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Kwegyir Tsiboe A, Raghuraman S, Marshall TC. Caught between two worlds: mental health literacy and stigma among bicultural youth. Int J Qual Stud Health Well-being 2024; 19:2321644. [PMID: 38431901 PMCID: PMC10911255 DOI: 10.1080/17482631.2024.2321644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 02/18/2024] [Indexed: 03/05/2024] Open
Abstract
PURPOSE Bicultural youths are at higher risk of mental health problems and are less likely to utilize mental health services, yet our knowledge of their mental health literacy and help-seeking behaviours remains limited. METHODS To fill this gap, the current study explored bicultural youths' mental health literacy and stigma by conducting semi-structured interviews with 14 Canadian university students in 2021. RESULTS Our analysis revealed that bicultural youths may be torn between two worlds: intergenerational tensions between participants assimilated into individualistic Canadian culture and their more collectivist parents meant that they had different cultural perceptions of mental health literacy and stigma. While being caught between these two worlds may be detrimental for bicultural youth, our results also suggested that a trans-cultural factor-celebrities' mental health journeys-may promote help-seeking behaviour across participants. Furthermore, our study speaks to the ways that unprecedented events such as the COVID-19 pandemic impact mental health literacy among bicultural youth. Our findings might be used by university mental health services to encourage help-seeking among bicultural students. CONCLUSION The acculturation of mental health literacy, stigma, and associated intergenerational differences needs to be considered by university wellness services.
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Affiliation(s)
| | - Shruthi Raghuraman
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Canada
| | - Tara C. Marshall
- Department of Health, Aging & Society, McMaster University, Hamilton, Canada
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Tran PB, Ali A, Ayesha R, Boehnke JR, Ddungu C, Lall D, Pinkney-Atkinson VJ, van Olmen J. An interpretative phenomenological analysis of the lived experience of people with multimorbidity in low- and middle-income countries. BMJ Glob Health 2024; 9:e013606. [PMID: 38262681 PMCID: PMC10823928 DOI: 10.1136/bmjgh-2023-013606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/31/2023] [Indexed: 01/25/2024] Open
Abstract
People living with multimorbidity (PLWMM) have multiple needs and require long-term personalised care, which necessitates an integrated people-centred approach to healthcare. However, people-centred care may risk being a buzzword in global health and cannot be achieved unless we consider and prioritise the lived experience of the people themselves. This study captures the lived experiences of PLWMM in low- and middle-income countries (LMICs) by exploring their perspectives, experiences, and aspirations.We analysed 50 semi-structured interview responses from 10 LMICs across three regions-South Asia, Latin America, and Western Africa-using an interpretative phenomenological analysis approach.The bodily, social, and system experiences of illness by respondents were multidirectional and interactive, and largely captured the complexity of living with multimorbidity. Despite expensive treatments, many experienced little improvements in their conditions and felt that healthcare was not tailored to their needs. Disease management involved multiple and fragmented healthcare providers with lack of guidance, resulting in repetitive procedures, loss of time, confusion, and frustration. Financial burden was exacerbated by lost productivity and extreme finance coping strategies, creating a vicious cycle. Against the backdrop of uncertainty and disruption due to illness, many demonstrated an ability to cope with their conditions and navigate the healthcare system. Respondents' priorities were reflective of their desire to return to a pre-illness way of life-resuming work, caring for family, and maintaining a sense of independence and normalcy despite illness. Respondents had a wide range of needs that required financial, health education, integrated care, and mental health support.In discussion with respondents on outcomes, it appeared that many have complementary views about what is important and relevant, which may differ from the outcomes established by clinicians and researchers. This knowledge needs to complement and be incorporated into existing research and treatment models to ensure healthcare remains focused on the human and our evolving needs.
