Cultural diversity and mental health. Towards integrative practice

Cultural moderation in sports impact: exploring sports-induced effects on educational progress, cognitive focus, and social development in Chinese higher education

BACKGROUND

This research examines the nuanced challenges confronting Chinese university students within the dynamic milieu of Chinese education. The study comprehensively investigates factors encompassing educational progress, social development, cognitive focus, and Psychological Well-being (PWB), specifically emphasizing the role of sports participation.

METHODS

To scrutinize the moderation-mediation nexus between cultural context and social development, a distribution of 500 questionnaires was administered to Chinese university students, yielding 413 responses, corresponding to an 82.6% response rate. Methodologically, this study employed moderation and mediation analyses, incorporating statistical techniques such as a principal component matrix, factor analysis, and hierarchical regression.

FINDINGS

Prominent findings underscore the significant impact of age on educational progress, shaping the trajectory of academic advancement. Cumulative Grade Point Average (CGPA) emerges as a promising metric, establishing a link between academic performance and educational progress. Active involvement in sports and physical activities (PSPA) positively affects academic performance and study habits. Participation in sports teams and clubs (ISTC) enriches social development by nurturing interpersonal relationships, teamwork, and leadership skills. Sports activities (ESA) correlate with enhanced cognitive focus and improved psychological well-being. Significantly, the findings unveil a nuanced association between Perceived Social Development Through Sports (PSDTS) and educational progress.

CONCLUSIONS

Cultural Context (CC) moderates PSDTS, Sport-induced Cognitive Focus (SICF), and PWB, influencing educational progress. This study emphasizes the need for enhanced support systems-academic guidance, awareness, sports programs, and cultural competence training-to advance student well-being and academic achievement in China, fostering an empowering educational environment for societal progress.

Discovery of the Environmental Factors Affecting Urban Dwellers' Mental Health: A Data-Driven Approach

Mental health is the foundation of health and happiness as well as the basis for an individual's meaningful life. The environmental and social health of a city can measure the mental state of people living in a certain areas, and exploring urban dwellers' mental states is an important factor in understanding and better managing cities. New dynamic and granular urban data provide us with a way to determine the environmental factors that affect the mental states of urban dwellers. The characteristics of the maximal information coefficient can identify the linear and nonlinear relationships so that we can fully identify the physical and social environmental factors that affect urban dwellers' mental states and further test these relationships through linear and nonlinear modeling. Taking the Greater London as an example, we used data from the London Datastore to discover the environmental factors that had the highest correlation with urban mental health from 2015 to 2017 and to prove that they had a high nonlinear correlation through neural network modeling. This paper aimed to use a data-driven approach to find environmental factors that had not yet received enough attention and to provide a starting point for research by establishing hypotheses for further exploration of the impact of environmental factors on mental health.

Young Muslim Pakistani Women's Lived Experiences of Izzat, Mental Health, and Well-Being

This article explores how six Pakistani Muslim women interpret cultural concepts of izzat (honor and self-respect); what role, if any, it has in their lives; and whether there is interplay between upholding izzat and the participants' help-seeking strategies for mental health and well-being. Semistructured interviews were conducted and analyzed with an interpretative phenomenological analytic framework. Three themes were identified: (a) "the rules of izzat," (b) "negotiating tensions," and (c) "speaking out/breaking the 'rules.'" Findings highlighted new insights into the understanding of izzat and the implications these cultural concepts have for strategies in managing or silencing of psychological distress. Interviews illustrated tensions the participants experience when considering izzat, how these are negotiated to enable them to self-manage or seek help, and possible life experiences that might lead to self-harm and attempted suicide. Notably, cultural codes, in particular izzat, appear to vary over the life course and are influenced by migration.

How do mental health practitioners operationalise cultural competency in everyday practice? A qualitative analysis

BACKGROUND

Despite continued policy and research emphasis to deliver culturally competent mental healthcare, there is: (1) limited evidence about what frontline practitioners consider to be culturally competent care and; (2) what helps or hinders them in delivering such care in their everyday practice. The aims of this article are to address these gaps.

