s decision to strike down a New York state gun control law as counter to the Second Amendment has no apparent immediate mental health repercussions, there may be substantial public health consequences of such a ruling. In the past, a few state governments have legislated against the practice of health care providers inquiring about the presence of guns in the home, which most of us would deem standard practice when working with suicidal patients. Whether this decision will revitalize attempts to legislate health care practice remains to be seen but should be closely monitored.

Morgan T. Sammons

, PhD, ABPP, is the CEO of the National Register of Health Service Psychologists, and the Editor in Chief of the Journal of Health Service Psychology. He is a retired Navy captain and was formerly the U.S. Navy’s specialty leader for clinical psychology.