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Affiliation(s)
- Phuong Bich Tran
- Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
| | - Ayaz Ali
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Rubab Ayesha
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Jan R Boehnke
- School of Health Sciences, University of Dundee, Dundee, UK
- Department of Health Sciences, University of York, York, UK
| | - Charles Ddungu
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Dorothy Lall
- Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | | | - Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
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Aschbacher K, Rivera LM, Hornstein S, Nelson BW, Forman-Hoffman VL, Peiper NC. Longitudinal Patterns of Engagement and Clinical Outcomes: Results From a Therapist-Supported Digital Mental Health Intervention. Psychosom Med 2023; 85:651-658. [PMID: 37409793 DOI: 10.1097/psy.0000000000001230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE Digital mental health interventions (DMHIs) are an effective treatment modality for common mental disorders like depression and anxiety; however, the role of intervention engagement as a longitudinal "dosing" factor is poorly understood in relation to clinical outcomes. METHODS We studied 4978 participants in a 12-week therapist-supported DMHI (June 2020-December 2021), applying a longitudinal agglomerative hierarchical cluster analysis to the number of days per week of intervention engagement. The proportion of people demonstrating remission in depression and anxiety symptoms during the intervention was calculated for each cluster. Multivariable logistic regression models were fit to examine associations between the engagement clusters and symptom remission, adjusting for demographic and clinical characteristics. RESULTS Based on clinical interpretability and stopping rules, four clusters were derived from the hierarchical cluster analysis (in descending order): a) sustained high engagers (45.0%), b) late disengagers (24.1%), c) early disengagers (22.5%), and d) immediate disengagers (8.4%). Bivariate and multivariate analyses supported a dose-response relationship between engagement and depression symptom remission, whereas the pattern was partially evident for anxiety symptom remission. In multivariable logistic regression models, older age groups, male participants, and Asians had increased odds of achieving depression and anxiety symptom remission, whereas higher odds of anxiety symptom remission were observed among gender-expansive individuals. CONCLUSIONS Segmentation based on the frequency of engagement performs well in discerning timing of intervention disengagement and a dose-response relationship with clinical outcomes. The findings among the demographic subpopulations indicate that therapist-supported DMHIs may be effective in addressing mental health problems among patients who disproportionately experience stigma and structural barriers to care. Machine learning models can enable precision care by delineating how heterogeneous patterns of engagement over time relate to clinical outcomes. This empirical identification may help clinicians personalize and optimize interventions to prevent premature disengagement.
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Affiliation(s)
- Kirstin Aschbacher
- From Meru Health (Aschbacher, Rivera, Nelson, Forman-Hoffman, Peiper), San Mateo, California; Department of Anthropology (Rivera), Emory University, Atlanta, Georgia; Department of Psychology (Hornstein), Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychology and Neuroscience (Nelson), University of North Carolina Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology (Forman-Hoffman), The University of Iowa, Iowa City, Iowa; and Department of Epidemiology and Population Health (Peiper), University of Louisville, Louisville, Kentucky
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Adepoju OE, Kim LH, Starks SM. Hospital Length of Stay in Patients with and without Serious and Persistent Mental Illness: Evidence of Racial and Ethnic Differences. Healthcare (Basel) 2022; 10:healthcare10061128. [PMID: 35742179 PMCID: PMC9223052 DOI: 10.3390/healthcare10061128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Prior studies have documented racial and ethnic differences in mental healthcare utilization, and extensively in outpatient treatment and prescription medication usage for mental health disorders. However, limited studies have investigated racial and ethnic differences in length of inpatient stay (LOS) in patients with and without Serious and Persistent Mental Illness. Understanding racial and ethnic differences in LOS is necessary given that longer stays in hospital are associated with adverse health outcomes, which in turn contribute to health inequities. Objective: To examine racial and ethnic differences in length of stay among patients with and without serious and persistent mental illness (SPMI) and how these differences vary in two age cohorts: patients aged 18 to 64 and patients aged 65+. Methods: This study employed a retrospective cohort design to address the research objective, using the 2018 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample. After merging the 2018 National Inpatient Sample’s Core and Hospital files, Generalized Linear Model (GLM), adjusting for covariates, was applied to examine associations between race and ethnicity, and length of stay for patients with and without SPMI. Results: Overall, patients from racialized groups were likely to stay longer than White patients regardless of severe mental health status. Of all races and ethnicities examined, Asian patients had the most extended stays in both age cohorts: 8.69 days for patients with SPMI and 5.73 days for patients without SPMI in patients aged 18 to 64 years and 8.89 days for patients with SPMI and 6.05 days for patients without SPMI in the 65+ cohort. For individuals aged 18 to 64, differences in length of stay were significantly pronounced in Asian patients (1.6 days), Black patients (0.27 days), and Native American patients/patients from other races (0.76 days) if they had SPMI. For individuals aged 65 and older, Asian patients (1.09 days) and Native American patients/patients from other races (0.45 days) had longer inpatient stays if they had SPMI. Conclusion: Racial and ethnic differences in inpatient length of stay were most pronounced in Asian patients with and without SPMI. Further studies are needed to understand the mechanism(s) for these differences.
