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Ahuvia IL, Sotomayor I, Kwong K, Lam FW, Mirza A, Schleider JL. Causal beliefs about mental illness: A scoping review. Soc Sci Med 2024; 345:116670. [PMID: 38402842 DOI: 10.1016/j.socscimed.2024.116670] [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: 08/21/2023] [Revised: 11/02/2023] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
Research on causal beliefs about mental illness-the beliefs people hold about what causes a particular mental illness, or mental illnesses in general-is split across a number of theories and disciplines. Although research on this subject has provided a number of insights and practical applications, the diversity of theories, terminology, and keywords makes it challenging for a new reader to gain a comprehensive understanding. We sought to address this by conducting a systematic scoping review of research on causal beliefs. This review included English-language articles from any year that mentioned causal beliefs for mental illness in their title or abstract. We identified articles in two stages. In the first stage, we used a narrow set of search terms referring specifically to causal beliefs (1227 records identified, 417 included). In the second stage, we used a comprehensive set of terms relevant to research on causal beliefs (10,418 records identified, 3838 included). We analyzed articles qualitatively, organizing them into one of five theories or categories: the common-sense model of self-regulation, explanatory models, mental health literacy, biogenetic causal beliefs, and other research on causal beliefs. We provide a comprehensive summary of these literatures in terms of their history, typical research questions and study design, findings, and practical applications. These theories differ in their theoretical orientation towards causal beliefs, research methods, findings, and applications. However, they broadly share a view of causal beliefs as multifaceted, culturally determined, and relevant for additional psychosocial variables such as mental illness stigma and help-seeking. We conclude by making recommendations for researchers, clinicians, public health messaging, and for individuals with mental illness.
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Affiliation(s)
- Isaac L Ahuvia
- Stony Brook University, Department of Psychology Stony Brook University, Stony Brook, NY, 11794-2500, USA.
| | - Ian Sotomayor
- Stony Brook University, Department of Psychology Stony Brook University, Stony Brook, NY, 11794-2500, USA
| | - Kelly Kwong
- Stony Brook University, Department of Psychology Stony Brook University, Stony Brook, NY, 11794-2500, USA
| | - Fiona W Lam
- Stony Brook University, Department of Psychology Stony Brook University, Stony Brook, NY, 11794-2500, USA
| | - Aqsa Mirza
- New York University Steinhardt School of Culture, Education, and Human Development 246 Greene St. New York, NY 10003, USA
| | - Jessica L Schleider
- Northwestern University Feinberg School of Medicine Department of Medical Social Sciences, 625 N. Michigan Ave., 21st Floor, Chicago, IL, 60611, USA
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Ghanem M, Evangeli-Dawson C, Georgiades A. The role of culture on the phenomenology of hallucinations and delusions, explanatory models, and help-seeking attitudes: A narrative review. Early Interv Psychiatry 2023; 17:843-863. [PMID: 37458202 DOI: 10.1111/eip.13449] [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: 12/05/2022] [Revised: 02/23/2023] [Accepted: 07/02/2023] [Indexed: 09/07/2023]
Abstract
AIM Culture has been posited to be involved in the formation and maintenance of delusions and hallucinations. The extent of these differences and how they affect explanatory models of psychosis and help-seeking attitudes remains to be understood. This review aims to present a cultural formulation to account for psychosis onset, symptom maintenance, and help-seeking attitudes. METHODS A narrative review was conducted to summarize the existing evidence base regarding cross-cultural differences in hallucinatory and delusional prevalence, explanatory models, and help-seeking attitudes in First Episode Psychosis (FEP) and Non-FEP Schizophrenia samples. RESULTS Sixteen studies were eligible for inclusion. In terms of positive symptom specificity, cross-cultural differences were found. Specifically, auditory and visual hallucinations occurred most frequently in African patients, persecutory and grandiose delusions occurred at higher rates in African, Pakistani, and Latino patients, while delusions of reference were most prevalent in White-British groups. Three explanatory models were identified. Westerners tended to endorse a bio-psychosocial explanation, which was associated with increased help-seeking, engagement, and positive medication attitudes. Asian, Latino, Polish, and Māori patients endorsed religious-spiritual explanatory models, while African patients opted for a bewitchment model. The religious-spiritual and bewitchment models were associated with a longer duration of untreated psychosis (DUP) and poorer engagement with mental health services. CONCLUSIONS These findings highlight the important influence of culture in the formation and maintenance of positive symptoms of psychosis, engagement, and help-seeking attitudes across different ethnic groups. The incorporation of cultural beliefs in formulation development could facilitate enriched CBTp practices and improved engagement amongst different cultural groups with Early Intervention Services.