METHODS

Qualitative in-depth interviews were conducted with 20 mental health practitioners working with immigrant patients to explore their understandings and experiences of culturally competent care. Interviews were conducted between September 2015 and February 2016 in the state of Victoria, Australia. Data were thematically analysed.

RESULTS

There were common understandings of cultural competence but its operationalisation differed by profession, health setting, locality, and years of experience; urban psychiatrists were more functional in their approach and authoritarian in their communication with patients compared to allied health staff in non-specialist mental health settings, in rural areas, with less years of experience. Different methods of operationalising cultural competence translated into complex ways of building cultural concordance with patients, also influenced by health practitioners' own cultural background and cultural exposures. Limited access to interpreters and organisational apathy remain barriers to promoting cultural competency whereas organisational support, personal motivation, and professional resilience remain critical facilitators to sustaining cultural competency in everyday practice.

CONCLUSION

While there is need for widespread cultural competence teaching to all mental health professionals, this training must be specific to different professional needs, health settings, and localities of practice (rural or urban). Experiential teaching at tertiary level or professional development programs may provide an avenue to improve the status quo but a 'one-size-fits-all' model is unlikely to work.

Cultural Diversity and Mental Health: Considerations for Policy and Practice

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.

Reconciling Rules with Context

In psychotherapy practice, a complex relationship exists between clients, culture and values. By drawing on psychology, philosophy and anthropology, we developed an interdisciplinary ethical framework for cultural psychotherapy. The framework, which reflects a hermeneutic approach, avoids the excesses of both an ‘objective’ view of ethics (and its relation to selfhood) and the social constructionist view, which tends towards relativism. To take this middle path, therapists need to do more than familiarize themselves with the professional codes of ethics set out for this practice. These ethical codes and the rules that constitute them are important, but they should not replace the difficult work of ethical thinking and judgment. These processes require psychotherapists to engage in the (often) difficult task of gaining a better understanding of a client’s culture or context, including their conceptions of good, and critiquing or correcting instances where the therapists’ own moral or cultural prejudices distort or compromise the therapist-client relationship. We also present a case example in which we illustrate the strength and relevance of our approach.

An Inquiry Into the “Agonies” (Agonias) of Portuguese Immigrants From the Azores

Previous research has found that psychiatric symptom expression is inextricably linked with culture and that psychiatric categories do not necessarily reflect the experiences of people from other cultures. Using a multidisciplinary approach, this study explored the Portuguese culture-specific phenomenon agonias (meaning “the agonies”). Fifty (21 males and 29 females) Portuguese immigrants from the Azores were interviewed concerning their immigration experience, family life, health, healing, suffering, and understanding of agonias. Although there was diversity among the participants’ responses, a cohesive and systemic understanding of agonias arose from the narratives. A link between the somatic symptoms of agonias and psychological processes, social context, and religious beliefs was demonstrated, and highlighted that psychiatric categories are limited when classifying a multidimensional experience like agonias.

Synergies for Wellness and Liberation in Counseling Psychology

Several fields within psychology, including counseling psychology, are struggling to promote a social justice agenda. Most efforts concentrate on a critique of existing values, assumptions, and practices. Whereas the level of critique is quite sophisticated, the level of social justice practice is rather embryonic. Critical psychologists have been constructing alternative practices that strive to go beyond the status quo and its critique. This article proposes an agenda for action that is conductive to wellness and liberation at the same time. The authors recommend several steps for advancing such an agenda. They argue that critical psychologists need to promote synergy between and among (a) diverse values, (b) wellness and liberation, and (c) existing critiques within psychology and other fields. To illustrate practical application, the authors discuss these recommendations in the context of people with physical disabilities.