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Affiliation(s)
- Omolola E. Adepoju
- Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, Houston, TX 77204, USA;
- Humana Integrated Health Systems Sciences Institute, University of Houston, Houston, TX 77204, USA;
- Correspondence:
| | - Lyoung H. Kim
- Humana Integrated Health Systems Sciences Institute, University of Houston, Houston, TX 77204, USA;
| | - Steven M. Starks
- Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, Houston, TX 77204, USA;
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Ge F, Huo Z, Wen Y. Incidence trends of major depressive disorder in 204 countries and territories between 1993 and 2017. J Affect Disord 2022; 296:241-243. [PMID: 34619450 DOI: 10.1016/j.jad.2021.09.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Fan Ge
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China; Department of Clinical Medicine, First Clinical School, Guangzhou Medical University, Guangzhou, 511436, China.
| | - Zhenyu Huo
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China; Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Yaokai Wen
- School of Medicine, Tongji University, Shanghai, 200092, China; Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, 200433, China
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Im H, Swan LET. Working towards Culturally Responsive Trauma-Informed Care in the Refugee Resettlement Process: Qualitative Inquiry with Refugee-Serving Professionals in the United States. Behav Sci (Basel) 2021; 11:155. [DOI: https:/doi.org/10.3390/bs11110155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Trauma-informed care (TIC) approaches have gained popularity in various contexts of human services over the past decades. However, relatively little has been explored about how it is applicable and built into services for refugee populations in resettlement programs. This study explores the current status of the application of TIC in refugee-serving agencies and identifies perceived and experienced challenges and opportunities for culturally responsive TIC in the United States. As designed as part of the evaluation of state-wide refugee health promotion programs, this study conducted individual interviews with 78 refugee service providers from five resettlement sites. Despite the burgeoning interest and attempt to embrace TIC, our findings show that there is clear inconsistency and inexperience in TIC adaptation in resettlement programs. This study highlights that TIC that is culturally responsive and relevant to refugee trauma and acculturation experiences is a vital way to address the chasms between refugee-specific programs and mainstream services including mental health care systems. This study also discusses community resources and opportunities to bridge the deep divide and substantial gaps between mental health services and refugee resettlement services and to address comprehensive needs around mental health and wellness in the refugee community.
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Im H, Swan LET. Working towards Culturally Responsive Trauma-Informed Care in the Refugee Resettlement Process: Qualitative Inquiry with Refugee-Serving Professionals in the United States. Behav Sci (Basel) 2021; 11:bs11110155. [PMID: 34821616 PMCID: PMC8614655 DOI: 10.3390/bs11110155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 12/04/2022] Open
Abstract
Trauma-informed care (TIC) approaches have gained popularity in various contexts of human services over the past decades. However, relatively little has been explored about how it is applicable and built into services for refugee populations in resettlement programs. This study explores the current status of the application of TIC in refugee-serving agencies and identifies perceived and experienced challenges and opportunities for culturally responsive TIC in the United States. As designed as part of the evaluation of state-wide refugee health promotion programs, this study conducted individual interviews with 78 refugee service providers from five resettlement sites. Despite the burgeoning interest and attempt to embrace TIC, our findings show that there is clear inconsistency and inexperience in TIC adaptation in resettlement programs. This study highlights that TIC that is culturally responsive and relevant to refugee trauma and acculturation experiences is a vital way to address the chasms between refugee-specific programs and mainstream services including mental health care systems. This study also discusses community resources and opportunities to bridge the deep divide and substantial gaps between mental health services and refugee resettlement services and to address comprehensive needs around mental health and wellness in the refugee community.
