Russians in Treatment: The Evidence Base Supporting Cultural Adaptations

Mental health literacy for social phobia in Ghana: Investigation of gender stereotypes and previous experience for recognition rates and prejudice

BACKGROUND

Mental health literacy (MHL) research has been of substantial interest internationally. Nevertheless, the interplay between beliefs, attitudes, previous experience with mental disorders, and knowledge of Ghanaians on specific mental disorders remains to be understood. The present study explored the interconnectedness between gender stereotypes, prejudice, previous experience with social phobia, and MHL among the general population in Ghana.

METHOD

Six hundred and one Ghanaians were recruited for an online experimental study design using a survey approach for data gathering. Respondents were randomly assigned to one of the two conditions (i.e., male and female vignettes) depicting symptoms of social phobia for a hypothetical person. Participants further completed self-reported measures including gender stereotypes (based on Ambivalent Sexism Inventory) and prejudice.

RESULTS

Results revealed a 15.5% recognition rate for social phobia. Recognition rates of social phobia did not differ by the experimental condition or by the gender of participants. However, personal experience of social phobia was positively related to an increased likelihood of correctly labeling social phobia among men in the female vignette condition, whereas correct recognition of social phobia was negatively related to prejudice among women in the male vignette condition. In the male vignette condition, men with more hostile sexism attitudes toward men exhibited more prejudice toward their hypothetical male counterpart. In contrast, women with hostile sexism attitudes toward men exhibited less prejudice, but greater benevolent sexism attitudes toward men was associated with more prejudice toward the hypothetical male in the vignette.

CONCLUSION

Findings from the current study emphasize the role of the cultural milieu in shaping effective mental health interventions. The results also have implications for promoting MHL to reduce prejudice in Ghana and other developing countries in the region.

The efficacy of augmented reality exposure therapy in the treatment of spider phobia-a randomized controlled trial

The evidence for the use of Augmented Reality (AR) in treating specific phobias has been growing. However, issues of accessibility persist, especially in developing countries. The current study examined a novel, but relatively simple therapist guided smartphone-based AR Exposure Treatment (ARET) of spider phobia. Participants who reported symptoms of Arachnophobia were randomized into one of three comparison groups: ARET (n = 20), traditional in vivo exposure therapy (IVET; n = 18) and a waitlist control group (n = 17). Behavioral approach, subjective symptom measures, and galvanic skin response were assessed pre- and post-treatment. The study was concluded with a one-month follow up assessment. Results indicated that both treatment groups showed statistically significant and clinically meaningful improvements in behavioral approach at post-test that were maintained at 1 month follow- up, compared to the wait-listed group. Moreover, the treatment groups demonstrated significant improvements in subjective symptom report at 1-month follow up. Given its utility and potential accessibility, our findings suggest that future AR evaluation research could be conducted in therapy settings with minimal resources.

How does trust affect help-seeking for Depression in Russia and Australia?

BACKGROUND

Depression is a major contributor to the global burden of disease that affects more than 300 million people worldwide. Cross cultural studies find that culture influences levels of trust which can impact upon an individual's likelihood to seek psychological help when experiencing Depression.

AIMS

Help seeking is essential for improved mental health outcomes. This study aims to consider how trust affects help-seeking as well as examine the differences in stigma and social distance between participants in Russia and Australia.

METHOD

Participants consisted of two separate samples from Australian (n = 229) and Russia (n = 259) which were recruited based on a vignette of a diagnostically unlabelled psychiatric case history with Depression using a cross-cultural research design. They completed items on the level of trust in health professionals, stigma and endorsement of help-seeking.

RESULTS

Findings suggest that trust can predict the endorsement of seeking help from a psychologist. Moreover, trust was lower for participants in Russia compared to those in Australia for mental health professionals. Participants in Russia had higher levels of stigma and social distance than their counterparts in Australia. Overall, participants in Australia were more likely to seek professional help than those in Russia.

CONCLUSIONS

Trust can predict the endorsement of help-seeking from mental health professionals cross culturally. Barriers to help-seeking such as stigma continue to negatively affect mental health outcomes, particularly in Russia.

[Family as a Health-Maintaining Resource for Late Repatriates? A Qualitative Study of Health Attitudes in Old Age]

BACKGROUND

In the context of demographic changes in Germany, it can be observed that the number of older people among the second largest migrant group - the so-called late repatriates - is on the rise. The health and utilisation behaviour of preventive measures by this group differs from that of the German population or people with a different migration background. An essential prerequisite for the design of target group-specific prevention measures is the knowledge of health expectations of the late repatriates.

