Learning from Our Patients: Training Psychiatry Residents in Refugee Mental Health

OBJECTIVE

Psychiatric residents are increasingly called upon to work cross-culturally, serving diverse populations including refugees. This study aims to (1) understand the training experience of psychiatry residents working with refugees and (2) assess the level of satisfaction of refugees, most of whom are Iraqi, who seek psychological treatment at the University of Colorado Hospital (UCH)'s Refugee Mental Health Program of Colorado (RMHPC).

METHODS

Using qualitative methodology, over a 1-year period, independent evaluators interviewed a group of nine residents who chose to participate in an RMHPC elective and also interviewed ten Iraqi refugee patients who sought services at the clinic. Recordings of the interviews were transcribed and analyzed using thematic analysis. Emerging themes were identified for both resident and refugee patient interviews.

RESULTS

Five major themes emerged summarizing residents' experiences: (1) adapting practices to meet refugee needs, (2) value of supervision, (3) cultural barriers, (4) need for extra resources, and (5) effect on future practice. Four major themes emerged summarizing Iraqi refugees' experiences: (1) reasons for seeking treatment, (2) barriers to treatment, (3) residents' knowledge of culture and needs, and (4) quality of treatment.

CONCLUSIONS

This study's findings highlight the complexities of effectively treating refugee patients and suggest ideas for training residents. Additionally, they offer important frameworks for developing, implementing, and evaluating culturally responsive practices in the context of training psychiatry residents and other mental health professionals. An essential key to this process was giving voice to refugees who accessed and engaged our services.

Portrayals of mental illness, treatment, and relapse and their effects on the stigma of mental illness: Population-based, randomized survey experiment in rural Uganda

BACKGROUND

Mental illness stigma is a fundamental barrier to improving mental health worldwide, but little is known about how to durably reduce it. Understanding of mental illness as a treatable medical condition may influence stigmatizing beliefs, but available evidence to inform this hypothesis has been derived solely from high-income countries. We embedded a randomized survey experiment within a whole-population cohort study in rural southwestern Uganda to assess the extent to which portrayals of mental illness treatment effectiveness influence personal beliefs and perceived norms about mental illness and about persons with mental illness.

METHODS AND FINDINGS

Study participants were randomly assigned to receive a vignette describing a typical woman (control condition) or one of nine variants describing a different symptom presentation (suggestive of schizophrenia, bipolar, or major depression) and treatment course (no treatment, treatment with remission, or treatment with remission followed by subsequent relapse). Participants then answered questions about personal beliefs and perceived norms in three domains of stigma: willingness to have the woman marry into their family, belief that she is receiving divine punishment, and belief that she brings shame on her family. We used multivariable Poisson and ordered logit regression models to estimate the causal effect of vignette treatment assignment on each stigma-related outcome. Of the participants randomized, 1,355 were successfully interviewed (76%) from November 2016 to June 2018. Roughly half of respondents were women (56%), half had completed primary school (57%), and two-thirds were married or cohabiting (64%). The mean age was 42 years. Across all types of mental illness and treatment scenarios, relative to the control vignette (22%-30%), substantially more study participants believed the woman in the vignette was receiving divine punishment (31%-54%) or believed she brought shame on her family (51%-73%), and most were unwilling to have her marry into their families (80%-88%). In multivariable Poisson regression models, vignette portrayals of untreated mental illness, relative to the control condition, increased the risk that study participants endorsed stigmatizing personal beliefs about mental illness and about persons with mental illness, irrespective of mental illness type (adjusted risk ratios [ARRs] varied from 1.7-3.1, all p < 0.001). Portrayals of effectively treated mental illness or treatment followed by subsequent relapse also increased the risk of responses indicating stigmatizing personal beliefs relative to control (ARRs varied from 1.5-3.0, all p < 0.001). The magnitudes of the estimates suggested that portrayals of initially effective treatment (whether followed by relapse or not) had little moderating influence on stigmatizing responses relative to vignettes portraying untreated mental illness. Responses to questions about perceived norms followed similar patterns. The primary limitations of this study are that the vignettes may have omitted context that could have influenced stigma and that generalizability beyond rural Uganda may be limited.

CONCLUSIONS

In a population-based, randomized survey experiment conducted in rural southwestern Uganda, portrayals of effectively treated mental illness did not appear to reduce endorsement of stigmatizing beliefs about mental illness or about persons with mental illness. These findings run counter to evidence from the United States. Further research is necessary to understand the relationship between mental illness treatment and stigmatizing attitudes in Uganda and other countries worldwide.

TRIAL REGISTRATION

The experimental procedures for this study were registered with ClinicalTrials.gov as "Measuring Beliefs and Norms About Persons With Mental Illness" (NCT03656770).

