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In recent years, there has been renewed interest in diversifying the understanding and discussion about the causes of depression to move beyond biomedical determinism—a view that biomedical factors are the ultimate cause of an individual's depression. There is increasing emphasis on diversity in how people seek to articulate the causes of depression to incorporate non-biomedical dimensions. Furthermore, the biomedical understanding of depression has been increasingly questioned due especially to emerging limitations in pharmacotherapy. These shifts encourage social analyses that explore what narratives as to the causes of depression are constructed and presented with relative plausibility in different contexts and why and how. By analysing published memoirs of individuals diagnosed with depression in Japan, this study aims to provide fresh insights into narratives around the causes of depression. It illustrates how memoirs portray depression and its perceived causes in characteristic ways in a nation that adopts Western diagnostic systems, biomedical therapeutics and other relevant technologies. I will show that 'burnout' is the dominant theme in the Japanese data, diverging from the predominantly biomedical narrative in Western societies. This burnout narrative depicts depression as the somewhat unfortunate but unsurprising result of overwork arising from individual active adaptations to structural features of the Japanese work culture. I argue that reasons, rather than causes, articulate the making of the burnout narrative by revealing the interplay between the structural and individual and ultimately enrich the understanding of depression. The paper concludes with a call for exploring the shifting relationship between illness and normalcy that the burnout narrative implies. I suggest that further studies could explore how the boundaries between normalcy and illness are enacted and re-enacted and to what avail through public discourse and through shifting diagnostic schemata in the context of different national norms and practices. • There are international differences in how depression is experienced and represented. • Biomedical explanations of depression are frequently documented in the literature. • This paper shows ways in which depression is explained in the language of burnout. • Burnout emphasises the interaction between the individual and the structural. • Distinguishing reasons from causes helps better understand burnout and depression. [ABSTRACT FROM AUTHOR]

A rising emphasis on patient involvement in clinical research and healthcare improvement has led to the steady incorporation of patients and caregivers into this work. However, interactional factors shaping recruitment processes are not well understood. In this paper, we present a qualitative analysis of interviews with twenty-six patients, family members, engagement staff and healthcare providers who are engaged in healthcare improvement work in the United States. We focus on how stakeholders account for recruitment decisions to participate in healthcare improvement work. We find that expressions of and judgments about patients' and caregivers' cultural health capital shape providers' decisions to extend invitations to participate in healthcare improvement work. These findings extend current conceptualizations of cultural health capital beyond the clinical encounter to reveal factors shaping patient recruitment into healthcare improvement work. In theorizing how cultural health capital shapes action in this new setting, we found that healthcare providers, engagement staff, and patients/caregivers attended to different aspects of cultural health capital when accounting for why they extended or received a recruitment pitch. We further found that participating in healthcare improvement work led to a boost in cultural health capital for patients and caregivers, which they could use to develop transmissible forms of cultural health capital for less centrally involved patients and caregivers. Finally, we describe how participants in healthcare improvement collaboratives account for a lack of diversity among partners. These findings help us hypothesize the consequences of recruitment processes that rely on displays and judgments of cultural health capital and identify possibilities for change. Using the case of healthcare improvement work in Collaborative Learning Health Systems, our findings advance past work on cultural health capital in medical sociology by theorizing the role of cultural health capital in recruitment processes. • Providers recruit patients for healthcare improvement work with subjective criteria. • Providers often recruit high-resourced, privileged patients that they "vibe" with. • Partners build cultural health capital from doing healthcare improvement work. • Recruiting for cultural health capital may exclude patients from diverse backgrounds. • The role of recruitment should be considered to improve partner representation. [ABSTRACT FROM AUTHOR]