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Affiliation(s)
- Hyojin Im
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Ave., 3rd Floor, Richmond, VA 23284, USA
- Correspondence: ; Tel.: +1-804-828-2607
| | - Laura E. T. Swan
- Department of Population Health Sciences, University of Wisconsin, Madison, WI 53726, USA;
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Lee M, Bhimla A, Ma GX. Depressive Symptom Severity and Immigration-Related Characteristics in Asian American Immigrants. J Immigr Minor Health 2020; 22:935-945. [PMID: 32221768 PMCID: PMC7442700 DOI: 10.1007/s10903-020-01004-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The study examined immigration factors associated with depressive symptom severity among Asian American immigrants. Participants were 458 Chinese, Korean and Vietnamese adults. Depressive symptom severity was measured by PHQ-9. Overall, the likelihood of being moderately to severely depressed was significantly increased among immigrants living in the US for < 10 years and Korean Americans compared to Chinese Americans. However, mild level of depressive symptoms was not associated with any immigration-related factors. The positive impact of shorter duration of living in the US and a younger age at immigration (≤ 17) on depressive symptoms was evident among women but not among men. For men, marital status and education level were significant predictors of being moderately to severely depressed. Differentiating immigrant factors and identifying depressive symptom severity can help drive community and clinical interventions to detect and treat depression early among Asian American immigrants.
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Affiliation(s)
- Minsun Lee
- Lewis Katz School of Medicine, Center for Asian Health, Temple University, Philadelphia, PA, USA.
| | - Aisha Bhimla
- Lewis Katz School of Medicine, Center for Asian Health, Temple University, Philadelphia, PA, USA
| | - Grace X Ma
- Lewis Katz School of Medicine, Center for Asian Health, Temple University, Philadelphia, PA, USA
- Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, 3440 N Broad St., Kresge Bldg, Ste. 325, Philadelphia, PA, 19140-4106, USA
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Roystonn K, Vaingankar JA, Chua BY, Sambasivam R, Shafie S, Jeyagurunathan A, Verma S, Abdin E, Chong SA, Subramaniam M. The Public Health Impact and Policy Implications of Online Support Group Use for Mental Health in Singapore: Cross-Sectional Survey. JMIR Ment Health 2020; 7:e18114. [PMID: 32749231 PMCID: PMC7435627 DOI: 10.2196/18114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/13/2020] [Accepted: 06/06/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The wide mental health treatment gap continues to pose a global and local public health challenge. Online support groups are on the rise and could be used to complement formal treatment services for mental health. OBJECTIVE This study aimed to examine the prevalence of online support group use and explore factors associated with the use in the general population using data from a national cross-sectional mental health survey in Singapore. METHODS Singapore residents aged 18 years and above participated in a nationally representative household survey in which the World Health Organization Composite International Diagnostic Interview 3.0 was administered by trained interviewers to examine the use of online support groups for mental health. Multiple logistic regressions were used to analyze the association of online support group use with various sociodemographic and health factors. RESULTS A total of 6110 respondents with complete data were included in this study. Overall, 10 individuals per 1000 adults (1%) reported seeking help from online support groups for their mental health problems. Compared to younger adults (those aged 18 to 34 years) and those with university education, individuals aged 50 to 64 years (P<.001; OR 0.1, 95% CI 0.0-0.3) and those with preuniversity qualifications (P=.02; OR 0.1, 95% CI 0.0-0.8) were less likely to use online support groups for mental health, respectively. Participants with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorder were 6.8 times more likely (P<.001; 95% CI 3.0-15.4) to use an online support group; in particular, individuals with major depressive disorder (P<.001; OR 5.4, 95% CI 2.1-13.8) and obsessive compulsive disorder (P=.01; OR 3.5, 95% CI 1.3-9.7) were more likely to use an online support group for their mental health. CONCLUSIONS Online support groups could be used to complement formal treatment services, especially for mood and anxiety-related disorders. As online support group use for mental health issues may be more prevalent among younger people, early detection and accurate information in online support groups may guide individuals toward seeking professional help for their mental health problems.