A Transdisciplinary, Transcultural Model for Health Care

For the past 28 years, members of the Transcultural Nursing Society have been pioneers in generating knowledge about transcultural health issues, and this important body of knowledge will continue to increase and influence nursing research and practice worldwide. Yet at the same time, worldwide changes, demographic disparities, and new discoveries necessitate transitioning what has been a nursing discipline approach to that of a more inclusive transdisciplinary alliance. This alliance will build on pioneering strengths but also link with other disciplines such as anthropology, genetics, epidemiology, law, economics, and health policy to build cutting-edge research and theory for transcultural health care. A transdisciplinary, transcultural model for health care is presented for discussion, debate, and input. Suggestions are made for how such a model might be implemented through a changed curriculum using on-line education including consultation, teaching, and research.

Determinants of Host Society Acculturation and Its Relationship with Health Behaviors and Outcomes: A New Research and Intervention Framework

Host society acculturation (or reverse acculturation) is a complex, multifactorial process reflecting the attitude- and behavior-level impact of immigrants on the host society. However, this phenomenon has rarely been the subject of systematic research in the area of public health. Using qualitative and quantitative findings from different health behavior domains, we strove to identify potential individual- and environment-level determinants of host society acculturation. Next, we developed a context-driven multilevel public health research and intervention framework for the study of the relationship between host society acculturation and health practices and outcomes. The framework posits a number of associations to be evaluated by future multidisciplinary research nationally and internationally.

Acculturation stress and mental health among the marriage migrant women in Busan, South Korea

Our study investigated mental health and associated factors, especially acculturation stress and coping resources, among "marriage migrant" women. Cross-sectional data were collected for 501 marriage migrant women, about 10 % of those living in Busan, South Korea. Acculturation stress, coping resources, sociodemographic factors were examined using structured questionnaires, and the General Health Questionnaire-28 was administered as a measure of mental health. Many factors were related to mental health, especially marital satisfaction. Core cultural shock and self-rated economic status, interpersonal stress, and social support were also significantly related to mental health status. This study highlights the importance of marriage migrant women's mental health in South Korea. To improve their mental health, increased marital satisfaction, social support, resettlement funds, and/or educational programs that foster coping are needed. Additionally, we should encourage establishment of and participation in marriage migrant self-help groups, which can facilitate adaptation to marriage and to Korean culture.

Evaluation of the organizational cultural competence of a community health center: a multimethod approach

Cultural competence is an important component of client-centered care in health promotion and community health services, especially considering the changing demographics of North America. Although a number of tools for evaluating cultural competence have been developed, few studies have reported on the results of organizational cultural competence evaluations in health care or social services settings. This article aims to fill this gap by providing a description of a cultural competence evaluation of a community health center serving a diverse population. Data collection included reviewing documents, and surveying staff, management, and the Board of Directors. The organization fully met 28 of 53 standards of cultural competence, partially met 21 standards, and did not meet 2 standards, and 2 standards could not be assessed due to missing information. The advantages and lessons learned from this organizational cultural competence evaluation are discussed.

Why an alternative to suicide prevention gatekeeper training is needed for rural Indigenous communities: presenting an empowering community storytelling approach

The need for effective youth suicide prevention is uncontested, and is particularly urgent for Indigenous populations. The Indigenous youth suicide rates in some North American communities can be 18 times greater than for other young people. Despite the clear need, evidence in support of Indigenous youth suicide prevention strategies remain mixed. The most common approach to youth suicide prevention - gatekeeper training - may have limited effects in Indigenous communities. Based on recent work undertaken with Indigenous leaders in rural Alaska, we describe culturally grounded, practical alternatives that may be more effective for Indigenous communities. We highlight the ways in which research informed, grassroots interventions can address cultural, practical and systemic issues that are relevant when addressing risks for suicide on a community level. Built on a transactional-ecological framework that gives consideration to local contexts, culture-centric narratives and the multiple, interacting conditions of suicide, the innovative approach described here emphasizes community and cultural protective factors in Indigenous communities, and extends typical suicide prevention initiatives in ways that have important implications for other ethnically diverse communities.