"The Thing Happened as He Wished": Recovering an American Indian Cultural Psychology

One of the chief questions confronting mental health professionals who serve American Indian communities is how best to offer genuinely helpful services that do not simultaneously and surreptitiously reproduce colonial power relations. To ensure that counselors and therapists do not engage in psy-colonization, it is crucial to recognize the sometimes divergent cultural foundations of mental distress, disorder, and well-being in "Indian Country." In this article, I will consider four excerpts from a research interview undertaken among my own people, the Aaniiih Gros Ventres of north-central Montana. At a superficial level, these excerpts seem to reinforce reigning sensibilities that are readily familiar within the mental health professions. And yet, closer analysis of these interview excerpts reveals several tantalizing facets of an indigenous cultural psychology that may well continue to shape life and experience among tribal members in this setting. I recover this distinctive cultural psychology through archival representations of cultural and community life, including analysis of an important tribal myth. This analysis makes possible an alterNative interpretation of these interview excerpts, grounded in an aboriginal cosmology, that yields important implications for conceiving a more inclusive knowledge base for psychology that only robust community engagement can reveal.

"It's When the Trees Blossom": Explanatory Beliefs, Stigma, and Mental Illness in the Context of HIV in Botswana

Mental illness is a common comorbidity of HIV and complicates treatment. In Botswana, stigma impedes treatment of mental illness. We examined explanatory beliefs about mental illness, stigma, and interactions between HIV and mental illness among 42 adults, from HIV clinic and community settings, via thematic analysis of interviews. Respondents endorse witchcraft as a predominant causal belief, in addition to drug abuse and effects of HIV. Respondents describe mental illness as occurring "when the trees blossom," underscoring a conceptualization of it as seasonal, chronic, and often incurable and as worse than HIV. Consequently, people experiencing mental illness (PEMI) are stereotyped as dangerous, untrustworthy, and cognitively impaired and discriminated against in the workplace, relationships, and sexually, increasing vulnerability to HIV. Clinical services that address local beliefs and unique vulnerabilities of PEMI to HIV, integration with peer support and traditional healers, and rehabilitation may best address the syndemic by facilitating culturally consistent recovery-oriented care.

Understanding the lived experiences of severe postnatal psychiatric illnesses in English speaking South Asian women, living in the UK: a qualitative study protocol

INTRODUCTION

The South Asian population is the UK's largest and fastest growing minority ethnic group. There is evidence to suggest the lay understanding of postnatal psychiatric illnesses of this group may fall outside the purview of Western biomedical perspectives. Alternative explanations include psychosocial, cultural and spiritual factors. Approaching psychiatric illnesses through a social perspective includes gaining insight to the patient's subjective experiences and understandings via qualitative inquiry. The objectives of this qualitative study are to explore South Asian women's narrative of living with a severe postnatal psychiatric illness and experiences of Perinatal Mental Health Services, care and support.

METHODS AND ANALYSIS

Data collection is ongoing and will continue until 31 December 2018. Participants will be identified and recruited from Perinatal Mental Health Services in Birmingham and London. Eligible participants will be English speaking South Asian females aged 18 years or above with the capacity to give written informed consent. Participants are clinically diagnosed with a severe postnatal psychiatric illness. This qualitative study uses individual in-depth face-to-face interviews that aim to last 1 hour. Interviews will be audio recorded with participants' permission. Interview audio recordings will be transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). The primary goal of IPA is for the researcher to closely study and interpret how individuals make sense of their life experiences in a particular context by drawing on the fundamental principles of phenomenology, hermeneutics and idiography.

ETHICS AND DISSEMINATION

The University of Birmingham, the South Birmingham Research Ethics Committee and the Health Research Authority have approved this study (approvals date: 18-12-2017 ref: 17/WM/0350). Local capability and capacity have been confirmed from Trust Research and Development departments. The researchers plan to publish the results from this study in journals and present findings at academic conferences.

Guest editors' introduction to the special section: Cultural adaptation of mental health interventions for Americans of East Asian descent

Overall, this special section makes a timely and significant contribution to providing various types of culturally specific interventions as well as the evidence of clinical trials. Although the sample size of each study is rather small, each intervention illustrates innovative methods in both reaching and treating underserved and understudied populations. Moreover, these interventions provide critical groundwork for building an evidence base of interventions tailored specifically to Asian Americans (AAs). These articles demonstrate the significance of development and testing of culturally adapted or culturally grounded interventions for intervention science that effectively treat and engage culturally diverse and hard-to-reach populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Increased Violence Involvement and Other Behavioral and Mental Health Factors Among Youth With Firearm Access

PURPOSE

The purpose of this study was to examine multiple ways youth may access firearms among a sample of urban, mountain west youth, and explore whether youth reporting various types of violence involvement and other behavioral or mental health factors have differential access to firearms compared with youth who do not report these issues.