We examine a 12-min video-recorded interaction among a patient (KN) in a disordered state of consciousness (DOC) and a speech language pathologist clinician (CL) that takes place in a medical rehabilitation setting. The video is a demonstration of how caregivers could use a clinical assessment to observe their loved one's behavior to communicate potential behavioral changes to healthcare professionals. The purpose of this paper is to make visible the communication practices used by participants that may not be obvious to researchers, medical rehabilitation practitioners, and clinical assessment developers. We use phenomenological, linguistic and conversation analytic approaches to analyze the interaction. We found that KN demonstrates multiple conversational competencies, some (but not all) of which are acknowledged by CL, and most of which are not directly addressed by the assessment scoring criteria. For example, KN demonstrates conversational competency by responding non-verbally to CL's prompts from the assessment protocol and following along with the unspoken rules of discourse. He does this primarily through gaze, which broadcasts the focus of his attention and actively signals his participation in the conversation. Though KN does not always respond correctly to CL's questions, he nevertheless demonstrates implicit conversational competencies during turns of talk such as returning to 'neutral' position which signals the completion of a turn of talk. KN's conversational competencies may be missed by CL and the assessment protocol but we argue that they are important in understanding KN's capacity. Our analyses show that competency is not simply a performance by one person who appropriately and correctly responds to a series of questions in a prescribed time frame. Competence is a collaborative achievement among participants, co-produced in situ , and influenced by linguistic and cultural habits of talk and epistemic norms that privilege clinical knowledge and expertise. • Competency is a collaborative achievement grounded on participants' conversational strategies. • Analytic pluralism allows for analyses using multiple perspectives. • Clinical assessments have unacknowledged epistemic privilege. [ABSTRACT FROM AUTHOR]

Urban health scholars explore the connection between the urban space and health through ontological perspectives that are shaped by their disciplinary traditions. Without explicit recognition of the different approaches, there are barriers to collaboration. This paper maps the terrain of the urban health scholarship to identify key urban health research traditions; and to articulate the main features distinguishing these different traditions. We apply a meta-narrative review guided by a bibliometric co-citation network analysis to the body of research on urban health retrieved from the Web of Science Core Collection. Five urban health research traditions were identified: (1) sustainable urban development , (2) urban ecosystem services , (3) urban resilience , (4) healthy urban planning , and (5) urban green spaces. Each research tradition has a different conceptual and thematic perspective to addressing urban health. These include perspectives on the scale of the urban health issue of interest, and on the conceptualisation of the urban context and health. Additionally, we developed a framework to allow for better differentiation between the differing research traditions based on (1) perspectives of the urban system as complicated or complex, (2) the preferred locus of change as a function of structure and agency and (3) the geographic scale of the urban health issue that is addressed. These dimensions have even deeper implications for transdisciplinary collaboration as they are underpinned by paradigmatic differences, rather than disciplinary differences. We conclude that it is essential for urban health researchers to reflect on the different urban health approaches and seek coherence by understanding their similarities and differences. Such endeavours are required to produce and interpret transdisciplinary knowledge for the goal of improving health by transforming urban systems. • Co-citation analysis of research publications shows five distinct urban health research traditions. • The scholarship of urban health is siloed with few scholars spanning boundaries. • Each research tradition has a different ontological perspective to urban health. • Articulating distinctiveness of approaches may foster transdisciplinary research. [ABSTRACT FROM AUTHOR]

The low rate of help-seeking and high rate of suicide completion among men has prompted public health officials to create suicide prevention campaigns that specifically target men. Drawing from data collected as part of a larger study of fire recovery in a rural county in Northern California, this paper utilizes 68 interviews with fire survivors (24 men and 44 women) and 40 interviews with mental health service providers to examine how rural residents interpret this type of campaign. To track patterns of help-seeking over time, I also draw upon 26 follow-up interviews – 20 with fire survivors (7 men and 13 women) and 6 with service providers – conducted one year after the first wave of interviews. In total, 134 in-depth interviews were conducted. This paper also draws on a secondary data source; I conducted content analysis of an internal Health and Human Services Agency focus group report used in the development of a local male-targeted suicide prevention campaign, Captain Awesome. As I show, male-targeted suicide prevention efforts have little salience in rural communities in which treatment resources are limited and stigma abounds. Perceptions about material conditions – i.e., treatment resources being few and far between – contribute to residents establishing a norm of not seeking help. Rural culture which emphasizes self-sufficiency and independence contributes to a pattern of both men and women repeating a narrative that frames men who seek help as weak. While research has identified women as key drivers for men's physical health maintenance, my research suggests that the same pattern might not hold around mental health maintenance in rural settings. In sum, I argue that male-targeted campaigns have limited resonance and efficacy in rural communities where material conditions and cultural narratives create physical and psychological barriers to accessing to treatment. • Male-targeted suicide prevention campaigns have little salience in rural areas. • Perceptions of limited treatment resources contribute to low rates of help-seeking in rural places. • A rural ethos emphasizing self-sufficiency contributes to low help-seeking. • Both men and women residents of rural places reinforce stigma against help-seeking. • Suicide prevention campaigns need to be developed with regional specificity. [ABSTRACT FROM AUTHOR]

