#### **COMMENTARY** ![](https://assets.reachrx.ai/images/10.1007%E2%98%8Ds11469-025-01592-1/_page_0_Picture_2.jpeg) # **Culture as Wind: Aligning the Direction of Mental Health Interventions with Cultural Values** **Yasuhiro Kotera1,2,[3](http://orcid.org/0000-0002-0251-0085)** Received: 6 November 2025 / Accepted: 7 November 2025 © The Author(s) 2025 #### **Abstract** Mental health problems represent a major global challenge, afecting over one billion people worldwide. Although interventions are increasingly used across diverse settings, their implementation and efectiveness often depend on how well they are adjusted to local culture: a process still under-evaluated. This paper proposes the Culture as Wind analogy, a new conceptual lens to visualise how the implicit values and philosophies of interventions align (or misalign) with the prevailing cultural "wind." When interventions move with this wind, their reach and impact are amplifed; when they move against it, even well-evidenced approaches may falter. The analogy's strengths and limitations are discussed, including its capacity to capture cultural evolution, vertical (generational, political, and technological) shifts, and local variation. Future directions include operationalising the analogy through the Cultural Distance Index and Cultural Compass. The paper concludes that acknowledging cultural wind direction can enhance the global efectiveness and personal relevance of mental health interventions. **Keywords** Culture · Metaphor · Cross-cultural psychology · Mental health · Intervention adaptation · Philosophy of wellbeing #### **Global Scale of Mental Health Problems** Mental health problems such as depression, anxiety, and other common mental disorders now represent a major global challenge. Over one billion people were afected around the world in 2016 (Rehm & Shield, [2019](#page-7-0)). The burden of mental and addictive disorders is rising rapidly across both high- and low-income settings (Iemmi, [2019\)](#page-6-0). In many countries, a large proportion of adults and adolescents experience symptoms of common mental disorders, yet access to services remains severely limited. For example, more than 75% of people with a serious mental disorder in low- and middle-income ³ Department of Social Sciences, Azerbaijan University, Baku, Azerbaijan ![](https://assets.reachrx.ai/images/10.1007%E2%98%8Ds11469-025-01592-1/_page_0_Picture_15.jpeg) ^\* Yasuhiro Kotera Yasuhiro.Kotera@nottingham.ac.uk ¹ Faculty of Medicine and Health Sciences, University of Nottingham, Institute of Mental Health, Nottingham, Nottinghamshire NG7 2TU, UK ² Center for Infectious Disease Education and Research, University of Osaka, Suita, Japan countries (LMICs) do not receive adequate treatment (van Ginneken et al., [2013\)](#page-7-1). The treatment gap magnifes the societal, economic, and human costs of untreated mental illness, from lost productivity to increased morbidity and mortality (Arias et al., [2022;](#page-5-0) Stelmach et al., [2022](#page-7-2)). What was once seen as a problem mainly of high-income nations is now unequivocally global (Henking et al., [2023](#page-6-1)). In addition, the sheer variety of contexts (cultural, economic, structural) means that interventions that work in one setting may not translate seamlessly to another (Kotera et al., [2024a,](#page-6-2) [2024b,](#page-6-3) [2024c\)](#page-6-4). The result is a pressing need for global mental health action that is sensitive to context and culture. Mental health interventions rarely exist in isolation from culture (Kirmayer et al., [2020](#page-6-5)). Culture is commonly defned as the shared patterns of meaning, values, and practices that shape how members of a group perceive, interpret, and respond to the world (Kirmayer, [2012;](#page-6-6) Matsumoto & Juang, [2016](#page-7-3)). Programmes developed in one country often refect the assumptions, values, and worldviews of that context (Kotera et al., [2025](#page-6-7)). When exported elsewhere, they can succeed, fail, or even cause harm depending not only on their evidence base but on how well they resonate with the host culture's deeper orientation toward self, others, and society (Heine, [2020;](#page-6-8) Watters, [2011](#page-7-4)). Conventional approaches to cultural adaptation tend to focus on surface modifcations such as language, examples, or symbols (Harper Shehadeh et al., [2016;](#page-6-9) Schaechter et