GOAL OF THE STUDY

The goal of this study was to show the importance of the family and the predominant role models of late repatriates in health attitudes.

METHOD

Guided interviews were conducted with 13 late repatriates in Russian and evaluated using the documentary method.

RESULTS

The family and the care for (grand-)children was a central element of the preservation of health of the respondents. The traditional role models brought from the Soviet Union were partly preserved and partly (regardless the gender) expanded by the care for the (grand-)children.

CONCLUSION

The involvement of (grand-)children has a health-promoting effect on maintaining health in late repatriates and can encourage their use of preventive measures.

More Similarity if Different, More Difference if Similar: Assimilation, Colorblindness, Multiculturalism, Polyculturalism, and Generalized and Specific Negative Intergroup Bias

The creation of a social climate where all ethnic groups can harmoniously coexist is a central challenge for many countries today. Should we emphasize similarities and common ground or, conversely, recognize that there are important differences between groups? The current study examined relations between diversity ideologies (assimilation, colorblindness, multiculturalism, polyculturalism) and generalized and specific intergroup bias (against Chechens, Belarusians, Uzbeks, Chinese, and Jews and Muslims) among ethnic Russians (N = 701). In Study 1, colorblindness (ignoring differences) and polyculturalism (emphasizing interconnectivity) were associated with lower generalized intergroup bias and lower bias against Chechens, Uzbeks, and Chinese, but not Belarusians. Bias against Belarusians was lower among those who endorsed multiculturalism (emphasizing differences). In Study 2, multiculturalism was associated with higher implicit bias when the target was a Chechen but in general more proximal variables (positive or negative contact experience and perceived group similarity) were more robust predictors of intergroup bias than diversity ideologies. In Study 3, colorblindness and polyculturalism were related to lower levels of fearful attitudes against Muslims. Colorblindness was also associated with lower levels of Antisemitism in contrast to multiculturalism that had an opposite association. We place these results in the context of cultural distance and existing cultural stereotypes about different groups among the majority of Russians. The strengths and weaknesses of each diversity ideology for the mainstream cultural group are discussed. The results of the current study suggest that the most fruitful strategy for mainstream cultural groups for maintaining harmonious intergroup relations in diverse societies might be that of optimal distinctiveness.

Do Migration and Acculturation Impact Somatization? A Scoping Review

Somatization is a phenomenon in which the individual experiences physical symptoms attributable to mental projections. It is a widely used term in common parlance to figuratively describe a stressful situation. Syndromes directly related to the mind have been described; pathologies are influenced by somatization. However, the extent of somatization is also related to social and cultural factors. In fact, each culture expresses varying levels of somatization characteristic of the country of origin. A disease can even manifest with different symptoms in different ethnic groups. The migration process arises from the need for change on the part of those who undertake it and culminates in the integration of the person in the host country. This process induces changes in the person of a psychological nature, which also affects somatization. In fact, the most integrated subjects show levels of somatization comparable to those of the host country. These considerations support the thesis that psychological changes are an integral part of health and can affect the development of organic and somatized pathologies.

Immigrant generation, acculturation, and mental health literacy among former Soviet Union immigrants in Israel

BACKGROUND

Research on Mental Health Literacy (MHL) has been growing in different geographical and cultural contexts. However, little is known about the relationship between immigrant generations, acculturation, stigma, and MHL among immigrant populations.

AIMS

This study aims to examine differences in MHL among immigrant generations (first, 1.5, and second) from the former Soviet Union (FSU) in Israel and to assess whether differences are accounted for by immigration generation or acculturation.

METHOD

MHL was assessed among 420 participants using a cross-sectional survey adapted from the Australian National Survey. Associations of immigrant generation, socio-demographic characteristics, and acculturation with MHL indices were examined using bivariate and multivariable analyses.

RESULTS

First generation immigrants reported poorer identification of mental disorders and higher personal stigma than both 1.5- and second-generation immigrants. Acculturation was positively associated with identification of mental disorders and negatively associated with personal stigma across all immigrants' generations. When all variables were entered into a multivariate model predicting MHL indices, acculturation and gender were associated with personal stigma and only acculturation was associated with better identification of mental disorders.

CONCLUSION

Differences in MHL among FSU immigrants in Israel are mainly explained by acculturation rather than by immigrant generation. Implications for policy makers and mental health professionals working with FSU immigrants are discussed.

