Speaking Distress, Interpreting Suffering: A Dyadic Linguistic Analysis of Emotional Expression and Mental Health Recognition among Older Adults and Family Caregivers in Pakistan

Abstract

Background: Older adults may describe emotional difficulties through bodily metaphors, indirect expressions and accounts of shifting family relationships. How family caregivers interpret such communication is an important but underexamined dimension of support. Objective: To examine Urdu- and Punjabi-language distress expressions and caregiver interpretations using a culturally situated dyadic framework. Methods: Fifteen older adult–caregiver dyads (30 participants) participated in separate semi-structured interviews in Urdu or Punjabi. Accounts were analysed using a contextualist approach integrating reflexive thematic analysis, metaphor identification and paired-case comparison. Results: Five themes were identified: giving distress a bodily form; protecting dignity through indirect expression; interpretive distance; practical care without assured emotional understanding; and recognition-to-response pathways. Five dyads illustrated convergence, five partial correspondence, four divergence and one ambiguity. Conclusion: Dyadic attention to speaker meaning, caregiver interpretation and response offer a useful approach to understanding emotional communication in family caregiving. Findings are qualitative and do not establish population prevalence.