Australian Indigenous Clients with a Borderline Personality Disorder Diagnosis: A Contextual Review of the Literature

What can Somali community talk about mental health tell us about our own? Contextualizing the symptoms of mental health

Purpose

The purpose of this paper is to review all the research on Somali refugee communities’ “explanatory models” of “mental health” or psychological suffering, and also report original research in order to allow for more contexts on their “mental health” terms to emerge.

Design/methodology/approach

The authors talked in a conversational manner with a small number (11) of Somali people (10 females and 1 male), but this was done intensively over time and on multiple occasions. They discussed their community terms for “mental health” issues but in their own contexts and with their own examples.

Findings

The results showed that Somali as a community had three main groupings of symptoms: Jinn or spirit possession; waali or “craziness”; and a group of terms for serious anxieties, rumination, worrying and thinking too much. What was new from their broader descriptions of context was that the community discourses were based on particular contexts of the person and their behavior within their life history, rather than aiming to universal categories like the DSM.

Practical implications

Both research and practice on mental health should focus less on universal diagnoses and more on describing the contexts in which the symptoms emerge and how to change those contexts, especially with refugee and other less well-understood groups.

Originality/value

The review and original results support symptom-based or contextual approaches to mental health; we should treat the “mental health” symptoms in their life contexts rather than as a disease or disorder. We can learn from how Somali describe their “mental health” symptoms rather than treat their descriptions as crude forms of the “correct” western diagnostics.

Does Indigenous health research have impact? A systematic review of reviews

Background

Aboriginal and Torres Strait Islander Australians (hereafter respectfully Indigenous Australians) claim that they have been over-researched without corresponding research benefit. This claim raises two questions. The first, which has been covered to some extent in the literature, is about what type(s) of research are likely to achieve benefits for Indigenous people. The second is how researchers report the impact of their research for Indigenous people. This systematic review of Indigenous health reviews addresses the second enquiry.

Methods

Fourteen electronic databases were systematically searched for Indigenous health reviews which met eligibility criteria. Two reviewers assessed their characteristics and methodological rigour using an a priori protocol. Three research hypotheses were stated and tested: (1) reviews address Indigenous health priority needs; (2) reviews adopt best practice guidelines on research conduct and reporting in respect to methodological transparency and rigour, as well as acceptability and appropriateness of research implementation to Indigenous people; and (3) reviews explicitly report the incremental impacts of the included studies and translation of research. We argue that if review authors explicitly address each of these three hypotheses, then the impact of research for Indigenous peoples’ health would be explicated.

Results

Seventy-six reviews were included; comprising 55 journal articles and 21 Australian Government commissioned evidence review reports. While reviews are gaining prominence and recognition in Indigenous health research and increasing in number, breadth and complexity, there is little reporting of the impact of health research for Indigenous people. This finding raises questions about the relevance of these reviews for Indigenous people, their impact on policy and practice and how reviews have been commissioned, reported and evaluated.

Conclusions

The findings of our study serve two main purposes. First, we have identified knowledge and methodological gaps in documenting Indigenous health research impact that can be addressed by researchers and policy makers. Second, the findings provide the justification for developing a framework allowing researchers and funding bodies to structure future Indigenous health research to improve the reporting and assessment of impact over time.

Electronic supplementary material

The online version of this article (doi:10.1186/s12939-017-0548-4) contains supplementary material, which is available to authorized users.

Culture and personality disorder: a focus on Indigenous Australians

PURPOSE OF REVIEW

To examine the validity of concept and diagnosis of personality disorder in transcultural settings using Indigenous Australian people as an example.

RECENT FINDINGS

There are significant deficits in comparative research on personality disorders across cultures. There is also a dearth of information regarding Indigenous Australians, and cultural applicability and clinical utility of the diagnosis of personality disorder in this group.

SUMMARY

The concept of culture is generally ignored when making a diagnosis of personality disorder. A valid diagnosis should incorporate what would be considered understandable and adaptive behavior in a person's culture. In Indigenous Australian culture, making diagnosis of a personality disorder is complicated by historical trauma from colonization, disruption of kinship networks, and ongoing effects of poverty and social marginalization.