Religiosity, perceived anti-Semitism, xenophobia and mental health: Experiences of Jewish immigrants from the former Soviet Union in Austria and Germany

Research about the relation between migration and mental health as well as factors influencing the mental health of migrants has been growing because challenges of migration can constitute a significant mental health burden. However, its divergent findings seem to reflect group-specific differences, e.g., regarding country of origin and receiving country. Almost no empirical studies about individual migrant groups in different receiving countries have been undertaken so far. The present population-based study explores symptoms of depression, anxiety, and somatization as well as quality of life in an Austrian and a German sample of ex-Soviet Jewish migrants. We mainly investigate the relationship of religiosity and perceived xenophobic and anti-Semitic discrimination to the psychological condition of the migrants. Standardized self-report scales, specifically the Beck-Depression-Inventory-II (BDI), State-Trait-Anxiety-Inventory (STAI), Brief Symptom Inventory (BSI), and WHO Quality of Life Questionnaire (WHOQOL-BREF), were used to measure mental health. Ex-Soviet Jewish migrants in Austria showed significantly more symptoms of depression than those in Germany. Regression analyses support a protective effect of religiosity on mental health in the sample in Germany and an adverse effect of perceived discrimination in the sample in Austria. The present study reveals a less favorable situation for ex-Soviet Jewish migrants in Austria, in terms of income, residence status, and xenophobic attitudes in the local population, compared to the group in Germany. Furthermore, our data suggest that the receiving country matters for the mental health of this migrant group. However, further research is needed to support these conclusions.

Cultural competence in multi-family psychoeducation groups: The experiences of Russian-speaking immigrant mothers of adults with severe mental illness

The successful integration of cultural competence with evidence-based practices in mental health services is still limited for particular cultural populations. The current study explored culturally adapted family psychoeducation intervention for immigrants from the former Soviet Union (FSU) in Israel who care for a family member with severe mental illness (SMI). Semi-structured in-depth interviews were conducted with 18 immigrant mothers about their experience of taking part in Russian-speaking multi-family psychoeducation groups (MFPGs). Qualitative content analysis revealed five salient processes and changes that participants attributed to their engagement in the intervention: 1) from a language barrier to utilization of and satisfaction with services; 2) from a lack of information to acquiring new mental health knowledge; 3) from harboring a family secret to exposure and sharing; 4) from social isolation to cultural belonging and support; 5) from families blurring boundaries to physical and emotional separation. The results showed that these changes-linguistic, cognitive, emotional, socio-cultural and relational-improved family coping and recovery. Implications for cultural adaptation of family psychoeducation for Russian-speaking immigrants are discussed.

Comparing the Different Manifestations of Postpartum Mental Disorders by Origin, among Immigrants and Native-Born in Israel According to Different Mental Scales

We conducted a prospective study, aimed to study whether the prevalence of mental disorders after birth differs by country of origin. Parturient mothers of Ethiopian origin, Former-USSR (FSU) origin, or nonimmigrant, native-Israeli origin (n = 974, all Jewish) were recruited in hospitals in Israel and were followed 6–8 weeks and one year after birth. General linear models were used to study the associations between origin and mental health, comparing Ethiopian and FSU origin with native-Israeli. Ethiopian and FSU mothers were more likely to report on somatic symptoms, compared with native-Israeli women. Ethiopian origin was negatively and significantly associated with anxiety in all three interviews (β = −1.281, β = −0.678 and β = −1.072, respectively; p < 0.05 in all). FSU origin was negatively associated with depression after birth (β = −0.709, p = 0.036), and negatively associated with anxiety after birth and one-year postpartum (β = −0.494, and β = −0.630, respectively). Stressful life events were significantly associated with all mental disorders in the three time points of interviews. Our findings suggest that immigrants tend to express higher mental distress with somatic symptoms. Additional tools are needed for mental distress screening among immigrants.

Mental health literacy in Ghana: Implications for religiosity, education and stigmatization

Research on Mental Health Literacy (MHL) has been growing internationally. However, the beliefs and knowledge of Ghanaians about specific mental disorders have yet to be explored. This vignette study was conducted to explore the relationships between religiosity, education, stigmatization and MHL among Ghanaians using a sample of laypeople (N = 409). The adapted questionnaire presented two vignettes (depression and schizophrenia) about a hypothetical person. The results revealed that more participants were able to recognize depression (47.4%) than schizophrenia (15.9%). Religiosity was not significantly associated with recognition of mental disorders but was positively associated with both social and personal stigma for depression, and negatively associated with personal and perceived stigma for schizophrenia. Moreover, education was found to be positively associated with disorder recognition, and negatively with perceived stigma. Finally, perceived stigma was positively associated with disorder recognition, whereas personal stigma for schizophrenia related negatively to recognition of mental disorders. In conclusion, education but not religiosity predicted identification accuracy, but both predictors were associated with various forms of stigma. Findings from this study have implications for MHL and anti-stigma campaigns in Ghana and other developing countries in the region.