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Affiliation(s)
- Mawada Ghanem
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Brent Early Intervention Service, CNWL, NHS Foundation Trust, London, UK
| | - Christian Evangeli-Dawson
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Brent Early Intervention Service, CNWL, NHS Foundation Trust, London, UK
| | - Anna Georgiades
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Brent Early Intervention Service, CNWL, NHS Foundation Trust, London, UK
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Patel K, Cardno A, Isherwood T. ' Like I said about culture. You don't talk about mental health ' : An interpretative phenomenological analysis of the experience of first-episode psychosis in South Asian individuals. Early Interv Psychiatry 2023; 17:771-783. [PMID: 36639135 DOI: 10.1111/eip.13368] [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: 06/03/2022] [Revised: 09/27/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND There is strong evidence of inequalities in mental healthcare access, experiences and outcomes for service users belonging to Black and Asian Minority Ethnic groups experiencing psychosis. Clinicians and academics have speculated that cultural variation in conceptualisations of psychosis, alongside inequitable service provision may explain disparities. There is, however, a dearth of literature exploring this in a South Asian population, despite this ethnic group being the second largest in the United Kingdom. The present study aimed to explore how people from this minority group have experienced and made sense of first-episode psychosis (FEP). METHODS A qualitative approach was used to explore the lived experience and sense-making of South Asian individuals experiencing FEP and accessing early intervention services. Eight people were interviewed using a semi-structured format. The data were analysed using Interpretative Phenomenological Analysis. RESULTS Three superordinate themes were identified in the group analysis: (1) Disconnection from self and others (2) Doubt and dispute (3) Power and shame. CONCLUSIONS Distinctive ethnic, cultural and systemic influences were strongly evident in how people conceptualized their experiences, how they managed their sense-making and where they sought support. Experiences were discussed in the context of power and shame, and this research proposes that socio-cultural context and racialised discourses have an impact on self-concept, the experiences of help-seeking (formal and informal), and fundamentally how services help individuals from marginalized communities.
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Affiliation(s)
- Krisna Patel
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alastair Cardno
- Psychological & Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tom Isherwood
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Farooq S, Sheikh S, Dikomitis L, Haq MMU, Khan AJ, Sanauddin N, Ali MW, Ali J, Khan MF, Chaudhry I, Husain N, Gul M, Irfan M, Andrews G, Kaistha P, Shah SMU, Azeemi I, Hamid S, Minhaz A, Mallen C, Lewis M. Traditional healers working with primary care and mental health for early intervention in psychosis in young persons: protocol for the feasibility cluster randomised controlled trial. BMJ Open 2023; 13:e072471. [PMID: 37451736 PMCID: PMC10351321 DOI: 10.1136/bmjopen-2023-072471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES In low/middle-income countries (LMICs), more than half of patients with first-episode psychosis initially seek treatment from traditional and religious healers as their first care. This contributes to an excessively long duration of untreated psychosis (DUP). There is a need for culturally appropriate interventions to involve traditional and spiritual healers to work collaboratively with primary care practitioners and psychiatrists through task-shifting for early detection, referral and treatment of first episode of psychosis. METHODS To prevent the consequences of long DUP in adolescents in LMICs, we aim to develop and pilot test a culturally appropriate and context-bespoke intervention. Traditional HEalers working with primary care and mental Health for early interventiOn in Psychosis in young pErsons (THE HOPE) will be developed using ethnographic and qualitative methods with traditional healers and caregivers. We will conduct a randomised controlled cluster feasibility trial with a nested qualitative study to assess study recruitment and acceptability of the intervention. Ninety-three union councils in district Peshawar, Pakistan will be randomised and allocated using a 1:1 ratio to either intervention arm (THE HOPE) or enhanced treatment as usual and stratified by urban/rural setting. Data on feasibility outcomes will be collected at baseline and follow-up. Patients, carers, clinicians and policymakers will be interviewed to ascertain their views about the intervention. The decision to proceed to the phase III trial will be based on prespecified stop-go criteria. ETHICS AND DISSEMINATION Ethical approval has been obtained from Keele University Ethical Review Panel (ref: MH210177), Khyber Medical University Ethical Review Board (ref: DIR/KMU-EB/IG/001005) and National Bioethics Committee Pakistan (ref no. 4-87/NBC-840/22/621). The results of THE HOPE feasibility trial will be reported in peer-reviewed journals and academic conferences and disseminated to local stakeholders and policymakers. TRIAL REGISTRATION NUMBER ISRCTN75347421.