al., [2025\)](#page-7-5). Yet the invisible layer beneath, involving moral and philosophical direction, is equally crucial (Corpus-Espinosa et al., [2025\)](#page-5-1). Some interventions carry implicit messages about what it means to be well or empowered (Kotera, Miyamoto, et al., [2024](#page-6-2)). If these messages fow with the prevailing cultural current, they are reinforced. If they fow against it, they face resistance. ### **Rise of Global Mental Health Interventions and Challenge of Cultural Fit** In response to the global burden, mental health interventions, such as psychological, psychosocial, and community-based ones, are increasingly used around the world. For example, scalable psychological interventions delivered by lay health workers and peer workers have become a key strategy in low-resource settings (Kotera et al., [2024a](#page-6-2), [2024b](#page-6-3), [2024c;](#page-6-4) Patel et al., [2010;](#page-7-6) Puschner et al., [2025](#page-7-7)). Digital and mobile interventions are also gaining traction as a way to increase reach (Cuijpers et al., [2022](#page-5-2); Slade et al., [2024](#page-7-8)). However, the implementation and efectiveness of these interventions are not straightforward. A major challenge is cultural adaptation (Fendt-Newlin et al., [2019\)](#page-6-10). Recent reviews have emphasised that simply translating language or providing superfcial adjustments is not sufcient; deeper adaptation to cultural values, metaphors, and philosophies is required (Corpus-Espinosa et al., [2025](#page-5-1); Mishu et al., [2023\)](#page-7-9). While culturally adapted interventions do show promise, methodological heterogeneity and weak reporting mean it remains unclear exactly which adaptation components drive improved outcomes (McDermott et al., [2024;](#page-7-10) Taylor et al., [2023\)](#page-7-11). In recent years, the idea of cultural co-creation has emerged: the notion that interventions should not just be adapted for a culture, but developed with local stakeholders (service users, community representatives, cultural experts) to ensure alignment and ownership (Gama et al., [2024\)](#page-6-11). This idea reafrms the need to optimise interventions for each cultural context, rather than simply transplanting models developed elsewhere. ![](https://assets.reachrx.ai/images/10.1007%E2%98%8Ds11469-025-01592-1/_page_1_Picture_6.jpeg) #### **Need for a New Conceptual Framework: The Culture as Wind Analogy** Despite the increasing global recognition of mental health problems and the corresponding growth of interventions delivered both in person and digitally, one persistent challenge remains: ensuring that these approaches work efectively across diverse cultural contexts. The global burden of mental ill health is immense, yet many evidence-based interventions struggle to translate beyond the cultures in which they were originally developed. At the same time, current approaches to cultural adaptation, though valuable, often remain superfcial, overlooking deeper philosophical and value-based alignment. To address these three realities, there is a need for a fresh conceptual lens to understand how interventions and cultures interact. I propose the Culture as Wind analogy, a metaphorical way of understanding how the direction of a culture's values and worldviews can either accelerate or resist the impact of a mental health intervention depending on their alignment. Analogical reasoning has long been used in psychology and cultural theory to illuminate abstract relationships through familiar imagery (Gentner & Holyoak, [1997\)](#page-6-12). The Culture as Wind analogy serves this function by ofering a simple yet powerful visualisation of cultural alignment. In this analogy, culture is like the wind: invisible yet pervasive, directional, and continuously shaping the trajectory of any object (or intervention) that moves through it. If a ball is hit in baseball, for example, when the wind blows from right to left, hitting toward the left increases distance; hitting into the wind reduces distance. Similarly, an intervention whose values and philosophies align with the cultural "wind" of a setting will travel further, gain momentum, and have a greater impact. Conversely, if it moves against the wind (i.e., when its underlying values are in tension with the cultural orientation), even an evidence-based intervention may struggle to gain traction. For example, I have witnessed many cases