METHODS

A cross-sectional community-based survey was conducted among adolescents aged 10-17 years and one of their parents. The main outcomes were youth firearm access and possession and associated violence and behavioral and mental health factors. Bivariate and binomial logistic regression, controlling for demographic factors, was used to determine associations and predictors.

RESULTS

One thousand one hundred youth and 730 parents participated. Nearly half of youth were male; 58.2% were Hispanic, 24.7% non-Hispanic black, 10.5% multiracial, 3.9% other, and 2.5% white. About 20% were categorized as having potential access to firearms (i.e., youth knows how and/or where to access firearms); 1.9% possessed a firearm. Analyses revealed that being physically aggressive (odds ratio [OR] 2.7), risk for future violence perpetration (OR 2.6), using alcohol (OR 2.0), having internalizing symptoms (OR 1.9), peer problems (OR 1.9), and older age (OR 1.26) predicted youth's possible access to firearms. Marijuana use (OR 9.9), parental gun ownership (OR 6.5), and reported delinquency (OR 8.3) predicted youth's firearm possession.

CONCLUSIONS

Youth with potential firearm access demonstrate more violence risk and involvement, and other behavioral or mental health issues than youth without potential firearm access. Parental firearm ownership predicts youth firearm possession. It is important for both health-care providers and parents to recognize these potentially lethal associations to provide appropriate counseling.

Longer Residence of Ecuadorian and Colombian Migrant Workers in Spain Associated with New Episodes of Common Mental Disorders

The healthy migrant effect and its impact on mental health has been reported in the general population of many countries. Information is limited about its impact on working populations. The aim of this study is to estimate the incidence of common mental disorders over a one-year follow-up period among a cohort of Colombian and Ecuadorian employees in Spain, taking into account the duration of residence and comparing with Spanish-born workers. Data was from the Longitudinal Studies on Immigrant Families Project (PELFI), a follow-up survey of immigrants and Spanish-born workers interviewed in 2015 and 2016. Mental health was assessed using the 12-item general health questionnaire (GHQ-12). Crude and adjusted odds ratios (ORas) for common mental disorders by sociodemographic and employment characteristics were created. There were differences for immigrants with time of residence less than or equal to 15 years (time of residence 11-15 years: ORa = 0.06, 95% CI = (0.26-0.01); time of residence 1-10 years: ORa = 0.06, 95% CI = (0.36-0.01)). There was evidence of a healthy immigrant worker effect, as newer arrivals from Ecuador and Columbia to Spain had a lower incidence of common mental disorders than either the Spanish-born or immigrant workers who had lived in Spain for more than 15 years.

Ethnic density and other neighbourhood associations for mortality in severe mental illness: a retrospective cohort study with multi-level analysis from an urbanised and ethnically diverse location in the UK

BACKGROUND

Neighbourhood social context might play a role in modifying mortality outcomes in severe mental illness, but has received little attention to date. Therefore, we aimed to assess in an ethnically diverse and urban location the association of neighbourhood-level characteristics and individual-level factors for all-cause, natural-cause, and unnatural-cause mortality in those with severe mental illness.

METHODS

We did a retrospective cohort study using a case-registry from a large secondary mental health-care Trust in an ethnically diverse and urban location in south London, UK. Linked data for deaths and areas of residence were identified from the case-registry. We included all individuals aged 15 years or more at the time of diagnosis for a severe mental illness from Jan 1, 2007, to Dec 31, 2014. We used individual-level information in our analyses, such as gender, marital status, and the presence of current or previous substance use disorders. We assessed neighbourhood or area-level indicators at the Lower Super Output Area level. Association of neighbourhood-level characteristics, which included the interaction between ethnicity and own ethnic density, deprivation, urbanicity, and social fragmentation, alongside individual-level factors for all-cause, natural-cause, and unnatural-cause mortality in those with severe mental illness was assessed.

FINDINGS

A total of 18 201 individuals were included in this cohort for analyses, with a median follow-up of 6·36 years. There were 1767 (9·7%) deaths from all causes, 1417 (7·8%) from natural causes, and 192 (1·1%) from unnatural causes. In the least ethnically dense areas, the adjusted rate ratio (aRR) for all-cause mortality in ethnic minority groups with severe mental illness compared with white British people with severe mental illness were similar (aRR 0·96, 95% CI 0·71-1·29); however in the highest ethnic density areas, ethnic minority groups with severe mental illness had a lower risk of death (aRR 0·52, 95% CI 0·38-0·71; p<0·0001), with similar trends for natural-cause mortality (p=0·071 for statistical interaction). In the cohort with severe mental illness, residency in deprived, urban, and socially fragmented neighbourhoods was not associated with higher mortality rates. Compared with the general population, age-standardised and gender-standardised mortality ratios were elevated in the cohort with severe mental illness across all neighbourhood-level characteristics assessed.

