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Strategy 2.2

Enhance understanding of how cultural diversity may influence the developmental trajectories of mental illness.

Multiple lines of research suggest that culture, variously defined, impacts mental health trajectories. NIMH seeks to move this research beyond a descriptive focus on unitary measures (e.g., race or ethnicity) toward a more explanatory focus on the mechanisms by which specific components of cultural experience (e.g., beliefs, stigma, acculturation pressures), combined with biological factors, impact mental health outcomes and differential responses to preventive and treatment interventions. Such mechanistic research will allow the integration of specific cultural elements into a broader risk profile; enable identification of unique and common influences of cultural factors on mental health trajectories (including the relative impact of related variables such as sex/gender and SES); and include an explicit focus on the behavioral and biological (e.g., genetic, epigenetic) mechanisms by which cultural influences exert their effects. Applications employing a descriptive approach or a focus on unitary factors would not be considered responsive to this objective.

Research Priorities

  1. Determine how risk and protective factors exert their impact throughout the development of disorder.

    Priority areas include:

    1. Investigating mechanisms by which culturally associated beliefs about mental illness and its treatability impact the early development and interpretation of symptoms as well as timely referral for evaluation and intervention.
    2. Studying the impact of culture-linked attitudes and socialization influences, in combination with biological and environmental factors, on developmental trajectories, including the role of these factors in moderating the mental-health impact of experiences or environmental exposures during key developmental periods.
    3. Examining mechanisms by which gender (and associated social factors) and sex (and associated biological influences) affect neurodevelopmental trajectories to alter risk for mental disorders across the lifespan.
  2. Improve intervention outcomes through examination of how differences associated with diverse ethnic and cultural groups affect how well interventions preempt or treat illness and enhance recovery.

    Priority areas include:

    1. Improving prediction of intervention response through the development of multivariate prediction profiles that include cultural variables, developmental stage, sex/gender, clinical data, genotype, and biomarkers.
    2. Identifying culturally associated attitudes that influence acceptance of evidence-based interventions and consequently affect engagement and/or outcomes across phases of the illness trajectory.
    3. Specifying ethnic or racial differences in metabolism of psychotropic drugs that, in combination with other patient characteristics (e.g., clinical information, biomarkers) account for observed differences in treatment response, with attention to periods in development when these have the greatest effect.

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