This paper explores the interaction between peer relationships and sexual health among street youth in three Sub-Saharan African cities: Accra (Ghana), Bukavu (Democratic Republic of Congo), and Harare (Zimbabwe). It begins by conceptualising peer relationships for youth globally and considers why these are pivotal for young people living in street settings. The paper reconceptualizes street peer relationships not as replacement families, but as sharing 'social anchorage' in the street space. It draws on qualitative ethnographic data from Growing up on the Streets, a longitudinal research project with a participatory methodology undertaken between 2012 and 2016 and engaging street youth (aged 14–20 at project outset) trained in ethnographic observations as research assistants (n = 18), following a network of ten peers (n = 229 by 2016), reporting their experiences in weekly interviews with facilitators. A wider network attended focus groups (n = 399). The project engaged a 'capability' approach, with ten capabilities defined by street youth as key to their daily lives. Empirical evidence is from a subset of data qualitatively coded (using NVivo) against capabilities 'Health and Wellbeing' and 'Friendship', across all interviews, focus groups and cities (n = 212 sources). In exploring this intersection, the paper demonstrates beneficial and adverse impacts of peer influence on sexual health, including misinformation about contraceptives and death from an informal sector abortion; highlighting findings from across the three cities around primacy of same-sex peer relations, mistrust between genders and in healthcare providers. The paper finds that while street youth remain subject to cultural norms around gender identities, street peer relationships hold a persuasive power; contributing to both everyday survival and moments of acute need. It concludes that recognising the right of young people to live and seek livelihoods in urban settings, and adopting the social networks they create to advance street youth's sexual health has become even more relevant in a (post)pandemic world. • Young people are the majority living in new urban informality. • A new conceptualization positions street peer relations as socio-spatially anchored. • Peers can play a critical role in the sexual wellbeing of young street people. • Policy, practice and peer social networks can advance sexual health of street youth. [ABSTRACT FROM AUTHOR]

Classic studies of medical education have examined how professional socialization reproduces the prevailing professional culture, as well as how students actively negotiate their place in educational processes. However, sociological research has not re-examined student culture in light of structural transformations in medical education, such as the introduction of new assessment types and their use as modes of commensuration. In this paper, we examine data from two studies of online forums where medical trainees and applicants to medical school discuss their experiences preparing for tests of professional skills, including judgment, empathy, and communication. Examining how medical students talk about these tests on such forums allows us to understand the meaning-making processes at work as students negotiate the commensuration processes such tests enable. We examine how these negotiations take place in online forums, where participants confront common challenges, form common perspectives, and share common solutions, all hallmarks of student culture. Through qualitative analysis, we find that online communities are spaces where students grapple with these new forms of commensuration, interrogate the standards and quantifications that underlie them, and collectively negotiate how to approach these assessments. Using the case of online forum communities, our findings advance past work on student culture in medical sociology by theorizing student culture as an extra-organizational phenomenon that spans multiple career stages. In so doing, we highlight the importance of online forum data for studying social processes. • Students grapple with their experiences of assessment in online forums. • Forums show students' meaning-making as they negotiate commensuration processes. • Students confront common challenges and share solutions, forming "student culture". • We theorize student culture as an extra-organizational phenomenon. • We highlight the importance of online forum data for studying social processes. [ABSTRACT FROM AUTHOR]

As health and social service professions increasingly emphasize commitments to equity, advocacy and social justice, non-traditional entrants to the professions increasingly bring much-needed diversity of social backgrounds and locations. Long the domain of elite social classes, the professions are not always welcoming cultures for those from lower social class backgrounds. This paper draws on notions of material, social and cultural capital, along with habitus , to examine the experiences of professionals with lower-class backgrounds, in educational programs and in their professions. The critical interpretive qualitative study draws on interviews with 27 professionals across Canada in medicine, nursing, social work and occupational therapy. While participants were clearly set apart from their colleagues by class origins, which posed distinct struggles, they also brought valuable assets to their work: enhanced connection and rapport with clients/patients, approachability, structural analysis and advocacy, plus nuanced re-envisioning of professional ethics to minimize power dichotomies. Rather than helping lower-class entrants adapt to the professions, it may be more beneficial to alter normative professional cultures to better suit these practitioners. • People from lower-class backgrounds may struggle in the professions. • The material, social and cultural capitals expected cast them as cultural outsiders. • They may more readily enact the social justice and equity aims of the professions. • We need transformational change to professional cultures of elitism and exclusion. [ABSTRACT FROM AUTHOR]