INTERPRETATION

For ethnic minority groups with severe mental illness, residency in areas of higher own-group ethnic density is associated with lower mortality compared to white British groups with severe mental illness.

FUNDING

Health Foundation, National Institute for Health Research, EU Seventh Framework, and National Institute of Mental Health.

Barriers to help-seeking in Israeli Arab minority adolescents with mental health problems: results from the Galilee study

BACKGROUND

The Galilee Study assessed mental health service needs among Israeli Muslim and Druze adolescents and their mothers. Studies show that mothers of adolescents belonging to the Arab minority have much lower help-seeking rates than Jewish mothers. This paper examines mothers' structural and cultural barriers to help-seeking.

METHODS

All 9th grade students living in 5 towns representative of Muslim and Druze localities in northern Israel, were eligible for the study and 1639 (69.3%) obtained parental agreement and participated. Emotional or behavioral problem were assessed in the classroom using the Strengths and Difficulties Questionnaire. A total of 704 adolescent-mother dyads participated in the follow-up, and were interviewed at home, using the Development and Well Being Assessment inventory, the Composite Barriers to Help-Seeking Questionnaire, the General Health Questionnaire - 12, the Subjective Feelings of Discrimination Index and socio-demographic questions. Pearson χ2 test and multivariate binary logistic regressions were performed to analyze mothers' consultation rates by risk factors. Exploratory factor analysis was performed to identify underlying factors and assess construct validity of the Composite Barriers to Help-Seeking Questionnaire, and also mean scores and standard deviations for the distinct scales were calculated.

RESULTS

More mothers of adolescents with a mental disorder than those without a mental disorder consulted a professional or school source (39.7% vs. 20.5%; χ2 = 45.636; p = < 0.001). The most important barriers to help-seeking were those related to "Accessibility", followed by barriers related to the belief that "Treatment is detrimental" and to the possibility of "Reprisal by authorities". Barriers related to "Stigma" and "Distrust of professionals" had the lowest means scores. Differences by ethnicity/religion were found.

CONCLUSIONS

Structural barriers related to lack of access, were considered the main obstacle to help-seeking in this Israeli Arab minority population. Cultural barriers such as stigma were considered of secondary importance. Structural barriers could be reduced by increasing the number of accessible public mental health clinics in the minority localities, a responsibility of the Ministry of Health and the HMOs. Information campaigns and psychoeducation for parents would help reduce other barriers to mental health treatment.

Mental health and quality of life among asylum seekers and refugees living in refugee housing facilities in Sweden

INTRODUCTION

In 2015, there was a high influx of refugees to Sweden, creating an extreme situation where individuals were forced to remain in large housing facilities for long periods. The present study aims to describe the mental health and quality of life of these individuals.

METHODS

Data, based on 510 individuals, were obtained by means of a questionnaire at open screenings conducted at or nearby refugee housing facilities. Of the participating refugees, 367 were asylum seekers and 143 had received a residence permit but were still awaiting a more permanent housing solution. The questionnaire included measures of depressive symptoms (PHQ-9), symptoms of anxiety (GAD-7), risk of having post-traumatic stress disorder (PC-PTSD), and quality of life (WHOQOL-BREF).

RESULTS

Of the total sample, 56-58.4% reported clinically significant levels of symptoms of depression, anxiety and risk of having PTSD. Prevalence estimates were higher among asylum seekers than among those who had received their residence permit. Quality of life was generally rated below population norms and correlated negatively with mental health outcomes.

CONCLUSIONS

Individuals residing in refugee housing facilities show high levels of psychological distress and rate their quality of life as low. Asylum seekers score higher than those having received a residence permit. These results are troublesome since the wait time for asylum decisions has lengthened considerably after 2015. The results of the present study calls for the urgency of societal actions to shorten the asylum process and improve conditions at the housing facilities.

Triple jeopardy: the joint impact of racial segregation and neighborhood poverty on the mental health of black Americans

PURPOSE

Because segregation may shield blacks from discrimination as well as increase their exposure to concentrated poverty, its net impact on the mental well-being of black Americans is unclear. We investigated the intersection between segregation, neighborhood poverty, race, and psychological well-being.

METHODS

Using data from the nationally representative 2008-2013 National Health Interview Survey merged with U.S. Census data, we examined the association between black-white metropolitan segregation (D-index and P-index) and psychological distress (a binary indicator based on the Kessler 6 score ≥ 13) for blacks and whites. Furthermore, we assessed whether neighborhood poverty explains and/or modifies the association. Logistic regression models were estimated separately for blacks and whites as well as for each segregation index.