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Affiliation(s)
- Saeed Farooq
- School of Primary, Community and Social Care, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Saima Sheikh
- School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Lisa Dikomitis
- Kent and Medway Medical School, University of Kent, Canterbury, UK
| | | | - Abdul Jalil Khan
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Noor Sanauddin
- Department of Sociology, University of Peshawar, Peshawar, Pakistan
| | | | - Johar Ali
- Department of Sociology, University of Peshawar, Peshawar, Pakistan
| | | | - Imran Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Pakistan
- Ziauddin University Hospital, Karachi, Pakistan
| | - Nusrat Husain
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Muhammad Gul
- Research and Innovation, Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Muhammad Irfan
- Department of Mental Health, Psychiatry & Behavioral Sciences, Peshawar Medical College, Peshawar, Pakistan
- Riphah International University, Islamabad, Pakistan
| | - Gabrielle Andrews
- Research and Innovation, Midlands Partnership NHS Foundation Trust, Stafford, UK
| | | | | | - Ishfaq Azeemi
- Department of Sociology, University of Peshawar, Peshawar, Pakistan
| | - Shumaila Hamid
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Aaliya Minhaz
- Department of Chemistry, Shaheed Benazir Bhutto Women University, Peshawar, Pakistan
| | - Christian Mallen
- School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Martyn Lewis
- School of Primary, Community and Social Care, Keele University, Keele, UK
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Hedemann TL, Asif M, Aslam H, Maqsood A, Bukhsh A, Kiran T, Ahsan U, Shahzad S, Zaheer J, Lane S, Chaudhry N, Husain MI, Husain MO. Clinicians', patients' and carers' perspectives on borderline personality disorder in Pakistan: A mixed methods study protocol. PLoS One 2023; 18:e0286459. [PMID: 37267274 DOI: 10.1371/journal.pone.0286459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 05/12/2023] [Indexed: 06/04/2023] Open
Abstract
Borderline Personality Disorder (BPD) is a condition characterised by significant social and occupational impairment and high rates of suicide. In high income countries, mental health professionals carry negative attitudes towards patients with BPD, find it difficult to work with patients with BPD, and even avoid seeing these patients. Negative attitudes and stigma can cause patients to fear mistreatment by health care providers and create additional barriers to care. Patients' self-stigma and illness understanding BPD also affects treatment engagement and outcomes; better knowledge about mental illness predicts intentions to seek care. The perspectives of mental health clinicians and patients on BPD have not been researched in the Pakistani setting and likely differ from other settings due to economic, cultural, and health care system differences. Our study aims to understand the attitudes of mental health clinicians towards patients with BPD in Pakistan using a self-report survey. We also aim to explore explanatory models of illness in individuals with BPD and their family members/carers using a Short Explanatory Model Interview (SEMI). The results of this study are important as we know attitudes and illness understanding greatly impact care. Results of this study will help guide BPD-specific training for mental health clinicians who care for patients with BPD and help inform approaches to interventions for patients with BPD in Pakistan.
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Affiliation(s)
| | - Muqaddas Asif
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Huma Aslam
- Department of Psychiatry and Behavioral Sciences, Allama Iqbal Medical College and Jinnah Hospital, Lahore, Pakistan
| | | | - Ameer Bukhsh
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Umair Ahsan
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Salman Shahzad
- Institute of Clinical Psychology, University of Karachi, Karachi, Pakistan
| | - Juveria Zaheer
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Steven Lane
- University of Liverpool, Liverpool, United Kingdom
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - M Omair Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addictions and Mental Health, Toronto, ON, Canada
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Zacharia T. An intercultural perspective toward supporting antipsychotic medication adherence in clinical practice. BJPsych Bull 2023; 47:38-43. [PMID: 35388782 PMCID: PMC10028547 DOI: 10.1192/bjb.2022.19] [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] [Indexed: 02/04/2023] Open
Abstract
In the UK, the incidence of schizophrenia appears highest in Black Caribbean and Black African communities (four- to six-fold that of the White British population). The incidence of psychosis in other minority ethnic groups is also raised, but to a lesser magnitude. Although there are numerous environmental confounding factors, the data stresses the importance of optimising treatment in high-risk (minority) groups. Antipsychotic nonadherence is the most common reason for schizophrenia relapse, and is associated with increased rates of relapse, readmission to hospital and suicide. This article examines available literature to discover how culture can affect antipsychotic nonadherence, and considers culture-based solutions that could enhance antipsychotic adherence. Acknowledging the importance of the therapeutic alliance and sociocultural aspects in antipsychotic adherence, I argue that current cultural competence training provided to clinicians is inadequate. Organisational- and system-level approaches are required to reduce oppressive practise and promote culturally competent, person-centred care.