A Multilingual Integrative Review of Health Literacy in Former Soviet Union, Russian-Speaking Immigrants

Large diasporas of former Soviet Union (FSU) immigrants are found in the USA, Germany, and Israel. To synthesize evidence, identify limitations, and propose future directions we conducted an integrative review on the health literacy of FSU immigrants, migrants, or refugees in four languages. Following integrative review and PRISMA guidelines, we searched four databases in English and performed supplementary searches in Russian, German, and Hebrew to identify qualitative and quantitative studies on FSU immigrants and health literacy. Six articles met inclusion criteria in English and one in German; the majority were published in the last five years. Only two articles measured health literacy of FSU immigrants, which was lower than the general population. Four articles were about immigrants with a mean age ≥50 years. All articles stressed the value of translated, culturally relevant health information. The health literacy of FSU immigrants is understudied, despite clear needs. Future research should include assessments of FSU immigrants’ health literacy and include diverse (e.g., age, gender) yet well-defined populations to determine both barriers and facilitators to their health literacy. This review, an example of a multilingual search, provided a comprehensive understanding of existing literature and is a useful approach for global health literacy research.

International Perspective on Health Literacy and Health Equity: Factors That Influence the Former Soviet Union Immigrants

Among the world's 272 million international migrants, more than 25 million are from the former Soviet Union (FSU), yet there is a paucity of literature available about FSU immigrants' health literacy. Besides linguistic and cultural differences, FSU immigrants often come from a distinct healthcare system affecting their ability to find, evaluate, process, and use health information in the host countries. In this scoping review and commentary, we describe the health literacy issues of FSU immigrants and provide an overview of FSU immigrants' health literacy based on the integrated health literacy model. We purposefully consider the three most common locations where FSU immigrants have settled: the USA, Germany, and Israel. For context, we describe the healthcare systems of the three host countries and the two post-Soviet countries to illustrate the contribution of system-level factors on FSU immigrants' health literacy. We identify research gaps and set a future research agenda to help understand FSU immigrants' health literacy across countries. Amidst the ongoing global population changes related to international migration, this article contributes to a broad-scope understanding of health literacy among FSU immigrants related to the system-level factors that may also apply to other immigrants, migrants, and refugees.

Differences in beliefs and attitudes toward Depression and Schizophrenia in Russia and the United States

BACKGROUND

Cross-cultural studies find that culture shapes people's understanding of mental illnesses, particularly Depression and Schizophrenia.

AIMS

To compare individuals' beliefs and attitudes toward Depression and Schizophrenia in Russia and the United States.

METHOD

Participants (N=607) were presented with vignettes of two diagnostically unlabeled psychiatric case histories and then answered questions regarding mental health literacy (MHL) and attitudes toward the person and the illness.

RESULTS

Our findings indicate that Depression was most often attributed to psychosocial stress while Schizophrenia was thought to be caused by biological factors. People from both countries considered those suffering from Schizophrenia to be unpredictable and dangerous. US participants were more likely to endorse lay and professional help for both disorders than their Russian counterparts. Russian participants reported being less likely to turn to someone they trust and more likely to deal with problems on their own. Russian participants were also more likely to view those with Depression as 'weak-willed' and leading an 'immoral lifestyle'.

CONCLUSION

Our findings further inform cultural understandings of these mental illnesses in an often neglected national group. Patterns suggest that both groups may benefit from exposure to corrective information about Depression and Schizophrenia.

Knowledge and attitudes about mental health among older immigrants from the former Soviet Union to Israel and their primary care physicians

Previous studies have documented a high prevalence of psychological distress and mental illness among older immigrants from the former Soviet Union (FSU) in Israel. Yet, this population rarely seeks help from mental health providers. The present study aimed to identify beliefs and attitudes about depression and anxiety among older immigrants from the FSU treated in primary care, and among their primary care physicians, who were also FSU immigrants. The study used focus group (FG) interviews with primary care patients (n = 12) and physicians (n = 23). The interviews were transcribed and analyzed using open thematic coding. Three main themes were identified: a) avoidance of discussion of mental health and stigma regarding mental illness; b) expectations to control one's mental state; and c) limited opportunities to acquire knowledge about Western mental health. Primary care physicians recognized the barriers facing their older immigrant patients concerning mental health diagnosis and treatment. Yet, due to work overload, their ability to assist older immigrants was limited. The findings suggest that older immigrants from the FSU might benefit from mental health information and exchange of ideas about Western mental health.