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Affiliation(s)
| | | | - Boon Yiang Chua
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Saleha Shafie
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Swapna Verma
- Clinical Education, Office of Education, Duke-NUS Medical School, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Lee M, Bhimla A, Lu W, Ma GX. Correlates of Mental Health Treatment Receipt Among Asian Americans with Perceived Mental Health Problems. J Behav Health Serv Res 2020; 48:199-212. [PMID: 32347427 DOI: 10.1007/s11414-020-09704-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Compared with other ethnic groups, Asian Americans report the lowest rates of mental health treatment and service utilization. This is true even among Asian Americans with mental illness, which indicates that the underutilization of mental health services is not due to the low prevalence of mental health disorders in this population. This study examined which sociodemographic factors, types of mental health problems, and barriers to treatment were associated with the treatment receipt among 126 Asian Americans who reported perceived mental health problems. Among sociodemographic factors, Chinese ethnicity and advanced English proficiency were associated with increased treatment receipt. Controlling for demographic variables, mental health problems such as psychosis, depression, and a history of abuse or trauma significantly increased the likelihood of receiving treatment, whereas addiction showed a tendency of decreased treatment receipt. Among reported barriers, difficulty finding a culturally appropriate therapist appeared to be an important barrier among Asian Americans with perceived mental health problems.
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Affiliation(s)
- Minsun Lee
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA, 19140, USA.
| | - Aisha Bhimla
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Wenyue Lu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA, 19140, USA
- Department of Sociology, College of Liberal Arts, Temple University, 1115 Polett Walk, Philadelphia, PA, 19122, USA
| | - Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA, 19140, USA
- Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, 3500 N. Broad Street, Philadelphia, PA, 19140, USA
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Martinez AB, Co M, Lau J, Brown JSL. Filipino help-seeking for mental health problems and associated barriers and facilitators: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1397-1413. [PMID: 32816062 PMCID: PMC7578164 DOI: 10.1007/s00127-020-01937-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 08/07/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE This systematic review aims to synthesise the evidence on behavioural and attitudinal patterns as well as barriers and enablers in Filipino formal help-seeking. METHODS Using PRISMA framework, 15 studies conducted in 7 countries on Filipino help-seeking were appraised through narrative synthesis. RESULTS Filipinos across the world have general reluctance and unfavourable attitude towards formal help-seeking despite high rates of psychological distress. They prefer seeking help from close family and friends. Barriers cited by Filipinos living in the Philippines include financial constraints and inaccessibility of services, whereas overseas Filipinos were hampered by immigration status, lack of health insurance, language difficulty, experience of discrimination and lack of acculturation to host culture. Both groups were hindered by self and social stigma attached to mental disorder, and by concern for loss of face, sense of shame, and adherence to Asian values of conformity to norms where mental illness is considered unacceptable. Filipinos are also prevented from seeking help by their sense of resilience and self-reliance, but this is explored only in qualitative studies. They utilize special mental health care only as the last resort or when problems become severe. Other prominent facilitators include perception of distress, influence of social support, financial capacity and previous positive experience in formal help. CONCLUSION We confirmed the low utilization of mental health services among Filipinos regardless of their locations, with mental health stigma as primary barrier, while resilience and self-reliance as coping strategies were cited in qualitative studies. Social support and problem severity were cited as prominent facilitators.
