The social and cultural context of the mental health of Filipinas in Queensland

Experiences of Stress and Help-Seeking Behaviors in Filipino Americans

A qualitative study using basic interpretive design identified the experiences of stress and barriers to professional help seeking among Filipino Americans (N = 12). Filipino Americans employed both engagement and disengagement strategies in response to stress characterized by Indigenous, religious, and cultural responses. Filipino Americans preferred to seek support from friends, family, and community leaders and described individual, cultural, and community barriers to pursuing professional mental health services.

Filipino help-seeking for mental health problems and associated barriers and facilitators: a systematic review

PURPOSE

This systematic review aims to synthesise the evidence on behavioural and attitudinal patterns as well as barriers and enablers in Filipino formal help-seeking.

METHODS

Using PRISMA framework, 15 studies conducted in 7 countries on Filipino help-seeking were appraised through narrative synthesis.

RESULTS

Filipinos across the world have general reluctance and unfavourable attitude towards formal help-seeking despite high rates of psychological distress. They prefer seeking help from close family and friends. Barriers cited by Filipinos living in the Philippines include financial constraints and inaccessibility of services, whereas overseas Filipinos were hampered by immigration status, lack of health insurance, language difficulty, experience of discrimination and lack of acculturation to host culture. Both groups were hindered by self and social stigma attached to mental disorder, and by concern for loss of face, sense of shame, and adherence to Asian values of conformity to norms where mental illness is considered unacceptable. Filipinos are also prevented from seeking help by their sense of resilience and self-reliance, but this is explored only in qualitative studies. They utilize special mental health care only as the last resort or when problems become severe. Other prominent facilitators include perception of distress, influence of social support, financial capacity and previous positive experience in formal help.

CONCLUSION

We confirmed the low utilization of mental health services among Filipinos regardless of their locations, with mental health stigma as primary barrier, while resilience and self-reliance as coping strategies were cited in qualitative studies. Social support and problem severity were cited as prominent facilitators.

"It has not occurred to me to see a doctor for that kind of feeling": a qualitative study of Filipina immigrants' perceptions of help seeking for mental health problems

BACKGROUND

Immigrant women face greater barriers to health care, especially mental health care, than non-immigrant women. However, immigrants are a heterogeneous group and bring with them a range of different personal, social, cultural and economic factors, which impact both mental health and access to care. In this study, we explored factors that influence Filipina immigrants' perceptions of help seeking from a general practitioner for mental health problems in Norway.

METHOD

Using data from semi-structured interviews, we applied a post-colonial feminist perspective to identify factors that affect perceptions of help seeking.

RESULTS

Findings indicated that a combination of the women's beliefs and values, stigma, experiences with healthcare services in Norway and familiarity with mental health services influence perceptions of help seeking. Some factors represented structural barriers to healthcare seeking in general, while others related to mental healthcare seeking in particular. The significance of each factor varied depending on the women's backgrounds.

CONCLUSIONS

Socioeconomic status, educational background, familiarity with health services and experience of mental health can influence immigrant women's perceptions of, and barriers for, help seeking for mental health problems. There are a number of barriers to address at a structural level to improve both the propensity to seek healthcare in general, as well as mental healthcare in particular. Efforts to increase awareness of primary mental healthcare services may also help change the perception that professional help is only appropriate for serious mental health disorders.

Barriers Accessing Mental Health Services Among Culturally and Linguistically Diverse (CALD) Immigrant Women in Australia: Policy Implications

Immigrant and refugee women from diverse ethnic backgrounds encounter multiple barriers in accessing mental healthcare in various settings. A systematic review on the prevalence of mental health disorders among culturally and linguistically diverse (CALD) women in Australia documented the following barriers: logistical, language and communication, dissonance between participants and care providers and preference for alternative interventions. This article proposes recommendations for policies to better address the mental health needs of immigrant and refugee women. Key policy recommendations include: support for gender specific research, implementation and evaluation of transcultural policies, cultural responsiveness in service delivery, review of immigration and refugee claims policies and social integration of immigrants.