“I Want Her to Make Correct Decisions on Her Own:” Former Soviet Union Mothers' Beliefs about Autonomy Development

This qualitative study examined Former Soviet Union (FSU) mothers' explicit and implicit attitudes and parenting practices around adolescents' autonomy development. Interviews were conducted with 10 mothers who had immigrated from the FSU to the US between 10 and 25 years ago, and who had daughters between the ages of 13 and 17 years. Mothers predominantly defined autonomy in terms of adolescents' ability to carry out instrumental tasks, make correct decisions, and financially provide for themselves, but rarely mentioned psychological or emotional independence. Mothers reflected on the various aspects of autonomy emphasized in their country of origin and America, and balancing the two sets of cultural values in their parenting. Although mothers discussed attempts to adopt a less authoritarian approach to parenting than they themselves experienced as children, some mothers' controlling attitudes were revealed through a close analysis of their language. The findings provide important insights into the parenting experiences of FSU immigrant mothers, and the way in which autonomy-related processes may vary cross-culturally. Implications for parenting and clinical practice are also discussed.

Assimilationism, Multiculturalism, Colorblindness, and Polyculturalism in the Russian Context

The present study examined the relationships between interethnic ideologies (assimilation, colorblindness, multiculturalism, polyculturalism) and generalized and specific prejudice towards Chechens, Belarusians, Uzbeks, and Chinese from the of perception ethnic Russian citizens. In order to take into account of the specific context of intergroup relations in Russia, we also included intergroup contact experience, which potentially associated with prejudice and intergroup tension (frequency and positivity of interethnic contacts, positive interethnic emotions) and perceived neighborhood ethnic density. The results indicated that colorblind and polycultural interethnic ideologies had negative associations with generalized prejudice and prejudice towards Chechens, Uzbeks, and Chinese but not with prejudice towards Belarusians, which was negatively associated with only multicultural interethnic ideology. The total sample was 359 ethnic Russians (female 46,5 %; male 53,5%) from the Central Federal district of the Russian Federation in the age from 16 to 68 years (M = 33,9; SD = 11,9).The obtained results were explained by perceived cultural distance and existing stereotypes towards considered ethnic groups. According to the perspective of two dimensions of the stereotype content model (warmth and competence), these stereotypes are substantially different.

Long-Term Depressive Symptoms and Acculturative Stress Issues Among Immigrants From the Former Soviet Union

BACKGROUND

Previous studies regarding depressive symptoms and acculturative stress among immigrants have been limited to the initial period after immigration.

OBJECTIVE

The relationships between depressive symptoms, acculturation, and acculturative stress among immigrants from the former Soviet Union were examined in this descriptive study.

DESIGN

Eighty immigrants from the former Soviet Union who had immigrated within the past 20 years were recruited in various community locations.

RESULTS

Participants (N = 80), including recent and longer residing immigrants, reported elevated depressive symptoms and acculturative stress. Acculturative stress predicted depressive symptoms, controlling for dominant culture (American) immersion. However, length of time in the United States was not associated with depressive symptoms, ethnic culture immersion, or acculturative stress.

CONCLUSIONS

Our results suggest that elevated depressive symptoms are related to acculturative stress but are not confined to the initial adjustment period. Steps to decrease acculturative stress might help decrease depressive symptoms in immigrants regardless of the number of years lived in the United States.

Prevalence and characteristics of suicide attempters and ideators among acutely admitted psychiatric hospital patients in northwest Russia and northern Norway

BACKGROUND

More knowledge about suicidality and suicide risk profiles in acute psychiatric hospital patients (both first-time and chronic patients) is needed. While numerous factors are associated with suicidality in such populations, these may differ across cultures. Better understanding of factors underlying suicide risk can be informed by cross-cultural studies, and can aid development of therapeutic and preventive measures.

METHODS

An explorative, cross-sectional cohort study was carried out. Acutely admitted patients at one psychiatric hospital in northwest Russia and two in northern Norway were included. At admission, demographic, clinical, and service use data were collected, in addition to an assessment of suicidal ideation and attempts, comprising five dichotomic questions. Data from 358 Norwegian and 465 Russian patients were analyzed with univariate and multivariate statistics. Within each cohort, attempters and ideators were compared with patients not reporting any suicidality.