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Affiliation(s)
- Andrea B. Martinez
- grid.11159.3d0000 0000 9650 2179Department of Behavioral Sciences, College of Arts and Sciences, University of the Philippines Manila, Manila, Philippines ,grid.13097.3c0000 0001 2322 6764Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - Melissa Co
- grid.13097.3c0000 0001 2322 6764Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - Jennifer Lau
- grid.13097.3c0000 0001 2322 6764Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - June S. L. Brown
- grid.13097.3c0000 0001 2322 6764Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
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Abstract
UNLABELLED ABSTRACTObjectives:This study aimed to determine the diagnostic utility of a Chinese test battery for evaluating cognitive loss in elderly Chinese Americans. METHODS Data from a pilot study at the Mount Sinai Alzheimer's Disease Research Center was examined. All participants were > 65 years old, primarily Chinese speaking, with adequate sensorimotor capacity to complete cognitive tests. A research diagnosis of normal mild cognitive impairment (MCI) or Alzheimer's disease (AD) was assigned to each participant in consensus conference. Composite scores were created to summarize test performance on overall cognition, memory, attention executive function, and language. Multivariable logistic regression models were used to assess the sensitivity of each cognitive domain for discriminating three diagnostic categories. Adjustment was made for demographic variables (i. e., age, gender, education, primary language, and years living in the USA). RESULTS The sample included 67 normal, 37 MCI, and 12 AD participants. Performance in overall cognition, memory, and attention executive function was significantly worse in AD than in MCI, and performance in MCI was worse than in normal controls. Language performance followed a similar pattern, but differences did not achieve statistical significance among the three diagnostic groups. CONCLUSIONS This study highlights the need for cognitive assessment in elderly Chinese immigrants.
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Gopalkrishnan N. Cultural Diversity and Mental Health: Considerations for Policy and Practice. Front Public Health 2018; 6:179. [PMID: 29971226 PMCID: PMC6018386 DOI: 10.3389/fpubh.2018.00179] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 05/31/2018] [Indexed: 11/13/2022] Open
Abstract
The purpose of this paper is to explore some of the key considerations that lie at the intersection of cultural diversity and mental health. Mental health providers and professionals across the world have to work with clients that are often from cultures other than their own. The differences in cultures have a range of implications for mental health practice, ranging from the ways that people view health and illness, to treatment seeking patterns, the nature of the therapeutic relationship and issues of racism and discrimination. This paper will excavate some of these considerations with a view to raising possible ways in which mental health systems and professionals can engage across cultures more equitably and sustainably.
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Lee M, Takeuchi D, Gellis Z, Kendall P, Zhu L, Zhao S, Ma GX. The Impact of Perceived Need and Relational Factors on Mental Health Service Use Among Generations of Asian Americans. J Community Health 2018; 42:688-700. [PMID: 27999991 DOI: 10.1007/s10900-016-0305-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The present study examined generational differences in the patterns and predictors of formal and informal mental health service utilization among a nationally representative sample of 1850 Asian Americans from the National Latino and Asian American Study. We focused on the effects of perceived need and relational factors on service utilization among 1st-, 1.5-, and 2nd-generation Asian Americans. Results of hierarchical logistic regression showed significant intergenerational differences. Specifically, 1.5-generation Asian Americans exhibited distinctive pattern of service use, with perceived need being associated with a higher likelihood of using formal mental health services, but only for those with high level of social support. First- and second-generation Asian Americans, on the other hand, perceived need was independently associated with formal service use, and a significant predictor of informal service use for first generation. Greater family conflict was also associated with greater use of formal and informal services for both first- and second generations. However, family cohesion was associated with only informal service use among first -generation Asian Americans. Implications for mental health service policy were discussed.
