Somatization among ethnic minorities and immigrants: Why does it matter to Consultation Liaison Psychiatry?

Attachment security and somatization: The mediating role of emotion dysregulation in a sample of Latinx young adults

BACKGROUND

Somatization has been linked to the underdiagnosis of mental health disorders among individuals from racial and ethnic minority groups, notably among Latinxs. While prior research has emphasized sociocultural factors, the exploration of potential inter- and intrapersonal mechanisms behind somatization remains limited.

METHODS

The current study examined the relation between attachment insecurity, emotion dysregulation, and somatization among Latinx young adults. Data were collected across seven separate Texas universities (N = 822). Most identified as female (76 %), were born in the United States (50.9 %) and were in their first or second year of university (60.6 %).

RESULTS

Hypothesis testing relied on two mediation models: maternal attachment security and paternal attachment security. The maternal attachment security model significantly predicted somatization, explaining 25 % of the variance. Notably, emotion dysregulation and maternal attachment security had main effects on somatization after accounting for country of origin, age, and gender. Results were similar for the paternal attachment security model.

LIMITATIONS

Limitations include skewed gender distribution, a non-clinical college student sample, cross-sectional design preventing causal inferences, and potential bias in self-report measures.

CONCLUSIONS

Attachment security and emotion dysregulation play an essential role in the experience of somatic symptoms among Latinx young adults. Our results suggest that health care providers take into account insecure attachment and emotion regulation history of Latinxs presenting with somatic symptoms.

Mental health in migrants contacting the mental health operational unit of the National Institute for Health, Migration and Poverty (NIHMP): preliminary data

Aim

Migration can lead to an increase in stress rates and can impact mental health, especially in certain migrant groups. Nonetheless, mental health needs and the importance of public health are not well captured in most studies using national samples. This study aimed to show the correlation between mental disorders, socio-demographic and cultural aspects among migrants.

Subject and methods

One hundred nineteen migrants, applying for assessment to the Mental Health Operational Unit of the National Institute for Health, Migration and Poverty (NIHMP) in Rome, were recruited.

Results

Migrants frequently reported mood disorders (mainly women). Men reported PTSD, somatization and adjustment disorders.

Conclusions

Over time, diverse factors may produce a decline in an initially healthy migrant status. The research unveils a new focus on the psychopathology of migrants accessing the NIHMP, with important implications for migrants’ mental health treatment and prevention.

Influence of resilience on the relations among acculturative stress, somatization, and anxiety in latinx immigrants

OBJECTIVE

In cultures where psychological distress is stigmatized, the presentation of emotional distress as somatic complaints is a frequent occurrence. Understanding factors that contribute to the presentation of somatization in Latinx immigrants is crucial due to its tie to poor quality of life. The purpose of this study was to explore relations among acculturative stress, anxiety, somatization, and resilience in a sample of Latinx immigrants living in the United States.

METHODS

Data were collected from 204 Latinx immigrants across diverse community settings.

RESULTS

Acculturative stress was positively related to both anxiety and somatization, and the relation between acculturative stress and somatization occurred through anxiety. Resilience moderated the relations between acculturative stress and somatization, and between anxiety and somatization.

CONCLUSION

This study suggests that Latinx immigrants presenting with somatic symptoms may benefit from the examination of a possible comorbid presentation of anxiety or acculturative stressors. An integrated behavioral healthcare approach is recommended when working with Latinx immigrants evaluating the impact of minority stressors on health. Clinicians are encouraged to incorporate cultural protective factors that reinforce the development and sustenance of resilience.