where a company employee undertook an assertiveness-training programme developed in the West and delivered by Western trainers, then applied the learning in a Japanese organisation. Rather than being praised, the employee received a negative evaluation, as directly transferring Western assertive communication into a Japanese organisational context was perceived as overstepping expected roles and showing insufcient awareness of hierarchy. What worked efectively in one cultural "wind" failed when transplanted to another without adaptation. Mental health interventions are not global fast-food chains (though those international chains make eforts to ft their products to local tastes and customs). Cultural wind direction refers to the predominant values, worldviews, metaphors, relational norms, and expectations within a cultural setting. Intervention sail alignment refers to the degree to which the intervention's implicit or explicit values (e.g., autonomy, selfexpression, communal harmony, spiritual meaning) are congruent with that cultural wind. When alignment is strong, the intervention catches the wind, facilitating uptake, engagement, and sustainability. When alignment is weak, or when the intervention "hits into the wind", greater adaptation or structural support is needed for success. This analogy emphasises directionality rather than mere diference. The question is not simply "How is this culture diferent?" but rather "In what direction is its cultural wind blowing, and how can the intervention be oriented accordingly?". Strengths of this analogy include, frst, being simple and intuitive, aiding communication with practitioners, policymakers, and planners (Hildenbrand, [2021\)](#page-6-13). Second, it emphasises value orientation and philosophical ft, dimensions often under-recognised in conventional cultural adaptation work (Bernal & Adames, [2017\)](#page-5-3). Third, it encourages proactive adaptation: ![](https://assets.reachrx.ai/images/10.1007%E2%98%8Ds11469-025-01592-1/_page_2_Picture_7.jpeg) rather than waiting for misalignment to emerge, developers can ask, "Which way is the wind blowing here?" Fourth, it recognises that wind changes direction over time: a reminder that cultures evolve. As generational norms shift, or as globalisation and migration reshape collective identities, the cultural wind may subtly or dramatically change course. Interventions aligned with today's cultural wind may therefore need re-orientation in the future. Finally, while wind usually blows horizontally, it can also move vertically, rising or descending. Metaphorically, this can represent intergenerational, hierarchical, or infrastructural cultural change: the upward movement of new ideas from younger generations or technological innovation, and the downward infuence of authority, institutions, or tradition. Emerging technologies such as artifcial intelligence and the widespread use of social media can accelerate these vertical winds, rapidly redistributing values, norms, and information across age and status boundaries. Political change can also generate powerful cultural shifts, as seen in societies that have undergone independence or regime transformation, where new policies, freedoms, and national identities redirect the prevailing cultural wind. Both upward and downward movements can alter the overall airfow in which interventions operate. Several limitations need to be noted. First, the analogy should not overshadow structural and resource determinants, such as infrastructure, workforce capacity, and policy environments, which also shape whether interventions succeed (Bulthuis et al., [2020](#page-5-4)). Culture is one wind among several forces (e.g., economic, political, and material) that together infuence implementation. Moreover, operationalising "wind direction" is challenging. While cultural metrics such as Hofstede's dimensions (Hofstede et al., [2010\)](#page-6-14) or Gelfand's tightness-looseness (Gelfand et al., [2021](#page-6-15)) can describe broad cultural tendencies, applying these frameworks to intervention design requires further empirical work. Similar to these established theories, the Culture as Wind analogy must be interpreted within clearly defned boundaries, such as an organisation, community, or region, rather than assumed to describe all entities in one nation or culture uniformly. Even within an individualistic cultural region, collectivism-oriented organisations