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Affiliation(s)
- Minsun Lee
- Department of Clinical Sciences, Lewis Katz School of Medicine, Center for Asian Health, Temple University, Philadelphia, PA, USA
| | - David Takeuchi
- Research in Social, Economic and Environmental Equity, School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Zvi Gellis
- School of Social Policy & Practice, Center for Mental Health & Aging, University of Pennsylvania, Philadelphia, PA, USA
| | - Philip Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Lin Zhu
- Department of Clinical Sciences, Lewis Katz School of Medicine, Center for Asian Health, Temple University, Philadelphia, PA, USA.,Department of Sociology, Temple University, Philadelphia, PA, USA
| | - Shanyang Zhao
- Department of Sociology, Temple University, Philadelphia, PA, USA
| | - Grace X Ma
- Department of Clinical Sciences, Lewis Katz School of Medicine, Center for Asian Health, Temple University, Philadelphia, PA, USA.
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Park H, Choi E, Park YS, Wenzel JA. Racial and Ethnic Differences in Mental Health among Asian Americans and Non-Hispanic Whites: Based on California Health Interview Survey. Issues Ment Health Nurs 2018; 39:208-214. [PMID: 29182435 DOI: 10.1080/01612840.2017.1379575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
While Asians are becoming the largest ethnic group in the United States, studies have focused on Asians as a single population. The purpose of this study was to explore the racial and ethnic mental health differences between non-Hispanic Whites and Asians, with an emphasis on understudied subgroups, from the California Health Interview Survey 2011/2012. In this dataset Asians had significantly lower adjusted odds ratios for both mental distress and serious mental illness. However, when Asians were divided into subgroups and compared to Whites, Vietnamese and Japanese subgroups were significantly lower than Whites for mental distress while Koreans were significantly higher. Vietnamese and Chinese were found to have significantly less serious mental illness than Whites in the subgroup analyses. Our results underscore the importance of recognizing that Asian subgroups should not be overlooked, and all Asians should not automatically be treated as a homogenous group.
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Affiliation(s)
- Hyunjeong Park
- a Department of Nursing , Towson University , Towson , Maryland , USA
| | - Eunsuk Choi
- b Kyungpook National University , School of Nursing & Research Institute of Nursing Science , Daegu , South Korea
| | - Young-Su Park
- c Department of Nursing , Catholic University of Pusan , Busan , South Korea
| | - Jennifer A Wenzel
- d School of Nursing , The Johns Hopkins University , Baltimore , Maryland , USA
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Lasebikan VO, Ayinde O. Profile and Determinants of Disability in Psychotic Disorders in Nigeria. Community Ment Health J 2017; 53:936-950. [PMID: 27909826 DOI: 10.1007/s10597-016-0070-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
Abstract
We compared profile and predictors of disability among 210 patients with schizophrenia, schizoaffective disorder, bipolar I disorder with psychosis and depression with psychosis, respectively in a Nigerian clinical population, using the WHO Disability Assessment Schedule, (2.0). Severity of psychosis was determined with Positive and Negative Symptoms Scale, functioning was assessed using the Global Assessment of Functioning Scale, medication adherence with the Medication Adherence Questionnaire. Analyses were by SPSS 20.0. There were remarkable differences in the predictors of disability across these psychotic disorders. The findings strengthens the significance of psychosocial rehabilitation in patients with psychosis as clinical remission and medication adherence did not equate functional recovery.