Life satisfaction and its associated factors among money boys in China

OBJECTIVES

Money Boy (MB) is a unique term used in China referring to a specialized population of men who sell sex to other men. Life satisfaction can influence one's health-related behaviors. The aim of our study was to find out the situation of MBs' life satisfaction and its associated factors.

STUDY DESIGN

A cross-sectional study among MBs was conducted between July and December 2013 in Hunan province, China.

METHODS

Respondent-driven sampling method was used for recruitment, with the initial seven 'seeds' found from a gay dating website, and 234 participants were enrolled into the study. They were asked to complete a questionnaire about their demographic characteristics, work experience as MB, family environment, health-related behaviors, status of self-esteem, self-stigma, and perceived life satisfaction. Descriptive statistics and multiple linear regression analysis were applied.

RESULTS

There were 205 valid questionnaires collected. The results showed that MBs' life satisfaction score was 17.9 ± 6.3. The multiple linear regression model identified five factors correlated with MBs' life satisfaction. Three factors were found to be positively correlated with life satisfaction, consistent condom use with clients (β = 3.093, P = 0.010), interpersonal relationship (β = 1.027, P = 0.017), and self-esteem (β = 0.253, P = 0.005). And two factors were found to be negatively correlated with life satisfaction, seeking for clients through mommy's arrangement (β = -2.091, P = 0.019) and had ever gotten at least one kind of sexually transmitted disease (STDs) (β = -1.971, P = 0.034).

CONCLUSIONS

The present study contributed to a better understanding of MBs' life satisfaction and behavioral and other psychosocial features. It is suggested that comprehensive interventions involving behavioral and psychosocial health promotion approaches are needed for this population. Those programs will be more acceptable among this group and tend to be sustainable.

A qualitative study of Filipina immigrants' stress, distress and coping: the impact of their multiple, transnational roles as women

Background

Migration is associated with a number of stress factors which can affect mental health. Ethnicity, gender and socioeconomic status can intertwine with and influence the process of migration and mental health. Philippine migration to Europe has increased in recent years and has become more feminised. Knowing more about the factors that influence immigrants’ mental health and coping can help aid health care delivery and policy planning. The purpose of this qualitative study was to explore the contextual factors that influence the mental health of Filipinas living in Norway and their coping strategies.

Method

Individual in-depth interviews were conducted with fourteen Filipinas 24–49 years, living in Norway. The analysis was informed by the post-colonial feminist perspective in order to examine the process by which gender, ethnicity and socioeconomic status interact with contextual factors in these women’s lives and influence their wellbeing.

Results

Data analysis revealed that all informants experienced some level of stress or distress. Two main factors: Sense of belonging and Securing a future contributed to the women’s level of distress associated with living abroad as an immigrant woman. Distress was heighted by the women’s multiple, transnational roles they occupied; roles as workers, breadwinners, daughters, wives and mothers. None of the women had sought professional help for their distress. Religion and informal support from friends and family appear to help these women cope with many of the challenges they face as immigrant women living and working abroad.

Conclusions

Filipinas face a number of challenges related to their status as immigrant women and the juggling of their transnational lives. Understanding the context of these women’s lives may aid the identification of mental health problems. Although the women show resilience and appear to cope successfully, some may benefit from professional help.