RESULTS

Higher D- and P-indices were associated with higher odds of psychological distress for blacks. Neighborhood poverty explained some, but not all, of the association. In models that allowed for the impact of metropolitan segregation to vary by neighborhood poverty, higher segregation was found to be detrimental for blacks who resided in high poverty neighborhoods but not for those living in low poverty neighborhoods. We found no evidence that segregation impacts the mental health of whites-either detrimentally or beneficially-regardless of neighborhood poverty level.

CONCLUSIONS

The impact of segregation differs by neighborhood poverty and race. The psychological harm of structural racism, resulting in segregation and concentrated poverty, is not additive but multiplicative, reflecting a "triple jeopardy" for blacks, whereby their mental health is detrimentally impacted by the compounded effects of both neighborhood distress and racial segregation.

Indigenous and non-Indigenous people experiencing homelessness and mental illness in two Canadian cities: A retrospective analysis and implications for culturally informed action

OBJECTIVES

Indigenous people in Canada are not only over-represented among the homeless population but their pathways to homelessness may differ from those of non-Indigenous people. This study investigated the history and current status of Indigenous and non-Indigenous people experiencing homelessness and mental illness. We hypothesised that compared with non-Indigenous people, those who are Indigenous would demonstrate histories of displacement earlier in life, higher rates of trauma and self-medication with alcohol and other substances.

DESIGN AND SETTING

Retrospective data were collected from a sample recruited through referral from diverse social and health agencies in Winnipeg and Vancouver.

PARTICIPANTS

Eligibility included being 19 years or older, current mental disorder and homelessness.

MEASURES

Data were collected via interviews, using questionnaires, on sociodemographics (eg, age, ethnicity, education), mental illness, substance use, physical health, service use and quality of life. Univariate and multivariable models were used to model the association between Indigenous ethnicity and dependent variables.

RESULTS

A total of 1010 people met the inclusion criteria, of whom 439 self-identified as Indigenous. In adjusted models, Indigenous ethnicity was independently associated with being homeless at a younger age, having a lifetime duration of homelessness longer than 3 years, post-traumatic stress disorder, less severe mental disorder, alcohol dependence, more severe substance use in the past month and infectious disease. Indigenous participants were also nearly twice as likely as others (47% vs 25%) to have children younger than 18 years.

CONCLUSIONS

Among Canadians who are homeless and mentally ill, those who are Indigenous have distinct histories and current needs that are consistent with the legacy of colonisation. Responses to Indigenous homelessness must be developed within the context of reconciliation between Indigenous and non-Indigenous Canadians, addressing trauma, substance use and family separations.

TRIAL REGISTRATION NUMBER

ISRCTN42520374, ISRCTN57595077, ISRCTN66721740.

Dangerous sadness: nervoza among first and second generation Macedonian immigrants to Australia

OBJECTIVE

Nervoza is a commonly-used illness category among Macedonian Australians. Although nervoza belongs broadly to the category of 'nerve illnesses' little is known of its meaning among Macedonian immigrants, and whether there is intergenerational attrition in its meaning and use. We aimed to explore how nervoza and its treatment are perceived by members of the Macedonian community in Australia.

DESIGN

In-depth interviews in Macedonian with 18 participants from the Macedonian community in Melbourne, Australia.

RESULTS

Nervoza is a layered concept relating shame, emotional experience and nerves, used as an idiom of distress and sadness in the presence of acute and chronic stressors. Nervoza develops in both the social world (through poverty, grief or the loss of war), and in the psyche of distressed and isolated people. It is viewed as dangerous on many levels: to physical health, as a 'gateway condition' to long-term psychological illnesses such as depression and schizophrenia, and to the person's social well-being. The normalised treatment for nervoza in Macedonia - benzodiazepines - is the subject of significant medical control in Australia.

CONCLUSION

For sufferers of nervoza, the social self is both medicalized and stigmatised. Health services in Australia are often considered marginal in the management of nervoza. Second generation Macedonians viewed the concept as unhelpful, and possibly increasing the stigmatisation of mental illnesses. The lack of knowledge about, and underutilisation of, mental health services and support groups in the Macedonian Australian community should be the focus of community-based inter-generational health literacy initiatives.

Not engaged in education, employment or training (NEET) in an Arctic sociocultural context: the NAAHS cohort study

OBJECTIVES

The purpose of the study is to explore the prevalence and predictors of not engaged in education, employment or training (NEET) status in a multicultural young adult population in Northern Norway.

DESIGN AND SETTING

The longitudinal design link a self-reported survey (2003-2005) with an objective registry linkage follow-up 8-10 years later.

PARTICIPANTS

Of all 5877 tenth graders (aged 15-16 years) in Northern Norway, 83% of the total age cohort from all 87 municipalities participated in the baseline survey. The follow-up studies consisted of 3987 consent giving adolescents (68%), were 365 (9.2%) reported indigenous Sami ethnicity.

OUTCOME MEASURES

Youth NEET at the age of 23-25 years.