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Affiliation(s)
| | - Olatunde Ayinde
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
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Wang SC, Iwamasa GY. Indigenous Healing Practices and Asian Immigrant Women. WOMEN & THERAPY 2017. [DOI: 10.1080/02703149.2017.1330917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sherry C. Wang
- Department of Counseling Psychology, Santa Clara University, Santa Clara, California
| | - Gayle Y. Iwamasa
- Department of Veterans Affairs, VA Central Office, Office of Mental Health Operations, Washington, D.C
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Depression Risks and Correlates among Different Generations of Chinese Americans: The Effects of Relationships with Friends and Relatives. SOCIAL SCIENCES-BASEL 2017. [DOI: 10.3390/socsci6020056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
PURPOSE This study described and evaluated the rapid recruitment of elderly Chinese into clinical research at the Mount Sinai Alzheimer's Disease Research Center (MSADRC). DESIGN AND METHODS Methods of publicizing the study included lectures to local senior centers/churches and publications in local Chinese newspapers. The amount of time and success of these methods were evaluated. A "go to them" model of evaluation was used to enable participants to complete the study visit at locations where they were comfortable. RESULTS From January to December 2015, we recruited 98 participants aged 65 years or older who primarily speak Mandarin/Cantonese and reside in New York. The mean age and years of education was 73.93±6.34 and 12.79±4.58, respectively. The majority of participants were female (65.3%) and primarily Mandarin speaking (53.1%). Of all enrollees, 54.1% were recruited from community lectures, 29.6% through newspapers, 10.2% through word of mouth, and 6.1% from our clinical services. About 40.8% of participants underwent evaluations at the MSADRC, 44.9% at local senior centers/churches, and 14.3% at home. IMPLICATIONS Given that the majority of our participants had low English proficiency, the use of bilingual recruiters probably allowed us to overcome the language barrier, facilitating recruitment. Our "go to them" model of evaluation is another important factor contributing to our successful recruitment.
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Wong EC, Marshall GN, Schell TL, Berthold SM, Hambarsoomians K. Characterizing the Mental Health Care of U.S. Cambodian Refugees. Psychiatr Serv 2015; 66:980-4. [PMID: 25975890 PMCID: PMC4558388 DOI: 10.1176/appi.ps.201400368] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined U.S. Cambodian refugees' utilization of mental health services across provider types, levels of minimally adequate care, and mode of communication with providers. METHODS Face-to-face household interviews about mental health service use in the past 12 months were conducted as part of a study of a probability sample of Cambodian refugees. The analytic sample was restricted to the 227 respondents who met past 12-month criteria for posttraumatic stress disorder (PTSD) or major depressive disorder or both. Analyses were weighted to account for complex sampling design effects and for attrition. RESULTS Fifty-two percent of Cambodian refugees who met diagnostic criteria obtained mental health services in the past 12 months. Of those who obtained care, 75% visited a psychiatrist and 56% a general medical provider. Only 7% had obtained care from other mental health specialty providers. Virtually all respondents who had seen a psychiatrist (100%) or a general medical doctor (97%) had been prescribed a psychotropic medication. Forty-five percent had received minimally adequate care. Most relied on interpreters to communicate with providers. CONCLUSIONS Cambodian refugees' rates of mental health service utilization and minimally adequate care were comparable to those of individuals in the general U.S. POPULATION Cambodian refugees obtained care almost entirely from psychiatrists and general medical doctors, and nearly all were receiving pharmacotherapy; these findings differ from rates seen in a nationally representative sample. Given this pattern of utilization, and the persistently high levels of PTSD and depression found among Cambodian refugees, treatment improvements may require identification of creative approaches to delivering more evidence-based psychotherapy.
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Affiliation(s)
- Eunice C Wong
- The authors are with RAND Corporation, Santa Monica, California (e-mail: ). Dr. Berthold is also with the School of Social Work, University of Connecticut, West Hartford
| | - Grant N Marshall
- The authors are with RAND Corporation, Santa Monica, California (e-mail: ). Dr. Berthold is also with the School of Social Work, University of Connecticut, West Hartford
| | - Terry L Schell
- The authors are with RAND Corporation, Santa Monica, California (e-mail: ). Dr. Berthold is also with the School of Social Work, University of Connecticut, West Hartford
| | - S Megan Berthold
- The authors are with RAND Corporation, Santa Monica, California (e-mail: ). Dr. Berthold is also with the School of Social Work, University of Connecticut, West Hartford
| | - Katrin Hambarsoomians
- The authors are with RAND Corporation, Santa Monica, California (e-mail: ). Dr. Berthold is also with the School of Social Work, University of Connecticut, West Hartford
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