title: Recent advances in cross-cultural measurement in psychiatric epidemiology: utilizing 'what matters most' to identify culture-specific aspects of stigma.
abstract: BACKGROUND
  While stigma measurement across cultures has assumed growing importance in psychiatric epidemiology, it is unknown to what extent concepts arising from culture have been incorporated. We utilize a formulation of culture-as the everyday interactions that 'matter most' to individuals within a cultural group-to identify culturally-specific stigma dynamics relevant to measurement.
  
  
  METHODS
  A systematic literature review from January 1990 to September 2012 was conducted using PsycINFO, Medline and Google Scholar to identify articles studying: (i) mental health stigma-related concepts; (ii) ≥ 1 non-Western European cultural group. From 5292 abstracts, 196 empirical articles were located.
  
  
  RESULTS
  The vast majority of studies (77%) utilized adaptations of existing Western-developed stigma measures to new cultural groups. Extremely few studies (2.0%) featured quantitative stigma measures derived within a non-Western European cultural group. A sizeable amount (16.8%) of studies employed qualitative methods to identify culture-specific stigma processes. The 'what matters most' perspective identified cultural ideals of the everyday activities that comprise 'personhood' of 'preserving lineage' among specific Asian groups, 'fighting hard to overcome problems and taking advantage of immigration opportunities' among specific Latino-American groups, and 'establishing trust among religious institutions due to institutional discrimination' among African-American groups. These essential cultural interactions shaped culture-specific stigma manifestations. Mixed method studies (3.6%) corroborated these qualitative results.
  
  
  CONCLUSIONS
  Quantitatively-derived, culturally-specific stigma measures were lacking. Further, the vast majority of qualitative studies on stigma were conducted without using stigma-specific frameworks. We propose the 'what matters most' approach to address this key issue in future research.
authors.affiliation: Department of Epidemiology, Columbia University, New York, NY, USA, Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK, Academic Division in Promotion of Health, School of Public Health, University of Chile Santiago, Chile and Mental Health Association of San Francisco, San Francisco, CA, USA.
authors.forename: Lawrence Hsin
authors.initials: LH
authors.lastname: Yang
authors.forename: Graham
authors.initials: G
authors.lastname: Thornicroft
authors.forename: Ruben
authors.initials: R
authors.lastname: Alvarado
authors.forename: Eduardo
authors.initials: E
authors.lastname: Vega
authors.forename: Bruce George
authors.initials: BG
authors.lastname: Link
mesh_terms: D003431:Cross-Cultural Comparison; D003469:Culture; D004641:Emigration and Immigration / Q000706:statistics & numerical data; D005006:Ethnicity / Q000208:ethnology / Q000523:psychology; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000208:ethnology* / Q000523:psychology; D013240:Stereotyping
keywords: Culture; literature review; measurement; psychometric; scales; stigma