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Subu MA, Holmes D, Arumugam A, Al-Yateem N, Maria Dias J, Rahman SA, Waluyo I, Ahmed FR, Abraham MS. Traditional, religious, and cultural perspectives on mental illness: a qualitative study on causal beliefs and treatment use. Int J Qual Stud Health Well-being 2022; 17:2123090. [PMID: 36097886 PMCID: PMC9481114 DOI: 10.1080/17482631.2022.2123090] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Limited information is known from studies regarding traditional, religious, and cultural perspectives on mental illness and the use of traditional and alternative therapies by mentally ill people in Indonesia. This study explored traditional, religious, and cultural beliefs about causes of mental illness and the use of traditional/alternative treatments for mentally ill patients. METHOD We adopted a qualitative content analysis method as proposed by Schreier. This study was conducted at a mental Hospital in Indonesia. We interviewed 15 nurses and 15 patients. Data were analysed using qualitative content analysis method. RESULTS Five discrete but interrelated themes emerged: 1) Possessed illness and belief in supernatural forces; 2) Sinful or cursed illness; 3) Witchcraft or human-made illness; 4) traditional/alternative treatments; and 5) Barriers to treatment of mental illness. CONCLUSION Traditional/alternative treatments play an important role in meeting the need for mental health treatment. The findings are relevant for mental health nurses who provide direct to their patients, and for other areas of mental health practice. We also found a lack of knowledge about the causes of mental illness among patients and families. Education should be at the heart of mental health promotion to raise the level of mental health literacy in Indonesia.
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Affiliation(s)
- Muhammad Arsyad Subu
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Adjunct Faculty, Universitas Binawan, Jakarta, Indonesia
| | - Dave Holmes
- Faculty of Health Sciences, University of Ottawa, Ottawa, IL, Canada
| | - Ashokan Arumugam
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Nabeel Al-Yateem
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Adjunct Faculty, Universitas Binawan, Jakarta, Indonesia
| | | | - Syed Azizur Rahman
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Imam Waluyo
- Politeknik Yayasan Cahaya Padmakumara, Jakarta, Indonesia
| | - Fatma Refaat Ahmed
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Mini Sara Abraham
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Abstract
South Asian American (SAA) youth are culturally diverse with respect to migration patterns, language, religion, and social determinants of health. Culturally specific stressors related to family, acculturation, discrimination, and intersectionality converge during developmentally sensitive periods, impacting mental health and identity development. "Model minority" stereotypes and somatic expressions of distress contribute to underdetection and limited perceived need for treatment. SAA families navigate structural barriers, including limited access to culturally tailored services, limited English proficiency, referral bias, and stigma, resulting in underutilization of services. Cultural considerations must be integrated into diagnostic conceptualization and treatment recommendations to effectively engage SAA youth and families in treatment.
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Husain MO, Chaudhry IB, Khan Z, Khoso AB, Kiran T, Bassett P, Husain MI, Upthegrove R, Husain N. Depression and suicidal ideation in schizophrenia spectrum disorder: a cross-sectional study from a lower middle-income country. Int J Psychiatry Clin Pract 2021; 25:245-251. [PMID: 34261408 DOI: 10.1080/13651501.2021.1914664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Depression has long been considered a significant feature of schizophrenia and is associated with more frequent psychotic episodes, increased service utilisation, substance misuse, poor quality of life and completed suicide. However, there is a distinct lack of literature on this comorbidity from low- and middle-income countries or non-western cultural backgrounds. METHODS This is a cross-sectional analysis of baseline data from a large randomised controlled trial, examining the prevalence of depression and suicidal ideation in patients with schizophrenia spectrum disorder. A total of 298 participants were recruited from inpatient and outpatient psychiatric units in Karachi, Pakistan. Participants completed the Calgary Depression Scale for Schizophrenia (CDSS), Positive and Negative Syndrome Scale (PANSS), Euro Qol (EQ-5D) and Social Functioning Scale (SFS). RESULTS Data indicate that 36% of participants in the study were depressed and 18% endorsed suicidal ideation. Depression was associated with higher positive symptom scores and reduced quality of life, but no significant difference in negative symptoms and social functioning. CONCLUSIONS Depression and suicidal ideation are prevalent in Pakistani patients diagnosed with schizophrenia spectrum disorder. Evaluation of depressive symptoms in this group may help identify individuals at higher risk of completed suicide, allowing for targeted interventions to improve outcomes.Key pointsTo our knowledge, this is the first study describing the prevalence of depression and suicidal ideation in individuals with schizophrenia from Pakistan.Our data indicate that 36% of individuals with schizophrenia in our sample were depressed and 18% endorsed suicidal ideation.Depression in schizophrenia was associated with poorer quality of life and higher positive symptom burden.This study adds to the scarce literature from low- and middle-income countries where the burden of mental illness is great and where the majority of suicide deaths occur.Addressing social inequality, food insecurity, high rates of unemployment and low levels of literacy in these settings may have a profound effect on population mental health and suicide risk.