Factors Associated to the Onset of Mental Illness Among Hospitalized Migrants to Italy: A Chart Review

Migration is a complex phenomenon and mental illness among immigrants remains a major matter of concern in Italy and worldwide. 243 medical and pharmacy records of patients admitted to University of Foggia hospital between 2004 and 2018 were retrospectively screened and included in the study. Socio-demographic data and clinical characteristics of inpatients were compared in those with and without first-episode of mental illness (FEMI). Subjects (140 men, 103 women; aged 34.4 ± 10.2 years) represented 6.66 ± 3.73% of all hospitalizations in 15 years. Nearly half of them (48.5%) had emigrated from other European countries. 30.8% were diagnosed with a DSM-IV TR unspecified psychosis. 103 patients (42.3%) were in first-lifetime episodes of mental illness. Factors significantly associated with FEMI were: younger age, sex (men), immigrating from Africa, poor language proficiency, lower amount of prescribed psychotropics. Mental health among immigrants is of major concern in Italy. Our findings report on factors possibly associated to the onset of mental illness among immigrant psychiatric inpatients.

Personality-Informed Care: Speaking the Language of Personality

BACKGROUND

Personality describes an enduring pattern of experiences and behaviors in the interpersonal and social sphere. Several aspects of personality, e.g., defenses, relational dynamics, and reactions, are commonly accentuated in the midst of medical care; therefore, understanding a patient's personality allows the clinician to make informed predictions about how a specific patient may respond to illness and how care interactions might be modified to optimize care engagement and outcomes.

OBJECTIVE/METHODS

This article provides a brief description of the personalities in the Psychodynamic Diagnostic Manual, Second Edition, and discusses how each one might inform clinical interactions. Two additional personality-like presentations-the traumatized patient and cognitive impairment-are included for clinical utility given their high prevalence in medical settings and their potential for broad impact on clinical relationships.

RESULTS

Personality-informed care is an approach that incorporates information about the patient's personality into the clinical relationship. It describes what the clinician might say and when, what recommendations to offer and how to frame them, and how to comport oneself while providing care.

CONCLUSIONS

Personality-informed care operationalizes several aspects of personalized medicine, and it offers a heuristic framework that may facilitate and enhance the implementation of evidence-based care.

Conference proceedings of the 4th Masterclass Psychiatry: Transcultural Psychiatry - Diagnostics and Treatment, Luleå, Sweden, 22-23 February 2018 (Region Norrbotten in collaboration with the Maudsley Hospital and Tavistock Clinic London)

BACKGROUND

According to estimates from the European Commission, Europe has experienced the greatest mass movement of people since the Second World War. More than one million refugees and migrants have arrived in the European Union in the past few years. Mental health and primary care professionals are more likely than ever to meet patients from different cultures and backgrounds.

AIMS

To equip mental health and primary care professionals with transcultural skills to deal with patients from unfamiliar backgrounds.

METHOD

Lectures and case discussions to explore the latest advances in the diagnosis and treatment of serious mental health problems in a transcultural context.

RESULTS

Lectures covered transcultural aspects of mental health problems, treatment in different cultural and ethnic contexts, and assessment of risk factors for self-harm and harm in migrant populations.

CONCLUSIONS

Clinicians require a sound grounding in transcultural skills to confidently and empathically deal with patients from unfamiliar backgrounds.

Cultural neuroscience: ideas worth knowing

BACKGROUND

Neuroscience is now promising significant advances in medical practice, such that it can improve the art and science of personalized medicine. A new discipline of cultural neuroscience is now forming, and few clinicians, researchers or educators are aware of it.

AIMS

To set out a brief synopsis of cultural neuroscience.

METHODS

A narrative, nonsystematic, review of experts on cultural psychiatry and cultural neuroscience.

RESULTS

Cultural neuroscience proposes that culture and biology have co-evolved with mutually beneficial affordances inhuman abilities that promote positive selection that help people to flourish. Neuroscience can support and improve cultural interventions when applied in a pan-diagnostic manner to culturally specific groups, ethnic minorities, and migrants.

CONCLUSIONS

Cultural neuroscience is an exciting new discipline with the potential for clinical benefit. Cultural psychiatry can advance in this direction, and at the same time offer a critique of the culture of neuroscience.