METHODS

Explanatory variables were sociodemographic factors (gender, ethnicity, residency, parental education), mental health problems and musculoskeletal pain in adolescence. Outcome variable characterised as NEET-status was defined by no educational engagement, long-term recipient of sickness benefit, medical and non-medical benefit receipt or long-term unemployment.

RESULTS

NEET-status in young adulthood was significantly higher among females (20.9%) than among males (16.2%). Ethnic differences occurred as being NEET among Sami males was significantly higher than among non-Sami males, 23.0% and 15.2% respectively. Minority Sami females experienced NEET-status to a lower degree (16.6%) than non-Sami females (20.8%). Among females adolescent peer problems (adjusted OR=1.09) and hyperactivity problems (adjusted OR=1.10) were associated with later NEET-status. Peer problems (adjusted OR=1.23), conduct problems (adjusted OR=1.17) and musculoskeletal problems (adjusted OR=1.15) in male adolescents were associated with later NEET-status, whereas emotional problems among males predicted significantly less later NEET- status (adjusted OR=0.88).We found lower parental education to be significantly associated with being NEET-later in young adults (females: adjusted OR=2.11, males: adjusted OR=3.22).

CONCLUSIONS

To address the disengagement of education and work, particular emphasis must be placed on supporting young people struggling with mental and physical health problems.

Common maternal health problems among Australian-born and migrant women: A prospective cohort study

BACKGROUND

Migrant women of non-English speaking background make up an increasing proportion of women giving birth in high income countries, such as Australia, Canada and the United Kingdom. The aim of this study was to assess the prevalence of common physical and psychosocial health problems during pregnancy and up to 18 months postpartum among migrant women of non-English speaking background compared to Australian-born women.

METHODS

Prospective pregnancy cohort study of 1507 nulliparous women. Women completed self-administered questionnaires or telephone interviews in early and late pregnancy and at 3, 6, 9, 12 and 18 months postpartum. Standardised instruments were used to assess incontinence, depressive symptoms and intimate partner violence.

FINDINGS

Migrant women of non-English speaking background (n = 243) and Australian-born mothers (n = 1115) reported a similar pattern of physical health problems during pregnancy and postpartum. The most common physical health problems were: exhaustion, back pain, constipation and urinary incontinence. Around one in six Australian-born women (16.9%) and more than one in four migrant women (22.5%) experienced intimate partner abuse in the first 12 months postpartum. Compared to Australian-born women, migrant women were more likely to report depressive symptoms at 12 and 18 months postpartum.

CONCLUSION

Physical and mental health problems are common among women of non-English speaking background and Australian-born women, and frequently persist up to 18 months postpartum. Migrant women experience a higher burden of postpartum depressive symptoms and intimate partner violence, and may face additional challenges accessing appropriate care and support.

Is the Black-White Mental Health Paradox Consistent Across Gender and Psychiatric Disorders?

This study assessed whether the black-white mental health epidemiologic paradox (i.e., blacks' lower or similar rates of mental disorder relative to whites) extends across 12 lifetime and past-year psychiatric disorders and whether it varies with gender. We used data from the National Comorbidity Survey Replication and the National Survey of American Life, 2001-2003 (n = 4,584 black and 6,668 non-Hispanic white persons). Results showed overwhelming evidence of the paradox across lifetime and past-year disorders for women and men. In addition, blacks' mental health advantage over whites widened after adjusting for socioeconomic factors. There was one exception: Black women experienced higher risk of lifetime posttraumatic stress disorder compared with white women. These findings provide strong evidence for the "black-white mental health paradox"; however, additional research is needed to understand black women's heightened risk for posttraumatic stress disorder.

A Look at Culture and Stigma of Suicide: Textual Analysis of Community Theatre Performances

Stigma against suicidal ideation and help-seeking is a significant barrier to prevention. Little detail is provided on what types of stigma interfere with help-seeking, how stigma is expressed, and how to reduce it. Five groups of two ethnically diverse community theatre programs were formed to analyze differences in Eastern Montana Caucasian and Native American adolescents and young adults’ experiences with stigma about mental illness and mental health treatment that affect help-seeking for suicidal thoughts and experiences. Over a ten-week period, a grassroots theatre project was used to recruit members from the same population as the audience to write and perform a play on suicide and depression (n = 33; 10 males, 23 females; 12 Native American, 21 Caucasian, ages 14–24). Using textual analysis, the community- and campus-based performance scripts were coded for themes related to stigma. Both ethnic groups reported that stigma is a barrier to expressing emotional vulnerability, seeking help, and acknowledging mental illness. We found that Caucasians’ experiences were more individually oriented and Native Americans’ experiences were more collectively oriented. Understanding the cultural bases of experiences with stigma related to mental health treatment for suicide is necessary to create educational programs to reduce stigma for diverse groups of adolescents and young adults.