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Affiliation(s)
- M Omair Husain
- Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Pakistan Institute of Living and Learning, Karachi, Pakistan.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Imran B Chaudhry
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK.,Department of Psychiatry, Ziauddin Hospital, Karachi, Pakistan
| | - Zainib Khan
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Ameer B Khoso
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | | - M Ishrat Husain
- Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Tan GTH, Shahwan S, Abdin E, Lau JH, Goh CMJ, Ong WJ, Samari E, Kwok KW, Chong SA, Subramaniam M. Recognition of Depression and Help-Seeking Preference Among University Students in Singapore: An Evaluation of the Impact of Advancing Research to Eliminate Mental Illness Stigma an Education and Contact Intervention. Front Psychiatry 2021; 12:582730. [PMID: 34054591 PMCID: PMC8149891 DOI: 10.3389/fpsyt.2021.582730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 04/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The SMHS 2016 revealed that young adults in Singapore had the highest 12-month prevalence of mental disorders, with depression being the most prevalent condition. Additionally, the study found that those with higher education were less likely to seek treatment. The recognition of mental illness and knowledge of where to seek help has been found to influence one's ability to seek timely psychological help. This study thus aims to evaluate the effects of ARTEMIS, an education and contact intervention on university students' recognition of depression and help-seeking preference. Methods: A total of 390 university students were recruited over a period of 6-months (October 2018 to April 2019). Students had to attend a one-off intervention which comprised a lecture on depression and personal contact with a person with lived experience of mental illness. Recognition of depression and help-seeking preference were assessed using a vignette approach, at pre- and post-intervention as well as at 3-month follow-up. Results: The intervention was effective at improving student's recognition of depression and this effect was sustained at 3-months follow-up. The intervention was also effective in shifting student's help-seeking preference, although the effects were not sustained at 3-month follow-up. Having a close friend or family with mental illness was associated with better recognition, and being able to correctly recognize depression was linked to a preference to seek psychiatric over non-psychiatric help. Conclusion: This study elucidated the efficacy of a knowledge-contact-based intervention in improving university students' recognition of depression and help-seeking preference. However, while the benefits on recognition of depression is more enduring, it is more transient for help-seeking beliefs, and booster sessions may be needed to improve the long-term effectiveness of the intervention on help-seeking preference. Lastly, to investigate the generalizability of this study's findings, future studies could replicate the current one across other non-self-selected samples, such as by integrating the intervention as part of student's orientation.
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Affiliation(s)
| | - Shazana Shahwan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Jue Hua Lau
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Wei Jie Ong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Ellaisha Samari
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Kian Woon Kwok
- President's Office, Nanyang Technological University, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Tan GTH, Shahwan S, Goh CMJ, Ong WJ, Samari E, Abdin E, Kwok KW, Chong SA, Subramaniam M. Causal beliefs of mental illness and its impact on help-seeking attitudes: a cross-sectional study among university students in Singapore. BMJ Open 2020; 10:e035818. [PMID: 32723737 PMCID: PMC7389507 DOI: 10.1136/bmjopen-2019-035818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES A considerable proportion of those who suffer from mental illnesses in Singapore do not seek any form of professional help. The reluctance to seek professional help could be due to misconceptions about the causes of mental illnesses. Research has shown that help-seeking attitudes can predict actual service use. As young adults are most at risk of developing mental illnesses, this study aims to elucidate the impact of causal beliefs about mental illness on help-seeking attitudes among university students in Singapore. DESIGN Prior to attending an anti-stigma intervention, data on the Causal Beliefs about Mental Illness, Inventory of Attitudes towards Seeking Mental Health services and questions pertaining to sociodemographic background were collected from participants using a self-administered questionnaire. Multiple linear regressions were performed to examine the relationship between causal beliefs and help-seeking, as well as their sociodemographic correlates. SETTINGS A university in Singapore. PARTICIPANTS 390 students who were studying in a University in Singapore. RESULTS Younger age was associated with higher scores on psychosocial attribution, while prior social contact with individuals with mental illness was significantly associated with lower scores on personality attribution. With regard to help-seeking attitudes; being a male and personality attribution were significantly associated with lower scores on 'Psychological Openness' and 'Indifference to Stigma', while psychosocial attribution was significantly associated with higher scores on 'Help-seeking Propensity'. Having prior social contact also predicted higher 'Psychological Openness', while being in Year 2 and 3 predicted lower scores on 'Indifference to Stigma'. CONCLUSION Findings from this study suggest that help-seeking attitudes might be influenced by causal beliefs, with personality attribution being the most impairing. Hence, to reduce the wide treatment gap in Singapore, anti-stigma interventions targeting young people could focus on addressing beliefs that attribute mental illness to the personality of the individual.