Psychological Wellbeing in Three Groups of Skilled Immigrants to New Zealand

The present study sought to investigate the current levels of psychological wellbeing in three immigrant groups to New Zealand. In addition, we sought to determine whether aspects of the acculturation process were related to mental health outcomes. This is a cross–sectional study from the fifth wave of annual in-depth interviews with three groups of recently arrived skilled immigrants from India, the People's Republic of China and South Africa. Interviews focused on international contacts and the migration of relatives and friends, housing, language, qualifications and employment, and social participation. Participants were also asked about health difficulties, homesickness, and whether they felt settled in New Zealand. The SF-36 Health Status Questionnaire (Ware, 1997), assessed the respondent's functional status and wellbeing in relation to four health concepts: vitality, social functioning, role limitations due to emotional health, and general mental wellbeing. The immigrant group differed significantly from the New Zealand population on only one of the four mental health scales, Vitality, with immigrants reporting higher levels. Different acculturation factors were found to predict different mental health subscales in regression analyses. Gender, home contact and health difficulty explained 22% of the unique variance in Vitality; employment status and health difficulty explained 18% of the variance in Social Functioning; health difficulty significantly contributed to the explained variance (14%) in the Role limitations due to emotional health subscale; gender, home contact and health difficulty explained 27% of the variance in the Mental Health subscale. There was little evidence for lower levels of psychological wellbeing for the three immigrant groups compared to the general New Zealand population, nor for differences between the three groups. However, results highlight the importance of differential predictors in the understanding of psychological health in migrant groups.

Social capital among migrating doctors: the "bridge" over troubled water

PURPOSE

The purpose of this paper is to examine the concept of social capital among International Medical Graduates (IMGs). It will specifically examine bridging social capital and greater intercultural communication which provides IMGs access to the wider community and plays a key role in cross-cultural adaptation and acculturation.

DESIGN/METHODOLOGY/APPROACH

A review of the literature.

FINDINGS

An Australian wide shortage of doctors has led to an increased reliance on the recruitment of IMGs. As IMGs migrate, they may encounter different meanings of illness, models of care and a number of social challenges. Nevertheless, greater cross-cultural adaptation and acculturation occurs through bridging social capital, where intercultural communication, new social networks and identity aids integration. This process produces more opportunities for economic capital growth and upward mobility than bonding social capital.

PRACTICAL IMPLICATIONS

Concerns regarding immigration, appropriate support and on-going examination processes have been expressed by IMGs in a number of studies and policy papers. However, there is very little insight into what contributes cross-cultural adaptation of IMGs.

ORIGINALITY/VALUE

As IMGs migrate to not only a new country, but also a new health system and workplace they arrive with different cultural meanings of illness and models of care. These differences may be in contrast to the dominant western medical model, but often bring positive contributions to patient care in the new environment. In addition, improving bridging social capital provides IMGs access to the wider community and has been demonstrated to play a key role in cross-cultural adaptation and ultimately acculturation.

Recent advances in cross-cultural measurement in psychiatric epidemiology: utilizing 'what matters most' to identify culture-specific aspects of stigma

BACKGROUND

While stigma measurement across cultures has assumed growing importance in psychiatric epidemiology, it is unknown to what extent concepts arising from culture have been incorporated. We utilize a formulation of culture-as the everyday interactions that 'matter most' to individuals within a cultural group-to identify culturally-specific stigma dynamics relevant to measurement.

METHODS

A systematic literature review from January 1990 to September 2012 was conducted using PsycINFO, Medline and Google Scholar to identify articles studying: (i) mental health stigma-related concepts; (ii) ≥ 1 non-Western European cultural group. From 5292 abstracts, 196 empirical articles were located.

RESULTS

The vast majority of studies (77%) utilized adaptations of existing Western-developed stigma measures to new cultural groups. Extremely few studies (2.0%) featured quantitative stigma measures derived within a non-Western European cultural group. A sizeable amount (16.8%) of studies employed qualitative methods to identify culture-specific stigma processes. The 'what matters most' perspective identified cultural ideals of the everyday activities that comprise 'personhood' of 'preserving lineage' among specific Asian groups, 'fighting hard to overcome problems and taking advantage of immigration opportunities' among specific Latino-American groups, and 'establishing trust among religious institutions due to institutional discrimination' among African-American groups. These essential cultural interactions shaped culture-specific stigma manifestations. Mixed method studies (3.6%) corroborated these qualitative results.