RESULTS

The observed prevalence of suicidal ideation and attempts was significantly higher in the Norwegian cohort than in the Russian cohort (χ(2) = 168.1, p < 0,001). Norwegian suicidal ideators and attempters had more depressed moods, more personality disorders, and greater problems with alcohol/drugs, but fewer psychotic disorders, cognitive problems or overactivity than non-suicidal patients. Russian suicidal ideators and attempters were younger, more often unemployed, had more depressed mood and adjustment disorders, but had fewer psychotic disorders and less alcohol/drug use than the non-suicidal patients.

CONCLUSIONS

Rates of suicidal ideation and non-fatal attempts in Norwegian patients were intermediate between those previously reported for patients admitted for the first time and those typical of chronic patients. However, the significantly lower rates of suicidal ideation and non-fatal attempts in our Russian cohort as compared with the Norwegian, contrasted with what might be expected in a region with much higher suicide rates than in northern Norway. We suggest that suicide-related stigma in Russia may reduce both patient reporting and clinicians' recognition of suicidality. In both cohorts, overlapping risk profiles of ideators and attempters may indicate that ideators should be carefully evaluated and monitored, particularly those with depressed moods, alcohol/substance abuse disorders, and inadequate treatment continuity.

Toxicology and the biological role of methanol and ethanol: Current view

BACKGROUND

Alcohol variants such as ethanol and methanol are simple organic compounds widely used in foods, pharmaceuticals, chemical synthesis, etc. Both are becoming an emerging health problem; abuse of ethanol containing beverages can lead to disparate health problems and methanol is highly toxic and unfit for consumption.

METHODS AND RESULTS

This review summarizes the basic knowledge about ethanol and methanol toxicity, the effect mechanism on the body, the current care of poisoned individuals and the implication of alcohols in the development of diseases. Alcohol related dementia, stroke, metabolic syndrome and hepatitis are discussed as well. Besides ethanol, methanol toxicity and its biodegradation pathways are addressed.

CONCLUSIONS

The impact of ethanol and methanol on the body is shown as case reports, along with a discussion on the possible implication of alcohol in Alzheimer's disease and antidotal therapy for methanol poisoning. The role of ethanol in cancer and degenerative disorders seems to be underestimated given the current knowledge. Treatment in case of poisoning is another issue that remains unresolved even though effective protocols and drugs exist.

Interplay of identities: a narrative study of self-perceptions among immigrants with severe mental illness from the former Soviet Union

This study explored the self-perceptions of individuals with mental illness who immigrated from the Former Soviet Union (FSU) to Israel. In particular, we examined the double stigma borne by these individuals as new immigrants and psychiatric patients, which may threaten their identity and render them at risk for social marginalization. We interviewed 12 FSU immigrants diagnosed with severe mental illness (SMI), who had been hospitalized in psychiatric facilities in the past and, at the time of the interview, were residing in community rehabilitation centers. Their narratives revealed that they constructed multiple identities for themselves: as bearers of Russian culture, as Soviet Jews, as normative immigrants, and only lastly as consumers of mental health services. In the case of FSU newcomers with mental illness immigration may serve as a normalizing and positive experience. Study findings suggest that stressing patients' identity as mentally ill may be counterproductive in their rehabilitation; instead, clinicians may consider working to mobilize patients' personal and cultural assets and helping them reinstate a more complex self-perception. Further research is needed to explore how immigration may affect self-perceptions of individuals with SMI from other cultural groups.

Somatic perception, cultural differences and immigration: results from administration of the Modified Somatic Perception Questionnaire (MSPQ) to a sample of immigrants

The number of immigrants in Italy has doubled every 10 years from 1972 and Genoa hosts two large communities of immigrants from South America and Africa. We investigated differences in the somatic perception between immigrants and Italians and between South Americans and Africans living in the city of Genoa. During a 7 month period, an anonymous questionnaire asking for sociodemographic information and the Modified Somatic Perception Questionnaire (MSPQ) were administered to all immigrants accessing an outpatient clinic or the general practitioners offices. MSPQ mean scores were significantly higher in immigrant patients than in Italian patients, after adjusting for sex and age differences. We found no differences between South Americans and Africans in MSPQ score. The tendency to express discomfort through physical symptoms appears to be related to being a foreigner who arrived in Italy through a migratory trip and also to being a person who comes from a cultural context that is very different from the one of developed countries.