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Affiliation(s)
| | | | | | - Wei Jie Ong
- Research, Institute of Mental Health, Singapore
| | | | | | - Kian Woon Kwok
- School of Humanities and Social Sciences, Division of Sociology, Nanyang Technological University, Singapore
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Naeem F, Phiri P, Rathod S, Ayub M. Cultural adaptation of cognitive–behavioural therapy. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.15] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
SUMMARYThe study of cultural factors in the application of psychotherapy across cultures – ethnopsychotherapy – is an emerging field. It has been argued that Western cultural values underpin cognitive–behavioural therapy (CBT) as they do other modern psychosocial interventions developed in the West. Therefore, attempts have been made to culturally adapt CBT for ethnic minority patients in the West and local populations outside the West. Some frameworks have been proposed based on therapists’ individual experiences, but this article describes a framework that evolved from a series of qualitative studies to culturally adapt CBT and that was field tested in randomised controlled trials. We describe the process of adaptation, details of methods used and the areas that need to be focused on to adapt CBT to a given culture. Further research is required to move the field forward, but cultural adaptation alone cannot improve outcomes. Access to evidence-based psychosocial interventions, including CBT, needs to be improved for culturally adapted interventions to achieve their full potential.LEARNING OBJECTIVESAfter reading this article you will be able to:
•recognise the link between cultural factors and the need to adapt psychosocial interventions•identify the necessary steps to culturally adapt CBT•understand the modifications required to deliver therapy to individuals from diverse cultural backgrounds.
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Khan S, Lovell K, Lunat F, Masood Y, Shah S, Tomenson B, Husain N. Culturally-adapted cognitive behavioural therapy based intervention for maternal depression: a mixed-methods feasibility study. BMC WOMENS HEALTH 2019; 19:21. [PMID: 30691431 PMCID: PMC6350293 DOI: 10.1186/s12905-019-0712-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 01/08/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND British Pakistanis are one of the largest ethnic minority groups living in the UK, with high rates of maternal depression being reported in this population. Evidence suggests that culturally-adapted Cognitive Behavioural Therapy (CBT)-based interventions for depression, may improve clinical outcomes and patient satisfaction. This study was conducted to develop and test the feasibility and acceptability of a culturally-adapted, CBT-based, manual-assisted intervention in British Pakistani mothers experiencing maternal depression. METHODS A mixed-method feasibility study that included qualitative interviews followed by the development of a CBT-based intervention for mothers with mild to moderate depression. Following the qualitative interviews, a CBT-based intervention called the Positive Health Program (PHP) was developed and delivered consisting of 12-weekly sessions. A before and after design was used to explore the feasibility and acceptability of the Positive Health Programme. RESULTS A culturally-adapted CBT-based group intervention (PHP) was acceptable to this group and improvements were reported in depression and health-related quality of life. The women's understanding of 'depression' as a general consensus was in physical terms, but with an onset triggered by psychosocial causes. The most commonly reported factors contributing to depression were marital disharmony, lack of social support, and financial difficulties. Past help offered was primarily antidepressants, which were not welcomed by most of the women. A lack of availability of culturally sensitive interventions and the limited cultural sensitivity of NHS staff was also reported. CONCLUSION This study provides preliminary evidence for the feasibility and acceptability of a CBT-based culturally-adapted group psychological intervention for British Pakistani mothers. TRIAL REGISTRATION Study ethics registration number: 10/H1005/62 (University of Manchester).
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Affiliation(s)
- Sobia Khan
- The University of Manchester, 3rd Floor (East), Jean McFarlane Building, University Place, Oxford Road, Manchester, M13 9PL, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Room 6.322a, Jean McFarlane Building, University Place, Oxford Road, Manchester, M13 9PL, UK
| | - Farah Lunat
- Lancashire Care NHS Foundation Trust, The Mount, Whalley Road, Accrington, BB5 5AD, UK
| | - Yumna Masood
- Cumbria Partnership Foundation Trust, Garburn House, Westmoreland General Hospital, Burton Road, Kendal, LA97RG, UK
| | - Sadia Shah
- Lancashire Care NHS Foundation Trust, The Mount, Whalley Road, Accrington, BB5 5AD, UK
| | - Barbara Tomenson
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Nusrat Husain
- Lancashire Care NHS Foundation Trust, The University of Manchester, 3rd Floor (East), Jean McFarlane Building, University Place, Oxford Road, Manchester, M13 9PL, UK.