can exist; likewise, within a generally "tight" culture, some groups or institutions may operate with looser norms. Because such frameworks are inherently "cross"-cultural, clarity is also needed regarding the reference point: "compared to what?" Without specifying the comparative context (for example, comparing Japan to the UK, or a particular group to its national culture), interpretations of "wind direction" risk becoming too abstract. This is, in fact, consistent with the nature of wind itself. Even when a prevailing national wind blows from east to west, a park or valley within that same country may experience a wind moving in the opposite direction. Likewise, within a broader cultural pattern, local organisations or communities may generate their own micro-winds, shaped by history, leadership, or shared purpose. Recognising these layers of variation is essential for interpreting the analogy accurately and for applying it to real-world contexts. Finally, although the analogy assumes interventions can be "re-oriented", in reality, some elements are fxed. Just as a ship's sail has a maximum angle before losing integrity, interventions include core evidence-based components that cannot be changed without compromising fdelity. The ft–fdelity balance must be maintained (Bernal & Domenech Rodríguez, [2012\)](#page-5-5). ## **Future Research Agenda** To advance the Culture as Wind analogy, several research pathways are proposed. First, empirical validation is required. Future studies could develop instruments to (a) assess cultural wind direction, examining values, metaphors, and relational norms in diferent ![](https://assets.reachrx.ai/images/10.1007%E2%98%8Ds11469-025-01592-1/_page_3_Picture_5.jpeg) settings, and (b) evaluate the degree of sail-wind alignment for interventions. This would allow researchers to test whether alignment predicts uptake, engagement, adherence, and outcomes across diverse cultural contexts. Second, component analysis of adaptation strategies is needed. Using meta-analytic methods, researchers could identify which adaptation elements (e.g., language, conceptual metaphors, delivery format, or relational framing) most contribute to efective sail-wind alignment and improved outcomes, as recent reviews have highlighted that this area remains under-examined (McDermott et al., [2024](#page-7-10)). Third, mixed-methods co-creation studies can explore how cultural wind is mapped in practice, how interventions are re-oriented accordingly, and how this afects implementation metrics such as reach, fdelity, and sustainability. Fourth, structural considerations must also be examined. Future research should investigate how cultural alignment interacts with resource and system variables, such as workforce capacity, policy support, or stigma, to determine whether strong cultural alignment can mitigate structural constraints or whether supportive infrastructure remains necessary. Fifth, longitudinal research is required to examine how cultural wind changes over time. Generational, migratory, political, or digital forces can shift collective orientations, requiring interventions to be periodically re-aligned with emerging cultural conditions. Further, researchers could connect this analogy to existing quantitative and conceptual tools. For example, a Cultural Distance Index using Kogut and Singh's formulation [\(1988](#page-6-16)), could measure the magnitude and direction of the diference between cultural contexts, ofering an empirical indicator of where interventions may encounter resistance or support. Complementarily, a Cultural Compass (a term introduced here) could identify the key cultural components, such as relational orientation, autonomy, or connectedness to nature, that practitioners can use to orient their interventions within local winds. This tool would help determine one or two principal directions for cultural adjustment, corresponding to the most infuential cultural dimensions in a given context, thereby providing practical guidance for adaptation without oversimplifying cultural complexity. Together, these tools would help translate the Culture as Wind analogy from a conceptual metaphor into a practical and testable framework for cross-cultural mental health science. It is also important to distinguish between the aims of theoretical generalisation and clinical personalisation. The Culture as Wind analogy belongs to the domain of theory building, where