The relationship between emotional expression and psychological distress amongst British, Indian, Polish, and South African university students
Background: People from ethic minority groups living in the United Kingdom face inequalities when using mental health services. Young adults, particularly under the age of 25 years, are also less likely to receive mental health treatment than any other age group. These disparities in accessing and receiving treatment have been explained by a lack of cultural competence in mainstream healthcare services. Cultural values influence how people communicate their psychological distress and knowledge of cultural factors in emotional expression is needed to improve clinical practice. Several cross-cultural studies have described individual constructs of emotional expression, yet the organisation of the multiple emotional expression components remains unknown. This study aims to uncover the organisation of these constructs, clarify the link between emotional expressions and psychological distress, and highlight cultural differences in communicating psychological distress. Cultures that are most prevalent in the UK will be explored in the study. Method: A non-clinical sample of 399 university students (99 in India, 100 in Poland, 100 in South Africa, and 100 in the UK) were investigated. The questionnaires included the Emotional Self-Disclosure Scale, the Distress Disclosure Index, the Emotional Expressivity Scale, the Berkeley Expressivity Questionnaire, the Self-Concealment Scale, the Ambivalence over Emotional Expressiveness Questionnaire, and the Clinical Outcomes Routine Evaluation Outcome Measure. Results: An exploratory factor analysis was conducted on 15 emotional expression items and six factors were retained: Disclosure of Negative Emotions, Comfort with Emotional Expression, Expression of Distress, Lack of Affect, Expression of Positive Emotions, and Disclosure of Anger. An analysis of covariance indicated that only Comfort with Emotional Expression, Expression of Distress, and Expression of Positive Emotions significantly predicted psychological distress. Culture did not affect the level of psychological distress. A multivariate analysis of variance demonstrated cultural differences across two emotional expression factors – Expression of Distress and Expression of Positive Emotions. Further, discriminant analysis showed that South African students were significantly more expressive of distress compared to Polish and Indian students, while Indian students were more expressive of positive emotions than British, Polish, and South African students. Conclusion: The findings of this study provide a unique categorisation of emotional expression constructs that adds original support to existing taxonomic studies in a way that examines broad emotional expression dimensions - including verbal, behavioural, and comfort - with expression components. The results also show that ambivalence over emotional expression and disclosure of distress and positive emotions are strongly associated with psychological well-being. Significant differences of emotional expression were identified among British, Indian, Polish and South African participants in this research project. These findings have implications for the need to improve recommendations regarding cultural competency in mental health provision, particularly psychological therapy.
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