Retention in mental health care of Portuguese-speaking patients

We compared service outcomes of dedicated language and cultural competency services in adequacy of care, ER, and inpatient care among Portuguese-speaking patients in ethnic- and non-ethnic-specific behavioral health clinics. We assessed adequacy of mental health care, and use of inpatient emergency department among Portuguese-speaking patients, comparing individuals receiving care from a culturally and linguistically competent mental health care setting (the Portuguese Mental Health Program [PMHP]) with usual mental health care in a community health care system in the USA. Propensity score matching was used to balance patients in treatment and control groups on gender, marital status, age, diagnosis of mental disorder, and insurance status. We used de-identified, longitudinal, administrative data of 854 Portuguese-speaking patients receiving care from the PMHP and 541 Portuguese-speaking patients receiving usual care from 2005-2008. Adequate treatment was defined as receipt of at least eight outpatient psychotherapy visits, or at least four outpatient visits of which one was a psychopharmacological visit. PMHP patients were more likely to receive adequate care. No differences were found in rates of ER use or inpatient mental health care. The present study suggests increased quality of care for patients that have contact with a clinic that dedicates resources specifically to a minority/immigrant group. Advantages of this setting include greater linguistic and cultural concordance among providers and patients. Further research is warranted to better understand the mechanisms by which culturally appropriate mental health care settings benefit minority/immigrant patients.

Problemas de nervos: a multivocal symbol of distress for Portuguese immigrants

This article outlines research on a previous unstudied form of suffering specific to the Portugese immigrant community: problemas de nervos. Thirty-two Portuguese immigrant women (in Waterloo, ON and Boston, MA) were interviewed and each completed a questionnaire. Cluster analysis demonstrated that problemas de nervos has many meanings. The study profiled symptoms, causes and therapies associated with four variations of this culture-specific form of distress: "mal da cabeca" meaning problems with/in the head (e.g., lack of control, visions); " aflição" meaning affliction (e.g., nervous attacks, heart problems); immigration stress (causing sleep disturbances); and, conflicts with others (resulting in pressure within the body). None of the symptom clusters reported matched criteria for a DSM-IV-TR diagnosis, suggesting that problemas de nervos represents an idiomatic rather than universal expression of distress.

Migrant well-being is a multilevel, dynamic, value dependent phenomenon

Research demonstrates that the well-being of migrants is a multilevel, dynamic, and value dependent phenomenon. It is multilevel because risk and protective factors are present at various ecological planes, from the individual to the social sphere. It is dynamic because objective and subjective risk and protective factors interact across ecological levels, creating favorable or unfavorable conditions for migrants to adjust to the new surroundings. Finally, it is value dependent because access to resources is conditioned by norms of justice prevalent in the host society. Findings from this special section on acculturation are combined with previous literature to support the three claims advanced in this article.

Addressing diversity in mental health care: A review of guidance documents

Discriminated against and marginalised groups of people within our communities continue to be over represented within mental health services and frequently their particular needs are not met. Challenging discrimination and working towards more equitable services are a vital part of anyone's role working within mental health services. This paper provides a review of guidance documents on diversity issues with a particular focus on ethnicity, gender, sexuality, learning disability, spirituality, homelessness and age. The review concludes with a summary of the range of approaches that are currently being advocated for translating guidelines and recommendations into improved and equitable mental health services that meet the needs of service users from a wide range of diverse groups.

A framework for cultural competence in advanced practice psychiatric and mental health education

TOPIC

Cultural competence in psychiatric advanced practice education.

PURPOSE

To present a framework for educators to use when addressing culturally competent advanced psychiatric nursing practice.

SOURCES

NONPF competencies, published literature, and Web resources.

CONCLUSIONS

Development of cultural competence is an important link to the reduction of mental health disparities. Situating the advanced nursing practice process within a negotiating space allows for incorporation of cultural information into patient care. The framework presented in this paper provides a theoretical and practical approach to orienting students to meeting the elements of cultural competence set out in the NONPF recommendations.