the goal is to identify broad regularities and tendencies that can guide understanding across contexts. In contrast, clinical and medical approaches rightly prioritise tailoring interventions to individual needs. These perspectives are complementary rather than opposing: general principles ofer a navigational map, while personalised care determines the precise route. Far from ignoring individuality, cross-cultural generalisations prepare practitioners to recognise patterns that may shape each person's experience. In this sense, the analogy bridges theory and practice, ofering a conceptual compass to support culturally sensitive, personalised mental health care. #### **Conclusion** The global burden of mental health problems and the growing international use of psychological, psychosocial, and digital interventions highlight the need not only for evidencebased design but also for culturally attuned implementation. The Culture as Wind analogy ofers a fresh way to conceptualise how interventions interact with cultural values, emphasising directionality, alignment, and philosophical ft rather than mere diference. This ![](https://assets.reachrx.ai/images/10.1007%E2%98%8Ds11469-025-01592-1/_page_4_Picture_6.jpeg) analogy invites researchers and practitioners to "check the wind": to ask which way culture is blowing and how interventions can be oriented accordingly. By integrating tools such as the Cultural Distance Index and the Cultural Compass, future work can translate this metaphor into measurable and practical frameworks. Ultimately, recognising and working with the cultural wind may enhance the reach, resonance, and sustainability of mental health interventions worldwide, bridging theory and practice to support culturally sensitive, personalised care. **Author Contribution** Conceptualization, Investigation, Project administration, Resources, Writing—original draft, review, and editing: YK. **Funding** No funding was used for this work. **Data Availability** Not applicable. **Code Availability** Not applicable. ## **Declarations** **Ethics Approval and Consent to Participate** Not applicable **Consent for Publication** Not applicable. **Confict of interest** The author declares no competing interests. **Open Access** This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by/4.0/.](http://creativecommons.org/licenses/by/4.0/) #### **References** - Arias, D., Saxena, S., & Verguet, S. (2022). Quantifying the global burden of mental disorders and their economic value. *EClinicalMedicine*. - Bernal, G., & Adames, C. (2017). Cultural adaptations: Conceptual, ethical, contextual, and methodological issues for working with ethnocultural and majority-world populations. *Prevention Science, 18*(6), 681–688. - Bernal, G., & Domenech Rodríguez, M. M. (2012). *Cultural adaptations: Tools for evidence-based practice with diverse populations*. American Psychological Association. - Bulthuis, S. E., Kok, M. C., Raven, J., & Dieleman, M. A. (2020). Factors infuencing the scale-up of public health interventions in low- and middle-income countries: A qualitative systematic literature review. *Health Policy and Planning, 35*(2), 219–234. - Corpus-Espinosa, C., Mac Fadden, I., del Carmen Torrejón-Guirado, M., & Lima-Serrano, M. (2025). Exploring cultural adaptations: A scoping review on adolescent mental health and substance use prevention programs. *Prevention Science, 26*(2), 204–221. - Cuijpers, P., Heim, E., Ramia, J. A., Burchert, S., Carswell, K., Cornelisz, I., Knaevelsrud, C., Noun, P., van Klaveren, C., Van't Hof, E., Zoghbi, E., van Ommeren, M., & El Chammay, R. (2022). Guided digital health intervention for depression in Lebanon: Randomised trial. *Evidence-Based Mental Health, 25*(e1), e34–e40. ![](https://assets.reachrx.ai/images/10.1007%E2%98%8Ds11469-025-01592-1/_page_5_Picture_18.jpeg) - Fendt-Newlin, M., Jagannathan, A., & Webber, M. (2019). Cultural adaptation framework of social interventions in mental health: Evidence-based case studies from low- and middle-income countries. *International Journal of Social Psychiatry,66*(1), 41–48. - Gama, A., Marques, M., Seyfulayeva, A., Hamwi, S., Machado, A., Osbourne, R., & Dias, S. (2024). Cocreation of migrant health interventions in Portugal: Insights from the VO(I)CES project. *European Journal of Public Health, 34*. - Gelfand, M. J., Jackson, J. C., Pan, X., Nau, D., Pieper, D., Denison, E., Dagher, M., Van