Idioms of distress and ethnopsychology of pregnant women and new mothers in Sierra Leone [Working paper]
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Date
2025-06
Citation
Bah, A.J., Wurie, H.R., Samai, M., Horn, R. and Ager, A. (2025) Idioms of distress and ethnopsychology of pregnant women and new mothers in Sierra Leone. Institute for Global Health and Development, Queen Margaret University.
Abstract
Studies suggest high rates of ante- and post-natal depression in low- and middle-income
countries (LMICs), yet relatively little scholarship addresses how perinatal women experience
and express psychological distress in these low-resource settings. To address this gap, we
conducted a rapid ethnographic study including 96 free list interviews with community members
and 16 key informants (KI) pile sorts. Thematic analysis of data was supported by frequency
analysis and multidimensional scaling. Participants included pregnant and new mothers, nonpregnant and non-lactating mothers, elderly women, and men in the community to gauge a
diverse range of views. Twenty signs of distress were identified. The heart (at), mind (maynd)),
and body (bodi) comprised the self-concept and were related to sadness, stress, loneliness, anger,
worry, and thinking too much. They used the heart and mind to describe problems associated
with emotions and thoughts respectively. Participants articulated several idioms of distress,
including stres(stress), poil at (spoil heart), and ed nor de or e wan go off (pre-psychosis or
crase), that occur within a context of poverty, marital disharmony or inter-partner conflict and
gender inequality. These idioms of distress exist as discrete indicators with overlapping features,
operating on a continuum of severity that could progress over time, both within and across
idioms. These findings can inform mental health literacy and communications that is less
stigmatizing; the development of culturally salient screening tools and interventions that are
locally appropriate. This could potentially increase uptake and engagement with services, and
enhance therapeutic outcomes for perinatal women with psychological distress.