"Tension" and distress in South Asia: A systematic literature review

This systematic literature review summarizes academic knowledge on "tension" among South Asian and diaspora populations. "Tension" (sometimes transliterated as tenshun) is a term used across South Asia to talk about stress and distress, but the existing literature is dispersed and has never been analyzed synthetically. Following PRISMA guidelines, we searched 8 academic databases and solicited additional contributions from professional listservs. This process led to a final group of 122 records addressing "tension" in South Asian groups. The majority of studies took place in India and focused on mixed-gender adult samples. Many records reported differences in "tension" experience and vulnerability based on gender, while a few addressed differences based on age or socioeconomic group. Across records, "tension" described a wide range of physical and affective symptoms, and reflected distress experiences ranging from everyday hassles up to severe distress or even suicidality. "Tension" was often conceptualized via a hydraulic ethnopsychological model in which pent-up emotion expressed itself through physical or affective symptoms. Tension was often understood as an intermediary state between external stressors and internal states of pathology. People endorsed a variety of internal and external coping strategies, but several emphasized that only meaningful changes in adverse circumstances could solve "tension." There was no consensus on whether "tension" is best characterized as an idiom of distress or a cultural syndrome, but based on the breadth of results reflected in this literature, we suggest that it is best understood under the umbrella term cultural concept of generalized psychosocial distress. To address gaps in the literature on "tension," future research could work among populations outside India, could conduct direct comparative studies of how experiences vary by caste, gender, age, and socioeconomic status, and could explore the potential clinical value of "tension" for broaching discussions between patients and providers about distress.