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Mirza A, Birtel MD, Pyle M, Morrison AP. Cultural Differences in Psychosis: The Role of Causal Beliefs and Stigma in White British and South Asians. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2019. [DOI: 10.1177/0022022118820168] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While previous research has demonstrated the negative impact of stigma in individuals with mental health problems, little is known about cross-cultural differences in experiences and explanations of mental health, in particular in young people, despite the first episode of psychosis often occurring in adolescence. Aim of this study was to examine cultural differences in causal beliefs and stigma toward mental health, in particular psychosis. White British and South Asian young people ( N = 128) from two schools and colleges in the United Kingdom, aged 16 to 20 years, completed a cross-sectional survey. Results revealed significant associations between ethnic group and our dependent measures. White British reported more previous contact with a mental health service as well as with people with mental health problems than South Asians. They also reported lower stigma in form of a greater intentions to engage in contact with people with mental health problems. Furthermore, South Asians reported higher beliefs in supernatural causes of psychosis than White British. Psychotic experiences moderated the effect of ethnic group on supernatural beliefs, with South Asians reporting higher supernatural beliefs than White British when their own psychotic experiences were low to moderate. We discuss the implications of the findings, arguing that a greater culture-sensitive understanding of mental health is important to reach ethnic minorities with psychosis, and to challenge stigma toward psychosis from an early age on.
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Affiliation(s)
| | | | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, UK
| | - Anthony P. Morrison
- University of Manchester, UK
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, UK
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The Singaporean public beliefs about the causes of mental illness: results from a multi-ethnic population-based study. Epidemiol Psychiatr Sci 2018; 27:403-412. [PMID: 28367774 PMCID: PMC6998867 DOI: 10.1017/s2045796017000105] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
AIMS To identify the common causal beliefs of mental illness in a multi-ethnic Southeast Asian community and describe the sociodemographic associations to said beliefs. The factor structure to the causal beliefs scale is explored. The causal beliefs relating to five different mental illnesses (alcohol abuse, depression, obsessive-compulsive disorder (OCD), dementia and schizophrenia) and desire for social distance are also investigated. METHODS Data from 3006 participants from a nationwide vignette-based study on mental health literacy were analysed using factor analysis and multiple logistic regression to address the aims. Participants answered questions related to sociodemographic information, causal beliefs of mental illness and their desire for social distance towards those with mental illness. RESULTS Physical causes, psychosocial causes and personality causes were endorsed by the sample. Sociodemographic differences including ethnic, gender and age differences in causal beliefs were found in the sample. Differences in causal beliefs were shown across different mental illness vignettes though psychosocial causes was the most highly attributed cause across vignettes (endorsed by 97.9% of respondents), followed by personality causes (83.5%) and last, physical causes (37%). Physical causes were more likely to be endorsed for OCD, depression and schizophrenia. Psychosocial causes were less often endorsed for OCD. Personality causes were less endorsed for dementia but more associated with depression. CONCLUSIONS The factor structure of the causal beliefs scale is not entirely the same as that found in previous research. Further research on the causal beliefs endorsed by Southeast Asian communities should be conducted to investigate other potential causes such as biogenetic factors and spiritual/supernatural causes. Mental health awareness campaigns should address causes of mental illness as a topic. Lay beliefs in the different causes must be acknowledged and it would be beneficial for the public to be informed of the causes of some of the most common mental illnesses in order to encourage help-seeking and treatment compliance.
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Grupp F, Moro MR, Nater UM, Skandrani SM, Mewes R. "It's That Route That Makes Us Sick": Exploring Lay Beliefs About Causes of Post-traumatic Stress Disorder Among Sub-saharan African Asylum Seekers in Germany. Front Psychiatry 2018; 9:628. [PMID: 30534091 PMCID: PMC6275318 DOI: 10.3389/fpsyt.2018.00628] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/06/2018] [Indexed: 11/26/2022] Open
Abstract
Many asylum seekers have been confronted with traumatizing events, leading to high prevalence rates of post-traumatic stress disorder (PTSD). Within the diagnostic context, clinicians should take into account patients' culturally shaped presentation of symptoms. Therefore, we sought to provide insights into beliefs about causes of PTSD held by Sub-Saharan African asylum seekers living in Germany. To this aim, we used a quantitative and qualitative methodological triangulation strategy based on a vignette describing symptoms of PTSD. In the first part of the study, asylum seekers (n = 119), predominantly from Eritrea (n = 41), Somalia (n = 36), and Cameroon (n = 25), and a German comparison sample without a migration background (n = 120) completed the Revised Illness Perception Questionnaire (IPQ-R). In the second part, asylum seekers reviewed the results within eight focus group discussions (n = 26), sampled from groups of the three main countries of origin. Descriptive analyses of the first part demonstrated that asylum seekers predominantly attributed PTSD symptoms to psychological and religious causes, and rather disagreed with supernatural causes. In comparison to the German sample without a migration background, asylum seekers attributed symptoms less strongly to terrible experiences, but more strongly to religious and supernatural causes. Within the focus group discussions, six attribution categories of participants' causal beliefs were identified: (a) traumatic life experiences, (b) psychological causes, (c) social causes, (d) post-migration stressors, (e) religious causes, and (f) supernatural causes. Our findings suggest that the current Western understanding of PTSD is as relevant to migrants as to non-migrants in terms of psychological causation, but might differ regarding the religious and supernatural realm. While awareness of culture-specific belief systems of asylum seekers from Sub-Saharan Africa regarding PTSD is important, our findings do underline, at the same time, that cultural differences should not be overstated.