Lange, P. A. M., Chiu, C. Y., & Wang, M. (2021). The relationship between cultural tightness-looseness and COVID-19 cases and deaths: A global analysis. *The Lancet Planetary Health, 5*(3), e135–e144. [https://doi.org/10.1016/s2542-5196\(20\)30301-6](https://doi.org/10.1016/s2542-5196(20)30301-6) - Gentner, D., & Holyoak, K. J. (1997). Reasoning and learning by analogy: Introduction. *American Psychologist, 52*(1), 32–34. - Harper Shehadeh, M., Heim, E., Chowdhary, N., Maercker, A., & Albanese, E. (2016). Cultural adaptation of minimally guided interventions for common mental disorders: A systematic review and meta-analysis [Original Paper]. *JMIR Ment Health, 3*(3), e44. - Heine, S. J. (2020). *Cultural psychology* (4th ed.). WW Norton. - Henking, C., Reeves, A., & Chrisinger, B. (2023). Global inequalities in mental health problems: Understanding the predictors of lifetime prevalence, treatment utilisation and perceived helpfulness across 111 countries. *Preventive Medicine, 177*, Article 107769. [https://doi.org/10.1016/j.ypmed.](https://doi.org/10.1016/j.ypmed.2023.107769) [2023.107769](https://doi.org/10.1016/j.ypmed.2023.107769) - Hildenbrand, G. M. (2021). Healthcare provider analogies as memorable messages. *Journal of Health Communication, 26*(11), 764–772. - Hofstede, G., Hofstede, G. J., & Minkov, M. (2010). *Cultures and organizations: Software of the mind* (3rd ed.). McGraw-Hill Education. - Iemmi, V. (2019). Sustainable development for global mental health: A typology and systematic evidence mapping of external actors in low-income and middle-income countries. *BMJ Global Health, 4*(6), Article e001826. - Kirmayer, L. J. (2012). Cultural competence and evidence-based practice in mental health: Epistemic communities and the politics of pluralism. *Social Science & Medicine, 75*(2), 249–256. [https://doi.](https://doi.org/10.1016/j.socscimed.2012.03.018) [org/10.1016/j.socscimed.2012.03.018](https://doi.org/10.1016/j.socscimed.2012.03.018) - Kirmayer, L. J., Worthman, C. M., Kitayama, S., Lemelson, R., & Cummings, C. A. (2020). *Culture, mind, and brain: Emerging concepts, models, and applications*. Cambridge University Press. - Kogut, B., & Singh, H. (1988). The efect of national culture on the choice of entry mode. *Journal of International Business Studies, 19*(3), 411–432. - Kotera, Y., Miyamoto, Y., Vilar-Lluch, S., Aizawa, I., Reilly, O., Miwa, A., Murakami, M., Stergiopoulos, V., Kroon, H., Giles, K., Garner, K., Ronaldson, A., McPhilbin, M., Jebara, T., Takhi, S., Repper, J., Meddings, S., Jepps, J., Simpson, A. J., … Eguchi, S. (2024). Cross-cultural comparison of recovery college implementation between Japan and England: Corpus-based discourse analysis. *International Journal of Mental Health and Addiction*. - Kotera, Y., Ronaldson, A., Hayes, D., Hunter-Brown, H., McPhilbin, M., Dunnett, D., Jebara, T., Takhi, S., Masuda, T., Camacho, E., Bakolis, I., Repper, J., Meddings, S., Stergiopoulos, V., Brophy, L., De Ruysscher, C., Okoliyski, M., Kubinová, P., Eplov, L., Toernes, C., Narusson, D., Tinland, A., Puschner, B., Hiltensperger, R., Lucchi, F., Miyamoto, Y., Castelein, S., Borg, M., Klevan, T. G., Meng, R. T. B., Sornchai, C., Tiengtom, K., Farkas, M., Jones, H. M., Moore, E., Butler, A., Mpango, R., Tse, S., Kondor, Z., Ryan, M., Zuaboni, G., Elton, D., Grant-Rowles, J., McNaughton, R., Harcla, C., Vanderplasschen, W., Arbour, S., Silverstone, D., Bejerholm, U., Powell, C., Ochoa, S., Garcia-Franco, M., Tolonen, J., Yeo, C., Charles, A., Jepps, J., Simpson, A., Kellermann, V., Todowede, O., Asher, L., Murakami, M., Hopkins, L., Jahau, N., Arakawa, N., Scanferla, E., Henderson, C., & Slade, M. (2024). Cross-cultural insights from two global mental health studies: Selfenhancement and ingroup biases. *International Journal of Mental Health and Addiction*. [https://](https://doi.org/10.1007/s11469-024-01307-y) [doi.org/10.1007/s11469-024-01307-y](https://doi.org/10.1007/s11469-024-01307-y) - Kotera, Y., Ronaldson, A., Hayes, D., Hunter-Brown, H., McPhilbin, M., Dunnett, D., Jebara, T., Takhi, S., Masuda, T., Camacho, E., Bakolis, I., Repper, J., Meddings, S., Stergiopoulos, V., Brophy, L., De Ruysscher, C., Okoliyski, M., Kubinová, P., Eplov, L., … Slade, M. (2024). 