Shared heritability and functional enrichment across six solid cancers

Quantifying the genetic correlation between cancers can provide important insights into the mechanisms driving cancer etiology. Using genome-wide association study summary statistics across six cancer types based on a total of 296,215 cases and 301,319 controls of European ancestry, here we estimate the pair-wise genetic correlations between breast, colorectal, head/neck, lung, ovary and prostate cancer, and between cancers and 38 other diseases. We observed statistically significant genetic correlations between lung and head/neck cancer (rg = 0.57, p = 4.6 × 10-8), breast and ovarian cancer (rg = 0.24, p = 7 × 10-5), breast and lung cancer (rg = 0.18, p =1.5 × 10-6) and breast and colorectal cancer (rg = 0.15, p = 1.1 × 10-4). We also found that multiple cancers are genetically correlated with non-cancer traits including smoking, psychiatric diseases and metabolic characteristics. Functional enrichment analysis revealed a significant excess contribution of conserved and regulatory regions to cancer heritability. Our comprehensive analysis of cross-cancer heritability suggests that solid tumors arising across tissues share in part a common germline genetic basis.

The Intrapsychic Psychological Binds of Poverty and Race: The Intersection of Mind and Milieu

Race and poverty are poignant factors in how individuals and communities experience the world. The reality is that more people of color than White people live in poverty (Milner, 2013). How these inequalities intersect with the mind and environment is of compelling importance. The experiences of race and living in poverty are riddled with innumerable stressors and barriers, and as a result are subject to the experience of a range of mental health issues. Those that live the experience of trauma related to race and poverty suffer disproportionately from a host of hardships that contribute to psychological distress that can have a profound effect on mental health and serve as intrapsychic binds. These internalized weights require therapeutic supports to alleviate the internal oppressive circumstances by those that are immersed in the experience on a daily basis. This article explores the intersection of these psychological binds and their effect on human behavior.

Evaluation of the Integrated Intervention for Dual Problems and Early Action Among Latino Immigrants With Co-occurring Mental Health and Substance Misuse Symptoms: A Randomized Clinical Trial

IMPORTANCE

Immigrants are at an increased risk for co-occurring mental health and substance misuse symptoms; however, effective treatments are lacking.

OBJECTIVE

To evaluate the effectiveness of the Integrated Intervention for Dual Problems and Early Action (IIDEA) program compared with enhanced usual care.

DESIGN, SETTING, AND PARTICIPANTS

This effectiveness randomized clinical trial was conducted from September 2, 2014, to February 2, 2017, in 17 clinics or emergency departments and 24 community sites in Boston, Massachusetts, as well as in Madrid and Barcelona, Spain. Equal randomization (1:1) in 2-person blocks was used, assigning participants to either the IIDEA treatment group (n = 172) or the enhanced usual care control group (n = 169). Intent-to-treat analyses assessed effectiveness, and post hoc analyses examined whether results varied by symptom severity or treatment dose. Eligible participants were between 18 and 70 years of age, self-identified as Latino, screened positive for co-occurring symptoms, and were not receiving specialty behavioral health services.

INTERVENTIONS

Participants were randomized to a 10-session IIDEA treatment or to enhanced usual care.

MAIN OUTCOMES AND MEASURES

Primary outcomes were changes in alcohol and drug misuse and results of a urine test for drug metabolites but not for alcohol misuse. Secondary outcomes were symptoms of depression, generalized anxiety, posttraumatic stress disorder, and overall mental health.

RESULTS

In total, 341 participants were randomized to either the IIDEA treatment group (n = 172; 94 [54.7%] female, mean [SD] age, 33.5 [11.6] years) or the enhanced usual care control group (n = 169; 80 [47.3%] female, mean [SD] age, 34.3 [11.8] years). No statistically significant effects of IIDEA were found for primary drug and alcohol outcomes (ASI Lite-drug score: β = -0.02 [SE, 0.69; P = .88; Cohen d, 0.00; 95% CI, -0.17 to 0.17]; ASI Lite-alcohol score: β = -0.01 [SE, 1.19; P = .66; Cohen d, 0.00; 95% CI, -0.12 to 0.12]; urine drug test result: β = -0.36 [SE, 0.43; P = .50; OR, 0.70; 95% CI, 0.30-1.61]), but statistically significant effects were observed for secondary mental health outcomes. The IIDEA treatment was effective in reducing depressive symptoms per the Public Health Questionnaire-9 score (β = -1.14; SE, 0.47; P = .02; Cohen d, 0.20 [95% CI, 0.04-0.36]), posttraumatic stress disorder symptoms per the Posttraumatic Stress Disorder Checklist-5 score (β = -3.23; SE, 1.59; P = .04; Cohen d, 0.25 [95% CI, 0.01-0.37]), and overall mental health symptoms per the Hopkins Symptom Checklist-20 (β = -0.20; SE, 0.07; P = .01; Cohen d, 0.25 [95% CI, 0.08-0.42]) and composite mental health (β = -3.70; SE, 1.75; P = .04; Cohen d, 0.19 [95% CI, 0.01-0.36]) scores at the 6-month follow-up. Exploratory analyses suggested that 6-month treatment effects occurred for patients whose drug misuse was moderate to severe at the baseline assessment. Among patients with moderate to severe substance misuse, IIDEA substantially reduced substance use per the urine test results (odds ratio, 0.25 [95% CI, 0.09-0.67]; P = .01). Treatment dose showed small to large effect sizes by outcome.