The conditions under which people labour in mental health research affect how and what knowledge is produced – and who benefits or doesn't from involvement in health research systems. There has been, however, little sustained investigation of the uneven modalities of labour exploitation across what are increasingly financialised systems of mental health research. This theoretical paper advances conceptual and empirical investigations of labour in health research – outlining how material precarity and epistemic precarity often go hand in hand, and largely drawing on examples from the UK. The intertwining of labour relations and epistemic cultures can be understood by bringing together insights from two bodies of knowledge not commonly in contact with one another – survivor/service user research and critical research on universities and academic labour. The article addresses how mental health research makes significant use of the labour of (i) contract researchers (many of whom work on precarious and exploitative contracts); (ii) lay contributors (through 'patient and public involvement'); and (iii) research participants (where the conditions underpinning participation in various kinds of research increasingly blur the distinction between volunteering, and 'gig' work). Labour relations affect, and are affected by, efforts to change epistemic cultures and reduce epistemic inequalities, and epistemic and material precarity make efforts to improve research culture much more difficult. Those experiencing both material and epistemic precarity in health research systems need to be at the heart of efforts to combat both. • Labour conditions in mental health research affect how and what knowledge is produced. • Health research systems frequently rely on exploited labour. • Material and epistemic precarity frequently go hand in hand in mental health research. • Improving research cultures in mental health research demands addressing labour relations. • Those experiencing material/epistemic precarity should be core to improvement efforts. [ABSTRACT FROM AUTHOR]

Health systems in fragile states need to respond to shifting demographics, burden of disease and socio-economic circumstances in the revision of their health service packages. This entails making difficult decisions about what is and is not included therein, especially in resource-constrained settings offering or striving for universal health coverage. In this paper we turn the lens on the 2017–2021 development of Afghanistan's Integrated Package of Essential Health Services (IPEHS) to analyse the dynamics of the priority setting process and the role and value of evidence. Using participant observation of meetings and interviews with 25 expert participants, we conducted a qualitative study of the consultation process aimed at examining the characteristics of its technical, socio-cultural and organisational aspects, in particular data use and expert input, and how they influenced how evidence was discussed, taken up, and used (or not used) in the process. Our analysis proposes that the particular dynamics shaped by the context, information landscape and expert input shaped and operationalized knowledge sharing and its application in such a way to constitute a sort of "vernacular evidence". Our findings underline the importance of paying attention to the constellation of the priority setting processes in order to contribute to an ethical allocation of resources, particularly in contexts of resource scarcity and humanitarian need. • Describes the process of Afghanistan's latest health system revision. • Examines the complex process of priority setting in a fragile state. • Vernacular evidence is created through expert consultation where data gaps exist. • Unpacking the constellation of expert input is critical in priority setting. • Balanced process facilitation improves discussion around ethical resource allocation. [ABSTRACT FROM AUTHOR]

Current institutional frameworks in sex- and gender-based analysis (SGBA) are promising, but significant gaps remain in their relation to recent developments in research praxis. In this paper we draw from our own experiences with a national health research funding agency, the Canadian Institutes of Health Research (CIHR), to critically examine the uptake and implementation of its current frameworks and practices of sex and gender analysis in health research. We conducted semi-structured interviews with a cohort of 18 health researchers alongside an institutional policy analysis to show how sex and gender have been understood, integrated, and addressed within the agency and initiative. Our findings reveal that attention to date has focused on representation (human and data) while deeper justice issues that are attentive to intersectionality, positionality and reflexivity—remain ambiguous. Finally, we discuss possible strategies for institutions to improve the uptake of knowledge, training, and policy to better support intersectional and culturally-relevant frameworks across the diverse research community. • Research institutes are taking up new concepts and frameworks of sex and gender analysis. • We examine whether sex and gender frameworks are attending to power and knowledge production. • Intersectionality positionality and reflexivity remain underdressed in sex and gender analysis. [ABSTRACT FROM AUTHOR]