28-country global study on associations between cultural characteristics and recovery college fdelity. *Npj Mental Health Research, 3*(1), Article 46. - Kotera, Y., Ronaldson, A., Takhi, S., Felix, S., Namasaba, M., Lawrence, S., Kellermann, V., Kapka, A., Hayes, D., Dunnett, D., Jebara, T., Murakami, M., Bakolis, I., Repper, J., Meddings, S., Stergiopoulos, V., Brophy, L., De Ruysscher, C., Eplov, L., … Slade, M. (2025). Cultural infuences on fdelity ![](https://assets.reachrx.ai/images/10.1007%E2%98%8Ds11469-025-01592-1/_page_6_Picture_18.jpeg) - components in recovery colleges: A study across 28 countries and territories. *General Psychiatry, 38*(3), Article e102010. - Matsumoto, D., & Juang, L. (2016). *Culture and psychology* (6 ed.). CENGAGE learning Custom Publishing. - McDermott, L., Hameed, I., & Lau-Zhu, A. (2024). Cultural adaptations, efcacy, and acceptability of psychological interventions for mental health in adults with refugees and asylum-seeker status: A systematic review. *Trauma, Violence, & Abuse, 25*(5), 3758–3776. [https://doi.org/10.1177/15248](https://doi.org/10.1177/15248380241262262) [380241262262](https://doi.org/10.1177/15248380241262262) - Mishu, M. P., Tindall, L., Kerrigan, P., & Gega, L. (2023). Cross-culturally adapted psychological interventions for the treatment of depression and/or anxiety among young people: A scoping review. *PLoS ONE, 18*(10), Article e0290653. - Patel, V., Weiss, H. A., Chowdhary, N., Naik, S., Pednekar, S., Chatterjee, S., De Silva, M. J., Bhat, B., Araya, R., King, M., Simon, G., Verdeli, H., & Kirkwood, B. R. (2010). Efectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): A cluster randomised controlled trial. *The Lancet, 376*(9758), 2086–2095. [https://doi.org/](https://doi.org/10.1016/S0140-6736(10)61508-5) [10.1016/S0140-6736\(10\)61508-5](https://doi.org/10.1016/S0140-6736(10)61508-5) - Puschner, B., Nakku, J., Hiltensperger, R., Wolf, P., Adler Ben-Dor, I., Bugeiga, F., Charles, A., Gai Meir, L., Garber-Epstein, P., Goldfarb, Y., Grayzman, A., Hadas-Grundman, S., Haun, M., Heuer, I., Iboma, B., Kalha, J., Kamwaga, L., Korde, P., Kotera, Y., … Slade, M. (2025). Efectiveness of peer support for people with severe mental health conditions in high-, middle- and low-income countries: Multicentre randomised controlled trial. *The British Journal of Psychiatry, 1–9*, 1. [https://doi.org/10.1192/bjp.](https://doi.org/10.1192/bjp.2025.10299) [2025.10299](https://doi.org/10.1192/bjp.2025.10299) - Rehm, J., & Shield, K. D. (2019). Global burden of disease and the impact of mental and addictive disorders. *Current Psychiatry Reports, 21*(2), Article 10. - Schaechter, T., Flowers, S., Weiss, M., Becker-Haimes, E., & Sanchez, A. (2025). Culturally adapted interventions for anxiety and trauma-related disorders in marginalized youth: A systematic review. *Child psychiatry and human development*. - Slade, M., Rennick-Egglestone, S., Elliott, R. A., Newby, C., Robinson, C., Gavan, S. P., Paterson, L., Ali, Y., Yeo, C., Glover, T., Pollock, K., Callard, F., Priebe, S., Thornicroft, G., Repper, J., Keppens, J., Smuk, M., Franklin, D., Walcott, R., Harrison, J., Smith, R., Robotham, D., Bradstreet, S., Gillard, S., Cuijpers, P., Farkas, M., Zeev, D. B., Davidson, L., Kotera, Y., Roe, J., Ng, F., & Llewellyn-Beardsley, J. (2024). Efectiveness and cost-efectiveness of online recorded recovery narratives in improving quality of life for people with non-psychotic mental health problems: A pragmatic randomized controlled trial. *World Psychiatry, 23*(1), 101–112. - Stelmach, R., Kocher, E. L., Kataria, I., Jackson-Morris, A. M., Saxena, S., & Nugent, R. (2022). The global return on investment from preventing and treating adolescent mental disorders and suicide: A modelling study. *BMJ Global Health, 7*(6), Article e007759. - Taylor, A., Radford, G., & Calia, C. (2023). Review: Cultural adaptations to psychosocial interventions for families with refugee/asylum-seeker status in the United Kingdom – A systematic review. *Child and Adolescent Mental Health, 28*(2), 241–257. - van Ginneken, N., Tharyan, P., Lewin, S., Rao, G. N., Meera, S. M., Pian, J., Chandrashekar, S., & Patel, V. (2013). Non-specialist health worker interventions for the care of mental, neurological and substanceabuse disorders in low- and middle-income countries. *Cochrane Database Syst Rev*(11), Cd009149. - Watters, E. (2011). *Crazy like us: The globalization of the western mind*. Robinson. **Publisher's Note** Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional afliations. ![](https://assets.reachrx.ai/images/10.1007%E2%98%8Ds11469-025-01592-1/_page_7_Picture_15.jpeg)