CONCLUSIONS AND RELEVANCE

The IIDEA treatment did not change drug misuse but did improve secondary mental health and substance misuse outcomes for a heterogeneous population with moderate to severe symptoms; this finding provides a path for treating Latino immigrants with co-occurring mental health and substance misuse symptoms.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02038855.

Translating research to support practitioners in addressing disparities in child and adolescent mental health and services in the United States

Despite increased recognition of disparities in youth mental health, racial/ethnic disparities in mental health burden and in mental health service use persist. This phenomenon suggests that research documenting disparities alone has not led to extensive action in practice settings in order to significantly reduce disparities. In this commentary, we present a framework to actively target this research-to-practice gap by describing the development of a resource titled, "Addressing the Mental Health Needs of Racial and Ethnic Minority Youth-A Guide for Practitioners." We begin by presenting social justice as the impetus for eliminating disparities and then reviewing current knowledge and efforts aimed at reducing disparities. Subsequently, we describe knowledge transfer frameworks and goals guiding our work. Finally, we detail the steps taken in our approach to translation and implications for subsequent dissemination of this guide. Translation focused on evidence-based information on (a) mechanisms that contribute to disparities, and (b) strategies for providers to address disparities in their work. We reflect on the framework guiding our translation to offer future directions for others interested in bridging research and action. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Compulsory community treatment and ethnicity: Findings from a culturally and linguistically diverse area of Queensland

OBJECTIVE

To compare the use of community treatment orders (CTOs) and forensic orders (FOs) in a culturally and linguistically diverse (CALD) population to that in a non-CALD population.

METHODS

We analysed the relationship between coming from a CALD background and the use of CTOs and FOs on discharge from hospital using merged data from the Metro South Addiction and Mental Health Service's Transitions of Care (ToC) and Consumer Integrated Mental Health Application (CIMHA) databases.

RESULTS

Nine hundred and seventy-six individual records were included in the data set, of whom eighty-six were from a CALD background (8.8%). Three hundred and eleven patients were on compulsory community treatment. Use of compulsory community treatment (CTOs and FOs) was similar for those born in Australasia, British Isles, North America and Europe but significantly higher for those born elsewhere even after adjusting for socio-demographic and clinical variables (Adj OR 2.19, 95% CI 1.36-3.52). The use of an interpreter significantly increased the likelihood of compulsory community treatment (Adj OR 2.76, 95% CI 1.20-6.35). Restricting the analyses to CTOs only did not alter these results.

CONCLUSIONS

Metro South residents from a CALD background outside of Europe were over-represented on compulsory community treatment orders. This could reflect the difficulties in accessing voluntary services, communication barriers, stigma associated with mental illness, discrimination, or issues related to accurately diagnosing mental illness cross-culturally. Clinicians need to be aware of the complexity of working with people from diverse cultures and apply these orders judiciously.

Do Norwegian Sami and non-indigenous individuals understand questions about mental health similarly? A SAMINOR 2 study

The Western culturally developed Hopkins Symptom Checklist (HSCL-10) is a self-report measure of mental distress widely used for both clinical and epidemiological purposes - also in the multiethnic epidemiological SAMINOR studies in Northern Norway, but without any proper cross-cultural validation. Our objective was to test invariance of the HSCL-10 measurements among Sami and the non-indigenous majority population in Northern Norway (participants in the SAMINOR 2 study) and whether the previously used HSCL-10 cut-off level (1.85) fits the Sami subgroups in the study. Participants belonged to Sami core, Sami affiliation, Sami background or majority Norwegian groups. The confirmatory factor analysis framework adapted for testing of measurement invariance showed no significant measurement invariance between the groups indicating that the HSCL-10 response scale predominantly was used in the same way and that significantly different meanings were not ascribed to the same set of questions. The cut-off criteria of 1.85 as indicative of psychological distress based on Norwegian data equal a score of 1.89, 1.94 and 1.91 in the Sami core, Sami affiliation and Sami background groups, respectively. Thus, the same cut-off criterion 1.85 may be safely used in all groups. However, one should still be looking for culture-specific expressions of mental stress.