Assessing psychological health and empowerment in women: the Personal Progress Scale Revised

Empowerment is a primary outcome of many health interventions with women. Typical outcome measures, however focus exclusively on specific symptoms, neglecting the clinically important attitudes and behaviors associated with increased empowerment and well-being. Empowerment is conceptualized as enabling women to access skills and resources to cope more effectively with current as well as future stress and trauma. This study investigated a new measure of personal empowerment in women, the Personal Progress Scale-Revised (PPS-R). Results suggest that the PPS-R is a promising measure of empowerment in women, demonstrating excellent reliability and validity in diverse sample of women. Additionally, the PPS-R demonstrated preliminary utility with a subgroup of abused women, a vulnerable group of women for whom empowerment is a variable of high importance.

Migration and mental health in Europe (the state of the mental health in Europe working group: appendix 1)

BACKGROUND

This paper is a part of the work of the group that carried out the report "The state of the mental health in Europe" (European Commission, DG Health and Consumer Protection, 2004) and deals with the mental health issues related to the migration in Europe.

METHODS

The paper tries to describe the social, demographical and political context of the emigration in Europe and tries to indicate the needs and (mental) health problems of immigrants. A review of the literature concerning mental health risk in immigrant is also carried out. The work also faces the problem of the health policy toward immigrants and the access to health care services in Europe.

RESULTS

Migration during the 1990s has been high and characterised by new migrations. Some countries in Europe, that have been traditionally exporters of migrants have shifted to become importers. Migration has been a key force in the demographic changes of the European population. The policy of closed borders do not stop migration, but rather seems to set up a new underclass of so-called "illegals" who are suppressed and highly exploited. In 2000 there were also 392,200 asylum applications. The reviewed literature among mental health risk in some immigrant groups in Europe concerns: 1) highest rate of schizophrenia; suicide; alcohol and drug abuse; access of psychiatric facilities; risk of anxiety and depression; mental health of EU immigrants once they returned to their country; early EU immigrants in today disadvantaged countries; refugees and mental health. Due to the different condition of migration concerning variables as: motivation to migrations (e.g. settler, refugees, gastarbeiters); distance for the host culture; ability to develop mediating structures; legal residential status it is impossible to consider "migrants" as a homogeneous group concerning the risk for mental illness. In this sense, psychosocial studies should be undertaken to identify those factors which may under given conditions, imply an increased risk of psychiatric disorders and influence seeking for psychiatric care. COMMENTS AND REMARKS: Despite in the migrants some vulnerable groups were identified with respect to health problems, in many European countries there are migrants who fall outside the existing health and social services, something which is particularly true for asylum seekers and undocumented immigrants. In order to address these deficiencies, it is necessary to provide with an adequate financing and a continuity of the grants for research into the multicultural health demand. Finally, there is to highlight the importance of adopting an integrated approach to mental health care that moves away from psychiatric care only.

Measurement equivalence of the center for epidemiological studies depression scale for Latino and Anglo adolescents: a national study

The cross-ethnic measurement equivalence of the Center for Epidemiologic Studies Depression Scale (CES-D; L. S. Radloff, 1977) was examined using a subsample of adolescents (N=10,691) from the National Longitudinal Study of Adolescent Health. Configural and metric invariance, as well as functional and scalar equivalence, were examined for Anglo American, Mexican American, Cuban American, and Puerto Rican American youths age 12-18 years. Confirmatory factor analysis (CFA) in each group provided evidence of configural invariance for European and Mexican American adolescents but not for Cuban and Puerto Rican youths. A 2-group CFA for Anglo and Mexican Americans demonstrated partial metric invariance for these groups. Multigroup structural equation modeling indicated similar relations between CES-D scores and self-esteem for all 4 groups, supporting cross-ethnic functional and scalar equivalence. The results have implications for using the CES-D in cross-ethnic research and, more broadly, for the assessment and treatment of depression in Latinos.