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Affiliation(s)
- Freyja Grupp
- Division of Clinical Biopsychology, Department of Psychology, University of Marburg, Hesse, Germany
| | - Marie Rose Moro
- University of Paris Descartes, Hospital Cochin Paris, Paris, France
| | - Urs M Nater
- Division of Clinical Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Sara M Skandrani
- University of Paris Nanterre, Hospital Cochin Paris, Paris, France
| | - Ricarda Mewes
- Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, Vienna, Austria
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Awan NR, Jehangir SF, Irfan M, Naeem F, Farooq S. Explanatory model of illness of the patients with schizophrenia and the role of educational intervention. Schizophr Res 2017; 190:68-73. [PMID: 28291691 DOI: 10.1016/j.schres.2017.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/16/2017] [Accepted: 03/02/2017] [Indexed: 11/25/2022]
Abstract
This randomized controlled trial was conducted at Department of Psychiatry, Lady Reading Hospital, Peshawar from February to August 2015 to explore beliefs and concepts of patients with schizophrenia about their illness and to find out the effectiveness of structured educational intervention in changing the explanatory models of illness of the patients and in their symptoms reduction. One hundred and three patients were recruited in the trial who were randomly assigned to two groups i.e., Experimental (n=53) and Control i.e., Treatment As Usual, TAU (n=50). Intervention was applied to experimental group only, once a month for three months. Short Explanatory Model Interview (SEMI), Brief Psychiatric Rating Scale (BPRS), Positive And Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF) and Compliance Rating Scale were applied on all patients at baseline and at 3months follow up. Scores on PANSS (Total), BPRS and GAF showed improvement in the experimental group as compared to TAU group, at follow up, with the p values of 0.000, 0.002 and 0.000, respectively. On follow up, 44 (95.6%) patients of experimental group achieved complete compliance as compared to 17 (47.2%) patients of TAU group [p=0.000]. On baseline analysis of SEMI, in the experimental group, only 3.8% (n=2) knew about name of the illness, which increased to 54.3% (n=25) on follow up, while in TAU group it improved to 5.6% (n=2) as compared to 0% at baseline (p=0.000). The result suggest that Structured educational intervention can be effective in modifying the beliefs of the patients regarding their illness.
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Affiliation(s)
- Naila Riaz Awan
- Department of Psychiatry, Lady Reading Hospital, Peshawar, Pakistan.
| | | | - Muhammad Irfan
- Department of Mental Health, Psychiatry and Behavioural Sciences, Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Farooq Naeem
- Department of Psychiatry, Queens University, Kingston, Canada
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Abstract
PURPOSE OF REVIEW Patient and physician perspectives about mental health, illness, and recovery, which affect different aspects of help seeking and healthcare, needs to be understood and theorized. RECENT FINDINGS People seem to simultaneously hold multiple and contradictory illness beliefs and seek help from diverse sources of cure and healing. Explanatory models elicited at baseline do not predict outcomes of illness, change over time, and are dependent on the interaction between the trajectory of individual's illness and the sociocultural milieu. Illness narratives contextualize the patient, describe the patient's reality and his/her ways of coping, and attempt to make sense of illness experiences, control them, and improve quality of life. On the other hand, diversity of beliefs among psychiatrists, family physicians, and public health specialists is dependent on their disciplinary perspectives. Nevertheless, the variability within psychiatric syndromes and the inability to predict individual trajectories of illness support cultural beliefs about uncertainties of life. These are identified by cultures through idioms and metaphors and labeled as luck, chance, karma, fate, punishment by God, evil spirits, black magic, disease and so on. SUMMARY There is a need for a broad-based approach to mental health, which allows individuals to make sense of their contexts and find meaning in life.
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