CONCLUSION

Quantitatively-derived, culturally-specific stigma measures were lacking. Further, the vast majority of qualitative studies on stigma were conducted without using stigma-specific frameworks. We propose the 'what matters most' approach to address this key issue in future research.

Mental health research and evaluation in multicultural Australia: developing a culture of inclusion

INTRODUCTION

Cultural and linguistic diversity is a core feature of the Australian population and a valued element of national identity. The proportion of the population that will be overseas-born is projected to be 32% by 2050. While a very active process of mental health system reform has been occurring for more than two decades - at national and state and territory levels - the challenges presented by cultural and linguistic diversity have not been effectively met. A key area in which this is particularly an issue is in the collection, analysis and reporting of mental health data that reflect the reality of population diversity. The purpose of this study was to examine: what is known about the mental health of immigrant and refugee communities in Australia; whether Australian mental health research pays adequate attention to the fact of cultural and linguistic diversity in the Australian population; and whether national mental health data collections support evidence-informed mental health policy and practice and mental health reform in multicultural Australia.

METHODS

The study consisted of three components - a brief review of what is known about mental health in, and mental health service use by, immigrant and refugee communities; an examination of national data collections to determine the extent to which relevant cultural variables are included in the collections; and an examination of Australian research to determine the extent to which immigrant and refugee communities are included as participants in such research.

RESULTS

The review of Australian research on mental health of immigrant and refugee communities and their patterns of mental health service use generated findings that are highly variable. The work is fragmented and usually small-scale. There are multiple studies of some immigrant and refugee communities and there are no studies of others. Although there is a broadly consistent pattern of lower rates of utilisation of specialist public mental health services by immigrants and refugees the absence of adequate population epidemiological data prevents judgments about whether the observed patterns constitute under-utilisation. There are virtually no data on quality of service outcomes. The examination of national data collections revealed multiple gaps in these data collections. The review of papers published in four key Australian journals to determine whether immigrants and refugees are included in mental health research studies revealed a high rate (9.1%) of specific exclusion from studies (usually due to low English fluency) and a much higher rate of general neglect of the issue of population diversity in study design and reporting.

CONCLUSIONS

While there are many positive statements of policy intent in relation to immigrant and refugee communities in national mental health policies and strategies there is virtually no reporting by Commonwealth or State and Territory governments of whether policies that are relevant to immigrant and refugee communities are effectively implemented. It is not possible, on the basis of the data collected, to determine whether immigrant and refugee communities are benefiting from the mental health system reforms that are being actively carried out. The majority of Australian mental health research does not adequately include immigrant and refugee samples. On the basis of the findings of this study eight strategies have been recommended that will contribute to the development of a culture of inclusion of all Australians in the national mental health research enterprise.

The mental health status of Filipinas in Queensland

OBJECTIVE

To determine the prevalence and investigate potential predictors of psychological distress in Filipino women living in Queensland, Australia.

METHODS

The sample of n = 487 women (88% response rate) was drawn from Filipino organization membership lists and supplemented by snowball sampling. Participants were interviewed in their homes or at a community event in 1996/1997. Follow-up in 1997/1998 involved n = 346 women (71% response rate) who were interviewed either in their homes or by telephone. The two surveys included measurement of demographic, immigration, physical health, satisfaction with life in Australia and life event variables. The GHQ-28 was included in the follow-up survey as a measure of psychological distress.

RESULTS

The proportion of women having an above threshold score (using the cut-off of 4/5) on the GHQ-28 was 23%. Women who were single, dissatisfied with life in Australia, had reported a major change in their financial situation, their relationship or their health in the year between surveys were significantly more likely to have an above threshold score.

CONCLUSIONS

The level of mental distress among Filipinas in Queensland appears to be slightly higher than the levels reported in the general population but lower than other migrant groups. The determinants of mental distress in this population contrast with those in the general Australian population and other migrant groups. The social context of these determinants in Filipinas needs to be elicited for an understanding of these differences.